Psych final

What nursing care is done after ECT?

-maintain airway -VS q15m until alert -reorient

What is the therapeutic range of Lithium?

0.5-1.5 mEq/L

When can delirium tremens appear?

12-36 hours

What is the important neurotransmitter that involves memory?

Acetylcholine

When is the best time to interact with a client with OCD?

At the completion of a ritual bc anxiety is lowest at this point

What disorder is caused by severe anxiety related to a traumatic event?

PTSD

What level of anxiety causes the client to be unable to differentiate what is real/unreal. Causes loss of rational/logical thinking. Feels overwhelmed. Loss of control. Inability to function.

Panic

After the 4th group meeting, the informal leader makes the statement that she believes she can help the group more than the assigned facilitator and has better credentials. What is the group dynamic and phase of development?

The informal leader is "testing" which is a behavior indicative of a new group trying to establish trust. This group is still in the orientation phase of development.

What are the two most commonly used coping styles used by alcohol/drug abusers?

denial and rationalization

What are some forbidden phrases in mental health nursing?

you should... you'll have to... you can't... If it were me, I'd... Why... I think... Everyone... Don't worry

What are some nursing interventions for a client with mania?

-Provide nutrition, rest, and hygiene -Provide safe environment -Decrease stimulation -Frequent, brief contact to decrease anxiety -Provide food that can be carried -Avoid stimulation before bedtime -Praise control and acceptable behavior

What nursing care is done prior to ECT?

-Teaching -Avoid using the word shock -anticholinergic usually given 30 mins before -quick-acting muscle relaxant given to prevent bone/muscle damage -have emergency cart, suction, and O2 available

What are benzodiazepines indicated for?

-reduce anxiety -induce sedation, relax muscles, inhibit convulsions -treat alcohol and drug withdrawal

A husband is upset that his wife's alcohol withdrawal delirium has persisted for the second day. What is the most appropriate initial response by the nurse? 1. "I see that you are very worried. Medications are being used to lessen your wife's discomfort." 2. "This is expected. I suggest that you go home because there is nothing you can do to help at this time." 3. "Are you afraid that your wife may die? I assure you that very few alcoholics die during the detoxification process." 4. "Do you think that your wife is uncomfortable while she is undergoing the withdrawal process? I am sure that your wife is not in pain."

1. Recognizing the spouse's feelings and giving simple factual information help to allay anxiety.

When communicating with a client with a psychiatric diagnosis, the nurse uses silence. When silence is used in therapeutic communication, clients should feel: 1. Unhurried to answer 2. It is their turn to talk 3. The nurse is thinking about the interaction 4. The nurse expects that further communication is unnecessary

1. Silence is a tool employed during therapeutic communication that indicates that the nurse is listening and receptive; it allows the client time to collect thoughts, gain control of emotions, or speak without hurrying.

A client who has recently been diagnosed with HIV infection comments to the nurse, "There are so many terrible people around. Why couldn't one of them get HIV instead of me?" What is the best nurse's response? 1. "It seems unfair that you should have this disease." 2. "I'm sure you really don't wish this on someone else." 3. "It might be good if you speak with your religious leader." 4. "I'm sure you know that HIV infection is now considered a chronic illness."

1. The client is in the anger or "why me" stage of grieving; encouraging the client to express feelings will help resolve them while moving toward acceptance.

The best initial approach to take with a self-accusatory, guilt-ridden client is to: 1. Contradict the client's persecutory delusions 2. Accept the client's statements as the client's beliefs 3. Medicate the client when these thoughts are expressed 4. Redirect the client whenever a negative topic is mentioned

2. The nurse must accept the client's statement and beliefs as real to the client to develop trust and move into a therapeutic relationship.

The nurse can best handle the answering of personal questions asked by the client in any phase of the nurse-client relationship by: 1. Reviewing the positive and negative aspects of the subject 2. Providing brief, truthful answers and redirecting the focus of conversation 3. Offering an honest, brief expression of personal views on the subject raised 4. Reminding the client gently that the nurse's feelings are not the client's concern

2. Unless the nurse answers the question, the client will continue to focus on the nurse rather than on the self; the nurse can best redirect after a brief answer.

At times a client's anxiety level is so high it blocks attempts at communication and the nurse is unsure of what is being said. To clarify understanding, the nurse states. "Let's see whether we both mean the same thing." This is an example of the technique of: 1. Reflecting feelings 2. Making observations 3. Seeking consensual validation 4. Attempting to place events in sequence

3. This is a technique that prevents misunderstanding so that both the client and the nurse can work toward a common goal in the therapeutic relationship.

When can you see signs of alcohol withdrawal?

4-6 hours

A male client is preparing to leave the hospital and return to college. When saying good-bye, he hugs and kisses the nurse on the cheek. What is the nurse's most appropriate response? 1.Hug the client in return 2. Smile at the client but say nothing 3. Encourage him to visit periodically 4. Wish him well with his future studies

4. An explicit termination statement is most appropriate; offering an expression of well-wishes sets an optimistic, positive tone while maintaining t he nurse-client relationship.

When speaking with a client diagnosed with schizophrenia, the nurse identifies that the client keeps interjecting sentences that have nothing to do with the main thoughts being expressed. The client asks whether the nurse understands. What is the nurse's best response? 1. "You aren't making any sense; let's talk about something else." 2. "You are so confused; I cannot understand what you are saying to me." 3. "Why don't you take a rest, then we can talk about your concerns again later this afternoon." 4. "I'd like to understand what you are saying, but I'm having difficulty following what you are saying."

4. This lets the client know the nurse is trying to understand; it increases the client's feeling of self-esteem and points out reality.

A newly admitted client looks at but does not respond to the nurse. Which is the most appropriate statement by the nurse? 1. "You may prefer to be alone for now. I will return later so we can talk." 2. "I am talking to you. You must be having trouble understanding what I am saying." 3. "This is the mental health unit of the hospital. Let me tell you about the many services we have to offer." 4. "I am here to offer you my help. I am now going to tell you about the services available to you on the mental health unit."

4. This statement addresses the reality that the client is on the mental health unit and offers assistance.

During the first session of a therapy group one of the clients asks, "What is supposed to happen in this group?" What is the most appropriate response by the nurse leader? A. "Before I answer that, I'd like for you to tell me what you want to happen." B. "This is your group and your participation will determine what will happen." C. "The purpose of this group is to examine the way each of you interacts with the others." D. "You and the others are supposed to discuss any reality-based concerns you have about your illness."

A. "Before I answer that, I'd like for you to tell me what you want to happen." To achieve the greatest therapeutic value from a group session, the members must be involved in deciding what will be discussed.

When working with clients during group therapy, the working phase usually begins when the group displays: A. cohesiveness B. confrontation C. imitative behavior D. corrective recapitulation

A. Cohesiveness When the group becomes united (cohesive) it enables clients to feel accepted, valued, and part of the group; this is the optimum time for the working phase to begin.

When leading the first session of a newly formed group of clients in a mental health clinic, the nurse identifies that group members frequently assume self-serving roles. The nurse anticipates that: A. Early group development consists of these behaviors B. Some group members will need to be placed in another group C. Certain group members may be emerging to control attention seekers D. The group is attempting to reconcile conflicting viewpoints among its members

A. Early group development consists of these behaviors. This is a necessary phase of group development because it helps members discover what they can expect from the leader and other members.

4 A's to help remember characteristics of schizophrenia

Autism (preoccupied w self) Affect (flat) Associations (loose) Ambivalence (difficulty making decisions)

What types of personality disorders are in cluster C and what are they characterized by?

Avoidant, dependent, obsessive compulsive anxious, fearful

The nurse is scheduled to be the co-leader of a therapy group being formed in the mental health clinic. When planning for the first meeting, it is of primary importance that the nurse consider the: A. Number of clients in the group B. Needs of the clients being included C. Diagnoses of the clients being included D. Socioeconomic status of the clients in the group

B. Needs of the clients being included When planning a group, the nurse must ensure that clients have similar needs to promote relationships and interactions; diverse needs do not foster group process.

What is the best way to ask a patient about suicide?

Be direct. ask "have you had thoughts about harming yourself" "do you have a plan to hurt yourself"

A newly admitted client with schizophrenia has a treatment plan that includes participation in a physical activity group for several days before being assigned to an analytic group. The basis for this decision is that the client will: A. Develop skills in managing leisure time B. Have time to develop insight into personal problems C. Be too disruptive to benefit from group therapy at this time D. Cultivate trust before moving into a potentially anxiety-producing group

D. Cultivate trust before moving into a potentially anxiety-producing group The development of trust is the first step in developing a nurse-client relationship.

During a therapy group session, after several members relate traumatic incidents that happened during the week, a client with a smile states, "Things haven't gone well in my life this week either." It is most appropriate for the nurse to: A. Ask the client to share what has been happening during this week. B. Make a note of the incongruity of the client's message but remain silent C. Comment, "This seems to have been a bad week for several group members." D. Say to the client, "You say things have been bad this week, yet you are smiling."

D. Say to the client, "You say things have been bad this week, yet you are smiling." This is an open-ended nonjudgmental response that points out incongruity between the client's verbal and nonverbal communication.

A nurse-group leader in a mental health center uses a variety of techniques in an effort to promote group cohesion. The nurse identifies the presence of group cohesion when the group members: A. Withdraw from disliked members B. Accept new members by saying "welcome" C. Socialize more when productivity decreases D. Use the phrase "our group" during discussions

D. Use the phrase "our group" during discussions The use of pronouns "we," "us," and "our" often indicates that group members experience a sense of belonging.

What are the common SE of ECT?

HA, muscle soreness, nausea

What are the three most common causes of delirium in the older patient?

O2 sat Na level UTI

What is an anxiety associated disorder that presents with repetitive thoughts and impulses?

OCD

What are the types of personality disorders in cluster A and what are they characterized by?

Paranoid, schizoid, and schizotypal characterized by suspicious, strange behavior, odd, eccentric

What drugs can be prescribed with treatment of OCD?

SSRId tricyclic antidepressants antianxiety

What is the best way to react if a patient tells you they do have thoughts of suicide and do have a plan?

Say, "I am concerned that you are feeling so badly that you want to hurt yourself." and, "I need to share this info with the staff so that we can provide for your safety until you feel better."

What is the difference between Schizoid and Schizotypal?

Schizoid is someone who is shy and dull and Schizotypal is someone you'd see walking the streets wearing weird clothes

What level of anxiety stimulates fight or flight. Sensory input disorganized. Perceptions distorted. Impaires concentration and problem solving. Produces physical symptoms

Severe

How do cholinesterase inhibitors act to help Alzheimer's patients?

They slow the action of acetylcholinesterase which breaks down acetylcholine, an important memory neurotransmitter

What are S/S of delirium tremens?

^ HR, RR diaphoresis tremors hallucinations paranoia

What are some S/S of anxiety?

^HR and BP Rapid, shallow RR dry mouth tight feeling in throat anorexia tremors muscle tension urinary frequency palmar sweating

What is Wernicke's syndrome?

alcohol Encephalopathy usually caused by deficiency in vitamin b1

What types of personality disorders are in cluster B and what are they characterized by?

antisocial, borderline, histrionic, narcissistic dramatic, emotional

What are some S/S of alcohol withdrawal?

anxiety, nausea, insomnia, tremors, hyperalertness, restlessness, increase in VS

S/S of depression

appetite changes sleep changes fatigue hopelessness inability to concentrate thoughts of death suicide

What is a priority in nursing care for the confused older patient?

consistent caregivers bc change ^ anxiety and confusion

What state is characterized by temporary loss of one's reality and the ability to feel and express emotions?

depersonalization

What are early signs of lithium toxicity?

diarrhea, vomiting, muscle weakness, drowsiness, lack of coordination

What are some causes of ineffective communication?

failure to listen nonverbal cues judgement false reassurance giving advice agreeing/disagreeing changing the subject

What are major warning signs of suicide attempt?

giving away possessions or becoming happy

What is the difference between hallucinations, illusions, delusions?

hall=false sensory perception ill=misinterpretation of external environment (obj is actually there) delu=false, fixed beliefs that cannot be changed by reason

What are some nursing interventions for a patient in alcohol withdrawal?

high-protein diet adequate fluids vitamins prevent aspiration reduce stimuli

What are S/S of severe mania?

hyperactivity flight of ideas sexually inappropriate explicit language talkative distracted agitation sleep disturbances delusions

What are some characteristics of PTSD?

intrusive thoughts flashbacks nightmares emotional detachment

What can be affected with dementia?

judgement abstract thinking social behavior

Which level of anxiety is associated with daily life and serves as motivation. Produces increase levels of awareness and alertness.

mild

What level of anxiety motivates learning. Allows client to be attentive, focus, and problem solve. Dulls perception of sensory stimuli. Causes speech rate and volume to increase. May show physical symptoms and become restless?

moderate

What is the most important intervention when a client is suicidal?

never leave them alone

What class of drug is Buspirone (BuSpar)?

nonbenzodiazepine

What are appropriate activities for a manic patient?

noncompetitive physical activities that require the use of large muscle groups

What is a priority need in chemically dependent clients?

nutrition

Which phase of group therapy is characterized by high anxiety, superficial interactions and testing the therapist to see if they can be trusted?

orientation

What are SE of benzo's?

sedation drowsiness ataxia dizziness irritability blood dycrasias

What are some teaching point for patients taking Benzodiazepines?

take at bedtime caution when taking with other CNS depressants avoid alcohol and driving taper to avoid withdrawal effects used short-term

Which phase of group therapy is characterized by evaluation of the experience, and expression of feelings ranging from anger to joy?

termination

Which phase of group therapy is characterized by problem ID, problem solving and the beginning of a sense of "we"?

working