Psych test 5

alcohol intoxication

-slurred speech -nystagmus -memory impairment -altered judgment -dec motor skills -dec LOC -respiratory arrest -peripheral collapse -death

opioid intoxication

-slurred speech; impaired memory; pupillary changes -dec respiration; Dec LOC that can lead to death -maladaptive behavioral or psychological changes -impaired judgment or social fxning -antidote; naloxone

borderline personality disorder

pervasive and enduring pattern of unstable interpersonal relationships, self-image, and affect; marked impulsivity; frequent self-mutilation behavior

Paranoid personality disorder is characterized by

pervasive mistrust and suspiciousness of others. Clients with this disorder interpret others' actions as potentially harmful.

Opioids

popular drugs of abuse because they desensitize the user to both physiologic and psychologic pain and induce a sense of euphoria and well-being.

Methadone

potent synthetic opiate, is used as a substitute for herion in some maintenance programs. The client takes one daily dose of this, which meets the physical need for opiates nut does not produce cravings for more

disease conviction:

preoccupation with the fear that one has a serious disease

illness anxiety disorder:

preoccupation with the fear that one has a serious disease or will get a serious disease; also called hypochondriasis

disease phobia:

preoccupation with the fear that one will get a serious disease

Thiamine (vitamin b1)

prevents or treats wernicke-korsakoff syndrome in alcoholism

Substance dependence

problems associated with addiction such as tolerance withdrawal, and unsuccessful attempts to stop using the substance.

Emotion-focused strategies include

progressive relaxation, deep breathing, guided imagery, and distractions such as music or other activities

Caffeine

pyschoactive drug; most widely used, restlessness, insomnia, excitement, etc.

flushing

reddening in the face and neck as a result of increased blood flow, been linked to variants of genes for enzymes involved in alcohol metabolism.

Treatment clients with pain disorder

referral to a chronic pain clinic methods of pain management such as visual imaging and relaxation

hysteria:

refers to multiple, recurrent physical complaints with no organic basis

temperament

refers to the biologic processes of sensation, association, and motivation that underlie the integration of skills and habits based on emotion

Withdrawal syndrome

refers to the negative psychological and physical reactions that occur when use of a substance ceases or dramatically decreases.

Spontaneous Remission

reports exist that some people with alcohol-related problems can modify or quit drinking on their own without a treatment program, also called natural recovery

time-out

retreat to a neutral place to give the opportunity to regain self-control

Benzodiazepines

sedative-hypnotics and have largely replaced barbituates; relieve tension, but may cause rapid mood changes, impaired judgment, and slurred speech

Clients are

self-absorbed and focus most of their thinking on themselves, with little or no thought about the needs of others. They are highly suggestible and will agree with almost anyone to get attention.

Clients have very low

self-esteem. They are hypersensitive to negative evaluation from others and readily believe themselves to be inferior.

Physiologic and Self-Care Concerns of client with somatization

sleep pattern disturbances lack basic nutrition get no exercise prescription pain meds (withdrawal)

conversion disorder:

sometimes called conversion reaction; involves unexplained, usually sudden deficits in sensory or motor function related to an emotional conflict the client experiences but does not handle directly

Substance induced conditions

substances can induce symptoms that are similar to other mental illness diagnosis, such as anxiety, psychosis, or mood disorders.

Hallucinogens

substances that distort the users perception of reality and produce symptoms similar to psychosis, including hallucinations and depersonalization.

Falling-out episodes

sudden collapse during which the person cannot see or move sudden collapse during which the person cannot see or move

Opioids withdrawal

symptoms that develop include nausea, vomiting, dysphoria, lacrimation, rhinorrhea, sweating diarrhea, yawning, fever, and insomnia

confrontation

technique designed to highlight the incongruence between a person's verbalizations and actual behavior; used to manage manipulative or deceptive behavior

emotion-focused coping strategies:

techniques to assist clients to relax and reduce feelings of stress

problem-focused coping strategies:

techniques used to resolve or change a person's behavior or situation or to manage life stressors

People with personality disorders have traits

that are inflexible and maladaptive and cause either significant functional impairment or subjective distress.

cognitive restructuring therapy

that focuses on changing the way one thinks about or interprets one's self, relationships, and/or environment

Personality disorders are not diagnosed until adulthood

that is, at age 18, when personality is more completely formed. Nevertheless, maladaptive behavioral patterns can often be traced to early childhood or adolescence.

The tendency of these clients to exaggerate

the closeness of relationships or to dramatize relatively minor occurrences can result in unreliable data.

Sedatives Hypnotics Axiolytics

the effects of the drugs, symptoms of intoxication, and withdrawal symptoms are similar to those of alcohol. In usual prescribed doses, these drugs can cause drowsiness and reduce anxiety.

malingering:

the intentional production of false or grossly exaggerated physical or psychological symptoms

secondary gain:

the internal or personal benefits received from others because one is sick, such as attention from family members, comfort measures, and being excused from usual responsibilities or tasks

Somatic symptom illnesses

the presence of physical symptoms that suggest a medical condition without a demonstrable organic basis to account fully for them

primary gain:

the relief of anxiety achieved by performing the specific anxiety-driven behavior; the direct external benefits that being sick provides, such as relief of anxiety, conflict, or distress

somatization:

the transference of mental experiences and states into bodily symptoms

Alcohol Intoxication

there is slurred speech, unsteady gait, lack coordination, and impaired attention, concentration, memory, and judgment.

Substance abuse

this can be defined as using a drug in a way that is inconsistent with medical or social norms and despite negative consequences.

Naltrexone

this drug is an opioid receptor antagonists often used to treat overdose, also been found to reduce cravings for alcohol

inhalant intoxication

this involves dizziness, nystagmus, lack of coordination, slurred speech, unsteady gait, tremor, muscle weakness, and blurred vision.

Tapering

this is essential with barbiturates to prevent coma and death that occur if the drug is stopped abruptly

Alcoholism and other substance abuse

this is often a family illness, all those who have a close relationship with a person who abuses substances suffer emotional, social, and sometimes physical anguish.

Detoxification

this is the process of safely from a substance.

acamprosate (campral)

this maybe prescribed for clients recovering from alcohol abuse or dependence to help reduce cravings for alcohol and decrease the physical and emotional discomfort that occurs especially in the first few months of recovery.

Disulfiram (Antabuse)

this maybe prescribed to help deter clients from drinking, if clients are on this and drink a severe adverse reaction occurs with flushing, a throbbing headache, sweating, nausea, and vomiting.

Alcohol overdose, or excessive alcohol intake

this results in vomiting, unconsciousness , and respiratory depression. This combo can cause aspiration pneumonia or pulmonary obstruction.

Teaching social skills and role-playing

those skills in a safe, nonthreatening environment can help clients to gain confidence in their ability to interact socially. The nurse must be specific in describing and modeling social skills, including establishing eye contact, engaging in active listening, and respecting personal space. It also helps to outline topics of discussion appropriate for casual acquaintances, closer friends or family, and the nurse only.

Clients may be quite sensitive

to discussing self-esteem and may respond with exaggerated emotions. It is important to explore personal strengths and assets and to give specific feedback about positive characteristics.

Nurses must use self-awareness skills

to minimize client manipulation and deal with feelings of frustration.

main purposes of pharm treatment in substance abuse

to permit safe withdrawal from alcohol, sedative-hypnotics, and benzos, and prevent relapse

Treatment of benzo overdose

treatment includes gastric lavage followed by ingestion of activated charcoal and a saline cathartic; dialysis can be used if symptoms are severe.

treatment of stimulants overdose

treatment includes using chlorpromazine (Thorazine), an antipsychotic, controls hallucinations, lowers blood pressure, and relieves nausea

Cyanocobalamin (vitmin B12)

treats nutritional deficienies

Folic Acid (folate)

treats nutritional deficienies, may turn urine yellow

Amphetamines

trigger the release of epinephrine (adrenaline) which stimulates the central nervous system; hyper alterness, high doses make one moody

psychosomatic:

used to convey the connection between the mind (psyche) and the body (soma) in states of health and illness

safe withdrawal from alcohol

usually accomplished with the administration of benzos such as lorazepam (ativan), chlordiazepoxide (librium), or diazepam (valium) to suppress the withdrawal symptoms

A client with a long history of bulimia nervosa is seen in the emergency department. The client is seeing things that others do not, is restless, and has dry mucous membranes. Which is most likely the cause of this client's symptoms?

vomiting, which may lead to dehydration and electrolyte imbalance People who frequently vomit have many dental problems, such as loss of tooth enamel, chipped and ragged teeth, and dental caries. Frequent vomiting may also result in mouth sores. ... (more)

Munchausen's syndrome by proxy:

when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnel or to be a hero for "saving" the victim

Benzodiazepines

when taken orally in overdose, are rarely fatal, but the person is lethargic and confused.

Several therapeutic strategies are effective

when working with clients with personality disorders. Cognitive restructuring techniques such as thought stopping, positive self-talk, and decatastrophizing are useful; self-help skills aid the client to function better in the community.

Cocaine

white crystallized powder; produce feeling of well being and euphoria and then to depression

Somatic symptom illnesses are more common in

women

Which client statements demonstrate a risk for the development of an eating disorder? Select all that apply.

• "Everything about my school work needs to be perfect." • "I want things to be the way I want them to be." • "Things being out of order really bothers me." Both anorexia and bulimia are characterized by perfectionism, obsessive-compulsiveness, neuroticism, negative emotionality, harm avoidance, low self-directedness, low cooperativeness, and traits associated with avoidant personality disorder. Depression and obsessive-compulsive disorders are commonly associated with eating disorders. (less)

A client's diagnosis of anorexia nervosa is supported when the psychiatric nurse documents assessment data that includes which of the following? Select all that apply.

• Client reports of "being depressed" • Claims that she "hasn't had a menstrual period in over 2 years." • Overheard telling other clients "I weigh myself three times a day when I'm home." • Consistently denies that she "has a problem with the way she looks Depression is characteristic of anorexia, as is amenorrhea and an intense fear of gaining weight. Additionally, denial of seriousness of current extremely low body weight is characteristic of anorexia. However, it is insomnia, not excessive sleeping, that is characteristic of anorexia. (less)

Inhalants

drugs that produce vapors that cause Psychoactive effects when inhaled or sniffedl solvents, aerosols

stimulates

drugs that stimulate or excite the central nervous system and have limited clinical use and a high potential for abuse.

screening tools

-michigan alcohol screening test -drug abuse screening test -CAGE questionnaire -alcohol use disorders identification test -CIWA -clinical opiate withdrawal scale

nursing considerations

-monitor vital signs -neurological status -provide client safety by implementing seizure precautions

ACT

-promote acceptance of client's experiences and promotes client commitment to positive behavior changes -acceptance and commitment therapy

older adults

-prone to falls/injury -memory loss -somatic reports (headaches) -changes in sleep patterns

cocaine effects

-rush of euphoria -pleasure -inc energy

Why don't students use drugs?

-lack of interest, religion, athletics, etc.

A client on an in-patient psychiatric unit has been diagnosed with bulimia nervosa. The client states, "I'm going to the bathroom and will be back in a few minutes." Which response by the nurse is most appropriate?

"I will accompany you to the bathroom." After each meal or snack, clients may be required to remain in view of staff for 1 to 2 hours to ensure they do not empty the stomach by vomiting. Some treatment programs limit client access to bathrooms without supervision, particularly after meals, to discourage vomiting. The response "I will accompany you to the bathroom" is appropriate. Any client suspected of self-induced vomiting should be accompanied to the bathroom for the nurse to be able to deter this behavior. The response, "I'll stand outside your door to give you privacy" does not address the nurse's responsibility to deter the behavior. The nurse should accompany the client to the bathroom. Providing privacy is secondary to preventing further nutritional deficits. (less)

A nurse is performing an admission assessment for an adolescent girl with an eating disorder who is being admitted to the psychiatric unit. Which statement would the nurse interpret as most likely supporting the client's diagnosis?

"I've never really liked myself." Body dissatisfaction is strongly related to low self-esteem and is a key characteristic of anorexia nervosa. Results of numerous studies have shown that low self-esteem, body dissatisfaction, and feelings of ineffectiveness and inadequacy put individuals at risk for an eating disorder. A father's body type has little impact on the development of this disorder. Families of individuals with anorexia are often labeled as overprotective, enmeshed, unable to resolve conflicts, and rigid related to boundaries. Thus, a close relationship would not be associated with this disorder. (less)

A nurse is interviewing a client diagnosed with bulimia nervosa about her family and her relationship with her mother. Which statement by the client would the nurse least likely associate with bulimia nervosa?

"My mother and I are close but not joined at the hip." The statement about being close but not joined at the hip is not reflective of a family associated with bulimia. The families of individuals who experience bulimia nervosa are reported to be chaotic, with few rules and unclear boundaries. Often there is an overly close or enmeshed relationship between the daughter and mother. Daughters may relate that their mother is their "best friend." The boundaries are blurred in that the mother may interact with the daughter as a confidante, and this unhealthy relating further impedes the separation-individuation process. The daughters often feel guilty about separation and responsible for their mother's happiness and emotional well-being. (less)

A nurse who provides care at an inpatient eating disorder clinic is performing an admission assessment of a young woman who has been diagnosed with anorexia nervosa. Which of the following assessment questions reflects therapeutic communication?

"What do you think about how much you weigh right now?" Open-ended questions that are not "loaded" or accusatory are most likely to elicit data from a client who has an eating disorder. Offering food at this early stage of care is likely to inhibit rather than enhance rapport between the nurse and the client. (less)

A 24-year-old woman is in treatment for anorexia nervosa. The therapist, using solution-focused brief therapy, poses which of the following questions to the client as a basis for designing interventions?

"When do you manage your eating behaviors successfully?" People with eating disorders tend to have perfectionistic personalities and to think in all-or-nothing terms. The client defines rigid appropriate behaviors for herself in terms of "walking on a tightrope," with the need for constant vigilance to keep from falling off. The client must learn balance and moderation in thinking and behavior. The nurse reassures the client that life is more like walking in a big meadow and that she can move safely in many directions. (less)

Jamie is 16 years old and her identical twin sister was just diagnosed with anorexia nervosa. Jamie tells the nurse she is concerned that she may also develop the disorder. Which of the following responses by the nurse is the most appropriate?

"While eating disorders have shown a genetic link, environmental factors also play a role in the development of easting disorders." Studies of twins and the sisters and daughters of people with eating disorders suggest a genetic link. Monozygotic twins have a concordance rate of 50% to 80% for eating disorders. Wade and colleagues (2000) attribute 58% of cases of anorexia nervosa to genes, with environmental factors also having a strong influence. The exact role of genetics in eating disorders, however, remains speculative. (less)

The nurse is seeing a Chinese client who reports chronic pain that radiates to the lower back. The client reports the pain has been unresolved with analgesia, physical therapy and therapeutic massage. The client's diagnostic imaging reports are all unremarkable. Which statement by the nurse would be the most supportive response to this client?

"You must be so frustrated with this unexplained pain. Do you have other stresses in your life too?

People with personality disorders are often described as

"treatment resistant." This is not surprising, considering that personality characteristics and behavioral patterns are deeply ingrained. It is difficult to change one's personality

The nurse would assess for which of the following characteristics in a client with narcissistic personality disorder? (A) Entitlement (B) Fear of abandonment (C) Hypersensitivity (D) Suspiciousness

(A) Entitlement

The most important short-term goal for the client who tries to manipulate others would be to (A) acknowledge own behavior. (B) express feelings verbally. (C) stop initiating arguments. (D) sustain lasting relationships.

(A) acknowledge own behavior.

Transient psychotic symptoms that occur with borderline personality disorder are most likely treated with which of the following? (A) Anticonvulsant mood stabilizers (B) Antipsychotics (C) Benzodiazepines (D) Lithium

(B) Antipsychotics

The nurse working with a client with antisocial personality disorder would expect which of the following behaviors? (A) Compliance with expectations and rules (B) Exploitation of other clients (C) Seeking special privileges (D) Superficial friendliness toward others (E) Utilization of rituals to allay anxiety (F) Withdrawal from social activities

(B) Exploitation of other clients (C) Seeking special privileges (D) Superficial friendliness toward others

Which of the following underlying emotions is commonly seen in an avoidant personality disorder? (A) Depression (B) Fear (C) Guilt (D) Insecurity

(B) Fear

When working with a client with a personality disorder, the nurse would expect to assess which of the following? (A) High levels of self-awareness (B) Impaired interpersonal relationships (C) Inability to empathize with others (D) Minimal insight (E) Motivation to change (F) Poor reality testing

(B) Impaired interpersonal relationships (C) Inability to empathize with others (D) Minimal insight

Clients with a schizotypal personality disorder are most likely to benefit from which of the following nursing interventions? (A) Cognitive restructuring techniques (B) Improving community functioning (C) Providing emotional support (D) Teaching social skills

(B) Improving community functioning

When interviewing any client with a personality disorder, the nurse would assess for which of the following? (A) Ability to charm and manipulate people (B) Desire for interpersonal relationships (C) Disruption in some aspects of his or her life (D) Increased need for approval from others

(C) Disruption in some aspects of his or her life

When working with a client with a narcissistic personality disorder, the nurse would use which of the following approaches? (A) Cheerful (B) Friendly (C) Matter-of-fact (D) Supportive

(C) Matter-of-fact

Cognitive restructuring techniques include all of the following except (A) decatastrophizing. (B) positive self-talk. (C) reframing. (D) relaxation.

(D) relaxation.

Sangue dormido

(sleeping blood) report pain, numbness, tremors, paralysis, seizures, blindness, heart attacks, and miscarriages

CLIENT/FAMILY EDUCATION For Borderline Personality Disorder

* Teaching social skills *Maintaining personal boundaries *Realistic expectations of relationships *Teaching time structuring *Making a written schedule of activities *Making a list of solitary activities to combat boredom *Teaching self-management through cognitive restructuring *Decatastrophizing situation *Thought stopping *Positive self-talk *Using assertiveness techniques such as "I" statements *Using distraction, such as walking or listening to music

CLIENT/FAMILY EDUCATION For Antisocial Personality Disorder

*Avoiding use of alcohol and other drugs *Appropriate social skills *Effective problem-solving skills *Managing emotions such as anger and frustration *Taking a time-out to avoid stressful situations

Maladaptive or dysfunctional personality traits exhibited by individuals with a personality disorder may include:

*Negative behaviors toward others, such as being manipulative, dishonest, deceitful, or lying *Anger and/or hostility *Irritable, labile moods *Lack of guilt or remorse, emotionally cold and uncaring *Impulsivity, poor judgment *Irresponsible, not accountable for own actions *Risk-taking, thrill-seeking behaviors *Mistrust *Exhibitionism *Entitlement *Dependency *Eccentric perceptions

NURSING INTERVENTIONS For Borderline Personality Disorder

*Promoting client's safety *No-self-harm contract *Safe expression of feelings and emotions *Helping client to cope and control emotions *Identifying feelings *Journal entries *Moderating emotional responses *Decreasing impulsivity *Delaying gratification *Cognitive restructuring techniques *Thought stopping *Decatastrophizing *Structuring time *Teaching social skills *Teaching effective communication skills *Entering therapeutic relationship *Limit setting *Confrontation

NURSING INTERVENTIONS For Antisocial Personality Disorder

*Promoting responsible behavior * Limit setting *State the limit. *Identify the consequences of exceeding the limit. *Identify expected or acceptable behavior. *Consistent adherence to rules and treatment plan *Confrontation *Point out problem behavior. *Keep client focused on self. *Help clients solve problems and control emotions. *Effective problem-solving skills *Decreased impulsivity *Expressing negative emotions such as anger or frustration *Taking a time-out from stressful situations *Enhancing role performance *Identifying barriers to role fulfillment *Decreasing or eliminating use of drugs and alcohol

meds for opioid withdrawal

-methadone substitution -clonidine -buprenorphine -naltrexone -levo-alpha-acetylmethadol

Points to Consider When Working with Clients with Disruptive Behavior Disorders and Their Families

*Talking to colleagues about feelings of frustration will help you to deal with your emotional responses so you can be more effective with clients. *Clear, frequent communication with other health care providers can help to diminish the client's manipulation. *Do not take undue flattery or harsh criticism personally; it is a result of the client's personality disorder. *Set realistic goals, and remember that behavior changes in clients with personality disorders take a long time. Progress can be very slow.

Alcohol

-0.08%; death > 0.4% BAC depends on many factors -body weight -gender -consideration of alcohol in drinks -number of drinks -gastric absorption rate -individual's tolerance level -relaxation; dec social anxiety; stress reduction

nicotine long term

-HTN -stroke -emphysema -lung cancer -smokeless causes oral mucous membrane irritation and cancer

alcohol withdrawal symptoms

-abd cramping -vomiting -tremors -restlessness/inability to sleep -inc HR -transient hallucinations or illusion -anxiety -inc BP, RR, temp -tonic-clonic seizures

culture

-alaska native; native american -high percentage of members who have alcohol use disorder -Asians have lower rate of alcohol

inhalants

-amyl nitrate -nitrous oxide -solvents are sniffed, huffed, bagged -often by children or adolescents -euphoria

hallucinogen intoxication

-anxiety -depression -paranoia -impaired judgment -impaired social fxning -pupil dilation -tachycardia -diaphoresis -palpitation -blurred vision -tremors -incoordination -panic attacks

benzo withdrawal

-anxiety -insomnia -diaphoresis -HTN -possible psychotic reactions -hand tremors -n/v -hallucinations/illusions -psychomotor agitation -possible seizure activity

opioid withdrawal

-begins with sweating and rhinorrhea Progressing to -piloerection -tremors -irritability -severe weakness -diarrhea -fever -insomnia -pupil dilation -n/v -pain in muscles/bones/spasms

inhalant intoxication

-behavior or psychological change -dizziness -nystagmus -uncoordinated movements or gait -slurred speech -drowsiness -hyporeflexia -muscle weakness -diplopia -stupor or coma -respiratory depression -possible death

Review of systems

-blackout or loss of consciousness -changes in bowel movements -weight loss or weight gain -experience of stressful situation -sleep problems -chronic pain -concern over substance use -cutting down on consumption behavior

meds for nicotine withdrawal

-bupropion -nicotine replacement therapy -varenicline

alcohol withdrawal delirium

-can occur 2-3 days after quitting -medical emergency -severe disorientation -psychotic manifestations -severe HTN -cardiac dysrhythmias -delirium -can progress to death

amphetamine withdrawal

-craving -depression -fatigue -sleeping -not life threatening

indications older adult

-dec in ability for self care (functional status) -urinary continence -manifestations of dementia -effects of alcohol at lower doses -polypharmacy and alcohol -age related physiological changes raise the likelihood of adverse effects (confusion/falls)

cocaine withdrawal

-depression -fatigue -craving -excess sleeping or insomnia -dramatic unpleasant dreams -psychomotor retardation -agitation -non life threatening but possible occurrence of suicidal ideation

meds for alcohol withdrawal

-diazepam -carbamazepine -clonidine -chlordiazepoxide -phenobarbital -naltrexone

benzo

-diazepam, barbiturates, flunitrazepam -dec anxiety; sedation

chronic use of alcohol

-direct cardio damage -liver dmg (fatty liver to cirrhosis) -erosive gastritis -GI bleed -acute pancreatitis -sexual dysfxn

alcohol abstinence

-disulfiram -naltrexone -acamprosate

cocaine intoxication mild

-dizziness -irritability -tremor -blurred vision

Positive addiction rewards

-excitement, physical relaxation, sensory stimulation, and escape mental boredom

benzo antidote

-flumazenil IV -none for barbiturate

risk factors

-genetics -chronic stress -socioeconomic -Hx of trauma, abuse, combat exp -lowered self esteem -lowered tolerance for pain/frustration -few meaningful personal relationship -few life successes -risk taking tendencies

cocaine intoxication severe

-hallucinations -seizures -extreme fever -tachycardia -HTN -chest pain -possible cardiovascular collapse and death

hallucinogens

-heightened sense of self and altered perceptions

statistics

-highest rate of use in 20-29 -younger onset/higher disorder chance -cocaine is down/marijuana up -86.8% over age 18 report alcohol use at some point -56.4% in last month

nicotine intoxication

-highly toxic -acute toxicity seen only in children or when exposure in pesticides -contain harmful chemicals that are highly toxic and have long term effects

amphetamine intoxication

-impaired judgment -psychomotor agitation -hypervigilance -extreme irritability -acute cardiovascular effects (tachycardia, elevated BP) -could cause death

benzo intoxication

-inc drowsiness and sedation -agitation -slurred speech -uncooordinated motor activity -nystagmus -disorientation -n/v -resp depression; dec LOC; could be fatal

pot withdrawal

-irritability -aggression -anxiety -insomnia -lack of appetite -restlessness -depressed mood -abd pain -tremors -diaphoresis -fever -headache

nicotine withdrawal

-irritability -craving -nervousness -restlessness -anxiety -insomnia -inc appetite -difficulty concentrating -anger -depressed mood

Hx to assess

-type of substance/behavior -pattern/frequency of use -amount used -age at onset -changes in occupational/school performance -changes in use patterns -periods in abstinence in Hx -previous withdrawal manifestations -date of last use/behavior

hallucinogen withdrawal

-visual disturbances or flashback hallucinations -intermittently for years

Which of the following percentages accurately reflects the prevalence of anorexia and bulimia in the United States?

1% to 4% Estimates of the prevalence of anorexia nervosa and bulimia nervosa range from 1% to 4% of the U.S. general population.

Limit setting is an effective technique that involves three steps:

1. Stating the behavioral limit (describing the unacceptable behavior) 2. Identifying the consequences if the limit is exceeded 3. Identifying the expected or desired behavior

Conversion disorder usually occurs between

10 and 35 years of age

Personality disorders are relatively common, occurring in

10% to 20% of the general population.

Addiction

A behavioral pattern characterized by compulsion, loss of control, and continued repetition in spite of adverse consequences

Which statement made by the nurse managing the care of an anorexic teenager demonstrates an understanding of the client's typical, initial reaction to the nurse? A) "I realize this must be very difficult for you but try to remember I'm not your enemy." B) "I'm not going to take your insults personally but you need to be more respectful." C) "I'm sorry that you are angry but you cannot throw food at me." D) "I'm not the root of your problem."

A) "I realize this must be very difficult for you but try to remember I'm not your enemy."

A nurse is interviewing a client and suspects an eating disorder. Which client statement would the nurse interpret as demonstrating a risk for the development of an eating disorder? Select all that apply. A) "I want things to be the way I want them to be." B) "I consider myself a really laid-back individual." C) "Things being out of order really bothers me." D) "Everything about my school work needs to be perfect." E) "I'll stand up for what I want, regardless of what you say."

A) "I want things to be the way I want them to be." C) "Things being out of order really bothers me." D) "Everything about my school work needs to be perfect."

The nurse has been teaching a client about bulimia. Which statement by the client indicates that the education has been effective? A) "I'll eat small meals and snacks regularly." B) "I'll take my medication when I feel the urge to binge." C) "How I feel about my body has little to do with my binging." D) "I know if I eat pasta, I'll binge."

A) "I'll eat small meals and snacks regularly."

A nurse is providing care to a client with an eating disorder. Which client statement best demonstrates an understanding of the etiology of the disorder? A) "There are many factors involved with how I developed anorexia ." B) "My strict dieting led to my problem with anorexia." C) "There is a history of obsessive-compulsive disorder in my family." D) "Society told me I needed to be thin and I believed that."

A) "There are many factors involved with how I developed anorexia ."

A nurse who provides care at an inpatient eating disorder clinic is performing an admission assessment of a young client who has been diagnosed with anorexia nervosa. Which assessment question reflects therapeutic communication? A) "What do you think about how much you weigh right now?" B) "Why do you prefer not to eat food?" C) "What do you believe has caused your anorexia?" D) "Is there anything that I can get you to eat right now?"

A) "What do you think about how much you weigh right now?"

Fluoxetine has been approved for the treatment of anorexia nervosa. Fluoxetine is from which drug classification? A) Antidepressant B) Antimanic C) Antiparkinsonian D) Antianxiety

A) Antidepressant

A client is an overweight 32-year-old who regularly binges on large amounts of food. After the client binges, the client feels guilty and ashamed about eating the food. Despite the bad feelings, the client binges almost daily. Which would the nurse most likely suspect? A) Binge eating disorder B) Eating disorder not otherwise specified C) Bulimia nervosa D) Anorexia nervosa

A) Binge eating disorder

A mental health nurse is caring for a client who is obsessed with a blemish on the client's face and states, "I am so ugly." The client has been unable to work for the past 2 days. The client is suffering from which medical problem? A) Body image disturbance B) Conversion disorder C) Hypochondriasis D) Somatization disorder

A) Body image disturbance

A client was admitted to the eating disorder unit with bulimia. When the nurse assesses for a history of complications of this disorder, which are expected? A) Dental erosion and chronic edema B) Bacterial gastrointestinal infections and overhydration C) Respiratory distress and dyspnea D) Metabolic acidosis and constricted colon

A) Dental erosion and chronic edema

Which is the most common disorder found in clients diagnosed with bulimia nervosa? A) Depression B) Psychosis C) Anxiety D) Substance abuse

A) Depression

During a physical assessment, the nurse would recognize that there is the potential for medication-induced weight loss in a client who is being treated with which medication? A) Fluoxetine B) Ziprasidone C) Olanzapine D) Risperidone

A) Fluoxetine

Exacerbation of anorexia nervosa results from the client's effort to do what? A) Gain control of one part of life B) Diminish conflict C) Live up to family expectations D) Manipulate family members

A) Gain control of one part of life

A nurse is reviewing the plan of care for a client with anorexia nervosa and notes a behavioral plan for increasing weight. The nurse correlates this intervention with which nursing diagnosis? A) Imbalanced nutrition: less than body requirements B) Anxiety C) Ineffective coping D) Disturbed body image

A) Imbalanced nutrition: less than body requirements

At the prompting of friends, a 16-year-old client has agreed to meet with the school nurse who suspects that the client may have an eating disorder. During the nurse's assessment, the nurse has asked the client to describe the client's family. Which family process and characteristic is thought to contribute to eating disorders? A) Poor communication and enmeshed family dynamics B) The absence of a parent and/or the presence of a stepparent C) Passive parenting and lack of encouragement D) An overemphasis of peer relationships over family relationships

A) Poor communication and enmeshed family dynamics

The client with bulimia reports feeling helpless and says, "What's the use?" As the nurse plans the client's care, the priority diagnosis is which? A) Risk for self-directed violence B) Anxiety C) Ineffective individual coping D) Nutrition that is less than body requirements

A) Risk for self-directed violence

People diagnosed with bulimia nervosa have lower levels of which neurotransmitter? A) Serotonin B) Norepinephrine C) Acetylcholine D) Dopamine

A) Serotonin

The school nurse is evaluating a 16-year-old student who came to the office complaining of dizziness. The student is very thin and was pacing in the office while waiting to see the nurse. The nurse asks the student to step on the scale. The student asks if the student can go to the bathroom first to empty the student's bladder, stating, "That can make a big difference." The student's comment raises the nurse's suspicion that the student has ... A) anorexia nervosa. B) binge-eating disorder. C) bulimia nervosa. D) eating disorder not otherwise specified.

A) anorexia nervosa.

A nurse is reviewing the medical history of a client diagnosed with somatic symptom disorder. Which would the nurse expect to find as a comorbid condition?

Depression

The nurse is caring for a client with somatic symptom disorder. When assessing this client, the nurse would be especially alert for symptoms of what?

Depression

Which would be most important for a nurse to do when caring for a client with somatic symptom disorder?

Develop a sound, positive nurse-client relationship

Withdrawal

Development of symptoms that cause significant psychological and physical distress when an individual reduces or stops drug use

Polysubstance abuse

Abuse of more than one substance

A student nurse asks the mental health nurse about when somatic symptom disorder (SSD) usually begins. The nurse responds by saying that the first symptoms often appear during which time?

Adolescence

Clients from which continent or country may have symptoms of somatization disorder that include the nondelusional sensation of worms in the head or ants under the skin?

Africa

Pseudoneurologic symptoms of somatization disorder common in

Africa and South Asia

stimulates

Amphetamines Cocaine

Stimulants

Amphetamines, methamphetamine, cocaine

Treatment of eating disorders often combines psychotherapy and psychopharmacology. Which of the following classes of medications can be used to treat eating disorders?

Antidepressants Medications are useful for some clients with eating disorders. Because one theory posits that the cause of eating disorders is disturbed serotonin regulation, researchers have studied the effectiveness of antidepressants. Although pharmacologic therapy usually is not the primary intervention for anorexia, antidepressants or antianxiety drugs may benefit clients with depressive, anxious, or obsessive-compulsive symptoms. (less)

Tolerance

As a person continues to drink more and more they develop this and may need to consume more to produce the same effect

Nasal sprays and eyedrops

Avoid using for too many days in a row

During a therapy session, a client with anorexia tells the nurse, "I measured my thighs today. They are a quarter-inch larger than they were yesterday. I feel like a pig; I'm so fat." Which potential response by the nurse is most therapeutic? A) "I don't think you are fat." B) "Has something occurred that caused you to measure your thighs?" C) "You have always been very focused on your thighs. Is that the part of your body you like least?" D) "You are exactly the right weight for your height."

B) "Has something occurred that caused you to measure your thighs?"

What percentage of clients who have fully recovered from bulimia nervosa later experience a relapse? A) 10% B) 30% C) 23% D) 50%

B) 30%

Which area of the brain has been associated with the symptoms of eating disorders? A) Medulla B) Hypothalamus C) Pons D) Cerebellum

B) Hypothalamus

A severely dehydrated teenager admitted to the hospital with hypotension and tachycardia undergoes evaluation for electrolyte disturbances. The client's history includes anorexia nervosa and a 15-pound weight loss in the last month. The client is 5 feet 5 inches tall and weighs 75 pounds. Which is the priority nursing intervention? A) Monitoring vital signs and weight B) Initiating total parenteral nutrition as ordered C) Initiating cognitive behavioral therapy as ordered D) Addressing the client's low self-esteem

B) Initiating total parenteral nutrition as ordered

Which is a typical characteristic of parents of clients diagnosed with anorexia nervosa? A) Maintenance of emotional distance from their children B) Overprotective of their children C) Alternation between loving and rejecting their children D) A history of substance abuse

B) Overprotective of their children

A client has been diagnosed with bulimia. Which cognitive behavioral technique would be useful for the client? A) Music therapy B) Self-monitoring C) Guided imagery D) Distraction

B) Self-monitoring

When working with a client with bulimia, the nurse should encourage the client to keep a self-monitoring journal for what reason? A) To document physical problems the client wants to share with the physician B) To raise self awareness and a sense of control C) To show the family evidence of the client's progress D) For the nurse to be able to document in the client record accurately

B) To raise self awareness and a sense of control

When admitted to the inpatient unit, a client is 5 feet 10 inches tall and weighs 100 pounds. What is the initial goal in the client's care? A) To be on bedrest B) To stop losing weight C) To reduce fluid intake D) To assess for violence potential

B) To stop losing weight

Which is most often the criterion for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa? A) Positive self-esteem B) Weight gain C) Mood elevation D) Increased activity

B) Weight gain

A client with somatic symptom disorder is complaining of significant pain in the joints. When providing care to this client, which would be most important for a nurse to keep in mind?

The client's experience of pain is real.

Nursing Interventions of NPD

The nurse must use self-awareness skills to avoid the anger and frustration that these clients' behavior and attitude can engender.

Depressants

Benzodiazepines, barbiturates, alcohol (also includes opioids)

Brandon is an overweight 32-year-old man who regularly binges on large amounts of food. After he binges, Brandon feels guilty and ashamed about eating the food. Despite the bad feelings, Brandon binges almost daily. Which of the following conditions is Brandon most likely suffering from?

Binge-eating disorder Binge eating disorder (BED), an additional diagnostic category to the DSM-IV-TR, similarly affects males and females, many of whom are medically overweight or obese. Characteristics of BED include recurrent eating binges; guilt, shame, and disquiet about binging; and marked psychological distress. (less)

A client is suspected of having anorexia nervosa and meets the diagnostic criteria for the disorder. When conducting the physical examination, which of the following would be a probable finding from the assessment?

Bradycardia Associated physical exam findings include cold intolerance, complaints of constipation and abdominal pain, hypotension and bradycardia.

Which of the following is a cardiac complication of an eating disorder?

Bradycardia Cardiac complications include bradycardia, hypotension, small heart, and loss of cardiac muscle. Thrombocytopenia is a hematologic complication of eating disorders.

While a nurse talks to the mother of a 15-year-old female, the mother expresses concern over her daughter's eating and exercise habits. The mother says that as soon as her daughter comes home from school, she exercises for two to three hours every day. She says her daughter eats very little at dinner, but in the morning she notices that large amounts of food are missing from the kitchen. Her daughter was complaining of tooth pain, and when the mother took her to the dentist, her daughter had over 10 cavities. Which of the following disorders is her daughter most likely suffering from?

Bulimia nervosa Bulimia is characterized by episodic, uncontrolled, rapid ingestion of large quantities of food. It may occur alone or in conjunction with the food restriction of anorexia. Clients with bulimia nervosa compensate for excessive food intake by self-induced vomiting, obsessive exercise, use of laxatives and diuretics, or all of these behaviors. They may consume an incredible number of calories (an average of 3,415 per binge) in a short period, induce vomiting, and perhaps repeat this behavior several times a day. Clients with bulimia may develop dental caries from the frequent contact of tooth enamel with food and acidic gastric fluids. (less)

Codependence

a maladaptive coping pattern on the part of the family members or others that results from a prolonged relationship with the person who uses substances.

An adolescent diagnosed with anorexia nervosa is insistent on being allowed to take a laxative. Which response by the nurse best demonstrates the management of this client request? A) "Using a laxative to purge is not an acceptable way to manage your weight." B) "Why do you want to take a laxative?" C) "Laxatives are not a part of your treatment plan." D) "Using laxatives is bad for you because your electrolytes can become unbalanced."

C) "Laxatives are not a part of your treatment plan."

A college student has been referred to the clinic for evaluation for anorexia nervosa. The nursing assessment to substantiate this disorder should include what? A) Oily skin and acne B) Onset of symptoms in early adolescence C) Body weight significantly below ideal for height and age D) Temper tantrums and sleep disturbance

C) Body weight significantly below ideal for height and age

A 17-year-old client with a long-standing diagnosis of bulimia nervosa has been admitted to the emergency department after collapsing in a mall. The care team that admits the client to the hospital should prioritize which assessment? A) Evidence of injury to skin by cutting B) Complete blood count and differential C) Cardiac assessment and measurement of electrolyte levels D) Psychosocial assessment and determination of coping skills

C) Cardiac assessment and measurement of electrolyte levels

Which intervention has been found to be most effective reducing the initial symptoms of bulimia? A) Behavioral therapy and psychoeducation B) Clearly stated unit rules and a supportive milieu C) Cognitive behavior therapy and pharmacologic interventions D) Daily monitoring of sound dietary principles and meditation sessions

C) Cognitive behavior therapy and pharmacologic interventions

For clients with bulimia, nursing interventions are often directed toward improving self-concept and regaining control. Which would be included in the primary interventions? A) One-on-one time with psychiatric staff and antidepressant medication therapy B) Daily reinforcement of sound dietary principles and meditation sessions C) Cognitive-behavioral therapy (CBT) including self-monitoring D) Clearly stated unit rules and a supportive milieu

C) Cognitive-behavioral therapy (CBT) including self-monitoring

When working with the client with bulimia, the nurse should be aware that the nurse's own feelings and needs may affect care. Feelings that may be aroused in the nurse may include what? A) Depression B) Anxiety C) Control D) Dependency

C) Control

Despite being admitted to the hospital yesterday for the treatment of complications of anorexia nervosa, a 19-year-old client continues to refuse fluids and is only taking small bites of food during mealtime. Which nursing diagnosis is paramount in this client's care? A) Anxiety related to inadequate coping mechanisms B) Hyperactivity related to restlessness C) Deficient fluid volume related to refusal to drink D) Impaired social interaction related to aggressive behavior

C) Deficient fluid volume related to refusal to drink

A psychiatric-mental health nurse working in the community is planning an educational program for fifth- and sixth-grade teachers. Which would the nurse include? A) Emphasis on the need for teachers to focus their prevention efforts on female students B) Stressing the need to allow students to eat without undue attention or supervision in order to prevent inadvertently influencing eating patterns C) Discussion of strategies the teachers can use to counteract the role media plays in encouraging eating disorders D) Clarification that peer pressure is not typically problematic in children who are in the fifth and sixth grades

C) Discussion of strategies the teachers can use to counteract the role media plays in encouraging eating disorders

Which statement best describes the biologic theories of the etiology of eating disorders? A) Eating disorders involve dysregulation of multiple neurotransmitter systems and may be influenced by behavioral, cultural, and familial factors. B) Eating disorders result from family dysfunction involving a controlling mother; neurotransmitter dysfunction is a result, not a cause, of the eating disorder. C) Eating disorders involve dysregulation of multiple neurotransmitter systems, whether as a cause or an effect of the eating disorder, and may be influenced by behavioral, cultural, and familial factors. D) Eating disorders involve dysregulation of the serotonergic system and have a strong genetic component.

C) Eating disorders involve dysregulation of multiple neurotransmitter systems, whether as a cause or an effect of the eating disorder, and may be influenced by behavioral, cultural, and familial factors.

The nurse on an inpatient psychiatric unit is developing the plan of care for a 17-year-old client admitted with anorexia nervosa. The client's weight is 20% below normal. The client engages in many rituals related to eating, asks to be weighed several times per day, and complains that access to the bathroom is limited. The nurse develops a contract with the client. The purpose of the contract is to do what? A) Provide the nurse with a tool for evaluating the plan of care B) Provide the therapist with a strategy for client compliance C) Provide the client with a feeling of responsibility and control over the client's behavior D) Allow the client a tool by which to negotiate behavior

C) Provide the client with a feeling of responsibility and control over the client's behavior

An obese client is admitted to the facility for abusing amphetamines in an attempt to lose weight. Which nursing intervention is appropriate for this client? A) Reinforcing the client's concerns over physical appearance B) Using an abrupt, forceful manner to communicate with the client C) Teaching the client alternative ways to lose weight D) Encouraging the client to suppress feelings regarding obesity

C) Teaching the client alternative ways to lose weight

Factitious disorder, imposed on self, occurs when .

a person intentionally produces or feigns physical or psychological symptoms solely to gain attention Munchausen's syndrome

Dependent personality disorder is characterized by

a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation. These behaviors are designed to elicit caretaking from others.

Schizoid personality disorder is characterized by

a pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings.

A 17-year-old girl with a long-standing diagnosis of bulimia nervosa has been admitted to the emergency department after collapsing in a mall. The care team that admits the client to the hospital should prioritize which of the following assessments?

Cardiac assessment and measurement of electrolyte levels While this client would certainly receive a CBC and respiratory assessment, the priority assessment in this client with her short-term and long-term histories would be focused on electrolyte levels and cardiac abnormalities, both of which are common manifestations of the repeated vomiting that characterizes bulimia nervosa. Physical assessments would supersede psychosocial assessments and any injury to skin by intentional self harm in the emergency setting. (less)

Underlying self-esteem

is almost always fragile and vulnerable. These clients are hypersensitive to criticism and need constant attention and admiration.

Structuring the Clients' Daily Activities with BPD

Clients are often at a loss about how to manage unstructured time, become unhappy and ruminative, and may engage in frantic and desperate behaviors (e.g., self-harm) to change the situation. Minimizing unstructured time by planning activities can help clients to manage time alone.

Which is a significant obstacle in providing psychiatric care for clients who have somatic symptom illnesses?

Clients are often unrecognized because clients receive treatment in different primary care offices, and care is often fragmented.

When describing somatic symptom disorder to a group of nurses, which would the nurse include as a significant obstacle in providing psychiatric care for clients with that disorder?

Clients are often unrecognized because clients seek out multiple care providers and care is often fragmented.

Assessment of Antisocial personality disorder

Clients are skillful at deceiving others, so during assessment, it helps to check and to validate information from other sources.

Mood and Affect of Antisocial personality disorder

Clients often display false emotions chosen to suit the occasion or to work to their advantage. For example, a client who is forced to seek treatment instead of going to jail may appear engaging or try to evoke sympathy by sadly relating a story of his or her "terrible childhood." The client's actual emotions are quite shallow.

Dual diagnosis

Clients with this present challenges that traditional settings cannot meet

Designer drugs

Club drugs have become a problem in recent years. They are synthetic substances made by alternating existing medications or formulating new substances not yet controlled or regulated by the FDA.

The nurse is providing care to a client with somatic symptom disorder (SSD). Which would the nurse expect to be included in the client's plan of care?

Cognitive behavior therapy

A nurse is developing a plan of care for a client newly diagnosed with bulimia nervosa. Which of the following would the nurse expect to implement in conjunction with pharmacologic therapy?

Cognitive behavioral therapy Although behavioral, interpersonal, and family therapy may be used, the combination of cognitive behavioral therapy and pharmacologic interventions is best for producing an initial decrease in symptoms. (less)

For clients with bulimia, nursing interventions are often directed toward improving self-concept and regaining control. Which of the following would be included in the primary interventions?

Cognitive-behavioral therapy (CBT) including self monitoring For clients with bulimia, nursing interventions are often directed toward improving self-concept and regaining control. The primary interventions include cognitive-behavioral therapy (CBT) including self monitoring. (less)

Which of the following is the most common disorder found in clients diagnosed with bulimia nervosa?

Depression Mood disorders, anxiety disorders, and substance abuse/dependence are frequently seen in clients with eating disorders. Of those, depression and obsessive-compulsive disorder are most common. (less)

When working with the client with bulimia, the nurse should be aware that the nurse's own feelings and needs may affect care. Feelings that may be aroused in the nurse may include what?

Control Often, nurses feel the need to offer control for a client who is helpless in controlling food, anxiety, and life. This client should not evoke feelings of depression any more than any other client should. The client is likely to experience an accompanying depressed state. Although anxiety may arise in the nurse, this is not the best answer. The client is likely to be dependent in this hospital setting. Control or rescue issues are more likely to surface in the nurse. (less)

Individuals with anorexia nervosa concentrate on which of the following body cues?

Controlling food intake Individuals with anorexia nervosa ignore body cues, such as hunger and weakness, and concentrate all efforts on controlling food intake.

Which characteristic differentiates conversion disorder from malingering disorder?

Conversion disorder is an unconscious process, while malingering disorder is a deliberate fabrication of symptoms.

acamprosate (campral)

people with renal impairment cannot take this med, side effects are diarrhea, nausea, flatulence, and pruritis

Personality disorders are long-standing because

personality characteristics do not change easily.

Treatment of eating disorders often combines psychotherapy and psychopharmacology. Which classes of medications can be used to treat eating disorders? A) Stimulants B) Antipsychotics C) Mood stabilizers D) Antidepressants

D) Antidepressants

A client with anorexia nervosa self-describes as "a whale." However, the nurse's assessment reveals that the client is 5 feet 8 inches tall and weighs only 90 pounds. The nurse identifies this as reflecting what? A) Drive for thinness B) Interoceptive awareness C) Perfectionism D) Body image disturbance

D) Body image disturbance

Which is a cardiac complication of an eating disorder? A) Thrombocytopenia B) Enlarged heart C) Hypertension D) Bradycardia

D) Bradycardia

While a nurse talks to the mother of a 15-year-old client, the mother expresses concern over the client's eating and exercise habits. The mother says that as soon as the client comes home from school, the client exercises for 2 to 3 hours every day. She says the client eats very little at dinner, but in the morning she notices that large amounts of food are missing from the kitchen. The client was complaining of tooth pain, and when the mother took the client to the dentist, the client had over 10 cavities. Which disorder is the client most likely suffering from? A) Anorexia nervosa B) Eating disorder not otherwise specified C) Binge-eating disorder D) Bulimia nervosa

D) Bulimia nervosa

Which medication has been found to be worthy of a trial in clients with bulimia nervosa who have obsessive-compulsive traits? A) Bupropion B) Lithium C) Haloperidol D) Fluoxetine

D) Fluoxetine

The nurse is performing the history and physical examination on a client who is being admitted for anorexia nervosa. The client, a 23-year-old, is 5 feet 2 inches, and weighs 88 pounds. The nurse assesses the client's history of weight gain and loss, typical daily food intake, electrolyte and other blood studies, and elimination patterns. The nurse observes typical physical findings such as dry skin, lanugo, and brittle hair and nails. Which factor is a priority for the nurse to assess next? A) Patterns of activity and rest B) Throat and esophagus C) Condition of mouth and gums D) Heart rate and rhythm

D) Heart rate and rhythm

A client with bulimia nervosa is scheduled for a visit to the clinic. When assessing this client, which would a nurse expect to find? A) Panic B) Delusions C) Hyperactivity D) Impulsivity

D) Impulsivity

A nurse is developing the plan of care for a client with bulimia. Which intervention would the nurse most likely include? A) Encouraging client take time away from peers for a time B) Communicating aggressively with the client C) Nurturing the client's need for dependency D) Increasing client's coping skills for anxiety

D) Increasing client's coping skills for anxiety

An adolescent client has been diagnosed with anorexia nervosa. Which intervention should be included in the client's plan of care? A) Restrict visits with the family until the client begins to eat B) Provide privacy during meals C) Encourage the client to exercise, which will reduce the client's anxiety D) Set up a strict eating plan for the client

D) Set up a strict eating plan for the client

After complaining of weakness and confusion while at school, a 16-year-old client was admitted to the hospital where admission assessments revealed hypokalemia. The client has normal body weight. In planning the client's nursing care and treatment, which outcome should be prioritized? A) The client will acknowledge self-harm thoughts. B) The client will identify alternatives to current coping patterns. C) The client will verbalize fears relating to the client's health needs. D) The client will be free of self-induced vomiting.

D) The client will be free of self-induced vomiting.

The nurse is carrying out the nursing process in the care of a client who has been diagnosed with body image disturbance. Which goal should be prioritized in the planning of this client's care? A) The client will demonstrate measures to reduce body mass index. B) The client will demonstrate actions that promote health maintenance. C) The client will experience diminished episodes of delusional thinking. D) The client will verbalize acceptance of appearance.

D) The client will verbalize acceptance of appearance.

A nurse is reviewing the medical records of several clients at the community mental health center being treated for eating disorders. Which behavior would the nurse identify as differentiating a client who is believed to have bulimia nervosa from one who has anorexia nervosa? A) The person has feeling of powerlessness B) The person is preoccupied with body image. C) The person judges worth based on a lack of fat. D) The person engages in episodic binge eating.

D) The person engages in episodic binge eating.

What behavior is likely a result of an adolescent's attempt to manage the effects of over-productive parenting? A) becoming sexually promiscuous B) compulsively washing his or her hands C) socially withdrawing D) engaging in severe dieting

D) engaging in severe dieting

Antisocial personality disorder is characterized by

a pervasive pattern of disregard for and violation of the rights of others—and by the central characteristics of deceit and manipulation.

Gambling disorder

DSM-5 classification Has similar effect on brain and behavior as other addictions

Denial

Deny directly having any problems or may minimize the extent of problems or may minimize the extent of problems or actual substance use.

A psychiatric-mental health nurse working in the community is planning an educational program for fifth- and sixth-grade teachers. Which of the following would the nurse include?

Discussion of strategies the teachers can use to counteract the role media plays in encouraging eating disorders Counteracting the influence of media should be stressed; both boys and girls are at risk for developing eating disorders. Other preventive educational strategies include the need to improve self-esteem and the importance of the influence of peer pressure on eating and weight. (less)

Biology of dependence

Dopamine release from drugs can change pathways in the brain

Psychological dependence

Emotional or mental attachment of the use of a drug

The nurse is educating the spouse of a client with a somatic symptom disorder about how to best help the client. Which strategy should the nurse suggest?

Empathize about physical discomfort but encourage independence.

For a client diagnosed with anorexia nervosa, which goal takes the highest priority?

Establishing adequate daily nutritional intake According to Maslow's hierarchy of needs, physiologic needs are the most basic. Adequate daily intake of food and fluids would be of the highest priority for this client.

When assessing a client diagnosed with hypochondriasis, the most serious risk factor to be identified for this client is what?

Extensive use of over-the-counter medications

A group of nursing students is reviewing information about somatic symptom and related mental health disorders. The students demonstrate understanding of the information when they identify which disorder as involving physical or psychological symptoms (or both) fabricated to assume the sick role?

Factitious disorder

In which disorder is the individual motivated solely by the desire to become a health care client?

Factitious disorder

GHB/GBL

GBL is industrial solvent turned into GHB which release growth hormone. Induce euphoria and sex because rise in dopamine. Large doses lead to passing out/coma

Somatic symptom disorder is rare in men in the United States but more common in

Greece and Puerto Rico

Clients with a somatization disorder typically do what?

Have a history of going to many different providers without satisfaction

Nursing Interventions for substance abuse

Health teaching for the client and family Dispel myths surrounding substance abuse Decrease codependent behaviors among family members Make appropriate referrals for family members Promote coping skills Role Play potentially difficult situations Focus on the here and now with clients Set realistic goals such as staying sober today

The nurse is performing the history and physical examination on a client who is being admitted for anorexia nervosa. The client, a 23-year-old woman, is 5'2" and weighs 88 lbs. The nurse assesses her history of weight gain and loss, typical daily food intake, electrolyte and other blood studies, and elimination patterns. She observes typical physical findings such as dry skin, lanugo, and brittle hair and nails. Which of the following factors is a priority for the nurse to assess next?

Heart rate and rhythm Physical examination may reveal numerous symptoms related to disturbances in nutrition and metabolism. Possible findings include dehydration, hypokalemia, cardiac dysrhythmia, hypotension, bradycardia, dry skin, brittle hair and nails, lanugo, frequent infections, dental caries, inflammation of the throat and esophagus, swollen parotid glands (from purging), amenorrhea, and hypothermia. A priority area to assess during physical examination is electrolyte abnormalities and associated cardiac dysfunction. (less)

Nursing Interventions for DPD

Helping clients to identify their strengths and needs is more helpful than encouraging the overwhelming belief that "I can't do anything alone!" Cognitive restructuring techniques such as reframing and decatastrophizing may be beneficial.The nurse may also need to teach problem-solving and decision-making and help clients apply them to daily life.

Which mental health disorder is characterized by a fear of developing a serious illness based on a misinterpretation of body sensation?

Hypochondriasis

Which of the following areas of the brain has been associated with the symptoms of eating disorders?

Hypothalamus The hypothalamus has been associated with the symptoms of eating disorders.

A client who has been having difficulty functioning in daily life comes to the nurse and states, "I'm really afraid. I've had these funny feelings in my stomach. I'm scared that I might have cancer." The client has been seen by numerous health care professionals and no evidence of cancer has been demonstrated. The nurse suspects what?

Illness anxiety disorder

During a client interview, the nurse determines that the client has a fear of developing a serious illness based on a misinterpretation of body sensation. The nurse identifies this as being characteristic of what?

Illness anxiety disorder

A nurse is reviewing the plan of care for a client with anorexia nervosa and notes a behavioral plan for increasing weight. The nurse correlates this intervention with which nursing diagnosis?

Imbalanced Nutrition: Less Than Body Requirements A behavioral plan for increasing weight is part of a refeeding program that is instituted for a nursing diagnosis of Imbalanced Nutrition: Less Than Body Requirements. Interventions for Disturbed Body Image and Anxiety involve addressing interoceptive awareness, helping clients understand their feelings, and initiating interpersonal therapy. Interventions for Ineffective Coping would address integrating the clients back into school, renewing friendships and relationships, and promoting participation in family therapy. (less)

Histrionic personality disorder is characterized by

a pervasive pattern of excessive emotionality and attention seeking. It is found in 1% to 3% of the general population, but in as much as 10% to 15% of inpatient populations.

A client with bulimia nervosa is scheduled for a visit to the clinic. When assessing this client, which of the following would a nurse expect to find?

Impulsivity Clients with bulimia often demonstrate impulsivity. Situations that produce feelings of being overwhelmed and powerless need to be explored, as does the client's ability to set boundaries, control impulsivity, and maintain quality relationships. These underlying issues precipitate binge eating. Panic, hyperactivity, and delusions are not associated with bulimia nervosa. (less)

Which of the following are psychological characteristics associated with bulimia nervosa? Select all that apply.

Impulsivity • Boundary problems • Difficulties setting limits Psychological characteristics associated with bulimia nervosa include boundary problems, difficulties setting limits, and impulsivity. Ritualistic behaviors may surround the relationship with food. Maturity fears are more commonly associated with anorexia nervosa. (less)

When describing the major difference between somatic symptom disorder and factitious disorders, which would the nurse include?

In somatic symptom disorder, clients are not consciously aware that needs are being met through physical complaints.

Nursing Interventions of APD

In the nonthreatening context of the relationship, the nurse can help them to explore positive self-aspects, positive responses from others, and possible reasons for self-criticism. Helping clients to practice self-affirmations and positive self-talk may be useful in promoting self-esteem. Other cognitive restructuring techniques such as reframing and decatastrophizing (described previously) can enhance self-worth.

A severely dehydrated teenager admitted to the hospital with hypotension and tachycardia undergoes evaluation for electrolyte disturbances. The client's history includes anorexia nervosa and a 15-pound weight loss in the last month. She is 5'5" tall and weighs 75 pounds. Which of the following is the highest priority nursing intervention?

Initiating total parenteral nutrition as ordered Severely malnourished clients may require total parenteral nutrition, tube feedings, or hyperalimentation to receive adequate nutritional intake. Medical management focuses on weight restoration, nutritional rehabilitation, rehydration, and correction of electrolyte imbalance. (less)

A client's family member asks the nurse, "What is a conversion disorder?" Which is the best response by the nurse?

It involves unexplained, usually sudden, deficits in sensory or motor function.

Synthetic designer drugs

KS, Bath salts, "Spice"

Hwa-byung

Korean folk syndrome attributed to the suppression of anger and includes insomnia, fatigue, panic, indigestion, and generalized aches and pains

A nurse is conducting an inservice presentation for a group of newly hired mental health nurses. Which would the nurse most likely include when describing conversion disorder (functional neurologic symptom disorder)?

Laboratory and diagnostic test results are usually negative.

Most commonly prescribed benzos for alcohol

Lorazepam Chlordiazepoxide Diazepam

Ecstasy

MDMA; stimulant/hallucinogen, parties over academics, more sexual partners, binge drink, etc.

Intoxication

Maladaptive behavioral, psychological, and physiological changes that occur as a result of substance abuse

Which occurs when an individual intentionally produces illness symptoms to avoid work?

Malingering

Which best describes the concept of somatization?

Manifestation of physical symptoms from psychological distress

Cough syrup

Many active ingredients are ineffective

Cannabinoids

Marijuana, hashish

Quetiapine (seroquel)

Med used to control alcohol cravings as well as moderating their psychiatric symptoms

Opioids

Morphine Meperidine (Demerol) codeine hydromorphone oxycodone methadone oxymorphone hydrocodone propoxyphene

Opioids

Morphine, codeine, heroin

Community based care

Must people receiving treatment for substance abuse do so in this setting such as outpatient treatment, freestanding substances abuse treatments facilities, and recovery programs such as AA and rational recovery.

Opioid intoxication treatment

Naloxone (narcan)

The nurse obtains a psychosocial history from a client who may have psychological factors affecting the medical condition. Which should the nurse recognize as pertinent to this diagnosis?

No physiologic cause has been found for the client's symptoms.

Nursing Interventions for OCPD

Nurses may be able to help clients to view decision-making and completion of projects from a different perspective. Helping clients to accept or to tolerate less-than-perfect work or decisions made on time may alleviate some difficulties at work or home. Clients may benefit from cognitive restructuring techniques.

What community resources or referrals would be beneficial for Susan?

Outpatient therapist, community support services, vocational/career counseling, self-help group.

Overdose of stimulants

Overdose of this can result in seizures and coma; deaths are rare.

Pain medications

Oxycodone and hydrocodone

Dissociative drugs

PCP, ketamine

Abuse

Pattern of use resulting in negative consequences or impairment

Which is an inaccurate statement regarding malingering?

People who malinger usually do not stop the physical symptoms when given a reward.

three central features of somatic symptom illnesses

Physical complaints suggest major medical illness but have no demonstrable organic basis. Psychological factors and conflicts seem important in initiating, exacerbating, and maintaining the symptoms. Symptoms or magnified health concerns are not under the client's conscious control

At the prompting of her friends, a 16-year-old girl has agreed to meet with her school nurse who suspects that the student may have an eating disorder. During the nurse's assessment, the nurse has asked the student to describe her family. Which of the following family processes and characteristics is thought to contribute to eating disorders?

Poor communication and enmeshed family dynamics Family systems theories emphasize the role of the family in the development of eating disorders. Among the characteristics that are thought to contribute are enmeshed patterns of relationship and impaired communication. The absence of a parent and/or the presence of a step-parent has not been emphasized. Passive parenting styles, lack of encouragement, and an overemphasis on peer relationships are not healthy patterns of being, but none has been identified as a specific contributor to eating disorders. (less)

Sangue dormido occurs among

Portuguese Cape Verde Islanders

Speech is usually

colorful and theatrical, full of superlative adjectives. It becomes apparent, however, that although colorful and entertaining, descriptions are vague and lack detail.

Sleep aids

Practice sleep hygiene

Thiamine (vitamin b1)

Prevents or treats wernicke-korsakoff syndrome in alcoholism

Which of the following medications has been found to be worthy of a trial in clients with bulimia nervosa who have obsessive-compulsive traits?

Prozac (fluoxetine) Clients who display obsessive-compulsive traits particularly may benefit from treatment with clomipramine (Anafranil) or fluoxetine (Prozac). Fluoxetine is the only antidepressant with FDA approval for the treatment of bulimia nervosa. (less)

A client is diagnosed with somatic symptom disorder. Which would the nurse expect to assess as the major clinical finding?

Report of symptoms with no demonstrable pathology on testing or examination

When assessing a client with somatic symptom disorder, which would the nurse most likely note?

Reports of physical symptoms do not have a demonstrable organic basis to fully account for them

Elder considerations

Risk factors for late-onset substance abuse in elders include chronic illness that cause pain, long-term use of prescription medication.

The client with bulimia complains of feeling helpless and says, "What's the use?" As the nurse plans the client's care, the most important priority diagnosis based on these data is what?

Risk for self-directed violence Ineffective individual coping is a very likely diagnosis, but this is not the priority diagnosis. Although anxiety is a factor in this illness, the data do not support this diagnosis. The diagnosis of altered nutrition does not directly address the patient's current status. The verbalized helpless feelings, the use of the term black future, and the hopeless comment of "What's the use?" may very likely support risk for suicide. Depression is often present in the client with bulimia; therefore, suicide potential should be addressed. (less)

Identify two priority nursing diagnoses that would be appropriate for Susan on her admission to the unit.

Risk for self-mutilation, ineffective coping

List three nursing interventions for each of the identified nursing diagnoses.

Risk for self-mutilation: Discuss presence and intensity of self-harm urges with client; negotiate a no-self-harm contract with the client; help the client to identify triggers for self-harm behavior. Ineffective coping: Help the client to identify feelings by keeping a journal; discuss ways the client can use distraction when gratification must be delayed; discuss alternative ways the client can express feelings without an exaggerated response.

Write an expected outcome for each of the identified nursing diagnoses.

Risk for self-mutilation: The client will be safe and free of significant injury. Ineffective coping: The client will demonstrate increased control of impulsive behavior.

Herbal drugs

Salvia, khat

In the care of a client with somatic symptom disorder, the nurse should anticipate that drug treatment will prioritize which class in order to treat the disorder?

Selective serotonin reuptake inhibitors (SSRIs)

Medications have been tried for somatic symptom disorder. Which drugs have been shown to be effective in some cases?

Selective serotonin reuptake inhibitors (SSRIs)

antidepressants used most commonly for somatic symptom illnesses w/ depression

Selective serotonin reuptake inhibitors such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) are

Nursing Interventions for Personality Disorders and Behaviors

Serious, straightforward approach; teach client to validate ideas before taking action; involve client in treatment planning

People diagnosed with bulimia nervosa have lower levels of which neurotransmitter?

Serotonin The most frequently studied biochemical theory in bulimia nervosa relates to lowered brain serotonin neurotransmission. People with bulimia nervosa are believed to have altered modulation of central serotonin neuronal systems. (less)

Following a long history of multiple visits to community clinics and emergency departments, a client has been diagnosed with hypochondriasis. During this current visit to the emergency department, the client has just been informed that diagnostic testing and assessment reveal no severe illness. Despite this, the client persists in verbalizing physical complaints. How should the nurse respond to this?

Set limits with the client about the complaints.

Somatic symptom illness disorders are characterized by what?

Severe physical symptoms that cannot be explained by any organic or physical pathology

A client complains of severe low back pain that began shortly after the death of the client's mother 2 years ago. No physical cause has been found to account for the pain. The client has been largely responsible for the care of four younger siblings because the client's father spends much of the week out of town on work-related business. Based on the client's symptoms, which nursing diagnosis is most appropriate for the client at this time?

Somatic complaints due to anxiety related to life stressors

Over the past 5 years, a client has had two exploratory surgeries and numerous examinations for severe abdominal pain. All diagnostic and laboratory results have been negative for organic problems. The client has had vague descriptions of periods of anxiety and depression and has continued to seek medical assistance for the abdominal pain and various other physical problems. The nurse would assess this client as using which defense mechanism?

Somatization

ELDER CONSIDERATIONS

Some persons with personality disorders tend to stabilize and experience fewer difficulties in later life.

A 21-year-old client admits to recently using diuretics and laxatives to lose weight quickly. She doesn't want to feel fat in her bathing suit on vacation. Her sodium level is 150 mEq/L; her potassium level is 3.2 mEq/L. She is 5' tall, weighs 100 lbs, and has lost 15 lbs in 3 weeks. Which of the following goals is a priority at this time?

Stabilize her electrolyte levels. Restoring nutritional balance is a priority for clients with severe eating disorders. Clients who are clearly malnourished need to become physiologically stabilized until they are no longer at risk for severe medical complications related to starvation. Refeeding the very-low-weight client with anorexia means that nurses must carefully monitor cardiac function; another important intervention is to carefully monitor electrolytes. These clients are at risk for developing a "refeeding syndrome" with accompanying hypokalemia. (less)

For clients who purge, what is the most important goal is to

Stop the behavior The most important goal for a client who purges is to stop the behavior. All other options would not be the most important goal.

Pain killers

Take only when needed

A client with anorexia nervosa describes herself as "a whale." However, the nurse's assessment reveals that the client is 5' 8" tall and weighs only 90 pounds. Considering the client's unrealistic body image, which intervention should be included in the care plan?

Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy A client with anorexia nervosa has an unrealistic body image that causes consumption of little or no food. Therefore, the client needs assistance with making decisions about nutritious foods to keep her healthy. (less)

Pathological Gamblers

Tend to be male, single, nonwhite, and less educated Phases of gambling: winning, losing, desperation, giving up

After teaching a group of nursing students about somatic symptom disorder, the instructor determines that additional education is needed when the students identify which as true?

The client usually thinks anxiety is behind the symptoms.

After complaining of weakness and confusion while at school, a 16-year-old female was admitted to the hospital where admission assessments revealed hypokalemia. The client has normal body weight. In planning her nursing care and treatment, which of the following outcomes should be prioritized?

The client will be free of self-induced vomiting. The client's self-induced vomiting is the direct cause of her present health crisis. There is no evidence of fear or deliberate self-harm in this client's case. The client likely has ineffective coping skills, but the immediacy of the need to prevent any subsequent vomiting supersedes her need to develop new coping skills. (less)

The nurse is carrying out the nursing process in the care of a client who has been diagnosed with body image disturbance. Which of the following goals should be prioritized in the planning of this client's care?

The client will verbalize acceptance of appearance. Central to body image disturbance is a lack of acceptance of physical appearance. Consequently, acceptance of appearance is a priority in the care of a client with this problem. The thinking that characterizes the disorder is not classified as delusional. Promoting health maintenance is a relevant goal but is not specific to body image disturbance. Reducing BMI does not address the etiology of this condition. (less)

A parent brings a teenage child, who is complaining of having a severe headache, to the clinic. The teenager is groaning with pain. During assessment, the client asks the nurse for a note to excuse the absence from school. After further assessment, the nurse suspects that the client is malingering. What leads the nurse to come to this conclusion? Choose the best answer.

The client's symptoms disappeared after getting the medical note.

Which statement about the etiology of somatic symptom disorder is accurate?

The exact etiology is unknown.

The nurse is teaching basic physical exercises and meditation techniques to a client recently diagnosed with conversion disorder. What outcome does the nurse expect from teaching the client these exercises? Choose the best answer.

The exercises may help the client manage stress underlying the disorder

Polyabuse

The misuse of more than 1 drug

Evaluation

The nurse evaluates the effectiveness of treatment based on attainment of or progress toward outcomes. If a client can maintain a job with acceptable performance, meet basic family responsibilities, and avoid committing illegal or immoral acts, then treatment has been successful.

A nurse was placed in charge of the pediatric care unit. Over a period of time it was discovered that most of the children on the unit experienced sudden cardiac arrest. Although the nurse went to great lengths to revive the children, most of these children died. On further investigation, it was found that the nurse had been injecting high doses of digoxin drug in the children, which caused the cardiac arrest. The nurse was arrested and found guilty. What would have been the most likely cause of the nurse's behavior?

The nurse might have Munchausen's syndrome by proxy.

Physical dependence

The physiological attachment to, and need for, a drug

What is the major clinical finding in somatic symptom disorder?

The report of symptoms with no demonstrable pathology on testing or examination

Laxatives

Use fiber and exercise instead

character

consists of concepts about the self and the external world

Reshaping Thinking Patterns for BPD

These clients view everything, people and situations, in extremes—totally good or totally bad. Cognitive restructuring is a technique useful in changing patterns of thinking by helping clients to recognize negative thoughts and feelings and to replace them with positive patterns of thinking. Thought stopping is a technique to alter the process of negative or self-critical thought patterns such as "I'm dumb, I'm stupid, I can't do anything right." When the thoughts begin, the client may actually say "Stop!" in a loud voice to stop the negative thoughts. In positive self-talk, the client reframes negative thoughts into positive ones: "I made a mistake, but it's not the end of the world. Next time, I'll know what to do"

The demeanor of these clients is formal and serious, and they answer questions with precision and much detail.

They often report feeling the need to be perfect beginning in childhood. They were expected to be good and to do the right thing to win parental approval. Expressing emotions or asserting independence was probably met with harsh disapproval and emotional consequences.

Methamphetamine

This can cause substance-induced psychosis, but the psychotic symptoms may persist due to the damage to the brain.

Methadone

This drug can be used as a replacement for opioid, and the dosage is decreased over 2 weeks.

The Simple Screening Instrument for Alcohol and other Drugs (SSI-AOD)

This is a useful screening device to detect hazardous drinking patterns as well as full-blown substance use disorders

Intoxication

This is the use of a substance that results in maladaptive behavior

Symptoms of withdrawal from alcohol

This usually begin 4 to 12 hours after cessation or marked reduction of alcohol intake, symptoms include coarse hand tremors, sweating, elevated pulse and bp, insomnia, anxiety, and nausea or vomiting.

The nurse is planning care for a client with a somatic symptom illness. What should the nurse's goals be while formulating the plan to treat the client? Select all that apply.

To help the client express emotions freely, To help the client cope with interpersonal conflicts and To help the client identify the cause of the physical illness

Diversion

Transfer of medication from person it was prescribed to another

Treatment of barbiturates

Treatment in an intensive care unit is required using lavage or dialysis to remove the drug from the system and to support respiratory and cardiovascular function.

Cyanocobalamin

Treats nutritional deficiencies

Folic acid

Treats nutritional deficiencies

Eating disorders primarily affect which of the following populations?

Young white females from upper socioeconomic groups Historically, anorexia and bulimia have been diagnosed most frequently in white, affluent, well-educated adolescent and young-adult females. Both disorders, however, are becoming more widely distributed among social classes and cultures. (less)

Ondanestron (zofran)

a 5-ht3, antagonist that blocks the vagal stimulation effects of serotonin in the small intestine, is used as an antimetic.

no-self-harm contract

a client promises to not engage in self-harm and to report to the nurse when he or she is losing control

Dual Diagnosis

a client with both substance abuse and another psychiatric illness is said to have this

positive self-talk

a cognitive-behavioral technique in which the client changes thinking about the self from negative to positive

thought stopping

a cognitive-behavioral technique to alter the process of negative or self-critical thought patterns

Buprenorphine/naloxone (suboxone)

a combination drug is used for opiate maintenance and to decrease opiate cravings

Munchausen's syndrome:

a factitious disorder where the person intentionally causes injury or physical symptoms to self to gain attention and sympathy from health-care providers, family, and others

conversion disorder often remits in

a few weeks but recurs in 25% of clients

Hallucinogens

a group of mind-altering drugs that affect the brain and nervous system bringing about changes in thought, self-awareness, emotion and sensation; nutmeg, LSD, PCP

Narcissistic personality disorder is characterized by

a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy. It occurs in 1% to 6% of the general population. Fifty to seventy-five percent of people with this diagnosis are men.

Obsessive-compulsive personality disorder is characterized by

a pervasive pattern of preoccupation with perfectionism, mental and interpersonal control, and orderliness at the expense of flexibility, openness, and efficiency.

Schizotypal personality disorder is characterized by

a pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual distortions and behavioral eccentricities.

Avoidant personality disorder is characterized by

a pervasive pattern of social discomfort and reticence, low self-esteem, and hypersensitivity to negative evaluation.

Borderline personality disorder is characterized by

a pervasive pattern of unstable interpersonal relationships, self-image, and affect as well as marked impulsivity. About 2% to 3% of the general population has borderline personality disorder; it is five times more common in those with a first-degree relative with the diagnosis. Borderline personality disorder is the most common personality disorder found in clinical settings. It is three times more common in women than in men. Under stress, transient psychotic symptoms are common. Between 8% and 10% of people with this diagnosis commit suicide, and many more suffer permanent damage from self-mutilation injuries, such as cutting or burning.

Methamphetamine

a powerful addictive stimulant; remains in the central nervous system and the body, producing prolonged stimulant effects

la belle indifférence:

a seeming lack of concern or distress; a key feature of conversion disorder

decatastrophizing

a technique that involves learning to assess situations realistically rather than always assuming a catastrophe will happen

treatment of intoxication of inhalants

consists of supporting respiratory and cardiac functioning until the substance is removed from the body. There are no antidotes or specific medication to treat inhalant toxicity

inhalant intoxication

acute toxicity causes anoxia, respiratory depression, vagal stimulation, and dysrhythmias. Death may occur from bronchospasm, cardiac arrest, suffocation, or aspiration of the compound or vomitus.

Tapering

administering decreasing doses of a medication

somatic symptom disorder often experience symptoms in _________________ although these diagnoses may not be made until ____________

adolescence early adulthood (about 25 years of age).

Tolerance break

after continued heavy drinking, the person experiences this, which means that a very small amounts of alcohol intoxicate the person.

Why students use drugs?

alcohol use, family history, social norms, race/ethnicity, etc.

Clonidine (Catapres)

an alpha 2 adrenergic agonist used to treat hypertension. It is given to clients with opiate dependence to suppress some effects of withdrawal or abstinence.

PCP

an anesthetic that blocks nerve receptors from pain and temperature without producing numbness; angel dust

Clients may display

an arrogant or haughty attitude. They lack the ability to recognize or to empathize with the feelings of others.

limit setting

an effective technique that involves three steps: stating the behavioral limit (describing the unacceptable behavior), identifying the consequences if the limit is exceeded, and identifying the expected or desired behavior

personality

an ingrained, enduring pattern of behaving and relating to self, others, and the environment; includes perceptions, attitudes, and emotions

Clients are preoccupied with orderliness

and try to maintain it in all areas of life. They strive for perfection as though it were attainable and are preoccupied with details, rules, lists, and schedules to the point of often missing "the big picture."

Ketamine

anesthetic used by veternarians, lead to hallucinations, amnesia, depression, fatal respiratory problems

A female client is 5 feet 6 inches tall, weighs 105 lb, exercises 4 hours per day, and does not engage in any binging or purging behaviors. She believes that she is becoming obese and states, "I'm shocked that you think I'm underweight. You don't understand me." The most likely diagnosis for this client is which of the following?

anorexia nervosa, restricting type. Anorexia nervosa is characterized by a voluntary refusal to eat and a weight less than 85% of normal for height and age. Clients with anorexia nervosa, restricting type have a distorted body image, eat very little, and often obsessively pursue vigorous physical activity to burn "excess calories." (less)

Hallucinogen intoxication symptoms

anxiety, depression, paranoid ideation, ideas of reference, fear of losing ones mind, potentially dangerous behavior such as jumping out a window in belief that one can fly

Cluster C personality disorders

anxious or fearful behaviors Avoidant Dependent Obsessive

People with obsessive-compulsive personality disorder

are preoccupied with orderliness, perfection, and interpersonal control at the expense of flexibility, openness, and efficiency.

Rapid or substantial changes in personality

are unlikely. This can be a primary source of frustration for family members, friends, and health care professionals.

Clients perceive themselves

as unable to function outside a relationship with someone who can tell them what to do. They are very uncomfortable and feel helpless when alone,

Central Nervous System depressants

barbiturates nonbarbiturate hypnotics anxiolytics Benzos

12-step program

based on the philosophy that a total abstinence is essential and that alcoholics need the help and support of the others to maintain sobriety

Intoxication of marijuana

begins to act less then a minute after inhalation. Peak effects usually occur 20-30 minutes and last at least 2 to 3 hours. Users report a high feeling similar to that with alcohol, lowered inhibitions, relaxation, euphoria, and an increased appetite.

Potiental side effects of amphetamines/meth

bingeing, crashing, sexual dysfunction, and brain damage

Pseudoneurologic symptoms of somatization disorder

burning hands and feet and the nondelusional sensation of worms in the head or ants under the skin

Schizotypal personality disorder is characterized

by social and interpersonal deficits, cognitive and perceptual distortions, and eccentric behavior.

Barbiturates

can be lethal when taken in overdose

Alcohol

central nervous system depressant that is absorbed rapidly into the bloodstream. Initially, the effects are relaxation and loss of inhibitions.

passive-aggressive behavior

characterized by a negative attitude and a pervasive pattern of passive resistance to demands for adequate social and occupational performance

dependent personality disorder

characterized by a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation

depressive behavior

characterized by a pervasive pattern of depressive cognitions and behaviors in various contexts

schizoid personality disorder

characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings

antisocial personality disorder

characterized by a pervasive pattern of disregard for and violation of the rights of others and with the central characteristics of deceit and manipulation

histrionic personality disorder

characterized by a pervasive pattern of excessive emotionality and attention seeking

narcissistic personality disorder

characterized by a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy

obsessive-compulsive personality disorder

characterized by a pervasive pattern of preoccupation with perfectionism, mental and interpersonal control, and orderliness at the expense of flexibility, openness, and efficiency

schizotypal personality disorder

characterized by a pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual distortions and behavioral eccentricities

avoidant personality disorder

characterized by a pervasive pattern of social discomfort and reticence, low self-esteem, and hypersensitivity to negative evaluation

somatic symptom disorder:

characterized by multiple, recurrent physical symptoms in a variety of bodily systems that have no organic or medical basis; also called somatization disorder

paranoid personality disorder

characterized by pervasive mistrust and suspiciousness of others

somatic symptom illnesses tend to be

chronic or recurrent

General Appearance and Motor Behavior of client with somatization

clients walk slowly or with an unusual gait because of the pain or disability caused by the symptoms facial expression of discomfort or physical distress describe their complaints in colorful, exaggerated terms but often lack specific information.

enabling

codependent behavior, is a behavior that seems helpful on the surface but actually perpetuates the substance use.

symptoms of withdrawal from stimulants

crashing; the person may experience depressive symptoms, including suicidal ideas for several days. This is not treated pharmacologically

The therapeutic relationship is

crucial in caring for clients with personality disorders. Nurses can help clients to identify their feelings and dysfunctional behaviors and to develop appropriate coping skills and positive behaviors. Therapeutic communication and role modeling help to promote appropriate social interactions, which help to improve interpersonal relationships.

Mood and Affect of client with conversion disorder

display unexpected lack of distress

drugs that decrease cravings for cocaine

disulfiram modafinil (provigil) an antiarcoleptic; propanolol (inderdall) beta blocker topiramate (topamate) anticonvulsant also used to stabilize moods and treat migraines

Inhalants

diverse group of drugs that include anesthetics, nitrates, and organic solvents that are inhaled for their effects

Rohypnol

date rape drug

Clients with borderline personality disorder tend to demonstrate

decreased impulsive behavior, increased adaptive behavior, and more stable relationships by 50 years of age.

intoxication from stimulants

develops rapidly; effects include the high euphoric feeling, hyperactivity, hyper vigilance, talkativeness, anxiety, grandiosity, hallucinations, stereotype or repetitive behavior, anger, fighting, and impaired judgement.

opioid intoxication

develops soon after initial euphoric feeling; symptoms include apathy, lethargy, listlessness, impaired judgement, psychomotor retardation or agitation constricted pupils, drowsiness, slurred speech, and impaired attention and memory

personality disorders

diagnosed when personality traits become inflexible and maladaptive and significantly interfere with how a person functions in society or cause the person emotional distress

Between age 15-17

early course of alcoholism begins with the first episode intoxication at what age?

Club drugs

ecstasy, GHB, GBL, nitrates

What behavior is likely a result of an adolescent's attempt to manage the effects of over-productive parenting?

engaging in severe dieting Two essential tasks of adolescence are the struggle to develop autonomy and the establishment of a unique identity. Autonomy, or exerting control over oneself and the environment, may be difficult in families that are overprotective or in which enmeshment (lack of clear role boundaries) exists. Such families do not support members' efforts to gain independence, and teenagers may feel as though they have little or no control over their lives. They begin to control their eating through severe dieting and thus gain control over their weight. Losing weight becomes reinforcing: By continuing to lose, these clients exert control over one aspect of their lives. While the remaining options may demonstrative reactive behaviors, they are not generally associated with over-productive parenting. (less)

They may express

envy and begrudge others any recognition or material success because they believe it rightfully should be theirs.

Blackout

episode during which the person continues to function but has no conscious awareness of his or her actions at the time or any later memory of the actions.

Cluster B personality disorders

erratic or dramatic behaviors Antisocial Borderline Histrionic Narcissistic

Nitrates

especially abused in gay/bi men; used for high feeling and intensified sexual experiences; headaches, dizziness, skin flushing, etc.

The nurse must be quite clear about

establishing the boundaries of the therapeutic relationship to ensure that neither the client's nor the nurse's boundaries are violated.

Thought Process and Content of client with somatization

exaggerated physical concerns talk about dying won't talk about emotions

Clients are emotionally

expressive, gregarious, and effusive. They often exaggerate emotions inappropriately. For example, a client says, "He is the most wonderful doctor! He is so fantastic! He has changed my life!" to describe a physician she has seen once or twice. They experience rapid shifts in moods and emotions and may be laughing uproariously one moment and sobbing the next.

Factitious disorders are also called

fabricated and induced illnesses

fabricated and induced illness:

factitious disorders characterized by physical symptoms that are feigned or inflicted on one's self or another person for the sole purpose of gaining attention or other emotional benefits; also called factitious disorder, imposed on self or others

Thought Process and Content of client with hypochondriasis

focus on the fear of serious illness rather than the existence of illness won't talk about emotions preoccupied with bodily functions, ruminate about illness, are fascinated with medical information unrealistic fears about potential infection and prescription medication.

self concept of client

focus only of physical part of self won't think of personal characteristics or strengths low self esteem lack confidence unsuccessful

Psychotropic medications are prescribed

for clients with personality disorders based on the type and severity of symptoms the client experiences in aggression and impulsivity, mood dysregulation, anxiety, and psychotic symptoms.

pain disorder:

has the primary physical symptom of pain, which generally is unrelieved by analgesics and greatly affected by psychological factors in terms of onset, severity, exacerbation, and maintenance

People with borderline personality disorder

have markedly unstable mood, affect, self-image, interpersonal relationships, and impulsivity; they often engage in self-harm behavior.

what is the focus of emotion focused strategies

helping the client manage or diminish the intensity of the symptoms

dhat

hypochondriacal concern about loss of semen men in India

symptoms of intoxication of marijuana

impaired motor function inappropriate laughter impaired judgement short term memory distortions of time and perception

Clients are overly concerned with

impressing others with their appearance and spend inordinate time, energy, and money to this end.

Personality disorders are relatively common and diagnosed

in early adulthood, although some behaviors are evident in childhood or adolescence.

physiologic effects

increased appetite conjunctival injections (bloodshot eyes) dry mouth hypotension tachycardia

nonsuicidal self-injury

intentional physical damage to the body, such as cutting or burning; results from self-harm urges or thoughts; injury is not an attempt at suicide

In mental health outpatient settings, the incidence of personality disorder

is 30% to 50%

Passive-aggressive behavior

is characterized by a negative attitude and a pervasive pattern of passive resistance to demands for adequate social and occupational performance. These clients may appear cooperative, even ingratiating, or sullen and withdrawn, depending on the circumstances. Their mood may fluctuate rapidly and erratically, and they may be easily upset or offended.

Depressive behavior

is characterized by a pervasive pattern of depressive cognitions and behaviors in various contexts. It occurs more often in people with relatives who have major depressive disorders.

Narcissistic personality disorder

is characterized by grandiosity, need for admiration, lack of empathy for others, and a sense of entitlement.

Avoidant personality disorder

is characterized by social discomfort and reticence in all situations, low self-esteem, and hypersensitivity to negative evaluation.

Cannabis sativa

is the hemp plant that is widely used for its fiber used to make cloth and rope and for oil from its seeds.

internalization:

keeping stress, anxiety, or frustration inside rather than expressing them outwardly

Mood and Affect of client with somatization

labile, shifting from seeming depressed and sad when describing physical problems to looking bright and excited when talking about how they had to go to the hospital in the middle of the night by ambulance

Clients cannot tolerate

lack of control, and hence may organize family outings to the point that no one enjoys them.

Problem-focused coping strategies include

learning problem-solving methods, applying the process to identified problems, and role-playing interactions with others

Examples of inhalants

lighter fluid, gasoline, fingernail polish remover, and paint thinner; liver and kidney damage, bone marrow issues

judgement and insight of client

little to none into their behavior firm belief problem is physical

Benefits of caffeine

lower the risk for type 2 diabetes, reduce gallstones, Parkinson's disease, and colon cancer

LSD

lysergic acid diethylamide-24; a psychedelic drug that produces distorted reality.

Treatment focuses on

managing symptoms and improving quality of life

Somatic symptom disorder, illness anxiety disorder, and pain disorder often last for

many years, and clients report being in poor health

Severe symptoms of withdrawal of alcohol

may progress to transient hallucinations, seizures, or delirium called delirium tremens (DTs).

Hallucinogens

mescaline psilocybin lysergic acid diethylamide ecstasy PCP

Pyshcoactive

mind-altering

Herbal Ecstasy

mixture of stimulants; "natural alternative to ecstasy"; stroke, heart attack, and disfiguring skin condition

dysphoric

mood that involves unhappiness, restlessness, and malaise

Marijuana

most widely used illegal drug (THC); sense of euphoria that lasts for 3 hours, impairment in thinking and communicating

Levomethadyl

narcotic analgesic whose only purpose is the treatment of opiate dependence. It is used in the same manner as methadone

should pain disorder clients receive narcotic analgesics?

no - avoid because of the risk of dependency or abuse

Shenjing shuariuo

occurs in China physical and mental fatigue, dizziness, headache, pain, sleep disturbance, memory loss, gastrointestinal problems, and sexual dysfunction

withdrawal from stimulants

occurs within a few hours to several days after cessation of the drug and is not life threatening.

Cluster A personality disorders

odd or eccentric behaviors Paranoid Schizoid Schizotypal

People with antisocial personality disorder

often appear glib and charming, but they are suspicious, insensitive, and uncaring and often exploit others for their own gain.

Marital and parent-child relationships are

often difficult because these clients can be harsh and unrelenting. For example, most clients are frugal, do not give gifts or want to discard old items, and insist that those around them do the same. Shopping for something new to wear may seem frivolous and wasteful.

Clients with borderline personality disorder

often have self-harm urges that they enact by cutting, burning, or punching themselves; this behavior sometimes causes permanent physical damage. The nurse can encourage the client to enter into a no-self-harm contract in which the client promises to try to keep from harming himself or herself, and to report to the nurse when he or she is having self-harm urges.

Detoxification from sedatives, hypnotics, and anxiolytics

often managed medically by tapering the amount of the drug the client receives over a period of days or weeks, depending on the drug and how much the client has been using.

sedatives, hypnotics, and anxiolytics

onset of withdrawal symptoms depends on the half life of the drug

Oipoids

opioids relax the user, and impart feelings of euphoria while acting as powerful narcotics, or painkillers; addiction, weight loss

controlled substances

opioids, stimulants, and sedatives