NCLEX Mental Health

Tardive dyskinesia

A syndrome of involuntary movements that occur as a result of prolonged treatment with neuroleptic medications

Which initial nursing approach would the nurse take for a self-accusatory, guilt-ridden, delusional client?

Accepting the client's statements as real to the client

Which behavior is expected of members of Alcoholics Anonymous (AA)?

Acknowledging an inability to control the drinking

Intermediate Acting Benzodiazepines

Alprazolam Clonazepam Lorazepam

TCAs

Amitriptyline Nortriptyline Protriptyline

What are Benzodiazepines used for?

Anxiety

Personality Disorders: Histrionic

Attention Seeking Inappropriate Clothing

When working with the family of a child with attention-deficit/hyperactivity disorder, which priority assessment would the nurse complete first

Attitudes about the diagnosis

Defense Mechanism: Projection

Attributing one's own feelings, thoughts, behaviors, or motives to others "A partner who had an affair is convinced their partner is cheating"

Identification

Attributing to self or taking on the characteristics of another

Therapeutic Management for Anorexia

Body Temperature Heart Rate Electrolyte Imbalances

Defense Mechanism: Sublimation

Channeling negative emotions or socially unacceptable impulses into socially acceptable behavior "Deep cleaning the entire house after a breakup"

As a client addicted to cocaine withdraws from the drug, which behavior would the nurse observes

Depression

Long Acting Benzodiazepines

Diazepam

Psychophysiological insomnia

Difficulty attaining or maintaining sleep

Antihistamines

Diphenhydramine (Benadryl)

Which intervention would the nurse include in the plan of car for a client with posttraumatic stress disorder who verbalizes a desire to have control over personal feelings related to being the only survivor

Discuss life situations that the client is able to manage

A young female client has an argument with her boyfriend. Which defense mechanism is the client using when she complains that the hospital meals are always late and the food is terrible

Displacement

A client presents to the emergency department with bruises and a concussion. Which information would the nurse obtain to determine the client's risk for further injury

Frequency of abuse

For a client who has many self-inflicted nonlethal injuries over the preceding month, which level of suicidal behavior is demonstrated

Gestures

Which overwhelming feelings do children usually express if they have been sexually abused by a family member?

Guilt Anger Self-blame

Positive Schizophrenia Symptoms

Hallucinations Delusions Disorganized speech Bizarre behavior

First generation antipsychotics

Haloperidol

Which response would the nurse make to a depressed client who says, "I'm stupid and useless. Talk with the other people who are more important."

I want to talk with you because you are important to me

Despite the nurse's best efforts, a young client continuously complains about the nursing care. Which defense mechanism is the nurse by discussing stages of young adult development with a colleague

Intellectualization

MAOIs

Isocarboxazid Phenelzine

Which response is therapeutic for a client who says, "The world is filled with terrible people. Why couldn't one of them get HIV [human immunodeficiency virus] instead of me

It seems unfair that you should have this disease

Which intervention would the nurse implement for a client in alcohol detoxification who reports numbness and tingling in the feet and legs

Keeping the bed linens off the client's legs with a mechanical aid

Personality Disorders: Narcissistic

Lacks empathy Grandiose Thoughts Needs to be admired

Personality Disorders: Antisocial

Lacks empathy for others Manipulative Selfish

Mood Stabilizers

Lithium

What medication do we use for bipolar disorder?

Lithium (Mood stabilizers)

Negative Schizophrenia Symptoms

Low Emotional Range (Flat Affect) Low interest and drive in life Low inertia and initiative

Short acting Benzodiazepines

Midazolam

Which precipitating factors for depression would be common in the older adult without neurocognitive problems

Multiple losses Declines in health

Therapeutic Management for Bipolar Disorder

Provide high-calorie, finger food they can eat on the good Safe environment Medication: mood stabilizers

Second generation Antipsychotics

Quetiapine Olanzapine

Sublimation

Rechanneling unacceptable desires and drives into activities that are socially acceptable

Defense Mechanism: Displacement

Redirecting feelings to a safer, substitute object "When placed to sit in time-out, a child kicks and knocks over the chair"

Displacement

Reduces anxiety by transferring the emotions associated with an object or person to another emotioanlly safer object or person

Classes of Antidepressants

SSRIs TCAs MAOIs

Therapeutic management for Depression

Safe environment Assess risk for self-harm One to one observation Remove potentially harmful items

Therapeutic Management for Schizophrenia

Safe environment: Auditory hallucinations (Are they telling them to do something) Do not argue about the delusion or hallucination Set limits

Cognitive therapy

Seeks to find underlying self-defeating beliefs and replace them with more reality-based positive beliefs

Nursing Considerations for SSRIs

Serotonin Syndrome Suicide precautions important for 2-3 weeks

Therapeutic Management for PTSD

Sleeping Safe environment

Personality Disorders: Avoidant

Socially isolated Lacks support systems

Anxiety

The body's natural response to stress a feeling of fear, worry, and nervousness about what's to come

Depression

The feeling of severe despondency and dejection A state of low mood

Anosognosia

The inability to recognize one's illness

Intellectualization

The use of facts or other logical reasoning rather than feelings to deal with the emotional effect of a problem

Rationalization

The use of justification to make tolerable certain feelings, behaviors, and motives

What is Lorazepam?

benzodiazepine/antianxiety = treatment of anxiety disorders,

Lithium Therapeutic Levels

0.6-1.2

Schizophrenia

A long term mental disorder involving a breakdown in the relation between thought, emotion, and behavior.

Obsessive Compulsive Disorder

An anxiety disorder characterized by unwanted repetitive thoughts (obsession) and/ or actions (compulsions). Irritational obsessions and ritualized acts

Which common feature of mental illness is reflected when a client with severe mental illness informs the nurse that her coworkers are the ones with the real problems and states that she's always just had a short fuse

Anosognosia

Side effects the nurse would monitor for when administering a selective serotonin reuptake inhibitor (SSRI)?

Anxiety Nausea Sedation Restlessness Suicidal Ideation Increased energy level

Indications for Lorazepam

Anxiety Sedation Seizures

Substitution

Anxiety is reduced with a transfer of the emotions associated with an object or person to another, safer , object or person

Time for performing rituals has been allowed; however, the client is increasing the frequency and duration, and the rituals are now interfering with sleeping and eating. Which action will the nurse perform first

Assess for additional or new sources of stress and anxiety

Projection

Attempt to deal with unacceptable feelings by attributing them to another

Dissociation

Attempt to detach emotional involvement or the self from an interaction or the environment

Monoanime Oxidase Inhibitors (MAOIs) Nursing Considerations

Avoid foods that are high in tyramine (Aged cheeses, Wine, Pickled meats) Side effect: hypertensive crisis

Sublimation

Channeling of unacceptable thoughts or feelings into acceptable activity

When an uncoordinated person who wishes to be athletic excels in a music career, which defense mechanism could this be related to

Compensation

Psychomotor agitation

Constant motion such as pacing, hand wringing, nail biting, and other types of energetic body movements

Bulimia Signs & Symptoms

Consuming food in binge-episodes Purging food after eating Shame, anxiety, or guilt about eating Fixation with body weight/shape Use of medications like diuretics, laxatives Excessive exercise

Anorexia Signs & Symptoms

Distorted body Image Low Self-Esteem Restrict or avoid food & deny hunger Extreme fear of gaining weight Excessive, compulsive exercise Frequent dieting & obsession with calories Not maintaining a healthy weight Rituals around eating

Personality traits of borderline personality disorder

Engaging Manipulative

Assessment Findings of Bulimia

Esophageal Varices Tooth enamel break down Russell's Sign

Generalized Anxiety Disorder (GAD) Symptoms

Excessive worry Fatigue Irritability Muscle aches/soreness Restlessness Impaired concentration Difficulty Sleeping

Signs of Bipolar Disorder: Mania

Extremely high energy Grandiose levels of self-esteem Loud, rapid speech Very little need for sleep Engaging in risk behaviors (such as unprotected sex)

Depression Signs & Symptoms

Feeling of worthlessness, anger, inappropriate guilt & hopelessness Withdrawal from friends & family Poor concentration Changes in appetite Sleep problems Decreased energy Thoughts of death/suicide Drug/alcohol abuse Unintentional weight loss

Which short-term nursing objective would be essential for a client with agoraphobia who is admitted to the psychiatric unit of a local hospital?

Feeling safe in the unit

Signs of Bipolar Disorder: Depression

Feelings of lethargy (physically and mentally) Sense of personal worthlessness Eating too much or too little Overwhelming sadness Suicidal Ideations

If a client has overdosed on Lorazepam, what is the antidote?

Flumazenil

SSRIs

Fluoxetine Sertraline Escitalopram

Defense Mechanism: Denial

Ignoring or refusing to acknowledge unacceptable realities "Planning a vacation in a year after receiving terminal diagnosis"

Nursing Considerations for Haloperidol

Monitor for extrapyramidal side effects Tardive dyskinesia Neuroleptic malignant syndrome Can prolong the QT interval

Which intervention would the nurse use for a client taking quetiapine for acute psychosis who develops lead-pipe rigidity, trismus, and tachycardia

Perianal care Fall precautions Use of a cooling blanket Monitoring of intake and output Discontinuation of the medication Administration of bromocriptine as prescribed

Compensation

Replacing a weak area or trait with a desirable one

Defense Mechanism: Regression

Reverting to behaviors from an earlier stage of development in response to extreme stress "A teenager experiences episodes of wetting the bed after being bullied"

Which action would the nurse take for an adolescent client with anorexia nervosa

Reward weight gain by increasing privileges

Personality Disorders: Borderline

Risk for self harm Depression Poor Self-Image Unstable Relationships

The grieving spouse of a client who has just died says, "We should have spent more time together. I always felt that my work came first. Which interpretation would the nurse make

Spouse is expressing feelings of guilt over lost opportunities

Personality Disorders: Dependent

Struggles to make decisions Relies on others

Which intervention would the nurse use in the care of a drug-dependent mother and infant?

Support the mother's positive responses toward her infant

Tricyclic Antidepressant Side Effects

TCAs Tachycardia Cardiac effects Anticholinergic effects Sedation/Sexual dysfunction

Which action would the nurse take when a male client with exhibitionistic disorder exposes himself to a nurse and begins to masturbate in the dayroom?

Tell the client that the behavior is unacceptable and to stop

Which benefit accompanies mild apprehension?

There is an increased alertness

Which statement by an 8-year-old girl, who was just admitted to the hospital, needs to be explored

Those boys are so cute. I hope their room is next to mine

Which action would the nurse take next after successfully performing an abdominal thrust maneuver on an older adult client

Touch the client's hand while providing verbal support

Electroconvulsive Therapy

Treatment for severe depression/bipolar/schizophrenia

True or False: Informed consent is required for Electroconvulsive Therapy

True. Sedation is required for this procedure

Identification

Trying to unconsciously imitate the behavior of another who is considered important in an attempt to incorporate the relevant aspects of this individual into the self

Defense Mechanism: Repression

Unconscious suppression of unwanted thoughts or information from consciousness "After being mugged, a person is unable to recall the experience"