psych midterm
Which comment(s) by an elderly person best indicate successful completion of developmental tasks? Select all that apply. "I am proud of my children's successes in life." "I should have given to charities more often." "My relationship with my father made life more difficult for me." "My experiences in the war helped me appreciate the meaning of life." "I often wonder what would have happened if I had chosen a different career."
"I am proud of my children's successes in life." "My experiences in the war helped me appreciate the meaning of life." ability to look back and into the future about succes
A new nurse asks for advice about talking with a client recently diagnosed with dissociative identity disorder (DID). When the new RN asks "should I talk about her childhood abuse?", the nurse replies: "If she brings up the abuse, listen to her and be supportive" "You will need to really push her to get it all out" "Ask her to discuss this only with her therapist" "Remind her that sometimes adults exaggerate their childhood experiences"
"If she brings up the abuse, listen to her and be supportive"
A student nurse says, "I don't need to interact with my patients. I learn what I need to know by observation." An instructor can best interpret the nursing implications of Sullivan's theory to this student by responding: "Interactions are required in order to help you develop therapeutic communication skills." "Nurses cannot be isolated. We must interact to provide patients with opportunities to practice interpersonal skills." "Observing patient interactions will help you formulate priority nursing diagnoses and appropriate interventions." "It is important to note patients' behavioral changes, because these signify adjustments in person
"Nurses cannot be isolated. We must interact to provide patients with opportunities to practice interpersonal skills." sullivan theory focused on nurses interacting with patients
blood level for lithuim
0.8-1.4
major depressive disorder is related to what four things
1. mood 2. attention 3. wakefullness 4. appetite
what are the three changes that occur with anxiety
1. perceptual changes 2. physiological changes 3. psychological changes
what are the levels of interventions needed in the acute phase of schizophrenia
1. safety - CPI, restraints 2. milieu therapy (apart of community) 3. therepeutic communication - redirecting patient, focus on pt feelings , reassurance
how often a week is ect given
3 times a week could be spread out for 2-6 months
hypomania
4 days 3 or more manic episodes include increased energy
how long does depression occur for to be diagnosed
6 weeks
Which best exemplifies the use of the defense mechanism of sublimation? A child who has been told by parents that stealing is wrong reminds a friend not to steal A man who loves sports but is unable to play decides to become an athletic trainer Having chronic asthma with frequent hospitalizations, a young girl admires her nurses. She later chooses nursing as a career. A boy who feels angry and hostile decides to become a therapist to help others
A boy who feels angry and hostile decides to become a therapist to help others Channeling of socially or personally unacceptable drives or urges into positive actions
Which situation reflects the defense mechanism of projection? A husband has an affair and then buys his wife a diamond necklace A promiscuous wife accuses her husband of having an affair A wife, failing to become pregnant, works hard at becoming teacher of the year. A man who was sexually assaulted as a child remembers nothing of the event.
A promiscuous wife accuses her husband of having an affair
neurovegetative symptoms in depression
Appetite and weight changes Sleep disturbance Decreased energy, tiredness, and fatigue decrease in bowel movements - everything is slowing down decrease libido
Which belief will best support a nurse's efforts to provide patient advocacy during a multidisciplinary patient care planning session? All mental illnesses are culturally determined. Schizophrenia and bipolar disorder are cross-cultural disorders. Symptoms of mental disorders are unchanged from culture to culture. Assessment findings in mental disorders reflect a person's cultural patterns.
Assessment findings in mental disorders reflect a person's cultural patterns. - Culture can influence how symptoms are manifested and what belief system influences the understanding of the symptoms and illness.
A student in the Mood Disorders Clinic states that everything he does is wrong and that nothing he tries ever works. Although he has never failed an exam, he believes he will fail the next one. Based on evidence-based research, which of the following interventions would best address a presentation of this type? Psychoanalytic therapy Desensitization therapy Cognitive-behavioral therapy Alternative and complementary therapies
CBT Cognitive-behavioral therapy attempts to alter the patient's dysfunctional beliefs by identifying automatic and/or distorted thinking and then questioning it. This is then followed by rewording or reframing the thought in a more realistic manner. The patient is also taught the connection between thoughts and mood. Research shows that cognitive-behavioral therapy involves the formation of new connections between nerve cells in the brain and is at least as effective as medication. Evidence does not support similar effectiveness for the other psychotherapeutic modalities mentioned.
Which of the following best exemplifies the client's use of the defense mechanism of reaction formation? A client feels rage at being raped at a young age, which later is expressed by joining law enforcement. A client is unhappy about being a father, although others know him to dote on his son A client is drinking 6-8 beers a day while still going to AA as a group leader A client is angry that his call bell is not answered and decides to call the nurse when it is unnecessary.
Dealing with negative emotions by exaggerating opposite behaviors or emotions A client is unhappy about being a father, although others know him to dote on his son
what is used to gather a holistic sense of the patient and their needs. It used by all members of the mutlidisciplinary team in psych to ease communication
Diagnostic and stat manual - DSM 5
During an assessment interview, the client tells the nurse, "I can't stop worrying about my makeup. I can't go anywhere nor do anything unless my makeup is fresh and perfect. I wash my face and put on fresh makeup at least once and sometimes twice an hour". The nurse's priority should be to adjust the client's plan of care so that the client will be: Required to spend daytime hours out of own room Given advance notice of approaching time for all group therapy sessions Asked to keep a diary of feelings experienced if unable to groom self at will Allowed to use own cosmetics and grooming products
Given advance notice of approaching time for all group therapy sessions given time to adapt behaviors and positive coping skills
How would you document a diagnosis in a psych facility? I Acute renal failure II 75 III Bipolar disorder I, mixed IV Loss of disability benefits 2 months ago V None I Schizophrenia, paranoid type II Death of spouse last year III 60 IV None V Diabetes, type 2 I Polysubstance dependence II Narcissistic Personality Disorder III 90 IV Hyperlipidemia V Charges pending for assault I Major Depression II Avoidant Personality Disorder III Hypertension IV Home destroyed by hurricane last year V 80
I Major Depression II Avoidant Personality Disorder III Hypertension IV Home destroyed by hurricane last year V 80
A client treated for hypochondriasis has an upsetting phone call with her husband. She subsequently asks for an analgesic. The client states, "My head is killing me , and I know there is a tumor in there somewhere or it wouldn't hurt like this". The nurse's therapeutic response would be: "You have no brain tumor. It is just your anger towards your husband" "I'll get your vital signs and then call your doctor if they are abnormal" "You must try not to rely on the pain pills because they are addictive" "I'll get your medication and then, let's talk about what just happened".
I'll get your meds and then we can discuss what happened Feedback: Acknowledging her immediate needs and helping the patient to begin to make connection between her symptoms and emotions.
A 4-year-old grabs toys from siblings and says, "I want that now!" The siblings cry, and the child's parent becomes upset with the behavior. Using Freudian theory, the nurse can interpret this behavior as a product of impulses originating in the: id. ego. superego. preconscious.
ID impulses and primitive drives
The psychiatric nurse addresses axis I of the DSM as the focus of treatment but must also consider physical health problems that may affect treatment. Which axis contains the desired information? II III IV V
III - Axis III of the Diagnostic and Statistical Manual contains information about medical illnesses that may impact the psychiatric disorder and/or treatment.
A client with Bipolar II disorder is being seen in an outpatient setting. The nurse practitioner would want to be aware of what differences between Bipolar I and II disorders? Select all that apply: Bipolar I disorder is genetic and Bipolar II is situational Patients with Bipolar I disorder present with mania whereas Bipolar II presents with depression. The use of antiepileptic medication is usually used with patients with Bipolar II Antidepressants are contraindicated for Bipolar I and is used frequently for Bipolar II disorder
Patients with Bipolar I disorder present with mania whereas Bipolar II presents with depression. The use of antiepileptic medication is usually used with patients with Bipolar II Antidepressants are contraindicated for Bipolar I and is used frequently for Bipolar II disorder
what is the first line of medication used to treat depression
SSRI - pram ending or tine
section 12 or pink papered
Section 12(a) allows for an individual to be brought against his or her will to such a hospital for evaluation. Section 12(b) allows for an individual to be admitted to a psychiatric unit for up to three business days against the individual's will or without the individual's consent. - either discharge pt after 3 day evaluation - involuntarily commit pt - go to court
A patient with schizophrenia has received typical antipsychotics (e.g. haldol) for a year. His hallucinations are less intrusive, but he remains apathetic, has poverty of thoughts, cannot work, and is socially isolated. To address these symptoms, the nurse might consult with the prescribing health care provider to suggest a change to: Ativan Olanzapine (Zyprexa) Diphenhydramine (Benadryl) Chlorpromazine (Thorazine)
The atypical antipsychotics are thought to help with the negative symptoms of schizophrenia (avolition, apathy, poverty of thoughts, etc) olanzapine - zyprexa
There are physiological, psychological, and perceptual changes that occur as anxiety increases. Which of the following illustrates a change in perception? The patient experiences chest pain resembling a heart attack A patient denies that he has experienced changes in his job situation and doesn't talk about it with others An individual has experienced a loss in his family and can't function at work A man uses passive-aggressive behaviors to deal with loss of sense of control in his marriage.
The patient experiences chest pain resembling a heart attack
tca's may cause
aarythmia and sedation
The nurse is caring for a patient who is from Laos. The family is very involved in his care and believes that spirits are responsible for his delusions and auditory hallucinations. The nurse's intervention would include: Acknowledgement of the importance of his cultural background Attempt to distance the patient from his family for the sake of his treatment Education of the family to the importance of treatment Referral of the patient to community social services
acknowledge his cultural background
behaviors become more confusing and frightening less adl function need dependence on friends/family treatment focuses on alleviations of symptoms of schizophrenia - what stage is this
acute illness stage
when does social phobia begin
adolescents
main symptom for clozaril
agranulocytosis pharmacist need to receive blood lab order prior to refill checked every week
what should nurses monitor for self medication purposes if the pt has schizophrenia
alcohol abuse
Nonverbal communication is an essential component of therapeutic communication with a patient. An appropriate use of nonverbal techniques would include the following: Leaning forward while the patient is talking Maintaining eye contact Using silence All of the above
all of the above
A patient discloses several concerns and associated feelings. If the nurse wishes to seek clarification, which comment would be appropriate? "What are the common elements here?" "Tell me again about your experiences." "Am I correct in understanding that..." "Tell me everything from the beginning."
am I correct in understanding that
mania
an abnromally elevated mood for longer than 1 week
depression in children shows what signs
anhedonia school phobia social isolation agitation somatic complaints - headache
buspar
anti-anxiety sedative effect if pt has chemical dependency history
when meds to people with ptsd not respond well too
anti-depressants or anxiolytics serotonin receptor sites were altered
how do schizophrenia people interpret fear
as anger
how can touch be perceived
as poorly aggression and can bring flashabacks. be aware of pt reaction to touch prior to touching
A patient is being treated on an inpatient unit for an acute episode of Mania. Which of the following nursing actions would be of primary importance early in the acute phase of treatment? Assess for nutritional intake and sleep pattern Engage the family in education about the illness Ensure safety of other patients on the unit Reorient the patient
assess for nutritional intake and sleep pattern
what should be prescribed to treat catatonia in mdd
ativan
A windstorm severely damaged a client's farm. The client recalls very little about the storm and repeatedly says, "I can't believe the farm is destroyed". When the nurse is providing care, which of the following goals should take priority? The client will: Report decreased depression by day 2 Express anger about his loss by day 2 Apply for job retraining by day 2 Attend a support group for disaster survivors by day 2
attend a support group by day 2
features of MDD
atypical - overeating, oversleeping, poor concentration, decreased mood catatonia postpartum onset seasonal depression psychotic features - hallucinations, delusions, disorganized thought
A patient says, "I never know the answers," and "My opinion doesn't count." The nurse correctly assesses that this patient had difficulty resolving which psychosocial crisis? Initiative versus guilt Trust versus mistrust Autonomy versus shame and doubt Generativity versus self-absorption
autonomy versus shame and doubt according to Erickson's developmental theory, autonomy allows the individual to maintain their own individual identity, in the company of others. The failure of autonomy is the experience of shame and doubt.
why does anxiety occur
because coping skills are exceded
what therapy is based on challenging the negative cognitions
beck - cognitive
cognitive
beck - how we feel and think of the world is how we behave (behave and beck)
fluctuation between major depression and full manic episode - fluctuation is 2 weeks
bipolar I
major depression and hypomania
bipolar II
watch for patient with what disorder when prescribing ssri
bipolar increase suicidal risk
negative symptoms of schizophrenia
blunt affect ambivalence alogia - thought blocking, long time for response, distracted stimuli avolition - lack of motivation not getting out of bed social isolation, may interrupt poor hygeine anhedonia - lack of ability to feel joy
what eating disorder will more likely have depression
bullemia
third generation antipsychotic that is the last resort for schizophrenia
clozaril
what medication can mimic depression as a risk factor
cns depressant - cholinergic
adherence to meds, psychoeducation - not manic or depressive state > this is what stage of illness for bipolar
continuation/stabalization phase
crisis management strategies
crisis prevention intervention verbal de-escalation help to be safe
A patient's nursing care plan includes assessment for auditory hallucinations. Indicators that suggest the patient may be hallucinating include: Aloofness, increased distractability, and suspicion Elevated mood, hypertalkativeness, and distractability Performing rituals and avoiding open places Darting eyes, distracted, and mumbling to self
darting eyes, distracted and mumbling to self
most common side effects for ssri
decrease libido weight gain anticholinergic - fatigue/weight gain
what are the four positive symptoms for schizophrenia
delusions - fbi spying on me hallucinations disorganized speech disorganized behavior - unaware of how to get dressed in the am
if pt is elderly and could have dementia or depression; what do you treat first
depression
snri - wellbutrin and cymablta are more commonly used to treat
depression
erikson focused on
developmental stages of the adult and what ego phase they were in
The patient describes a sense of detachment from his body when he cut himself. This is an example of which defense mechanism? Dissociation Suppression Denial Projection
dissociation - Split from conscious awareness, memory, or feelings
if the pt states they are going to self harm themselves what is the nurse priority
do not be the last person to know this information
A nurse is working with a patient on an acute inpatient unit. Which of the following would be a barrier to communication? I'm not sure I follow you. Could you tell me again? Don't worry; it will all work out. Perhaps talking about it would help You might speak of this problem in group today and get some help from others.
dont worry it will all work out - false hope or dismissive
in atypical anti-psychotics what are you inhibiting
dopamine - causes eps symptoms like parkinsons (they do not have enough dopamine)
when is the termination phase discussed
during the orientation phase
what is the treatment of choice for people with psychotic features and depression - that are not able to be treated by medication
ect
what can be reported/ breach confidentiality
elderly abuse over 60 years old child abuse mental disability IQ less than 70
A client with Generalized Anxiety Disorder (GAD) states, "I now know that the best thing for me to do is just to try to forget my worries". How should the nurse evaluate this statement? The client is developing insight The client's coping skills are improving The client needs to be encouraged to verbalize feelings The nurse - client relationship should be terminated
encourage to verbalize feelings
A nurse influenced by Peplau's interpersonal theory works with an anxious, withdrawn patient. Interventions should focus on: rewarding desired behaviors. changing the patient's self-concept. administering medications to relieve anxiety. enhancing the patient's interactions with others.
enhacing the pt interactions with others peplau focused on curative features of the nurse - patient relationship as the healing intervention as the nurse helps the patient move to lower levels of anxiety.
first generation antipsychotics have what side effect
eps symptoms and anticholinergic symptoms
if a person is unresolved in a stage of development thy will have difficulty passing on to the next without some negative consequence
erickson - developmental theory
A cognitive strategy the nurse could use to help a dependent patient would be: avoidance training. filling the patient's pill minder. interpreting the patient's dream content. examining the patient's fears related to being independent.
examining the patient's fear related to being independent - Cognitive therapy focuses on the patient's thinking behind their actions. The other selections represent other theories of psychopathology and treatment.
response to ptsd
fear hopelessness horror
A client is diagnosed with depersonalization disorder. Which of the following is the nurse most likely to find in the assessment? Two or more personalities Feelings like "being in a dream" Indifference to the symptoms Amnesia about the event.
feelings like being in a dream
what is used to treat schizophrenia
first generation antipsychotic atypical antipsychotic
ptsd hallmark symptom
flashbacks
psychoanaltyical - main focus is impulse and drive
freud
axis V
functional level present with functional level 0-100 functional level is
50 year old who is unemployed does not have energy to leave the house is an example of what developmental stage
generativity vs stagnation
Operant conditioning is part of the treatment plan to encourage speech in a child who is nearly mute. Which technique applies? Encourage the child to observe others talking. Include the child in small group activities. Give the child a small treat for speaking. Teach the child relaxation techniques.
give the child a small treat - operant conditioning is when the behavior is rewarded
pt looks down and mumbles appears distracted is a sign of what
hallucinations in schizophrenia
first generation antipsychotics
halodol (slow time release depo shot come in once a month) prolixin trilafon
who put an emphasis on the healing power of interpersonal relationships
henry stax sullivan
who developed the interpersonal relationship theory
hildegard papleu
modeling
how the therapist comes across to the patient
expansive and mood irritability/regulation is not as severe this is called
hypomania in bipolar II
A client has Obsessive - Compulsive Disorder (OCD). Which of the following statements made by the client to the nurse would be the BEST indicator of improvement? "I have more control over my thoughts and behaviors" "I know that my thoughts and behaviors are not normal" "I only do my ritual to reward myself when I have been good" "My friends don't know about my disorder"
i have more control over my thoughts and behaviors
A client has chronic pain disorder. Which statement by the client indicates to the nurse that the plan of care has been successful? "I realize that my pain can be influenced by stress" "I should avoid most physical activity". "Relaxation techniques only work when I am anxious about my pain". "I should keep myself pain-free by increasing my pain medication as I need it"
i realize that my pain can be influenced by stress
A nurse interacts with a newly hospitalized patient. Select the example of offering self. "I've also had traumatic life experiences. Maybe it would help if I told you about them." "Why do you think you had so much difficulty adjusting to this change in your life?" "I hope you will feel better after getting accustomed to how this unit operates." "I'd like to sit with you for a while to help you get comfortable talking to me."
id like to sit with you for a while to help you get comfortable to me
physiological changes of ptsd
if early life changes then the hippocampus and amylglada change because of the increased cortisol level serotonin receptor sites altered
A newly admitted patient with schizophrenia approaches the unit nurse and says, "The voices are bothering me. They are yelling at me and telling me stuff. They are really bad". Which response by the nurse would be the most appropriate? Do you hear these voices very often? Do you have a plan for getting away from the voices? I'll stay with you. Tell me what you are hearing. Try to ignore them and play cards with the others
ill stay with you tell me what you are hearing
A depressed patient who is scheduled to receive electroconvulsive therapy this morning asks the nurse, "How is this treatment supposed to help me?" The best reply would be: "Electroconvulsive therapy seems to ____________." increase the activity of brain chemicals involved in mood interfere with one's memory of why he's feeling depressed serve as a punishment so you can stop punishing yourself open your mind to learning and trying new ways of coping
increase activity of brain chemicals involved in mood ECT seems to alter neurotransmitter activity, consistent with the biochemical theory of the cause of depression. The other options distort information from other etiological theories and are not supported by research on the mechanism of action of electroconvulsive therapy.
positive reinforcement will help the patient
increase self esteem and increase positive behavior develop more appropriate behavior
An elderly patient complains bitterly and repetitively about numerous somatic concerns, but he has been examined thoroughly by several different health care providers, and physical examinations suggest that he is in good health. The nurse should suspect that the patient's somatic complaints most likely are: indications of a hidden physical illness. a maladaptive way of coping with stress. indications that he is feeling depressed. typical responses to the aches of growing older.
indications of feeling depressed
what is the most common symptom for schizophrenia in the prodromal stage
isolation
where is lithium excreted
kidneys - do not give with any drug/drink that will dehydrate because decrease blood volume increase toxicity. watch for caffieine, alcohol, otc, diuretics NO
anhedonia
lack of ability to feel joy
avolition
lack of motivation
avolition
lack of motivation not getting out of bed isolation
other ways to self soothe is through holding the item, project, hands > these are all examples of
limiting inappropriate behaviors without rejecting the individual
alogia
lo
identification of triggers, aware of relapse symptoms. stepping beyond illness education and helping them take charge of their personal life > what stage of illness for bipolar
maintenance phase
two types of mood disorders are
major depressive disorder bipolar disorder
AXIS I
major diagnostic criteria - acute diagnosis
what helps us to focus our assessments and interventions with this patient population
maslow hierachy of needs
axis III
medical diagnosis **could be what is causing delirium
what age group is most likely to succeed at committing suicide
men over the age 60/65 - means are more lethal
a state of well being in which indivuduals function within society and are generally satisfied with their lives
mental health
a disturbance in an individuals thinking, emotions, behaviors and physiology
mental illness
side effects for atypical antipyschotic
metabolic syndrome - glucose dysregulation, hypercholesterolemia and hypertension. increase in abdominal girth psychosocial - self disturbance less eps symptoms
intimacy vs stagnation
middle age adults struggle contributing to the world through family and work with feeling a sense of purpose in the world
tca like amytriptilline are more commonly used to treat
migraine and depression
A patient would benefit from therapy in which peers as well as staff have a voice in determining patient privileges and psychoeducational topics. Which approach would be best? Milieu therapy Cognitive therapy Short-term dynamic therapy Systematic desensitization
milieu therapy - Milieu therapy is a model of therapy that focuses on forming a community among individuals with psychiatric disordes and the staff involved in their care. This form of therapy empowers patients and models appropriate behaviors
The nurse has identified that the patient with mania is not eating or taking fluids due to excessive activity. The most appropriate food item for this patient would be: Cheese and crackers Milkshake Chicken and baked potato French fries
milkshake - ppl in mania can not stop moving so need a food that can be used on the go
A patient says, "My marriage is great. My spouse and I usually agree on everything." The nurse observes the patient's foot moving continuously and fingers twirling a shirt button. What assessment can the nurse make? The patient's communication is: clear. mixed. explicit. inadequate.
mixed - patient's verbal and nonverbal communication is not congruent
Which comment most clearly shows a speaker views mental illness with stigma? "Some mental illnesses are inherited." "Most people with mental illness are unmotivated." "Severe environmental stress sometimes causes mental illness." "Some mental illnesses are brain disorders resulting from changes in how impulses are transmitted."
most people with mental illness are unmotivated
what medical diagnosis is highly related to depression
ms
U stress
must clean the house - manic good stress
what are the three risk factors for schizophrenia
neuro disturbance family genetic babies born in winter - and to mom's infected
effexor used to treat
ocd
what type of hallucinations are rare in schizophrenia
olfactory and tactile - think more brain tumor
depo injection is used for pt
once a month IM injection adherence struggle because of disorganized thought used for schizophrenia
establish rapport, boundaries/relationships/contract/confidentiality/terms of termination
orientation phase
D stress
overwhelmed
hallmark symptom of a panic disorder
panic attack - can feel like an MI
cyclothomia
periods of depression and periods of hypomania
the two parts to anxiety
person (coping skills) enviroment (Stressors)
axis II
personality disorder and mental retardation
A client is brought to the emergency room after a brutal physical assault. Although oriented and coherent, the client cannot remember the assault or events surrounding it. The priority intervention by the nurse is to provide: Frequent reality orientation Physical comfort and safety Thoughtful questioning for the police report Referral to a community support group
physical comfort and safety
where is maslow hierachy of need considered on the mutlidisciplinary axis
physical illness III
operant conditioning
positive reinforcement for rewarding behavoirs you instill in a person. shaping the behavior without the insight as to why the behavior occured
medication for schizophrenia is used to treat
positive symptoms
A new staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced practice nurse to perform which additional interventions? Conduct mental health assessments Establish therapeutic relationships Individualize nursing care plans Prescribe psychotropic medication
prescribe psychotropic medication
risperidal what levels should you watch
prolactin because dopamine inhibits prolactin
A single parent who is employed full time complains of feelings of inadequacy related to work and family. The parent seeks help from a therapist who specializes in cognitive behavioral therapy. The therapist will treat the parent by: discussing ego states the parent experiences. negatively reinforcing undesirable behaviors. promoting assertive behavior at home and work. helping the parent identify and change faulty thinking.
promoting assertive behavior at home and at work. One of the focus of CBT is to have the pt become more assertive at home and at work
A man with severe depression is admitted to the partial hospitalization program for mood disorders after exhibiting unintentional weight loss and refusal to go to work. He does not bathe or shave, sleeps poorly, and repeatedly states: "I'm useless, I'm no good to anyone." Which intervention would be best to include in the patient's initial care plan? Involve patient in activities akin to those at his work to restore comfort. Reinforce his interest in resuming work attendance when it returns. Provide patient with nutrient-dense finger foods and weigh daily. Provide activities that involve concentration and fine motor skills.
provide pt with nutrieint dense finger foods
axis iv
psychosocial stressors
partial program
pt able to go home at night, more healthy, provides structure and more in depth therapy
social cognition in schizophrenia
pt has difficulty reaeding others, isolated, may have paranoia and disorganized thought process
schizoaffective disorder
pt has symptoms of both schizophrenia and bipolar disorder shows manic mood symptoms but not enough to meet criteria for both to be diagnosed
regain quality of life, medication management and family support what stage of schizophrenia is this
recovery and maintence
A nurse uses Maslow's hierarchy of needs to plan care for a patient with mental illness. Which problem will receive priority? The patient: refuses to eat or bathe. reports feelings of alienation from family. is reluctant to participate in unit social activities. is unaware of medication action and side effects.
refuses to eat or breath
Information given to a depressed patient and family when the patient begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy should include the directive to: avoid exposure to bright sunlight. report increased suicidal thoughts. restrict sodium intake to 1 gm daily. maintain a tyramine-free diet.
reported suicidal thoughts
A client is admitted to the emergency department after a car accident, but does not remember anything about it. The client is using what defense mechanism? Undoing Rationalization Suppression Repression
repression - unconscious blocking of feelings or events
A client with Dissociative Identity Disorder (DID) is admitted after an overdose of alcohol and benzodiazepines, claiming that another alter "did it". The nurse formulates which of the following as the priority nursing diagnosis? Post trauma response Risk for self-directed violence Disturbed personal identity Anxiety
risk for self directed violence
in psych what risk diagnosis is a priority
risk for suicide use maslow hierachy of need suicide falls under safety category
The patient with new onset Mania is started on Lithium Carbonate. What medication would also be used until the Lithium reaches therapeutic levels? Ativan Cogentin Respiridal Antihypertensive agents
risperidal
humanistic
rogers - unconditional acceptance and positive regard for the patient
a decrease in brain gray matter and excessive/decrease in neurotransmitters is related to what mental illness and genetic predisposition
schizophrenia
first break often occurs at a milestone at age 20, women have an older onset, childhood is rare
schizophrenia
what is the major symptom for wellbutrin
seizure
what should you caution with snri
seizure
SNRI regulates
serotonin and NE
what nt deficits are in depression
serotonin dopamine and epinephrine
When a patient presents with disorganized thinking and flight of ideas, the nurse should: Reorient the patient Set limits and be consistent in approach Listen and be supportive Move away and ignore the patient
setting limits and be consistent in approach Setting limits help the patient with boundaries and safety concerns, being consistent is also important to maintaining safety
when is teaching not able to occur during anxiety
severe perceptual changes - all they focus on is how they feel
The spouse of a woman diagnosed with somatization disorder tells the nurse that he is "running out of patience with her" and feels that "she has all those many health problems on purpose". A therapeutic response by the nurse would be: "Have you tried asking her? I think she'd tell you the truth" "Your wife is trying to gain your attention" "she doesn't have the problem on purpose; however, this is probably difficult for both of you" "She has some significant emotional problems that she can not admit".
she doesnt have the problem on purpose but this may be difficult for the both of you
behavioral
skinner
the fact that behaviors can be changed and modified without insight as to what causes the behaviors
skinner
what does the prodromal stage look like in schizophrenia
sleep disturbance irritability isolation illicit drug use change in grades
how does culture influence psych assessment
social stressors coping and support
When assessing an apparently anxious client, the nurse ensures that questions related to the client's anxiety are: Abstract and nonthreatening Avoided until the anxiety disappears Avoided until the client brings up the subject Specific and direct
specific and direct
the person responds to the phobia by either avoiding it or tolerating it with great discomfort
specific phobia
what drug class should you be cautious with during rapid cycling
ssri - anti-depressant
pt in acute inpatient or outpatient symptoms have decreased with medication, treatment adherance and education. socialization increase and psychosocial rehab what stage of schizophrenia is this
stabalization period
if lithium toxicity occurs what do you do
stop med suicide precautions monitor: kidney, ekg, vital signs
if the pt is afraid of airplanes the pt would learn relaxation therapy, increase exposure over time to noxious stumuli - think about the plan go to the airport get a ticket on a plane
systematic desensitization
zoloft side effect
taken in the morning instead of at night can keep you up
During the first interview with a parent whose child died in a car accident, the nurse feels sorry for the patient and reaches out to take the parent's hand. Select the correct analysis of the nurse's behavior. The parent will perceive the gesture as intrusive and overstepping boundaries. It shows empathy and compassion. It will encourage the parent to continue to express feelings. The action is inappropriate. "No touch" rules are important in all psychiatric interactions. The gesture is premature. The patient's cultural and individual interpretation of touch is unknown.
the gesture is premature. The patient's cultural and individual interpretation of touch is unknown. Touch has various cultural and individual interpretations. Nurses should refrain from using touch until an assessment can be made regarding the way in which the patient will perceive touch. The other options present prematurely drawn conclusions.
integrity vs despair
the older adult may feel a sense of satisfaction or failure
if the pt wants to voluntarily commit themselves how long can they stay
the pt may either release themselves from the hospital and it is called a three day notice hospital can try for commitment during the three days
when does toxicity symptoms become visible for lithium
think see saw - unstable hand tremors blurry vision n/v tinnitus lack of coordination
alogia
thought blocking - long time for response
what was the goal for interpersonal relationship theory
to decrease anxiety
aversion
tolerate something with great discomort
In the development of anxiety, stressors can be real or perceived. True False
true
true or false - if you have an hx of substance abuse, self medicating or depression you are at a higher risk for depression
true
true or false: nurses help to build resiliency
true
what is the key element to a therepeutic relationship
trust - provides feeling of safety and security
maoi should not eat
tyramine food - gourmet food store red wine chocolate cured meat tanines
thought stoppping
use an elastic band to decrease the reward of anxiety
The client is experiencing a Panic Attack. Which of the following actions by the nurse would be appropriate? Select all that apply. Speak loudly and firmly Restrict the patient's physical activity Use simple short sentences Remain calm and serene Teach cognitive restructuring skills
use simple and short sentences remain calm
systematic desensitization
used for phobias when the therapist teaches the pt relaxation therapy or technique and pt is systematically exposed
compulsion
used to decrease the anxiety obsession leads to compulsions
lamictal side effect
used to treat depression in bipolar 1 steven johns syndrome life threatning
inderal
used to treat performance anxiety help lower bp, heart beating, diaphoretic
what is considered in the enviroment of communication
values attitutdes culture knowledge religion gender age social status
The wife of a patient with schizophrenia is worried about her 17 year old daughter. She asks the nurse what symptoms mark the Prodromal stage of schizophrenia. The nurse should respond by listing the behaviors as: Withdrawal, poor concentration, erratic sleep patterns, and possibility of auditory hallucinations Auditory hallucinations, ideas of reference, thought insertion, and broadcasting Stereotyped behavior, echopraxia, echolalia, waxy flexibility, and thought blocking Looseness of association, concrete thinking, echolalia, paranoid delusions
withdrawl, poor concentration, erratic sleep patterns and possible auditory hallucinations
The nurse is sitting with a patient diagnosed as having schizophrenia, disorganized type, who starts to laugh uncontrollably, although nothing funny has occurred. The nurse should say: "please share the joke with me" "why are you laughing?" "I don't think I said anything funny" "you're laughing. Tell me what's happening"
you are laughing tell me whats happening - The use of reflecting the patient's behavior helps to promote reality testing. It also conveys to the patient that the nurse wants to understand the behavior.
A recently divorced man with severe depression exhibits poor sleep and impaired concentration, leading him to function poorly at work. Inattention to hygiene and irritability with others aggravate problems at work. Co-workers do not recognize that he is depressed and instead assume his behavioral changes are due to drug abuse. One day he is fired. Work had been his one remaining source of self-worth. The man presents at the emergency room seeking medication to help him sleep. Which of the following responses would be most important for the triage nurse to take at this time? "Have you considered seeking treatment for the depression itself?" "Tell me what you have already been trying to help improve your sleep." "We usually don't prescribe sleep medications in the emergency room." "You said you are depressed; have you thought about harming yourself?"
you said you are depressed - have you thought about harming yourself
atypical antipsychotics
zyprexa, risperidal, abilify and seroquil
