Psych Test #2
Little interest or pleasure in doing things
1.
feeling down depressed or hopeless
2.
trouble staying or falling asleep, or sleeping too much
3.
feeling tired or having little energy
4.
poor appetite or over eating
5.
feeling bad about yourself - or that you are a failure or have let yourself or your family down
6.
Trouble concentrating on things, such as reading thenewspaper or watching television
7.
Moving or speaking so slowly that other people couldhave noticed. Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual
8.
Thoughts that you would be better off dead, or of hurting yourself in some way
9.
I will accompany you to the bathroom
A client on an in-patient psychiatric unit has been diagnosed with bulimia nervosa. The client states, "I am going to the bathroom and will be back in a few minutes." Which nursing response is most appropriate?
hallucinations and delusions
A nurse is assigned the care of four patients who are detoxing from alcohol. Which symptom is the nurses highest priority?
Panic!
A parent is shopping with a 5-year-old child in a large, busy urban mall. The parent suddenly realizes the child is missing. Which level of anxiety would likely result?
Listen, redirect the patient to his or her feelings, explore issue with staff
A patient states that unit staff members have been avoiding him or her since an attempt to self-mutilate. The psychiatric and mental health nurse's most appropriate intervention is to:
Collaborate with the patient to reduce the amount of time he or she engages in ritualistic behaviors
A patient who is admitted to the psychiatric unit with a diagnosis of obsessive-compulsive disorder spends a significant amount of time during the day and night washing his or her hands. On the third hospital day, the patient reports feeling better and more comfortable with the staff and other patients. The psychiatric and mental health nurse knows that the most appropriate nursing intervention is to:
I will walk with you to the dining room and sit with you while you eat
A patient who was admitted yesterday with an adjustment disorder and depressed mood has not left his or her room. The psychiatric and mental health nurse's most appropriate intervention at meal time today is to respond:
constricted
A person has recently abused morphine. The persons pupils would be...
Optimum functioning in the least restrictive environment
A short-term goal for a patient with Alzheimer's disease is:
Remain with the client
A woman comes into the emergency department in a severe state of anxiety following a car accident. The mo st important nursing intervention is to:
delirium
Acute onset of disordered thinking is most associated with
It takes approx.. two to four weeks for depression to lessen and side effects will dimisnish
After taking an antidepressant for about a week, a patient reports constipation and dizziness, with no improvement in mood. The psychiatric and mental health nurse informs the patient:
When was your last menstrual period?
An adolescent female is brought to the school nurse after fainting during gym class. She is grossly underweight, wears baggy clothes, and has dry skin. She complains of feeling cold despite wearing two sweaters. To further assess for an eating disorder, the nurse should ask:
So what if that kid was hurt? I should have beaten him more
An adolescent with a conduct disorder is taken to the principals office after assaulting and injuring another student. Which comment is he likely to make?
stay with them (safety) Physical and nutrition (less than body requirements) May need medical and nutritional implementation
Anorexia, bulimia, binging...
cluster b- sociopath - antagonistic, disrespectful, manipulative, high risk, disregard for responsibility and others, impulsive, lack of empathy, superficial, shallow, everything is an act conduct disorder is a precursor
Antisocial
Cluster C- low self esteem in social situations feelings of inferiority doesn't want to mix with new people peer or parent criticism history
Avoidant
cluster B personality disorder: In a constant state of crisis, promiscuous, unable to tolerate anxiety-causing situations, afraid of being alone, and having intense but brief relationships impulsive and antagonistic intolerant of being alone chronic feelings of emptiness (from abandonment as a child) inappropriate anger or rage self harming behavior
Borderline
Odd or Eccentric Paranoid Schizoid Schizotypal
Cluster A-
Dramatic, erratic, overly emotional Narcissistic Histrionic Antisocial Borderline
Cluster B-
anxious fearful thinking Dependent Obsessive compulsive Avoidant
Cluster C -
: fast onset, acute, caused by something else
Delirium
Use distraction and redirection (don't get into power struggle) set boundaries
Demanding patient in the day hall...
Cluster C - insecure, early experience which hurt independence (childhood illness) problems in functioning clingy, stay in bad relationships
Dependent
improvement in speech, dress, energy, sleep, eating..
Evaluation of improving from manic episode
patient is creating this...
Factitious disorder -
Cluster B - provacative and flirtacious impulsive and low agreeableness 3-5 years old overly attracted to opposite sex parent they do not think they need help
Histrionic
Peripheral Edema
Hypoalbuminemia in a patient with an eating disorder would produce which assessment finding?
conduct disorder oppositional defiance disorder
Impulse disorders:
Highest level of functioning possible
Intervention for dementia / alzheimers:
0.8-1.2 (therapeutic level)
Lithium levels
8-9 cups a day 2-3 grams salt a day replace fluids after sweating
Lithium teaching:
: tyramine and other serotonin meds (some cough meds incrase serotonin) cheese and wine salami : tyramine
MAOI - contraindication:
Cluster B, arrogant, self important, strains relationships, attention seeking
Narcissistic
sleep disorder
Narcolepsy is a type of..
Encourage the use of learned relaxation techniques
Nurse Winona educates the family about symptom management for when the patient with Bipolar Disorder, Mania becomes upset or anxious. Which of the following would Nurse Winona state is helpful?
Cluster C - rigid, no insight about their own inflexible behavior, excessive parental criticism control shame, try to control his/her environment perfectionism
Obsessive compulsive
They don't have lack of empathy, don't harm animals or people, may not do well in school
Oppositional defiant disorder -
Cluster A, Pervasive Distrust and Suspiciousness, projection is major defense mechanism, doesn't think anything is wrong with them, often grew up in rage and anger household anxious about being harmed
Paranoid
Warn them about any medications that have alcohol in them
Patient who is on antibuse:
Teach them resources.... AA Set up with groups
Patient with history of alcoholism -
obsessive - compulsive
Perfectionism is a trait likely to be evident in a person with which personality disorder?
Risk for violence or injury towards others
Priority diagnoses for antisocial personality disorder:
Risk for injury - invincible feeling, pacing, jumping, street corner Nutritional deficit - not eating not drinking, CV issues Encourage fluids and food (high protein, finger foods)
Priority nursing diagnoses - MANIA
Cluster A, does not seek out friends, not affected by approval or rejection, may have been raised in cold neglectful home.
Schizoid
Cluster A, odd beliefs, magical thinking in physics, genetically linked to schizophrenia, overly detailed and abstract, extreme anxiety, rambles...
Schizotypal
Have real (body) symptoms Really feel stomach ache.. really vomiting... true chest pain...
Somatic symptom disorders:
Dual diagnosis / comorbidities include major mental illness
Substance related and addiction -
Nonstop physical activity and poor nutritional intake
The nurse assesses a client with the admitting diagnosis of Bipolar Disorder, Mania. The symptom presented by the client that requires the nurse's immediate intervention is the client's:
I should call the doctor if my spouse shakes badly
The psychiatric and mental health nurse knows that the patient's spouse clearly understands the side effects of lithium carbonate (Eskalith), when he or she says:
lithium goes down
Too much salt -
salt
What effects lithium level?
Set limits, have one staff member for main use...
What to do for cluster b :
we lose ability to learn, we make bad decisions, we get tunnel vision
When anxiety goes up -
Provides an organized, structured environment
When planning inpatient psychotherapeutic activities for a patient who has antisocial personality disorder, the psychiatric and mental health nurse:
Trazodone
Which medication for insomnia is classified as an antidepressant rather than a hypnotic?
Frequent angry outburst noted toward peers and staff
Which of the following client behaviors documented in Gio's chart would validate the nursing diagnosis of Risk for other-directed violence?
Munchausen Syndrome by Proxy
Which problem does NOT fit the group? A. Conversion Disorder B. Illness Anxiety Disorder C. Munchausen Syndrome by Proxy D. Somatic Symptom Disorder
Kicks in quicker, helps with agitation, helps with hyperactivity (promotes slowing down to eat and sleep) It's a 2nd gen antipsychotic
Why are we using Zyprexa (lanzapine)
Can trigger manic episode - watch the mood
Worried about antidepressants with bipolar:
stabilization (protect from injury) begin meds safety and physical needs (nutrition)
acute
set limits and boundaries let patient know the behavior is inappropriate
agitated patient in a room with other patients -
might have constipation, diarrhea, dizziness (Gets better)
antidepressants take a few weeks to take effect but...
full blown mania and severe depression Outlandish, bright colors, fast speech, euphoric, cheerful, happy, over the top, agitation...
bipolar type 1
hypomania and severe depression
bipolar type 2
yes - they have depression too
can you use PHQ-9 for bipolar?
childhood disorder, - leads to antisocial, Lack of empathy, don't care for rules or norms
conduct disorder:
begin to get better, groups, therapy
continuation
know all 9...
depression: or anxiety (though there is one for anxiety also) assessment for suicide ( (9) for depression and suicide sleep, eating, activity, concentration, hopeless..
SSRI: zoloft, prozac, paxil
first line for depression
lasts months, daily excessive worry
generalized anxiety
acute continuation maintenance
goals to expect for patient in different stages of recovery -
slow taper them down...
if a patient has rituals due to OCD what should you encourage?
clear the day hall (have everyone else go to rooms)
if bipolar patient escalates around other people in day hall,
do they have a plan
if they say yes to the suicide question - what is the important thing to ask?
teach coping skills
main intervention with somatic
implement resources for discharge
maintenance -
seizures
major medical complication for alcohol withdrawal
check mouths (cheeking) check the levels (blood work) behaviors start coming back.. not sleeping / not eating / mania
patients don't want to take medications...
dilated
pupils on cocaine
constricted
pupils on opiates
helps with sleep and eating
remeron: atypical
wait a few weeks.
sexual dysfunction can be a side effect of antidepressants
lithium gets toxic
too little salt -
1.5 or greater
toxic lithium level
Tremors, N/V, sweating, imbalance, ataxia
toxic lithium signs
Every system is effected.
what is effects on alcohol?
stay with them.
what should you do if your patient is in a panic state?
mild
which anxiety level is healthy?
B
which cluster is manipulative?
obsessive compulsive
who is Rigid, inflexible, easily upset if things aren't controlled -