N222 MH Practice Test 2 Notes

Zolpidem

-is a sedative causes the following: -daytime drowsiness -sedation

A nurse is caring for an older PT whose provider will dishcarge him to an extended-care nursing facility the following morning. The PT asks the nurse whyhe has to go to "that place." What should the nurse say?

"Did your doctor or anyone else talk to you about going to the nursing home?" It's important to identify what the PT thinnks he has heard about his discharge. Clarification of oinformation can proceed after this.

A nurse in a MH facility is caring for a client who is upset about the loss of priveleges due to repetitive negative behavior. What statment demonstrates the effective use of assertive communication?

"I understand that you're angry. However, I followed the approrpriate protocol." "I" statmenets are assertive by allowing the nurse to state her position clearly and firmly but in a non-aggressive manner

Conversion disorder other

involuntary loss of a sensory functions such as hearing or vision

A charge nurse overhears another nurse talking with a client who has schizophrenia. Suddenly the client yells, "I am the devil! I am God! Open the gate for me!" What reply by the nurse requires intervention?

"There is no gate for me to open." This reply can be viewed as argumentative by the client and is notherapeutic for communicating with a CT who is experiencing a delusion.

Non assertive communication example

"You" statements are aggressive, rather than assertive, and are nontherapeutic "Why" questions are likely to make the PT feel defensive and are nontherapeutic

PTSD Expected findings

#1 - increasing anger and irritability -insomnia -detachment & avoidance of relationships avoidance of discussing the event

Chemical intervention for overdose of phencyclidine (PCP)

-Administer ammonium chloride This medication acidifies the urine and promotes excretionof PCP. In addition, the nurse should monitor the PT's respiratory status and be prepared to assist with intubation and mechanical ventilation.

Should a nurse compliment a PT who has anorexia nervosa? Why or why not?

-Don't compliment body -Comments about body image should be avoided because they are often distorted by a PT wit and eating disorder For example, the PT may take this comment to mean that she looks fat. She may renew efforts at weight-loss attemepts. Reinforcement should focus on positive efforts to eat planned meals and participate in other activities of the care plan. PT privelges are often linked to weight gain and adherence to the plan of care.

Bipolar disorder - appropriate coping strategies

-I get 7 hrs of sleep at night by skipping afternoon naps -I think about being on my favorite beach vacation when Iget anxious -I tense and release my muscles, starting with my feet -I see the glass as half-full when it starts looking empty

Nursing actions for school-age child who has a history of conduct disorder

-Introduce some humor during interactions with the child is correct -Explain to the child the need to pick up crayons when thrown on the floor -Shorten a reading activity when the child appears frustrated -Redirect with physical activities when the child's disruptive behavior begins

A nurse is developing a plan of care for a newly admitted PT who has schizophrenia and experiences frequent hallucinations and paranoid delusions. Which of the following actions should the nurse plan to take?

-Limit the number of questions asked during assessments -Why? PT will have difficulty concentrating on information & answering assessment questions -The nurse should plan to use other sources of PT information, such as medical records, familymembers, or reports from other interprofessional sources

Nurse is interviewing a PT during admission to an alcohol treatment center. Which of the following approaches should the nurse take?

-Maintain a nonjudgmental attitude, because it shows positive regard for the PT as a person -Nontherapeutic - offer sympathetic support (nurse should show empathy instead and demonstrate that she objectively understands the client's feelings)

Conversion disorder

-involves unconscious expression of mental stress into physical symptoms -one-fourth of PT's will experience a realpse episode, usually within a year after the inital occurrence -provider should rule out any physical cause as the first part of treating the PT -PT's are often very upset over loss of functioning

A nurse is caring for a client who lost all his possessions in a house fire and states, "I have no idea what I'm going to do. I can't think right now." What action should the nurse take?

-Maintain eye contact with the PT and summarize the PT's feelings This demonstrates therapeutic communication. During the initial interview, it's important for the nurse to provide an atmosphere of support and safety. If a person believes that someone is genuinely concerned, then he may believe that helps is available. Maintaining eye contact demonstrates support, empathy, and advocacy.

Should PT's with anorexia nervosa be allowed to eat at any time? Why or why not?

-No The therapeutic environment for PT's who have eating disorders usually consists of designated meal times and adherence to the selected menu. PT's will contract with staff for rewards based upon regular attendance at meals and the amount of the meal consumed. The PT should be closely monitored after meals to make sure that vomiting doesn't occur.

Should PT's with anorexia nervosa be given privacy when friends visit? Why or why not?

-No Until the PT earns this privelege, she will need to be monitored. Friends may bring laxatives, diuretics, or other weight-reduction remeidies. As the PT participataes in the plan of care, priveleges will be increased to lead to the transition to the home setting.

Acute anxiety crisis intervention - What is the highest priority?

-Protect the PT from injury The greatest risk to the PT is harm to himself through suicide or other injury when not in control of his actions, or to others while experiencing panic-leel anxiety. Therefore, the priority is to protect the PT from injury.

A nurse is planning care for a group clients on a mental health unit. Which of the following actions should the nurse plan to take to crate a therapeutic environment?

-Provide continuity of care by assigning the same staff Consistent interactions are importan in any care ssetting, especially in mental healt. This will help the PT's establish trust and a sens of security.

A nurse in a MH clinic is attempting to develop a therapeutic relationship with a PT. What action should the nurse take?

-Set limits for the relationship The nurse should set professional boundaries with the PT through limit setting regarding when and where to meet, roles of the relationship, personal space, and other parameters. Nurse should not: -Engage in friendly interactions with the PT Engaging in a friendly relationship meets the needs of both parties in a social relationship. However, in a therapeutic nurse-client relationship, the goal is to meet CT needs through the use of problem-solving and therapeutic communciation. A social relationship encourages blurring of boundaries and isn't part of the professional relationship. -Promote the use of transference by the CT -Instruct the CT on how he should behave

What nurse should include in teaching to a PT scheduled for electroconvulsive therapy (ECT)

-Some PT's report memory loss for several weeks following the procedure -The nures should inform the PT that this effect usually resolves, but could possibly be permanent

What rating scale should the nurse complete prior to administering the first dose of risperidone?

-The Abnormal Involuntary Movement Scale Risperidone, an antipsychotic, and 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 schedule intervals thereafter.

Should PT's with anorexia nervosa have regularly scheduled weigh-in times? Why or why not?

-Yes Treatment for anorexia nervosa is structured. The PT is weighted at regularly scheduled times. The goal is to achieve 90% of ideal body weight.

Delirium is characterized by

-a change in cognition that occurs over a short period of time -is a transient disorder

Depersonalization

-a loss of personal identity -PT might feel that parts of her body belong to someone else or are different in some way

Additional interventions for a PT with serotonin syndrome

-administering an anticonvulsant -padding side rails to prevent injury from delirium or sizure activity -applying a cooling blanket

Histrionic personality disorder

-always desires to be the center of attention -has shallow expression of emotions -demonstrates self-dramatization

Buproprion Info

-avoid alcohol and CNS depressants due to risk of seizure -takes 2 to 4 weeks for therapeutic effects causes dry mouth -used to counteract sexual dysfunction in PT's taking SSRIs -used for smoking cessation

When does postpartum blues begin? and how long does it usually last?

-begins 2 to 5 days after childbirth -lasts no more than 2 weeks

Paranoid personality disorder

-believes without evidence that others are deceiving him -worries constantly about trusting those that are close to him -persistently holds onto grudges -finds hidden demeaning meanings in benign remarks

Buproprion S/S

-can cause tachycardia -suppresses appetite -urinary retention

Olanzapine

-can lead to post injection delirium/sedation syndrome -nurse should monitor the PT for a minimum of 3 hrs after the injection -is injected deep into the gluteal muscle only

Risk for suicide in an adolescent PT

-death of a parent at a young age -recent or impending move -low parental expectations -sudden decline in school performance

Anorexia nervosa expected findings

-decreased gastric motility & constipation -bradycardia & muscle wwasting -hypotension

Contraindications for restraints

-drug overdose recovery -severe suicidal tendencies -dementia -not being able to tolerate decreased stimulation -don't use restraints for these due to the risk of injury

Foods to avoid with MAOI'S - tyramine

-hard cheeses and meats -salami -air dried sausage -smoked or pickled fish -avocados -soybean paste

Narcissistic personality disorder

-has a grandiose sense of self-importance -lacks empathy -has a sense of entitlement

Primary suicide intervention examples

-identifying PT's at risk for suicide

Risperidone additional S/S

-orthostatic hypotension -increases the risk of heat stroke Avoid becoming overhated while takin this medication Teach PT to avoid hot baths, hot tubs, hot showers & prolonged time outside in hot weather -muscle twitching a serious side effect that should be reported to the provider

Tertiary suicide intervention examples

-provide counseling to a family following the suicide of a client Following the suidide of a PT, family and friends are at risk for suicidde and can be helped by therapeutic communciation. They may require referral for grief counseling or other supportive measures.

For postpartum psychosis

-psychotic behavior is a common finding -psychosis doesn't occur with postpartum depression

Secondary suicide intervention examples

-recognizing the leatlity of the suicide plan -providing a safe environment to prevent the PT from committing suicide

ChlorpromazineS/S

-respiratory depression -dyspnea -laryngospasm -take antacids 2 hr before or after chlropromazine -may cause weight gain over time (not necessary to weigh PT daily) -doesn't increase a PT's risk of bleeding

Atomoxetine

-risk of weight loss (increase caloric intake) -insomnia (admin dose in the morning)

PT is experiencing a manic episode. Other PT's begin to complain about her disruptive behavior on the unit. What should the nurse do?

-set limit on the PT's behavior and be consistent in approach -communicate acceptable behavior to the PT -be consistent with consequences when the behavior plan is not followed

What are the most common S/S of postpartum depresion

-trouble sleeping -loss of appetite -loss of libido -fear of not being able to adequatel care for the baby

Wernicke-Koraskoff syndrome

-type of secondary dementia due to thiamine difeciency and is commonly associated with alcohol use disorder -results in confusion and memory loss -treated with thiamine replacement therapy -opiates are not associated with Wernicke-Korsakoff syndrome

Avoidant personality disorder

-views himself as inferior to others -worries constatntly about being criticized -does not fully engage in new interpersonal realtionships

Risperidone S/S

-weight gain

Olanzapine S/S

-weight gain -fatigue -sedation -drowsiness

ECT treatment regimen

2 or 3 times a week for a total of 6 to 12 weeks

Trazadone

may cause suicidal ideation in children and adolescents can increase appetite and weight gain (monitor child's weight weekly) takes 2 to 3 weeks for therapeutic effects to occur can cause sleepiness, take at bedtime

Additional appropriate responses by a nurse for PT with schizophrenia

Appropriate responses "It sounds frightening to feel like both God and the devel at the same time." "I don't understand. Can you tell me what that means?" "Are you saying that you are both good and bad?"

St. John's Wort S/S

vivd dreams due to the CNS effects

Plan of care for PT with dependent personality disorder

Give positive feedbak when PT is assertive with staff or other PT's This type of PT has great difficulty demonstrating assertive behavior and commonly relies on others to make decisions. The nurse should encourage the PT to be more assertive and independent.

Who is postpartum depression more likely to occur in

women who have a history of depression are at a higher risk of developing this condition

Bipolar disorder - inappropriate coping strategies

I exercise aerobically three times a day for 30 minutes at a time. Physical exercise helps the PT manage stress levels. Inorder to relieve stress it is recommended that adulsts exercise 20 minutes, 3 to 4 times weekly; however, this PT is exercising aerobically for over 600 minutes weekly. Excessive exercising may be an indication oa mania or hypomania and is not effective.

A nurse is creating a plan of care for a client who is experiencing mania. Which of the following interventions should the nurse include in the plan?

Offer finger foods to the PT every 2 hr. A PT who is having a manic episode has increased caloric needs due to constant physical activity but will be unable to sit down long enough for meals. The PT can eat finger foods while remaining active. Maintain an evironment with low stimuli. An environment with low stimuli prevents escalation of the PT's anxiety. Monitor vital signs every 1 to 2 hr through the

Bipolar disorder - what are findings that indicate the PT is at risk for suicide

PT becomes hostile, aggressive and impulsive

During ECT

PT will receive an electrical current, usually less than 1 second, to the brain that produces a tonic-clonic seizure lasting 30 to 60 seconds

A nurse is caring for a client who is exhibiting severe manifestations of serotonin syndrome. Which is the PRIORITY nursing intervention?

Preparing for artificial ventilation Delirium, sever vital sign changes & apnea may be present. Preparing for artificial intervention when taking the airway, breathing, circulation approach to PT care.

Community mental health intervention examples

Primary interventions -day care center Secondary interventions -crisis cennter (has the goal of early detection & treatment of mental health disorders) Tertiary interventions -outpatient rehabilatation center -community recreational center

Anurse in a mental healt facility is ineteracting with a PT who is angry and becoming increasingly aggressive. Which of the following actions should the nurse take?

Use clarification to determien wha the PT is feeling The nurse should do this to ensure the PT knows his feelings are heard and understood. Clarificaition can make the PT feel less vulnerable and aenable the client to channel agnger in a less threatening manner.

When can postpartum depression begin?

a few eeks to months after childbirth

Succinylcholine

a muscle paralyzing agent that decreases muscle distress prevent fractures during ECT

Atropine for Electroconvulsive Therapy (ECT)

administered prior to ECT to: - reduce secretions - protect agains vagal stimulation (bradycardia) during the procedure

Illness anxiety disorder

constant worry about the presence of a serious illness even though medical tests don't support this concern

Bulimia nervosa expected findings

dental erosion due to vomiting

Agranulocytosis symptoms

fever sore throat mouth sores fatigue

During recovery phase of ECT

orient the PT frequently due to confusion and short term memory loss that usually follows ECT continue to monitor the PT's vital signs, mental status and memory -PT and their family should undrstand that short term memory loss, confusion and diorientation can occur immediately following the procedure and can persist for a few weeks

Harming the infant is a manifestation of what

postpartum psychosis

Obsessions are

recurrent, persistent, and impulsive thoughts that increase anxiety

Priority nursing action for PT with acute moderate anxiety

remain with the client

Compulsions are

repetitive behaviros performed in an attempt to decrease anxiety

Delirium results from

secondary physiological conditions such as: -infection -surgery -prolonged hospitalization -hypoxia -fever -medication

Methohexiatal sodium for ECT

short acting barbiturate to induce sleep

The risk of panic-level anxiety is a risk factor for

suicide