NUR 201 EXAM 1

. A client admitted voluntarily for treatment of an anxiety disorder demands to be released from the hospital. Which action should the nurse take initially? 1. Contact the client's health care provider (HCP). 2. Call the client's family to arrange for transportation. 3. Attempt to persuade the client to stay "for only a few more days." 4. Tell the client that leaving would likely result in an involuntary commitment

1. Contact the client's health care provider (HCP).

. A client experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the nurse use to encourage the client to eat? 1. Using open-ended questions and silence 2. Sharing personal preference regarding food choices 3. Documenting reasons why the client does not want to eat 4. Offering opinions about the necessity of adequate nutrition

1. Using open-ended questions and silence

TCA

2. May reduce seizure threshold 3. May reduce effectiveness of antihypertensive agents 4. Concurrent use with alcohol or antihistamines can cause CNS depression. 5. Concurrent use with MAOIs can cause hypertensive crisis. 6. decrease sexual function

A hospitalized client has begun taking bupropion as an antidepressant agent. The nurse determines that which is an adverse effect, indicating that the client is taking an excessive amount of medication? 1. Constipation 2. Seizure activity 3. Increased weight 4. Dizziness when getting upright

2. Seizure activity

THC cannabinoids

3 minute onset with 20-30 minute peak time and last 2-3 hours (longer lasting when taken orally)

A client diagnosed with terminal cancer says to the nurse, "I'm going to die, and I wish my family would stop hoping for a cure! I get so angry when they carry on like this. After all, I'm the one who's dying." Which response by the nurse is therapeutic? 1. "Have you shared your feelings with your family?" 2. "I think we should talk more about your anger with your family." 3. "You're feeling angry that your family continues to hope for you to be cured?" 4. "You are probably very depressed, which is understandable with such a diagnosis."

3. "You're feeling angry that your family continues to hope for you to be cured?"

A client with a diagnosis of depression who has attempted suicide says to the nurse, "I should have died. I've always been a failure. Nothing ever goes right for me." Which response by the nurse demonstrates therapeutic communication? 1. "You have everything to live for." 2. "Why do you see yourself as a failure?" 3. "Feeling like this is all part of being depressed." 4. "You've been feeling like a failure for a while?"

4. "You've been feeling like a failure for a while?"

involuntary commitment

A civil proceeding in which people are hospitalized in psychiatric facilities against their will. 2 Drs must sign off on the pt. court ordered

NDRI

Bupropion Inhibits Dopamine Uptake Good Alternative to SSRI's for those who cannot tolerate sexual dysfunction DO NOT TAKE WITH A HISTORY OF SEIZURE No alcohol

Exceptions to confidentiality

Client is danger to self or others, Client requests release of info, Court orders a release of info, Counselor engaged in supervision, Clerical assistant processes client info, Legal/clinical consultations, Malpractice suit, Client less than 18 yrs old, Elderly abuse, Insurance co. requests diagnosis

Clinical Ethics

Decisions made at the bedside (end of life decisions)

Beneficence

Duty to promote good

Professional Ethics

Ethical standards and expectations of a particular profession Held to a higher standard because of privileged role in society Code of conduct Aimed at the highest ideals of practice Ex Don't Abandon Patients

Bioethics

Example: Downs fetus being terminated

Seclusion

IS A RESTRAINT

SSRIs can _______ suicidal Ideation

Increase

MAOI

Inhibit the enzyme monoamine oxidase, which is present in the brain, blood platelets, liver, spleen, and kidneys Monoamine oxidase metabolizes amines, norepinephrine, and serotonin, so the concentration of these amines increases with MAOIs. NOT the First choice of drug, "Wash out" for 2-5 weeks

voluntary admission

Inpatient care sought by a patient or patient's guardian through a written application to the facility.Willingly sign in /can leave when they want.

ethical problems

Involve situations where there are conflicts between one or more values and uncertainty about the correct course of action. Know the Right answer, easy to answer

Psychiatric-mental Heath RN

Licensed Registered Nurse may or may not be certified in psychiatric health. Typically the only 24 hr day 7 days a week professional working.

Paralinguistic

Nonverbal

informed consent

Patient doesn't need to sign written consent for many aspects of care. Expressed Consent -written or verbal Implied Consent- Physical actions imply their consent

Communication

The process of interaction between peoples

Serotonin Syndrome

With any drug that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular,sweating muscle spasms instability, flushing, diarrhea, seizures. -Treatment: cyproheptadine (5-HT2 receptor antagonist).

shared governance

a flat type of organizational structure with decision making decentralized

Maintenance or residual phase

condition has stabilized positive symptoms are absent and negative symptoms are present

The immediate nursing action for a client with anxiety is to

decrease stimuli in the environment and provide a calm and quiet environment.

Justice

distribute resources or care equally

Nurse-Nurse Collaboration

mentoring, shared governance (both making decisions)

Prodromal phase of schizophrenia

mild changes in thinking insufficient to meet the diagnostic criteria for schizophrenia. symptoms a[[ear a month to more than a year before the first full blown episode. person feels he is "not right" "something strange is happening"

autonomy

respecting the rights of others to make their own decisions

illusion

seeing something and misinterpreting it for something else

Carbamazepine complications

steven johnson syndrome double vision vertigo headache CBC, LIVER AND PLATLETTES need checked

diathesis-stress model

suggests that a person may be predisposed for a psychological disorder that remains unexpressed until triggered by stress (genetics) most accepted explanation for mental disorders

stabolization

symptoms are stabolizing and diminishing and there is movement toward previous level of functioning pt can use outpatient help instead of hospitalization.

DSM-5

the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; a widely used system for classifying psychological disorders.

negative symptoms of schizophrenia

the absence of appropriate behaviors (expressionless faces, rigid bodies)

positive symptoms of schizophrenia

the presence of something that should not be present such as hallucinations, delusions, paranoia, or disorganized bizarre thoughts, behavior or speech

varacity

truthfulness

Acute phase of schizophrenia

very from few and mild to many and disabling. Symptoms such as hallucinations, delusions, apathy, social withdrawal, diminished affect impaired judgment. Symptoms become apparent to others and hospitalization may be required.

Linguistic communication

written or verbal

The nurse provides an educational session on client rights. Which statement by a member of the session demonstrates the best understanding of the nurse's role regarding ensuring that each client's rights are respected? 1. "Autonomy is the fundamental right of each and every client." 2. "A client's rights are guaranteed by both state and federal laws." 3. "Being respectful and concerned will ensure that I'm attentive to my clients' rights." 4. "Regardless of the client's condition, all nurses have the duty to value client rights."

. "Being respectful and concerned will ensure that I'm attentive to my clients' rights."

SSRIs

. Inhibit serotonin uptake and elicit an antidepressant response DO NOT TAKE WITH MAOI's Citalopram ▪ Escitalopram ▪ Fluoxetine ▪ Fluvoxamine ▪ Paroxetine ▪ Sertraline

Lithium level (therapeutic)

0.6-1.2 mEq/L

When reviewing the admission assessment, the nurse notes that a client was admitted to the mental health unit involuntarily. Based on this type of admission, the nurse should provide which intervention for this client? 1. Monitor closely for harm to self or others. 2. Assist in completing an application for admission. 3. Supply the client with written information about his or her mental illness. 4. Provide an opportunity for the family to discuss why they felt the admission was needed.

1. Monitor closely for harm to self or others

. The nurse in the mental health unit plans to use which therapeutic communication techniques when communicating with a client? Select all that apply. 1. Restating 2. Listening 3.Asking the client "Why?" 4. Maintaining neutral responses 5. Providing acknowledgment and feedback 6.Giving advice and approval or disapproval

1. Restating 2. Listening 4. Maintaining neutral responses 5. Providing acknowledgment and feedback

On review of the client's record, the nurse notes that the admission was voluntary. Based on this information, the nurse plans care anticipating which client behavior? 1. Fearfulness regarding treatment measures 2. Anger and aggressiveness directed toward others 3. An understanding of the pathology and symptoms of the diagnosis 4. A willingness to participate in the planning of the care and treatment plan

4. A willingness to participate in the planning of the care and treatment plan

What is the most appropriate nursing action to help manage a manic client who is monopolizing a group therapy session? 1. Ask the client to leave the group for this session only. 2. Refer the client to another group that includes other manic clients. 3. Tell the client to stop monopolizing in a firm but compassionate manner. 4. Thank the client for the input, but inform the client that others now need a chance to contribute.

4. Thank the client for the input, but inform the client that others now need a chance to contribute.

A client with schizophrenia has been started on medication therapy with clozapine. The nurse should assess the results of which laboratory study to monitor for adverse effects from this medication? 1. Platelet count 2. Blood glucose level 3. Liver function studies 4. White blood cell count

4. White blood cell count

. A client's medication sheet contains a prescription for sertraline. To ensure safe administration of the medication, how should the nurse administer the dose? 1. On an empty stomach 2. At the same time each evening 3. Evenly spaced around the clock 4. As needed when the client complains of depression

At the same time each evening

Anticonvulsants

Carbamazepine Slows the enterance of sodium and calcium back into the neuron extending the time it takes for the nerve to return to its active state Inhibits Glutamic Acid to surpress the CNS Excitation

Benzodiazepines

Chlordiazepoxide have anxiety-reducing (anxiolytic), sedative-hypnotic, muscle-relaxing, and anticonvulsant actions Abrupt withdrawal of benzodiazepines can be potentially life-threatening, and withdrawal should occur only under medical supervision.

second generation antipsychotics

Clozapine Block Serotonin and Dopamine receptors treat Schizophrenia, psychosis, bipolar,impulse disorders

Patients' rights under the law

Right to treatment Right to refuse treatment Right to informed consent Rights surrounding involuntary commitment and psychiatric advance directives Rights regarding restraint and seclusion Right to confidentiality

Lithium requirements for a balance of

Sodium and Water (6-8)glasses If pt has diarrhea they still need to keep drinking water

ethical delimma

This is the choice between two or more equally justifiable alternatives. No easy right answer

first generation antipsychotics

Used to treat mainly positive psychotic symptoms ex haloperidol, chloropromazine

Research Ethics

conduct of research using humans and animals ex: Not giving a control group the cure because they are the control

Delusions

false beliefs, often of persecution or grandeur, that may accompany psychotic disorders

Frued's Psychoanalytic Theory

he focuses on the unconscious mind because he believed that it was a crucial key for personality development. experiences within the first 5 years of life determine individuals lifetime adjustment patterns

TCA

imipramine. Corrects the imbalance in neurotransmitter concentrations of serotonin and epinephrine at nerve endings in the cns can take 2-4 weeks to work

MAOI and tyramine

lead to dangerous inc. in blood pressure to control avoid: aged fermented foods, pickled meat, Avacodo, fermented cheeses, wine, overripe fruit, alcohol do not take with OTC Cough and Cold

Fidelity

loyalty