Mental Health Exam 4- Module 11-13
· What are some physical signs you may see in child abuse and/or child neglect?
○ Has unexplained burns, bites, bruises, broken bones, or black eyes ○ Has fading bruises or other marks noticeable after an absence from school ○ Seems frightened of the parents and protests or cries when it is time to go home ○ Lacks needed medical or dental care, immunizations, or glasses ○ Is consistently dirty and has severe body odor ○ Lacks sufficient clothing for the weather ○ Shrinks at the approach of adults ○ Extremes in behavior, such as overly compliant or demanding behavior, extreme passivity, or aggression ○ Inappropriately adult (e.g., parenting other children) or inappropriately infantile (e.g., frequently rocking or head-banging) behavior ○ Delays in physical or emotional development ○ Shows signs of depression or suicidal thoughts (or attempts) ○ Has difficulty walking or sitting ○ Demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior ○ Becomes pregnant or contracts a sexually transmitted disease, particularly if younger than age 14 ○ Attaches very quickly to strangers or new adults in their environment
What are assessment findings and interventions for patients with paranoid personality disorder?
○ Individuals with this disorder are suspicious of others' motives and assume that others intend to exploit, harm, or deceive them. § Small things can be misinterpreted due to paranoia ○ Constantly on guard ○ Hypervigilant ○ Ready for any real or imagined threat ○ Appear tense and irritable ○ Trusts no one ○ Constantly tests the honesty of others ○ Insensitive to the feelings of others ○ Oversensitive ○ Tends to misinterpret minute cues ○ Magnifies and distorts cues in the environment ○ Does not accept responsibility for his or her own behavior ○ Attributes shortcomings to others ○ Are constantly "testing" the honesty of others. ○ The most appropriate nursing intervention is to use clear, calm statements and to assume a confident physical stance. A calm attitude provides the client with a feeling of safety and security and avoids escalating the aggressive behavior Small things can be misinterpreted due to paranoia
What are important points with behavior modification to treat eatins disorders?
○ Issues of control are central to the etiology of these disorders. ○ For the program to be successful, the client must perceive that they are in control of the treatment. ○ Efforts to change the maladaptive eating behaviors of clients with anorexia nervosa and bulimia nervosa have become the widely accepted treatment. The importance of instituting a behavior modification program with these clients is to ensure that the program does not "control" them. Issues of control are central in these disorders. ○ The client has control over-eating, the amount of exercise pursued, and even over whether to induce vomiting. Staff and client also agree on a system of rewards and privileges that can be earned by the client, who is given ultimate control. The client has a choice of whether to abide by the c
What are characteristics of abusers?
○ Low self-esteem ○ Diminished feelings of self-worth ○ May show a different type of personality to the community than the one shown to the partner ○ Keep their partners isolated from others and this potentiates the cycle of abuse. ○ Threatening and intimidating ○ Extreme disciplinarian ○ Poor impulse ○ Perceives victim as bad ○ Violent outbursts ○ Poor coping skills ○ Feeling worthless ○ Possible history of substance abuse disorder ○ Difficulty assuming adult roles ○ Experienced violence as a child
What is the MOA of methylphenidate in ADHD?
○ Methylphenidate (Ritalin) is a central nervous symptom stimulant § Causes a decrease in appetite that often leads to weight loss. ○ Believed to elevate dopamine and norepinephrine levels, it has been hypothesized that their effectiveness is in response to neurotransmitter dysregulation ○ Low arousal theory: people with ADHD have chronically under aroused brains- stimulants increase arousal increasing neuron firing and neurotransmitter flow
What are the predisposing factors to Schizoid personality disorder?
○ Most likely had a bleak childhood, neglected when they were young, and possible hereditary factors ○ Possible hereditary link ○ Psychological § History of childhood trauma including neglect § Subject to early parental antagonism and harassment § They perceived the world has harsh and unkind- calling for protective vigilance and mistrust
What factors are related to the development of autism spectrum disorder?
○ Neurological implications § Abnormalities in brain structure or function § Role of neurotransmitters under investigation ○ Genetics § Familial association § Chromosomal involvement ○ Prenatal and perinatal influences § Advanced parental age, fetal exposure to valproate, gestational diabetes § Low birth weight, OB complications, congenital malformation, ABO or Rh factor incompatibilities
What are interventions for a client in the manic phase of bipolar disorder?
○ Offer high calorie foods ○ Distraction techniques/ways to channel excess energy ○ Treatment Modalities for Bipolar Disorder § Individual psychotherapy § Group therapy § Family therapy § Cognitive therapy § Psychopharmacology ○ First mood stabilization medication of choice is Lithium ○ 2nd choice: anticonvulsants/mood stabilizers § Example: Valproic Acid/Depakote
What is a priority intervention for clients with bulimia nervosa?
○ Perform an ECG, check electrolytes, & ABG: excessive vomiting and laxative or diuretic abuse may lead to problems with dehydration and electrolyte imbalances § Purging can cause hypokalemia ○ Monitor 1:1 for to prevent purging
What is a personality disorder?
○ Personality disorders: Occur when these traits become rigid and inflexible and contribute to maladaptive patterns of behavior or impairment in functioning.
What are positive symptoms of schizophrenia?
○ Positive behaviors. Characterized by the presence or exaggeration of behaviors. § Anything created or amplified by schizophrenia § Disturbances in thought content, thought process manifested in speech, or disturbances in perception
What is refeeding syndrome?
○ Refeeding syndrome § Usually in anorexic clients § A potential outcome of aggressive nutritional restoration in malnourished clients, is associated with hypophosphatemia, hypokalemia, hypocalcemia, and hypomagnesemia. § These electrolyte imbalances can result in cardiac arrhythmias, cardiovascular collapse, delirium, and death. § **when food is introduced too quickly after a period of malnourishment § Consult with the provider and dietitian to develop a controlled rate of nutritional support during initial treatment § Monitor blood electrolytes and administer fluid replacement as prescribed. § Place the client on continuous cardiac monitoring, if needed § Monitor vital signs frequently
What is the main difference between schizoid and avoidant personality disorder?
○ Schizoid "Aloof"- Not interested in forming relationships § Characterized primarily by a profound defect in the ability to form personal relationships § Emotionally cold § Failure to respond to others in a meaningful emotional way § Physical contact less pleasurable- less likely to seek out ○ Avoidant "Cowardly"- Strong desire to form relationships but struggle to § Awkward and uncomfortable in social situations § Desire close relationships but avoid them because of fear of being rejected § Perceived as timid, withdrawn, or cold and strange § Low self-esteem and self-worth, needs to state a positive personality trait as a goal during therapy § Extreme sensitivity to rejection
What are education points related to amytriptyline?
○ Suicide risk ○ Avoid smoking while receiving tricyclic therapy. § Smoking increases the metabolism of tricyclics, requiring an adjustment in dosage to achieve the therapeutic effect ○ Risk for serotonin syndrome
What are symptoms of anorexia nervosa?
○ Symptoms include: (everything decreases) § Gross distortion of body image § Preoccupation with food § Refusal to eat § Other signs include hypothermia, bradycardia, hypotension with orthostatic changes, peripheral edema, lanugo (fine, neonatal-like hair growth), bone fractures, acrocyanosis (bluish color to hands and feet related to poor circulation), and a variety of metabolic changes. § Anxiety and depression are common § Amenorrhea
How should you therapeutically deal with compulsions in a client with OCD?
○ The clients with OCD get relief by carrying out compulsions and if this is not discontinued therapeutically it will increase anxiety and set the client back in therapy ○ Compulsions help to relieve anxiety § Example: knocking the door 14 times, excess handwashing etc. ○ Do not stop compulsions unless it is life threatening- compulsions are a way for them to cope with their anxiety § Aim to stop gradually through therapy or medications Initially meet the patient's dependency needs as required.
What is the onset of Tourette's disorder and which population is it more common in?
○ The essential feature of Tourette's disorder is the presence of multiple motor tics and one or more vocal tics. ○ Onset may be as early as 2 years but occurs most commonly around age 6 or 7. ○ The disorder is more common in boys than in girls.
Define transference and countertransference
○ Transference § Nursing consideration: Assist the patient in clarifying the meaning of the current nurse-client relationship. § The nurse may remind the patient of someone in their life sibling etc and feelings toward that sibling- annoyed etc § Occurs when the patient unconsciously displaces (or "transfers") to the nurse feelings formed toward a person from his or her past (Sadock, Sadock, & Ruiz, 2015). These feelings may be triggered by something about the nurse's appearance or personality characteristics that remind the patient of another person. Transference can interfere with the therapeutic interaction when the feelings expressed include anger and hostility. Anger toward the nurse can be manifested by uncooperativeness and resistance to therapy. ○ Countertransference: nurse is reminded of someone by the patient
What are interventions for a client with OCD?
○ Treatments § Individual, cognitive behavior, behavior therapy ● Systematic desensitization (patient is gradually exposed to the phobic stimulus, either in a real or imagined situation) ● Implosion therapy (therapist "floods" the patient with vital information concerning situations that trigger anxiety in him or her) § Nonpharmacological treatments: Deep breathing exercises, progressive muscle relaxation, guided imagery, mindfulness meditation, and exercise § Medication: antidepressants ○ Do not stop compulsions unless it is life threatening- compulsions are a way for them to cope with their anxiety § Aim to stop gradually through therapy or medications ○ Work with the patient to determine the types of situations that increase anxiety and result in ritualistic behaviors.
What are pharmacological interventions for Autism Spectrum Disorder?
○ Two medications approved by the FDA § Risperidone § Aripiprazole ○ Targeted for the following symptoms § Aggression § Deliberate self-injury § Temper tantrums § Quickly changing moods ○ Dosage based on weight of child and clinical response
What are some nursing intervention for a patient experiencing command hallucinations and appears to be frightened?
○ Validate the patient's feelings. ○ Keep them physically safe. ○ Determine what the hallucination is telling them to do and provide reality testing PRN
What are risks associated with anorexia nervosa?
○ Weight loss is excessive, with some individuals who present for health-care services weighing less than 85 percent of expected weight. ○ "Thinks they're fat but is obviously underweight" ○ Self-induced vomiting and the abuse of laxatives or diuretics also may occur ○ Complications include: § Malnutrition § Hypoglycemia § Irregular Heartrate r/t abnormal levels of K § Kidney and Liver Damage § Insomnia § Anemia § Infertility § Osteopenia- Decreased Bone Density § Osteoporosis
An individual with a history of antisocial personality disorder was arrested for driving under the influence of alcohol and causing a serious car accident. Which comment on this behavior would be expected? "It's not my fault." "I'm too ashamed to talk about it." "I just don't remember doing it." "I'm really sorry about all the people."
A "It's not my fault." Individuals diagnosed with antisocial personality disorder lack remorse about their actions and view themselves as victims. This individual would most likely refuse to acknowledge responsibility for the accident.
A nurse is educating staff on personality disorders. Which statement by the staff indicates understanding? A Antisocial personality disorder can start as conduct disorder B It is very easy to categorize the clients based on their disorder C All clients with personality disorders were the victims of abuse DAll clients with personality disorders take advantage of others
A Antisocial personality disorder can start as conduct disorder- APD can start as conduct disorder while in childhood. The different disorders overlap and can be difficult for even prescribers to identify. These disorders have signs that you look for and will create a plan of care based on what behaviors and thoughts the client has.
A patient has anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and has lost 25% of body weight. The serum potassium is 2.7 mg/dL. This patient is at risk of what complication? A Cardiac Arrhythmia B Increased Bone Density C Increased Heart Rate D Possible decrease in cortisol
A Cardiac Arrhythmia- This patient presents with imbalanced nutrition related to not eating. The patient has hypokalemia which will result in changes in ECG. This client will also have bradycardia, elevated cortisol and osteopenia.
A nurse is caring for a client who has schizophrenia. The client states, "The weather channel lady loves me and she is going to quit her show to be with me!" The nurse should document that the client is experiencing which of the following types of delusions? A Erotomanic B Persecution C Control D Somatic
A Erotomanic- A client that is experiencing erotomania thinks that someone else loves them or that they are in love with the other party. These clients will maintain this delusion. This behavior can lead to stalking or other inappropriate actions on the part of the psychotic client.
An unlicensed assistive personnel (UAP) is working with clients that have diagnosis of obsessive compulsive disorder. The UAP understands the reason not to stop the carrying out of compulsions is: A If this is not done therapeutically the client will have an escalation in anxiety B The RNs don't trust the UAPs C Stopping compulsions is not part of the treatment plan D The obsessions are the client's problems not the compulsions
A If this is not done therapeutically the client will have an escalation in anxiety- The clients with OCD get relief by carrying out compulsions and if this is not discontinued therapeutically it will increase anxiety and set the client back in therapy. Both the obsession and the compulsions are problems and need to be addressed properly. A UAP is part of the healthcare team and should understand the roles that each member play and that this is not a discriminatory intervention on the part of the nurse
A client is experiencing command hallucinations and appears to be frightened. Which of the following actions are appropriate nursing interventions? A Keep the client physically safe B Ignore the client's feelings in response to altered perceptions C Assure the client that they are not experiencing something real D Inform the client that their hallucinations are just bad dreams
A Keep the client physically safe- Validate the patient's feelings. Keep them physically safe. Determine what the hallucination is telling them to do and provide reality testing PRN.
A client with anorexia nervosa is at increased risk for which of the following? A Osteopenia B Increased testosterone C Hyperglycemia D Hypertension
A Osteopenia- A client with anorexia nervosa is at risk for decreased bone density, osteoporosis and osteopenia. Osteopenia is a condition that begins as you lose bone mass and your bones get weaker. This happens when the inside of your bones become brittle from a loss of calcium
A nurse is performing an admission assessment for an adolescent client with a diagnosis of schizophrenia. Which of the following findings should the nurse identify as a positive symptom? A Somatic Delusions B Anhedonia C Waxy Posture (immobile posturing) D Anergia
A Somatic Delusions- Delusions are example of a positive symptom. Anhedonia, waxy posture, and anergia are negative symptoms. Positive symptoms, which include delusions, hallucinations, disorganized thoughts, and disorganized speech; can cause you or someone you love to lose touch with reality. Negative schizophrenia refers to behaviors or emotions that are deficient or lacking in people with schizophrenia
· A nurse is assessing a client who has a history of alcohol use disorder. Which of the following questions should the nurse include to determine how the use of alcohol affects the client's psychosocial behaviors? o A. "Has alcohol use affected your performance at work?" o B. "Do you take any over the counter medications?" o C. "Do you receive treatment for any mental health disorders?" o D. "What type of alcohol do you drink?"
A. "Has alcohol use affected your performance at work?"- Inquiring about work performance is appropriate to include in a psychosocial assessment related to substance use disorder. Understanding if the client has any other mental health diagnosis aides in the planning of care but is not specifically psychosocial. Understanding type doesn't address the psychosocial behavior of the client
· A nurse is assessing a child and suspects child abuse. Which assessment finding support the nurse's assumption? o A. A circular burn on the child's arm o B. A bump on the child's forehead o C. Redness on the child's legs o D. The child does not want to listen to instructions
A. A circular burn on the child's arm- A circular burn is not a normal finding and can indicate a burn from a cigarette or other smoked substance. Bruising is an expected finding if a child is active these will be in consistent areas that would indicate falls during play. Children that are active may present with bumps on head from falls. A child that has been abused may rather than acting out be subdued and fearful.
· The nurse working with a client diagnosed with Bulimia Nervosa asks the client to recall a time in life when food could be consumed without purging. Which best explains the purpose of the nurse's question? o A. To emphasize that the client is capable of consuming food without purging o B. To incorporate specific foods into the meal plan to reflect pleasant memories o C. To encourage autonomy in the treatment plan o D. To gain insight into the disorder
A. To emphasize that the client is capable of consuming food without purging- The nurse is identifying the client's previous successful coping strategies. The nurse will utilize the data to develop interventions to help the client employ prior coping skills to replace maladaptive eating behaviors. This is cognitive-behavioral therapy
With anorexia nervosa and bulimia nervosa, do they eat, compensate, and what is their weight?
Anorexia - Eat: yes and no -Compensate: yes -Weight: low Bulimia - Eat: yes -Compensate: yes -Weight: normal or slightly over/under
A client is pacing the hall near the nurse's station, swearing loudly. An appropriate initial intervention for the nurse would be to address the client by name and say: A "Please quiet down." B "You seem upset. Would you like to tell me about it?" C "Hey, why are you so upset?" D "You need to go to your room to get control of yourself."
B "You seem upset. Would you like to tell me about it?" This response is the most therapeutic. You should never use the why when capable of avoiding it.
A nurse is caring for a client who has a new prescription for risperidone. Which of the following rating scales should the nurse complete prior to administering the first dose of risperidone? A Beck's Depression Inventory B Abnormal Involuntary Movement Scale C Hamilton Depression Scale D The Body Attitude Test
B Abnormal Involuntary Movement Scale (AIMS)- Risperidone, an antipsychotic, can cause tardive dyskinesia, involuntary movements that may include the tongue, lips, and face. The nurse should perform the AIMS assessment prior to initiating treatment with risperidone and then at regularly scheduled intervals thereafter
Conduct disorder may be a precursor to the diagnosis of which personality disorder? A Narcissistic personality disorder B Antisocial personality disorder C Histrionic personality disorder D Passive-aggressive personality disorder
B Antisocial personality disorder- Antisocial personality disorder is a pattern of socially irresponsible, exploitative, and guiltless behavior that reflects a disregard for the rights of others. Conduct disorder can be a precursor to the diagnosis of antisocial personality disorder. A diagnosis of antisocial personality disorder would not be assigned until a client is 18 years of age or older.
When assessing a client diagnosed with narcissistic personality disorder, the nurse expects to identify which characteristic behavior? Odd beliefs and magical thinking Grandiose sense of self-importance Pattern of intense and chaotic relationships Submissive and clinging behaviors
B Grandiose sense of self-importance. Clients diagnosed with narcissistic personality disorder have an exaggerated sense of self-worth. They are often grandiose and believe they have an inalienable right to receive special consideration.
A nurse in the emergency department is implementing a plan of care for an older adult client who is experiencing delirium tremens (Severe alcohol withdrawal symptoms such as shaking, confusion, and hallucinations). Which of the following actions should the nurse take first? A Administer clonidine B Lower the bed and raise the side rails C Obtain a medical history D Complete CIWA scale
B Lower the bed and raise the side rails- The greatest risk to the client is injury from a fall; therefore, the first action by the nurse is to raise the side rails of the bed. The nurse should obtain a medical history and CIWA scale after making sure the client is safe; therefore, this is not a priority action. The nurse should administer diazepam when the client is safe and after obtaining a CIWA; therefore, this is not a priority action
The client states "I just can't fall asleep". The nurse responds, "You are having difficulty falling asleep?" Why is the nurse using the restating technique? A The nurse wants the client to know they understand B The nurse is allowing the client to elaborate or clear up misunderstanding C The nurse is keeping the conversation going D The nurse wants to focus on one idea
B The nurse is allowing the client to elaborate or clear up misunderstanding- Establishes priority with nursing goals and interventions related to therapeutic interaction. Using the client's words or close to is restating. This technique allows the client to be able to elaborate or clear up any miscommunications with nursing. This also gives the feedback that their concerns are being heard
A nurse is reviewing the medical histories of four clients. Which of the following clients will be most likely to develop extrapyramidal symptoms from medication therapy? A A client with depression taking selective serotonin reuptake inhibitors B A client with schizoaffective disorder taking an atypical antipsychotic C A client with schizophrenia taking a first-generation antipsychotic D A client with anxiety disorder taking an anxiolytic medication
C A client with schizophrenia taking a first-generation antipsychotic- A client who has schizophrenia and is taking first generation antipsychotic medication can develop extrapyramidal manifestations, such as acute dystonia, Parkinsonism, akathisia, and tardive dyskinesia. First generation = typical antipsychotics = more potent = have more side effects
An adolescent diagnosed with ADHD is having difficulty maintaining concentration in the in-client milieu. Which nursing intervention would help improve the client's task performance? A Mandate that the client remain in their room until all homework is complete. B Remove privileges if homework is not completed within a 2-hour period. C Encourage dividing tasks into smaller, attainable steps and reward successful completion. D Seek a physician's order to discontinue the stimulant methylphenidate (Ritalin)
C Encourage dividing tasks into smaller, attainable steps and reward successful completion -A client with a short attention span can be overwhelmed with large tasks. Rewards for task completion are more successful than punishments for task completion failure. Positive reinforcements increase self-esteem and provide incentives for future positive behaviors.
The nurse working in an acute care psychiatric facility is working with clients that have personality disorders. The nurse knows that cluster A personality disorders (odd, eccentric) tend to exhibit what behaviors? A Dramatic B Dependency C Indifference to social situations D Splitting between healthcare providers
C Indifference to social situations- Cluster A trademarks are odd, eccentric and indifferent to social situations. These clients do not seek out interaction and when in social situations may not interact in an appropriate manner. They exhibit some magical thinking or paranoia and are not perceived by others positively.
In assessing a client diagnosed with borderline personality disorder, which characteristic would the nurse expect to observe? Predictability Controlled anger Little tolerance for being alone Stable and satisfactory relationships
C Little tolerance for being alone. Clients diagnosed with borderline personality disorder have little tolerance for being alone. They prefer a frantic search for companionship, no matter how unsatisfactory, rather than experiencing feelings of loneliness, emptiness, and boredom.
Consider this comment to three different nurses by a patient diagnosed with antisocial personality disorder, "Another nurse said you don't do your job right." Collectively, these interactions can be assessed as: A Insightful B Guilt-producing C Manipulative D Detached
C Manipulative- The patient is demonstrating manipulation with this statement. This behavior is a hallmark of the cluster B personality disorders. This is technically defined as "splitting".
· A nurse is attempting to differentiate between the symptoms of anorexia nervosa and the symptoms of bulimia. Which statement delineates the difference between these two disorders? o A. Clients diagnosed with anorexia nervosa have eroded tooth enamel, whereas clients diagnosed with bulimia nervosa do not. o B. Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo, whereas clients diagnosed with anorexia nervosa do not. o C. Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not. o D. Clients diagnosed with bulimia nervosa experience amenorrhea, whereas clients diagnosed with anorexia nervosa do not.
C. Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not.- Bulimic clients tend to have some nutrient absorption prior to their purging however, clients with anorexia do not intake the food and thus have a lack of nutrients to their bodies.
What are treatments/therapies for anorexia nervosa?
CBT: strives to eliminate the emotional components associated with unhealthy eating patterns by confronting irrational thinking patterns and associated feelings ○ Care for the client in a hospital setting ○ Consult with the provider and dietitian to develop a controlled rate of nutritional support during initial treatment ○ Monitor blood electrolytes and administer fluid replacement as prescribed. ○ Place the client on continuous cardiac monitoring, if needed ○ Monitor vital signs frequently ○ Family Therapy: ○ Psychopharmacology: no definitive improvement with medication § Fluoxetine (Prozac) • Can take weeks for a response • Avoid hazardous activities • Watch out for sexual dysfunction § Clomipramine (Anafranil) § Cyproheptadine (Pariactin) § Chlorpromazine (Thorazine) § Olanzapine (Zyprexa)
What are important points with Narcissistic personality disorder?
Cluster B Have an exaggerated sense of self-worth Lacks empathy Hypersensitive to the evaluation of others Very self-centered to advance any personal agenda regardless of the consequence Believes they have the right to receive special consideration Prevalence: 1 to 6 % Diagnosed more often in men than in women
A nurse is admitting a client who is in the manic phase of bipolar disorder. The nurse should plan to make which of the following room assignments for the client? A A seclusion room until the client's activity level becomes more subdued B A semi-private room with a roommate who has a similar diagnosis C A private room away from the nursing station D A private room in a quiet location that can easily be monitored
D A private room in a quiet location that can easily be monitored- A private room in a quiet location is ideal for a client with mania. The client may easily become overstimulated by the number of people and activities in a nursing care unit. A private room can be used for time-out during the day and to settle down to sleep at night.
A 28-year-old client with body dysmorphic disorder (BDD) tells the nurse that they plan to have a surgical procedure that will affect their appearance. The nurse understands that this plan is an effort to A Suppress intrusive thoughts B Deal with multiple physical complaints C Treat associated depression D Cure the imagined defect
D Cure the imagined defect- With BDD the client has a perceived defect, they will seek to alter this defect through means such as plastics procedures. These clients seek extreme measures to cure this defect that only they see.
Which assessment finding would the nurse expect to find in clients diagnosed with bulimia? They are below normal weight. They binge when they experience hunger. They will be highly motivated to seek help. They are within their normal weight range.
D They are within their normal weight range- Clients diagnosed with bulimia nervosa are able to maintain a normal weight by purging and bingeing.
A client diagnosed with borderline personality disorder is admitted to a psychiatric unit. Which behavior pattern would the nurse expect to observe? Social isolation Suspiciousness of others Bizarre speech patterns Generates conflict among the staff
D- Generates conflict among the staff. Clients diagnosed with borderline personality disorder, having little empathy toward others, are unable to accept both positive and negative feelings, and view others as all good or all bad. They tend to split staff, generating conflict.
A client is 5′8″ tall and weighs 105 pounds. The client has been taking laxatives daily and self-induces vomiting after eating. Which is the priority nursing diagnosis for this client? Ineffective denial Disturbed body image Low self-esteem Imbalanced nutrition, less than body requirements
D- Imbalanced nutrition, less than body requirements. This client is malnourished and underweight due to self-induced vomiting and laxative abuse. Nutritional status is compromised, and the problem must be prioritized to establish physiological integrity.
What are s/s with ADHD?
Highly distractible Unable to contain stimuli Motor activity is excessive Movements are random and impulsive
· The following are characteristics of which cluster B personality disorder: Arrogance, grandiosity, lack of empathy, and sensitive to criticism.
Narcissistic Personality Disorder- Narcissistic personality disorder is a cluster B personality disorder with characteristics such as arrogance, grandiosity, lack of empathy, and sensitive to criticism
Will you introduce food right away to severely malnourished clients?
No. Because of Refeeding Syndrome
What is separation anxiety disorder?
The essential feature of separation anxiety disorder is excessive anxiety concerning separation from those to whom the individual is attached. The anxiety exceeds that which is expected for the person's developmental level and interferes with social, academic, occupational, or other areas of functioning
What is PTSD?
o A reaction to an extreme trauma, which is likely to cause pervasive distress to almost anyone, such as natural or manmade disasters, combat, serious accidents, witnessing the violent death of others, being the victim of torture, abuse, terrorism, rape, or other crimes o Characteristic symptoms Re-experiencing the traumatic event Sustained high level of anxiety or arousal General numbing of responsiveness Intrusive recollections or nightmares- treat with prazosin Clients with PTSD will have fatigue from loss of sleep.
· A nurse is admitting a 14-year-old with conduct disorder. What would the nurse anticipate finding in this assessment? o A. Bullying of others o B. Vulnerable demeanor o C. Repetitive counting o D. Ritualistic activities
o A. Bullying of others- Conduct disorder involves bullying and mistreatment of others as well as illegal and elicit behavior. These children often engage in behavior that is coercive and criminal. These clients will escalate into adulthood and can be diagnosed later in life with cluster B personality disorders as they continue to take advantage of others.
· A nurse questions the order to begin nourishing an emaciated client slowly. The prescriber explains the reason behind this choice is: o A. Clients may die from being nourished too quickly o B. Introducing food slowly encourages client compliance o C. There is no medical justification for this o D. Introducing nourishment quickly causes client anxiety
o A. Clients may die from being nourished too quickly- Nourishing the client too quickly causes an electrolyte shift and can cause death.
· A nurse is admitting an older adult client who has a suspected cognitive disorder. Which of the following inventories should be included as part of the admission assessment? o A. Mental status examination (MSE) o B. Scale for Assessment of Negative Symptoms (SANS) o C. Abnormal Involuntary Movements Scale (AIMS) o D. Brief Patient Health Questionnaire (Brief PHQ)
o A. Mental status examination (MSE)- The use of an MSE assists in identifying deterioration in mental status and brain damage, which are findings associated with cognitive disorders. SANS- schizophrenia, AIMS-tardive dyskinesia, brief PHQ- depression.
· A nurse is planning care for a client who has a diagnosed anxiety disorder. Which of the following intervention should the nurse implement to promote occupational functioning? o A. Help the client to identify prior accomplishments o B. Assist the client in identifying triggers o C. Identify the client's spirituality o D. Encourage the client to identify positive self attributes
o B. Assist the client in identifying triggers- This client may want to use their spirituality in aiding with relaxation, but the identification of spirituality will not in itself reduce the anxiety. This client needs to be able to identify stressors. If the client can identify some things that cause stress this client can learn to function day to day.
· People living with bulimia nervosa tend to be: o A. Underweight o B. Average weight o C. Obese o D. Morbidly obese
o B. Average weight- People with bulimia tend to be average or slightly overweight
· A nurse is caring for a newly admitted client who has obsessive-compulsive disorder (OCD). Which of the following actions should the nurse take first? o A. Provide a structured schedule for the client o B. Identify stressors that precipitate rituals o C. Instruct the client on meditation o D. Discuss alternative coping strategies with the client
o B. Identify stressors that precipitate rituals- This is the priority intervention when taking the nursing process approach to client care. The other interventions should be carried out after stressors are identified. The schedule should not be set until the client's stressors are identified.
· Personality traits most likely to be documented regarding a patient demonstrating characteristics of an obsessive-compulsive personality disorder are: o A. Affable, generous o B. Perfectionist, inflexible o C. Dramatic speech, impulsive o D. Suspicious, holds grudges
o B. Perfectionist, inflexible- OCP patients typically like things in a very orderly fashion and are inflexible in their ritualistic behaviors. These clients believe that the problems that they encounter are not their fault, but the fault of others. These clients are not impulsive as they like to have things set up and planned out.
· A patient tells the nurse, "I don't like you, you look like my grandmother." This is an example of what concept? o A. Staff splitting o B. Transference o C. Manipulation D. Delusion
o B. Transference- The client is demonstrating negative transference. This client has negative thoughts toward the nurse.
What are s/s of Bulimia nervosa?
o Bulimia nervosa: excessive, insatiable appetite § Binging & Purging • An episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period (bingeing) • Episode is followed by inappropriate compensatory behaviors to rid the body of the excess calories (self-induced vomiting or the misuse of laxatives, diuretics, or enemas). § "Eat a lot then vomit" Fasting or excessive exercise may also occur. Most clients with bulimia are within a normal weight range, some slightly underweight, and some slightly overweight. Depression, anxiety, and substance abuse are not uncommon. Excessive vomiting and laxative or diuretic abuse may lead to problems with dehydration and electrolyte imbalances. - priority to perform ECG Russel's sign: lesions on the back of the hand from inducing vomiting
· A client taking phenelzine has a blood pressure of 210/119, a HR of 104 bpm, and diaphoresis. The nurse discovers the client has recently taken over the counter medication for allergies and a cold. The nurse recognizes this client is experiencing: o A. Hypertension o B. Neuroleptic Malignant Syndrome o C. Hypertensive crisis o D. Serotonin Syndrome
o C. Hypertensive crisis- Hypertensive crisis brought on by over the counter cold medication. Clients on MAOI should be counselled not to take any OTC medications prior to consulting their physician.
· Which of the following defense mechanisms describes the underlying cause of somatic symptom disorder? o A. Denial of depression o B. Suppression of grief o C. Repression of anxiety o D. Displacement of anger
o C. Repression of anxiety- This group of disorders is caused by avoidance and repression of feelings. The reason the client experiences symptoms is that they do not deal with their feelings and anxiety.
What does each of these assess- CIWA, AIMS, & COWS?
o CIWA: alcohol withdrawal symptoms o AIMS: EPS- severity of involuntary movements o COWS: opiates withdrawal
· A nurse is caring for a client who with an eating disorder. The nurse is demonstrating which of the following ethical concepts when they allow the client to refuse to drink a between meal protein and calorie supplement? o A. Fidelity o B. Beneficence o C. Veracity o D. Autonomy
o D. Autonomy- Autonomy respects the rights of clients to refuse medication or treatment. The nurse is allowing the client to make the decision not to participate in this treatment at this time.
· A client is newly diagnosed with obsessive-compulsive disorder and spends 45 minutes washing their hands and completing ritualistic tasks. Which nursing intervention would best address this client's problem? o A. Lock the room to discourage ritualistic behavior. o B. Report the behavior to the psychiatrist to obtain an order for medication dosage change. o C. Distract the client with other activities whenever ritual behaviors begin. o D. Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors.
o D. Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors. Discussing triggers will enable the client to address and deal with obsessions and compulsions. Distracting the client will increase the anxiety. Discuss the triggers to be able to assist the client in their therapeutic recovery.
· A nurse is teaching a male client who has a depressive disorder about escitalopram. Which of the following information should the nurse include in the teaching? o A. This medication may cause muscle rigidity temporarily o B. You will notice an improvement in mood within 2-3 days o C. A fever is a common side effect of this medication o D. This medication may cause an inability to orgasm
o D. This medication may cause an inability to orgasm- Escitalopram is an SSRI. SSRIs may cause sexual dysfunction, including anorgasmia, impotence, or decreased libido. Fever and muscle rigidity are medical emergencies with this medication, this medication will take 4-6 weeks to reach full effect.
What are important points and behaviors with antisocial personality disorder?
o Example: Ted Bundy and other psychopaths o Must be 18 and older, if 17 and younger would be a conduct disorder § Can always start as a conduct disorder in childhood and progress to antisocial in adulthood o A pattern of socially irresponsible, exploitative, and guiltless behavior that reflects a general disregard for the rights of others. Belligerent and argumentative Lacks remorse Unable to delay gratification Low frustration tolerance Inconsistent work or academic performance Failure to conform to societal norms Impulsive and reckless Inability to function as a responsible parent Inability to form lasting monogamous relationship Manipulative Behaviors These clients must have clear boundaries set
What does it mean to be a mandatory reporter?
o Healthcare workers are legally required to report any suspicions of child abuse even if evidence does not exist. If the healthcare staff has suspicion it is mandatory to report and social services will evaluate.
What are important education points with phenelzine?
o Phenelzine - MAOI § Do not take any cold meds over the counter § Avoid foods high in tyramine- hypertensive crisis (SAP >180)
· This is a potentially fatal complication that results in the introduction of fluids and carbohydrates for patients who are malnourished.
o Refeeding syndrome- Refeeding syndrome is a potentially fatal complication resulting from aggressive initiating of feedings that results in the introduction of fluids and carbohydrates for patients who are malnourished.
What are the types and prevalence of anorexia?
§ Anorexia: prolonged loss of appetite § Characterized by morbid fear of obesity § Types of anorexia nervosa • Restricting: individual drastically restricts food intake and does not binge or purge • Binge/purge: individual engages in binge eating or purging behaviors. § Across all ages and genders, the lifetime prevalence for an episode of anorexia nervosa is 2.4 to 4.3 percent. • Age at onset is usually early to late adolescence • Men account for 25 percent of those with anorexia bulimia and 26 percent of those with binge—eating disorders. • Common on female ballet dancers, athletes, models, wrestlers
What are symptoms of oppositional defiant disorder?
§ Not physically aggressive § Characterized by a persistent pattern of angry mood and defiant behavior that occurs more frequently than is usually observed in individuals of comparable age and developmental level and interferes with social, educational, or vocational activities § Typically begins by age 8 and usually no later than any early adolescence. § Prevalence: 2 to 16%
What is an example of treatment for PTSD?
§ Prolonged exposure therapy is a type of behavioral therapy similar to implosion therapy or flooding. It can be conducted in an imagined or real (in vivo) situation. In the imagined situation, the individual is exposed to repeated and prolonged mental recounting of the traumatic experience
What hereditary factors are involved in the development of separation anxiety disorder?
○ A child whose mother is diagnosed with an anxiety disorder has a greater risk of developing an anxiety disorder. Research indicates that there is a hereditary influence in the development of separation anxiety disorder. More children with relatives who manifest anxiety problems develop anxiety disorders than those without
What are the symptoms of anorexia nervosa?
○ Anorexia: morbid fear of obesity § Symptoms include: Gross distortion of body image, Preoccupation with food, Refusal to eat § Weight loss is excessive, with some individuals who present for health-care services weighing less than 85 percent of expected weight. § Other symptoms include: Hypothermia, Bradycardia, Hypotension, Edema, Lanugo, Metabolic changes § Feelings of anxiety and depression are common, and those feelings needs to be addressed. § Can progress to being extremely malnourished § Restricting or binge/purge by vomiting/laxatives § "Thinks they're fat but is obviously underweight" S/S: bone fractures, acrocyanosis (bluish color to hands and feet related to poor circulation), and amenorrhea CBT strives to eliminate the emotional components associated with unhealthy eating patterns by confronting irrational thinking patterns and associated feelings
What common psychiatric disorders are prevalent with ADHD?
○ Anxiety ○ Depression ○ Substance use disorders ○ Conduct disorder ○ Bipolar disorder
What is the purpose of an MSE?
○ Assess cognition and cognitive function
What are interventions for a client diagnosed with anxiety disorder?
○ Assist the client in identifying triggers ○ This client may want to use their spirituality in aiding with relaxation, but the identification of spirituality will not in itself reduce the anxiety. ○ This client needs to be able to identify stressors. ○ If the client can identify some things that cause stress this client can learn to function day to day.
Define autonomy, justice, fidelity, beneficence, nonmaleficence, & veracity?
○ Beneficence: The quality of doing good; can be described as charity ○ Autonomy: Independence. The client's right to make their own decisions. However, the client must accept the consequences of those decisions. The client must also respect the decision of others. ○ Justice: Fair and equal treatment for all ○ Fidelity: Loyalty and faithfulness to the client and to one's duty ○ Veracity: Honesty when dealing with a client
What are symptoms of autism spectrum disorder?
○ Characterized by a withdrawal of the child into the self and into a fantasy world of his or her own creation. ○ ASD is believed to be caused by abnormalities in brain structure and/or function, not poor parenting. ○ ASD occurs in approximately 6 per 1000 children and is about four times more likely to occur in boys. ○ Onset occurs in early childhood. ○ ASD often runs a chronic course. ○ Impairment in social interaction ○ Impairment in communication and imaginative activity ○ Restricted activities and interests ○ Repetitive actions are a common feature of autism spectrum disorder.
What are characteristics of obsessive-compulsive personality disorder?
○ Characterized by inflexibility about the way in which things must be done ○ Especially concerned with matters of organization and efficiency ○ Tend to be rigid and unbending (perfectionist) ○ Socially polite and formal ○ Rank-conscious ○ On the surface, appear to be very calm and controlled ○ Has an overwhelming need to prioritize control, perfection, and order
What is the main difference between conduct disorder and oppositional defiant disorder?
○ Conduct disorder § This disorder may involve physical aggression unlike oppositional defiant disorder § Younger version of antisocial personality disorder/psychopath Known as a persistent pattern of behavior in which the basic rights of others and major age-appropriate societal norms or rules are violated. ○ Oppositional Defiant Disorder § Not physically aggressive § Characterized by a persistent pattern of angry mood and defiant behavior that occurs more frequently than is usually observed in individuals of comparable age and developmental level and interferes with social, educational, or vocational activities
What are s/s and nursing interventions for a conduct disorder?
○ Conduct disorder § This disorder may involve physical aggression unlike oppositional defiant disorder § Younger version of antisocial personality disorder/psychopath § Known as a persistent pattern of behavior in which the basic rights of others and major age-appropriate societal norms or rules are violated. § Conduct disorder involves bullying and mistreatment of others as well as illegal and elicit behavior. These children often engage in behavior that is coercive and criminal. § These clients will escalate into adulthood and can be diagnosed later in life with cluster B personality disorders as they continue to take advantage of others (eg. Antisocial personality). § Childhood-onset conduct disorder is more severe than the adolescent-onset type § Nursing care of the client with a conduct disorder • Ensuring safety of client and others • Assisting in the development of socially appropriate behaviors in interactions with others • Encouraging client to accept responsibility for own behaviors • Promoting increased feelings of self-worth • Recognize escalating aggressive behaviors and intervene before violence occurs.
What child disorder will likely develop as antisocial personality disorder in adulthood?
○ Conduct disorder as a child § When they are identified in children and adolescents, the diagnosis is conduct disorder and symptoms are bullying, fighting, physical cruelty to animals, destruction of property, and theft, among other ○ Other disorders § ADHD • Likelihood of developing antisocial personality disorder is increased if the individual had attention-deficit/hyperactivity disorder and conduct disorder as a child. § Antisocial personality disorder in adulthood is highly associated with physical abuse and neglect, teasing, and lack of parental bonding in childhood. • Severe physical abuse in childhood is particularly correlated to violent offending, triggering the development of a pattern of reactive aggression that is persistent over one's lifetime. • Parental deprivation in the first 5 years of life
What are symptoms of amphetamine (stimulant) withdrawal?
○ Craving for the substance ○ Develop a few hours to a few days after cessationor reduction ○ Often referred to as "crashing" ○ Fatigue ○ Cramps ○ Depression ○ Headaches ○ Nightmares
What are some ways to create a therapeutic environment for a cognitively impaired client?
○ Create a safe environment for the patient. ○ Ensure that small items are removed from area where patient will be ambulating and that sharp items are out of reach. ○ Store items that the patient uses frequently within easy reach. ○ Pad side rails and headboard of the patient with history of seizures. Prevent physical aggression and acting out behaviors by learning to recognize signs that the patient is becoming agitated.
What are goals that can be established for clients with avoidant personality disorder?
○ Discuss angry feelings and situations that precipitate hostility. ○ The patient will not harm others. ○ Verbalize understanding of treatment setting rules and regulations and the consequences for violation. ○ Will not manipulate others for own desires ○ Verbalize personal responsibility for difficulties in interpersonal relationships ○ Cope more adaptively by delaying gratification of his or her desires and following rules and regulations of the treatment setting. ○ Demonstrate ability to interact with others without becoming defensive, rationalizing behaviors, or expressing grandiose ideas.
What is Schizotypal personality disorder?
○ Display odd and eccentric behavior but not to the level of schizophrenia. ○ Marked by symptoms that look more like schizophrenia than schizoid personality and show significant peculiarities in thinking, behavior, and appearance. ○ Aloof and isolated ○ Behave in a bland and apathetic manner ○ Often talk or gesture to themselves, as if "living in their own world. ○ Exhibits bizarre speech pattern ○ When under stress, may decompensate and demonstrate psychotic symptoms ○ Demonstrates bland, inappropriate affect ○ Symptoms include § Magical thinking § Ideas of reference § Illusions § Depersonalization § Withdrawal into self § Superstitiousness- belief in clairvoyance, telepathy, or "sixth sense;" and beliefs that "others can feel my feelings."
What are therapeutic responses for clients diagnosed with antisocial personality disorder?
○ Do not attempt to coax or convince the patient to do the "right thing." ○ Do not use the words "You should (or shouldn't) ..."; instead, use the words "You will be expected to...." ○ Patient must eventually internalize societal norms, beginning with a step-by-step, "either/or" approach on the unit (either you do [don't do] this, or this will occur). ○ Explanations must be concise, concrete, and clear, with little or no capacity for misinterpretation. ○ Provide positive feedback or reward for acceptable behaviors to enhance self-esteem and encourages repetition of desirable behaviors. ○ Maintain attitude of "It is not you, but your behavior, that is unacceptable." An attitude of acceptance promotes feelings of dignity and self-worth. Help the patient identify the true object of his or her hostility (e.g., "You seem to be upset with ...").
What are erotomanic delusions?
○ Erotomanic delusions: Individuals with erotomanic delusions falsely believe that someone, usually of a higher status, is in love with him or her.
What are some side effects and examples of SSRIs?
○ Example: § Sertraline § Escitalopram ● May cause sexual dysfunction ○ Wof: increased risk of suicide ○ Feeling agitated, shaky or anxious. ○ Feeling or being sick. ○ Indigestion. ○ Diarrhea or constipation. ○ Loss of appetite and weight loss. ○ Dizziness. ○ Blurred vision. ○ Dry mouth.
Who is likely to develop EPS from medications?
○ First generation = typical antipsychotics = more potent = have more side effects ○ A client who has schizophrenia and is taking first generation antipsychotic medication can develop extrapyramidal manifestations, such as acute dystonia, Parkinsonism, akathisia, and tardive dyskinesia.
What are grandiose delusions?
○ Grandiose delusions: exaggerated feeling of importance, power, knowledge, or identity. § The individual may believe that he or she has a special relationship with a famous person or even assume the identity of a famous person (believing that the actual person is an imposter). § Grandiose delusions of a religious nature may lead to assumption of the identity of a deity or religious leader (e.g., "I am Jesus Christ").
