Mental Health Exam 3

A client says to the nurse, "You are the best nurse I've ever met. I want you to remember me." What is an appropriate response by the nurse?

"Are you thinking of suicide?"

A client with bipolar disorder begins taking lithium 300 mg four times a day. After 3 days of therapy, the client says, "My hands are shaking." The best response by the nurse is which of the following?

"Fine motor tremors are an early effect of lithium therapy that usually subsides in a few weeks."

The nurse observes that a client with depression sat at a table with 2 other clients during lunch. The best feedback the nurse could give the client is which of the following?

"I see you were sitting with others at lunch today."

The nurse is teaching a newly diagnosed patient about her diagnosis of schizophrenia with her family in attendance. Which of the following statements would indicate that the education provided to her family has been effective?

"Our only solace is finding that we are not the cause of her disorder."

Side effects of MAOIs

- Common: hypotension, sedation/weakness/fatigue, muscle cramps, changes in cardiac rhythm, urinary hesitancy/constipation, weight gain, sexual dysfunction - Serious: hypertensive crisis (medical emergency, s/sx: severe occipital headache, marked increase in BP, palpitations/chest pain, nuchal rigidity, nausea/vomiting, fever/sweating

When educating a client who is starting a new antipsychotic medication, which educational tool(s) should be incorporated?

-sugar-free beverages can be helpful for dry mouth -to avoid orthostatic hypotension, it is best to rise slowly from a sitting position -It is a good idea to apply sun screen before going outdoors.

What is the safe serum lithium level for maintenance and safety?

0.5 to 1.5

Which of the following would be most appropriate for the treatment of mania associated with bipolar disorder? A. Lithium B. Fluoxetine C. Citalopram D. Venlafaxine

A. Lithium Rationale: Lithium is an antimanic agent, which would be most appropriate for treating a manic patient with bipolar disorder. o Fluoxetine/ Prozac (SSRI), citalopram/Celexa (SSRI), and venlafaxine/Effexor(SNRI) are antidepressants.

Amantadine, Clonidine

Aids in hunger cessation, metabolic management. Antiviral effective for impulse control SE: dizziness, nausea, headache, constipation

Which of the following would indicate an increased suicidal risk?

An abrupt improvement in mood. Calling family members to make amends. Statements such as "Everything will be better soon".

Is the following statement true or false? When discussing personality disorders, the term treatment resistant refers to a lack of response to medications prescribed.

Answer to Question #1 False Rationale: Although a personality disorder is a psychiatric diagnosis, it is important to remember that it is not an illness with treatable symptoms in the way other mental disorders are. The term treatment resistant refers to the fact that it is difficult to change a person's personality. Changes occur slowly and over time. It is true that there is no "magic pill" that will result in a change in someone's personality for the better.

Transient psychotic symptoms that occur with borderline personality disorder are most likely treated with which of the following?

Antipsychotics

A 31-year-old patient newly diagnosed with schizophrenia asks the nurse about the difference between conventional and atypical antipsychotic medications. What is the best response by the nurse:

Atypical antipsychotics are both dopamine and serotonin antagonists, and conventional antipsychotics are only dopamine antagonists.

Which of the following would a nurse expect to assess in a patient with antisocial personality disorder? A. Overwhelming empathy B. High self-esteem C. Manipulative behaviors D. Pervasive suspiciousness

C. Manipulative behaviors Rationale: A patient with antisocial personality disorder typically exhibits manipulative behaviors, lack of empathy, and low self-esteem. o Suspiciousness would be assessed in a patient with paranoid personality disorder.

seasonal affective disorder

Controversial disorder in which a person experiences depression during winter months and improved mood during spring. Can be treated using phototherapy, using bright light and high levels of negative ions.

Which of the following would be considered a neurologic side effect of antipsychotic therapy? A. Blurred vision B. Agranulocytosis C. Sedation D. Tardive dyskinesia

D. Tardive dyskinesia Rationale: Tardive dyskinesia is a neurologic side effect of antipsychotic therapy. o Blurred vision, sedation, and agranulocytosis are nonneurologic side effects.

When interviewing any client with a personality disorder, the nurse would assess for which of the following?

Disruption in some aspects of his or her life.

What are the most common types of side effects from SSRIs?

Dizziness, drowsiness, dry mouth

Which of the following would be appropriate for a client with mania?

Drawing a picture Modeling clay Stretching exercises

Side effects of antipsychotics

Drowsiness, dizziness Dry mouth, constipation Increased appetite, weight gain ECG changes Extrapyramidal symptoms Hyperglycemia and diabetes

Haldol SE

EPS--involuntary muscle spasms usually of neck and shoulders

The nurse would assess for which of the following characteristics in a client with narcissistic personality disorder?

Entitlement

The nurse working with a client with antisocial personality disorder would expect which of the following behaviors?I

Exploitation of other clients Seeking special privileges Superficial friendliness towards others

Is the following statement true or false? A patient with narcissistic personality disorder typically likes to be the center of attention.

False Rationale: Being the center of attention is a finding typically associated with a patient with a histrionic personality disorder.

Is the following statement true or false? Positive symptoms of schizophrenia include a flat affect and social withdrawal.

False Rationale: Flat affect and social withdrawal are negative symptoms of schizophrenia.

Is the following statement true or false? The nurse should confront a patient's delusions

False Rationale: When a patient is experiencing delusions, the nurse should focus on the reality and not confront or reinforce the patient's delusions

Is the following statement true or false? When dealing with a patient who is suicidal, the nurse needs to assume a dependent role.

False Rationale: When dealing with a patient who is suicidal, the nurse must take an authoritative role.

Which of the following underlying emotions is commonly seen in an avoidant personality disorder?

Fear

Which of the following typifies the speech of a person in the acute phase of mania?

Flight of ideas

SE of Depakote

GI issues--upset, heartburn, indigestion, diarrhea

When working with a client with a personality disorder, the nurse would expect to assess which of the following?

Impaired interpersonal relationships Inability to empathize with others Minimal insight

Clients with a shizotypal personality disorder are most likely to benefit from which of the following nursing interventions?

Improving community functioning

Side effects of SSRIs and SNRIs

Insomnia, agitation, headache, weight loss, sexual dysfunction, serotonin syndrome

Mania

It is a distinct period during which the mood is abnormally and persistently elevated, expansive, or irritable. Typically lasts about 1 week, but may last longer.

What is the rationale for a person taking lithium to have enough water and salt in his/her diet?

Lithium is a salt that has greater affinity for receptor sites than sodium chloride (table salt).

When working with a client with a narcissistic personality disorder, the nurse would use which of the following approaches?

Matter-of-fact

The nurse observes that a client with bipolar disorder is pacing the hall, talking loudly and rapidly, and using elaborate hand gestures. The nurse concludes that the client is demonstrating which of the following?

Psychomotor agitation

restructuring vs. reframing

Reframing is the general change in a person's mindset, whether it be a positive or negative change. ... In this way, cognitive restructuring is a particular instance of cognitive reframing. Distortions are exaggerated and typically negative thoughts not supported by a rational thought process.

The nurse is planning to discharge a client taking clozapine (Clozaril). Which of the following is most important to include in discharge teaching?

Remind the client that they will need to go to the lab to have blood drawn for a WBC count.

Nursing Diagnoses Related to Schizophrenia

Risk for other-directed violence Risk for suicide Disturbed thought processes Disturned sensory perception Disturbed personal Identity Impaired Verbal Communication

latency of response

Seen when clients take up to 30 seconds to respond to a question.

substance-induced depressive or bipolar disorder

Significant disturbance in mood that is a direct physiologic consequence of ingested substances such as alcohol, other drugs, or toxins

side effects of lithium

Tremor, hypothyroidism, nephrogenic diabetes insipidus, fetal cardiac defects

Is the following statement true or false? Patients with depression often exhibit anhedonia

True Rationale: Anhedonia refers to the loss of any sense of pleasure from activities that a person formerly enjoyed. This is a manifestation of depression.

Is the following statement true or false? Depression is most commonly associated with suicide.

True Rationale: Depression is considered the most common diagnosis that results in suicide

electroconvulsive therapy (ECT)

a biomedical treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions. Used to treat severe depression in those who do not respond to antidepressants or who experience intolerable side effects.

cyclothymic disorder

a disorder marked by numerous periods of hypomanic symptoms and mild depressive symptoms without loss of social or occupational functioning

obsessive-compulsive disorder (OCD)

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

borderline personality disorder

a personality disorder characterized by lack of stability in interpersonal relationships, self-image, and emotion; impulsivity; angry outbursts; intense fear of abandonment; recurring suicidal gestures

hypomania

abnormally and persistently elevated, expansive, or irritable mood and some other milder symptoms of mania

The most important short-term goal for the client who tries to manipulate others would be to...

acknowledge own behavior

This emotion may occur in patients diagnosed with bipolar disorder and/or schizophrenia, and can commonly be described as feeling both the desire to live and die, or may be expressed as passive-aggressive behaviors. What is this commonly referred to as:

ambivalence

positive symptoms of schizophrenia

ambivalence associative looseness delusions echopraxia flight of ideas hallucinations ideas of reference perseveration bizarre behavior

SE of Ambien, Lunesta

amnesia poor motor coordination slurred speech increased impulsivity

Which of the following are considered to be negative symptoms of schizophrenia?

anhedonia social withdrawal also: alogia apathy blunted affected asociality catatonia flat affect avolition or lack of volition inattention

Trileptal SE

blurry or doubled vision, sleepiness, poor muscle coordination, tremor

Passive-Aggressive behavior

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

narcissistic personality disorder

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

Dependent personality disorder

characterized by an excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation. Persons with this disorder often seek treatment for anxious, depressed, or somatic symptoms.

schizoid personality disorder

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

Histrionic personality disorder

characterized by excessive emotionality and attention seeking. Clients usually seek treatment for depression, unexplained physical problems, and difficulties in relationships.

Paranoid Personality Disorder

characterized by pervasive mistrust and suspiciousness of others

dysthymic disorder

chronic, persistent mood disturbance characterized by symptoms such as insomnia, loss of appetite, decreased energy, low self-esteem, difficulty concentration, and feelings of sadness and hopelessness that are milder than those of depression

SE of Ativan, Klonopin, Valium, Xanax

confusion blurred vision muscle weakness headache sedation slurred speech tremor muscle spasms

SE of Clonidine/Tenex/Amantadine

constipation fatigue dry mouth diarrhea blood pressure changes

Seroquel SE

constipation, dizziness, sedation, upset stomach

Cogentin

controls EPS caused by antipsychotics SE: weakness, low blood pressure, constipation, decreased sweating

Propranolol

controls tremors caused by anticonvulsants SE: dizziness, fatigue, nervousness, cold extremities, low BP

Cognitive restructuring techniques include all the following

decatastrophizing positive self-talk reframing

personality

defined as an ingrained enduring pattern of behaving and relating to self, others, and the environment

Non-suicidal self-injury involves:

deliberate, intentional cutting, burning, scraping, hitting, or interference with wound healing. Persons who engage in self-mutilation often report reasons of alleviation of negative emotions, self-punishment, seeking attention, or escaping a situation or responsibility

A patient in a mental health facility claims that his neck is stuck to one side, and his eyes present to be exhibiting an oculogyric crisis. The nurse checks his chart and notes that he has been taking chlorpromazine (Thorazine) for 2 weeks. After alerting the doctor, the following PRN medication has been ordered for the client. Which one should the nurse administer?

diphenhydramine (Benadryl) 25 mg IM, PRN

mania

distinct period during which mood is abnormally and persistently elevated, expansive, or irritable

SE of Ritalin/Adderall/Concerta

dizziness insomnia weight loss palpitations nervousness

Interventions the nurse can take when dealing with a patient having delusions

do not openly confront the delusion or argue with the client establish and maintain reality for client use distracting techniques teach the client positive self-talk, positive thinking, and to ignore delusional beliefs

Tegretol SE

drowsiness, blurred vision, fatigue, nausea, dizziness

SE of Wellbutrin

dry mouth headache increased sweating N/V, constipation anxiety fatigue blurred vision

SE of Trazodone, Benadryl, Melatonin

dry mouth nervousness nausea photosensitivity priapism (prolonged erection)

SE of thorazine

dry mouth, dizziness, nasal congestion

Common Side effects of antidepressants

dry mouth, nausea, wt. loss or gain, nervousness, dizziness, headache, weakness, fatigue, diarrhea, blurred vision, rash, sweating, insomnia, cold hands and feet

emotional lability

emotions are unstable and can fluctuate

Abilify SE

headache, dizziness, blurred vision, weakness

Interventions for clients experiencing hallucinations

help present and maintain reality by frequent contact and communication with client elicit description of hallucination to protect the client and others. the nurse's understanding of the hallucination helps him or her know how to calm or reassure the client. engage client in reality based activities such as card playing, occupational therapy, or listening to music

Prazosin

helps with flashbacks, nightmares, etc. associated w/PTSD SE: blurred vision, upset stomach, tinnitus, headache, loss of appetite

Difference b/w mania and hypomania

hypomanic episodes do not impair the person's ability to function (they might even be quite productive) and there are no psychotic features (delusions, hallucinations)

difference b/w mania and hypomania

hypomanic epsidoes do not impair the person's ability to function, and can in fact make the person quite productive, and there are no psychotic features (delusions and hallucinations)

psychomotor agitation

increased body movements and thoughts (pacing, accelerated thinking, argumentativeness.

extrapyramidal symptoms

involuntary fine motor tremors, rigidity, uncontrollable restlessness, acute dystonia.

Major Depressive Disorder (MDD)

involves 2 or more weeks of a sad mood or lack of interest in life activities with at least four other symptoms of depression such as anhedonia, changes in wt., sleep, energy, concentration, decision making, self-esteem, goals.

Bipolar disorder

involves extreme mood swings from episodes of mania to episodes of depression

anergia

lack of energy

When assessing a new patient, the nurse notes that the patient hesitates approx. 20-25 seconds before responding to any of the questions being asked. This can be referred to as having:

latency of response.

SE of Straterra

lightheadedness heartburn fatigue vomiting decreased appetite

anhedonia

losing any sense of pleasure from activities formerly enjoyed

Lamictal SE

muscle aches, weight loss, insomnia, Stevens-Johnson's syndrome

euthymic mood

normal range of mood, implying absence of depressed or elevated mood

Bipolar II

one or more major depressive episodes accompanied by at least one hypomanic episodes

Bipolar II disorder

one or more major depressive episodes accompanied by at least one hypomanic episodes

Bipolar I

one or more manic or mixed episodes usually accompanied by major depressive episodes

Bipolar I disorder

one or more manic or mixed episodes usually accompanied by major depressive episodes

Hypomania

period of abnormally and persistently elevated, expansive, or irritable mood and some other milder symptom of mania.

mood disorders (affective disorders)

pervasive alterations in emotions that are manifested by depression, mania, or both.

Depressive Behavior

pervasive pattern of depressive cognitions and behaviors in various contexts. It occurs more often in people with relatives who have MDD

DDAVP

prevents and controls bed wetting SE: upset stomach, headache, nasal congestion, stomach pains

Flight of Ideas

racing, often unconnected thoughts

flight of ideas

racing, often unconnected thoughts

The overall goal of psychotic rehabilitation is for the client to gain...

recovery from the illness

seasonal affective disorder (SAD)

recurrent depressive episodes in a seasonal pattern

Pre-Menstrual Dysphoric Disorder (PMDD)

recurrent, moderate psychological and physical symptoms that occur during the week before menses and resolve with menstruation. labile mood, irritability, increased interpersonal conflict, difficulty concentrating, feeling overwhelmed or unable to cope, feelings of anxiety, tension, hopelessness

ruminate

repeatedly going over the same thoughts

post-partum psychosis

severe and debilitating psychiatric illness with acute onset in the days following childbirth. s/s begin with fatigue, sadness, emotional lability, poor memory, and confusion and progress to delusions, hallucinations, poor insight and judgement, loss of contact with reality.

Prodromal symptoms

sleep difficulties change in appetite loss of energy and interest odd speech hearing voices peculiar behavior Inappropriate expression of feelings paucity of speech ideas of reference feelings of unreality

psychomotor retardation

slow body movements, slow cognitive processing, and slow verbal interaction

avoidant personality disoder

social discomfort and reticence, low self-esteem, hypersensitivity to negative evaluation

post partum depression

symptoms are consistent with those of depression with onset within 4 weeks of delivery

kindling

the snowball-like effect seen when minor seizure activity seems to build up into more frequent and severe seizures

Synthroid

treatment for hypothyroidism caused by lithium SE: heart palpitations, nervousness, weight loss, increased appetite

Psychotherapy

treatment involving psychological techniques; consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth

SE of lithium

tremor fatigue increased thirst weight gain hypothyroidism

Risperdal SE

tremors, lactation in females and enlarged breasts in males

Pressured speech

unrelenting, rapid, often loud talking without pauses

pressured speech

unrelenting, rapid, often loud talking without pauses

Lithium

used to treat bipolar depression. lithium can stabilize bipolar disorder by reducing the degree and frequency of cycling or eliminating manic episodes

Zyprexa SE

weight gain, increased feelings of hunger

seasonal affective disorder (SAD)

winter depression or fall onset. people experience increased sleep, appetite, and carbohydrate cravings, weight gain, interpersonal conflict, irritability, and heaviness in the extremities beginning in late autumn and abating in spring and summer.