NUR 326 psychiatric meds, NUR326: MH/Psych E1 BP

What parts of the body should the nurse assess for bruises in the preschoolers to adolescence population?

Abdomen, back, or buttocks. -Bruising is common on arms and legs in these age groups.

Which tool is a standardized screening technique used to monitor involuntary movements and tradeoff dyskinesia in clients who take antipsychotic medication?

Abnormal Involuntary Movement Scale (AIMS)

In this stage, grieving people are unable or unwilling to accept that the loss has taken (or will shortly take) place. It can feel as though they are experiencing a bad dream, that the loss is unreal, and they are waiting to "wake up" as though from a dream, expecting that things will be normal.

Denial

An example would be looking at their foot but would not recognize that it is not part of their body.

Depersonalization

Diagnosed overwhelming sadness and despair that one feels drained of energy. They may feel so sad and empty that he or she becomes incapacitated by a loss of the will to live, and suicidal thoughts may prevail.

Depression

What is the #1 disabling illness in the world?

Depression

Nursing considerations for someone taking an antipsychotic that needs to watch out for agranulocytosis.

Advise client to observe for indications of infection, such as fever and sore throat. If these are present, obtain a CBC.

The observable response a person has to his or her own feelings

Affect

Name 2 foods to avoid when taking an MAOI

Aged cheese Red wine Beer Aged beef and chicken Liver Yeast Yogurt Soy sauce Chocolate Banans

What are 2 S/S of opiate withdrawal?

Agitation Anxiety Muscle aches Increase tearing/runny nose Sweating Nausea/vomiting Abdominal cramping/diarrhea Dilated pupils Goose flesh Insomnia

An extrapyramidal adverse effect characterized by the client's report of a sense of inner restlessness and by observable behaviors such as pacing, rocking forward and backward in a chair, and constant foot tapping.

Akathisia

____ is a normal part of mourning and should NOT be confused with a mental health disorder.

Depression

Trouble expressing yourself, usually through their emotional state

Alexithymia

Poverty of speech, reduction in the amount of speech. Negative symptom of psychosis and schizophrenia.

Alogia

Perception that the environment has changes (ex. the client believes that objects in her environment are shrinking.)

Derealization

-zepam

Antianxiety medications

What are 2 S/S of lithium toxicity?

Diarrhea Vomiting Drowsiness Muscle weakness Lack of coordination Hand tremor Muscle twitching Slurred speech Uncontrollable eye movement Confusion

Name 2 S/S of ETOH or Benzo withdrawal

Anxiety/agitation Restlessness Altered LOC Headache Insomnia Elevated VS Diaphoresis Seizure Nausea/vomiting

Lack of feelings, emotions, interests, or concern.

Apathy

Lack of interest, enthusiasm, or concern. A "normal" expression of grief.

Apathy

Forgetting how to use an everyday item

Apraxia

What is 1 medication used to treat ETOH withdrawal?

Diazepam (valium) Lorazepam (ativan) Cloridiazepoxide (librium)

Inferring that personal factors are the cause of an event or behavior

Attribution

Responding in a robot-like manner

Automatic obedience

What teaching must the nurse do with a patient taking antabuse?

Avoid anything with ETOH

Lack of motivation

Avolition

A nurse asks an older adult client, "Did you have any visitors yesterday?" The client responds, "Yes, several members of my church choir came to see me." The nurse knows that only the clients daughter visited the day before. Which of the following cognitive impairments is the client demonstrating? a. Perseveration b. Confabulation c. Apraxia d. Agnosia

B

A nurse is caring for a client on an acute mental health unit. The client reports hearing voices that are telling her to "kill your doctor." Which of the following actions should the nurse take first? a. Use therapeutic communication to discuss the hallucination with the client. b. Initiate one-to-one observation of the client. c. Focus the client on reality. d. Notify the provider of the client's statement.

B

A nurse is caring for a client who has bipolar disorder. The client states," I am very rich, and I feel I must give my money to you." Which of the following responses should the nurse make? a. "Why do you think you feel the need to give money away?" b. "I am here to provide care and cannot accept this from you." c. "I can request that your case manager discuss appropriate charity options with you." d. "You should know that giving away you money is inappropriate."

B

A nurse is caring for a client who has schizoaffective disorder. Which of the following statements indicates the client is experiencing depersonalization? a. "I am a superhero and am immortal." b. "I am no one, and everyone is me." c. "I feel monsters pinching e all over." d. "I know that you are stealing my thoughts."

B

A patient coming to the health clinic for a blood pressure check reports to the nurse that she just does not have the energy to go out much in winter but looks forward to gardening in summer. The nurse realizes that this patient is describing a major symptom of what condition? a. Anxiety b. Seasonal affective disorder c. Medication side effects d. Antisocial personality

B (Decreased exposure to sunlight in winter months can reduce the production of serotonin in the brain, leading to a type of depression termed seasonal affective disorder; this tends to resolve with the longer days and increased exposure to sun of spring and summer. There are not enough data to identify anxiety or signs linked to medication, which also tend to not resolve with seasons. Antisocial traits include isolation but also include behaviors of manipulation and lack of remorse in interpersonal relationships.)

When a colleague committed suicide, the nurse stated "I do not understand why she would take her own life." This is an expression of a. anger. b. denial. c. confusion. d. sympathy.

B (Denial and the minimization of suicidal ideation or gestures is a defense against experiencing the feelings aroused by a suicidal person. Denial can be seen in such statements as "I cannot understand why anyone would want to take his own life.")

A new psychiatric technician mentions to the nurse, "Depression seems to be a disease of old people. All the depressed clients on the unit are older than 60 years." The reply by the nurse that clarifies the prevalence of this disease is a. "That is a good observation. Depression does mostly strike people older than 50 years." b. "Depression is seen in people of all ages, from childhood to old age." c. "Depression is most often seen among the middle adult age group." d. "The age of onset for most depressive episodes is given as 18 years."

B (Depression can occur at any age. Children, adolescents, adults, and the elderly may all experience depression.)

What statement about the comorbidity of depression is accurate? a. Depression most often exists in an individual as a single entity. b. Depression is commonly seen in individuals with medical disorders. c. Substance abuse and depression are seldom seen as comorbid disorders. d. Depression may coexist with other disorders but is rarely seen with schizophrenia.

B (Depression commonly accompanies medical disorders. The other options are false statements.)

Which is the greatest protective factor against the risk of suicide? a. One or more previous suicide attempts b. A sense of responsibility to family, including spouse and children c. Fear of dying d. A cultural belief that suicide is a shameful resolution for a dilemma

B (Having family responsibilities makes a client less likely to commit suicide. Hopelessness is the greatest risk factor.)

Most commonly inferred from speech, defined by derailment, loose associations, tangentially, and incoherence

Disorganized thinking

Which of the following is true of the relationship between bipolar disorder and suicide? a. Patients need to be monitored only in the depressed phase because this is when suicides occur. b. Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide. c. Patients with bipolar disorder are not considered high risk for suicide. d. As long as patients with bipolar disorder adhere to their medication regimen, there is little risk for suicide.

B (Mortality rates for bipolar disorder are severe because 25% to 60% of individuals with bipolar disorder will make a suicide attempt at least once in their lifetime, and nearly 20% of all deaths among this population are from suicide. Suicides occur in both the depressed and the manic phase. Bipolar patients are always considered high risk for suicide because of impulsivity while in the manic phase and hopelessness when in the depressed phase. Although staying on medications may decrease risk, there is no evidence to suggest that only patients who stop medications commit suicide.)

An outcome for a manic client during the acute phase that would indicate that the treatment plan was successful would be that the client a. reports racing thoughts. b. is free of injury. c. is highly distractible. d. ignores food and fluid.

B (Risk for injury is a diagnosis of high priority for manic clients because of their hyperactivity. Lack of injury is a highly desirable outcome.)

A patient who is at a health clinic with complaints of a sore throat is exhibiting signs of depression. The nurse administers a basic screening for depression. What level of prevention is the nurse performing? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Modified prevention

B (Secondary prevention is aimed at early detection of problems, in this case, the identification of depression for early intervention. Primary prevention for mood disorders focuses on stress reduction and societal issues such as reducing poverty and racism. Tertiary prevention aims to reduce disability from a diagnosed condition; for mood disorders, this includes prevention of relapse and protection from harm. Modified prevention is not a recognized level of prevention, although prevention interventions may need to be adapted to meet specific individual situations.)

The risk of experiencing serotonin syndrome when SSRI's are given with monoamine oxidase inhibitors such as phenelzine (Nardil). Serotonin syndrome is best characterized in which of the following? A. Hypotension and urinary retention. B. Muscle rigidity and high fever. C. A productive cough and vomiting. D. Tea-colored urine and constipation.

B (Serotonin syndrome symptoms include high body temperature, agitation, muscle rigidity, tremor, sweating, dilated pupils, and diarrhea.)

The nursing diagnosis Imbalanced nutrition: less than body requirements has been identified for a client diagnosed with severe depression. The most reliable evaluation of outcomes will be based on the client's a. energy level. b. weekly weights. c. observed eating patterns. d. statement of appetite.

B (The client's body weight is the most reliable and objective evaluation of success in treating this nursing diagnosis.)

A nurse is caring for a client who states, "I plan to commit suicide." Which of the following assessments should the nurse identify as the priority? a. Client's educational and economic background b. Lethality of the method and availability of means c. Quality of the clients social support d. Client's insight into the reasons for the decision

B (The greatest risk to the client is self-harm as a result of carrying out a suicide plan. The priority assessment is to determine how lethal the method is, how available the method is, and how detailed the plan is.)

A nurse is caring for a client who has a new diagnosis of colon cancer. Shortly after the client receives the diagnosis, the nurse entered the client's room and the client begins yelling, "I have received terrible care here and no one cares about me." The nurse should recognize that the client is demonstrating which of the following defense mechanisms? a. Denial b. Displacement c. Reaction formation d. Projection

B (The nurse should identify displacement as the redirection of thoughts, feelings, and impulses from an object that causes to anxiety to a safer, more acceptable one. In this scenario, the client is directing his anxiety about the diagnosis to the staff that is providing care.)

When a hyperactive manic client expresses the intent to strike another client, the initial nursing intervention would be to a. question the client's motive. b. set verbal limits. c. initiate physical confrontation. d. prepare the client for seclusion.

B (Verbal limit setting should always precede more restrictive measures.)

A nurse is preparing to assess an infant who has shaken baby syndrome. Which of the following is an expected finding? (Select all that apply.) a. Sunken fontanels b. Respiratory distress c. Retinal hemorrhage d. Altered level of consciousness e. Increase in head circumference

B C D E

A nurse is assessing a client who is currently taking perphenazine. Which of the following findings should the nurse identify as an extrapyramidal symptoms (EPS)? (Select all that apply.) a. Decreased level of consciousness b. Drooling c. Involuntary arm movements d. Urinary retention e. Continual pacing

B C E

A nurse is discussing relapse prevention with a client who has bipolar disorder. Which of the following information should the nurse include in the teaching? (Select all that apply.) a. Use caffeine in moderation to prevent relapse. b. Difficulty sleeping can indicate a relapse. c. Begin taking your medications as soon as a relapse begins. d. Participating in psychotherapy can help prevent a relapse. e. Anhedonia is a clinical manifestation of a depressive relapse.

B D E

In this stage, people beg their "higher power" to undo the loss, saying things along the lines of, "I'll change if you bring her (or him) back to me". This phase usually involves promises of better behavior or significant life changes which will be made in exchange for the reversal of the loss.

Bargaining

Any observable, recordable, and measurable act, movement, or response.

Behavior

There are many theories as to why people commit interpersonal violence later in life. One theory emphasizes that it can be learned behavior that causes someone to commit interpersonal violence later in life. Which theory does this definition represent?

Behavioral theory

Your patient is exhibiting extrapyramidal side effects of their antipsychotic medication. What antiparkinsonian agent can you administer to this patient to reverse the side effects of this antipsychotic?

Benztropine

The complex process during the period of grief and mourning. During this time, people often experience fluctuating thoughts that occur in intense waves. We know from our own experience that significant losses are never forgotten. As time goes on, the painful feelings become less intense and more manageable.

Bereavement

There are many theories as to why people commit interpersonal violence later in life. One theory emphasizes the effects that an imbalance of hormones and neurotransmitters in the brain has on someone. Which category of theories does this definition represent?

Biologic

____ disorders are mood disorders with recurrent episodes of depression and mania.

Bipolar

Characterized by extreme mood swings--both lowering of mood and exaggerated elevation of mood.

Bipolar I disorder

One or more episodes of major depression with one or more episodes of mania Prevalence is 0.4%-1.6%

Bipolar I disorder

Characterized by mood swings but is less severe. There is a less exaggerated elevation of mood or "lesser mania". It does not lead to life-threatening consequences, nor does psychosis occur.

Bipolar II disorder

One or more episodes of major depression with periods of hypomania Prevalence is 0.5%

Bipolar II disorder

Showing little to no emotion, monotone voice, unusually brief responses

Blunting

What is 1 medication used for opiate detox?

Buprenorphine Methadone Clonidine

Name 1 non-benzodiazapine medication used to treat anxiety

Buspar SSRIs

A nurse is caring for a client who has depression and started taking paroxetine one week ago. The client states the the nurse, "My family would be better off without me." Which of the following responses should the nurse make? a. "Why do you feel your family would be better off without you?" b. "Many people feel this way when they are depressed." c. "You sound upset. Are you thinking of hurting yourself?" d. "Your medication hasn't started working yet. Then you'll be feeling differently."

C (This response exemplifies the therapeutic communication technique of showing empathy. Telling the client, "You sound upset," focuses on the client's feelings, which is a demonstration of therapeutic communication. In addition, the nurse addresses the possibility to suicidal ideation by asking the client directly whether or not she has an intent to harm herself.)

What lab test must be done weekly for patients taking clozaril?

CBC (WBC) Monitoring for agranulocytosis

Name 1 benzodiazepine

Chlodiazepoxine (librium) Diazepam (valium) Prazepam (Centrax) Oxazepam (serax) Alprazolam (Xanax) Lorazepam (Ativan)

Name 1 typical antipsychotic

Chlorpromaine (thorazine) Trifluoperazine (stelazine) Thiordazine (mellaril) Perphenazine (tilafon) Triflupromazine (vesprin) Loxapine (loxitane) Molindone (moban) Haloperidol (haldol) Thiothixene HCL (navane)

Thought and speech of a person associated with excessive and unnecessary detail that is usually relevant to a question; an answer is eventually provided.

Circumstantial thought/speech

The meaningless rhyming of words, often in a forceful manner.

Clang associations

What is is called when someone is giving signs that they are thinking of suicide, example: Brian, you can have my dog when I'm gone.

Covert cues

A client who has been assessed by the nurse as moderately depressed is given a prescription for daily doses of a selective serotonin reuptake inhibitor. The client mentions that she will take the medication along with the St. John's wort she uses daily. The nurse should a. agree that taking the drugs at the same time will help her remember them daily. b. caution the client to drink several glasses of water daily. c. suggest that the client also use a sun lamp daily. d. explain the high possibility of an adverse reaction.

D (Serotonin malignant syndrome is a possibility if St. John's wort is taken with other antidepressants.)

A client is prescribed with sertraline (Zoloft). To guarantee a safe administration of the medication, a nurse would administer the dose: A. As needed only for depressions. B. Early in the morning. C. Take on an empty stomach. D. At bedtime.

D (Sertraline (Zoloft) is an antidepressant. It may be administered in the morning or evening, but giving it in the evening is more favored since drowsiness is one of the side effects.)

A nurse is reviewing the health history of a young adult client who has a depressive disorder. Which of the following factors should the nurse identify as increasing the clint's risk for depression? a. The client is an only child. b. The client lives in an urban setting. c. The client is married. d. The client is female.

D (The nurse should identify female gender as a primary risk factor for depression. The incidence of depressive disorders is greater in women than in men by almost 2 to 1.)

A nurse is providing teaching to a client who is to start taking valproic acid. Which of the following instructions should the nurse include? a. "You should expect the provider to gradually increase your dosage of valproic acid." b. "You should take aspirin for pain you have while taking valproic acid." c. "You should undergo thyroid function tests every 6 months while taking valproic acid." d. "You should have your liver function levels monitored regularly while taking valproic acid."

D (The nurse should inform the client of the need to regularly monitor liver function levels due to the risk for hepatotoxicity while taking valproic acid. It is recommended to obtain baseline levels and then repeat every 2 months during the first 6 months of therapy. The nurse should identify that hypothyroidism is an adverse effect of lithium rather than valproic acid. )

A nurse is assessing a client who has been taking thioridazine for several days. The client reports hand tremors, drooling, and rigid extremities. Which of the following actions should the nurse take? a. Reassure the client that these effects are expected b. Administer diazepam c. Encourage deep breathing and relaxation d. Administer benztropine

D (This client is experiencing extrapyramidal effects of thioridazine, which includes pseudoparkinsonism. Benztropine is a medication that counteracts these adverse effects. The nurse should notify the provider if extrapyramidal effects occur and obtain a prescription to alleviate the manifestations.)

A client on one-to-one supervision at arm's length indicates a need to go to the bathroom but reports, "I cannot 'go' with you standing there." The nurse should a. say "I understand" and allow the client to close the door. b. keep the door open, but step to the side out of the client's view. c. leave the client's room and wait outside in the hall. d. say "For your safety I can be no more than an arm's length away."

D (This level of suicide watch does not make adjustments based on client preference. The explanation quoting the protocol and the reason (your safety) is appropriate.)

You are talking with Jennifer, a patient admitted with depression. Which statement by the patient indicates the need for further assessment? a. "I know a lot of people care about me and want me to get better." b. "I have suicidal thoughts at times, but I don't have any plan and don't think I would ever actually hurt myself." c. "I don't have a good support system, but I am planning on joining a recovery group." d. "I think things will be better soon."

D (This response may be a covert, or indirect, clue that the patient is thinking of suicide. The other options are all statements that, while they may be discussed further, are not clues to suicidality but rather clear communication.)

A nurse is caring for a client who is taking a tricyclic antidepressant. Which of the following adverse effects should the nurse report to the client's provider immediately? a. Dry mouth b. Constipation c. Drowsiness d. Urinary retention

D (Urinary retention can lead to bladder infection and, ultimately, loss of bladder tone.)

What is the difference between delirium and psychosis?

Delirium always has an organic etiology associated with it (e.g. illness/fever, drugs, electrolyte imbalance)

*Fixed beliefs that are not amenable to change in light of conflicting evidence.* An idiosyncratic belief or impression that is firmly maintained despite being contraindicated by what is generally accepted as reality or rational argument, typically a symptom of mental disorder. An altered state of thinking. Ex. Thinking you're a spy working for the government.

Delusion

A fixed, false belief that is firmly maintained even though it is not shared by others and is contraindicated by social reality.

Delusion

Alterations in thought are also called _____.

Delusions

What are 2 S/S of neuroleptic malignant syndrome?

High fever Tachycardia Stupor Increased respirations Severe muscle rigidity Unstable VS Elevated CPK

Dysfunction of which part of the brain often is associated with impulsivity?

Hippocampus

Which part of the brain regulates the recall of recent experiences and new information?

Hippocampus

A score from 7 to 10 on the SAD PERSONS scale would propose which clinical action?

Hospitalize or commit

Markedly abnormal behavior ranging from agitation to catatonia that is commonly situationally incongruent

Disorganized/abnormal motor behavior

List the most common adverse effect of MAOIs.

Hypertensive crisis from foods high in tyramine

A less severe episode of mania that lasts at least 4 days accompanied by three or more manifestations of mania. Hospitalization is not required, and the client who has it is less impaired compared to mania.

Hypomania

Dysfunction of the ____ can lead to overreaction to stress and over activation of the pituitary.

Hypothalamus

What is the alarm system of the brain?

Hypothalamus

List 2 anticholinergic effects

Dry mouth Blurred vision Tachycardia Nasal congestion Constipation Urinary retention Orthostatic hypotension

An extrapyramidal adverse effect characterized by muscle spasms of the tongue, neck, face, and back.

Dystonia

Meaningless repetition of another person's spoken words as a symptom of psychiatric disorder.

Echolalia

Purposeful imitation of movements made by others

Echopraxia

Great happiness and exhiliration

Elation

Misconstrues trivial events and attaches personal significance to them, such as believing that others, who are discussing the next meal, are talking about him.

Ideas of reference

What is the major job of the nurse as the beginning of a mental status exam?

Establishing trust and rapport

Normal, healthy fluctuations of mood

Euthymia

Subjective feeling and affect that follows a loss

Grief

What is the psych cocktail?

Haldol, lorazepam, and Congentin

An alteration in sensory perception. An experience involving the apparent perception of something not present.

Hallucination

What is one important nursing consideration when giving a client a mood stabilizing agent or benzodiazepine?

Inform the client of sedative effects.

The patient's understanding of the nature of the problem or illness.

Insight

The intentional use of physical force or power, threatened or actual, against oneself, another person, or a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.

Interpersonal violence

What is the typical age at onset of schizophrenia?

Late teens and early 20s

What is the most common mood stabilizer?

Lithium

Believes his actions or thoughts are able to control a situation or affect others, such as wearing a certain hat makes him invisible to others.

Magical thinking

Severe depressive mood symptoms that interfere with functional status, employment, and/or relationships that last for at least a two week period of time.

Major depressive disorder

An abnormally elevated mood, which can also be described as expansive or irritable; usually requires hospitalization. They last at least *one week*.

Mania

What is the difference between mania and hypomania?

Mania involves perceptual disturbances and is more severe than hypomania. With hypomania, there is less impairment.

The *undiagnosed* mood state characterized by sadness, despair, and loss of functional status

Melancholy

The way a person feels

Mood

Lithium carbonate is a ____ _____.

Mood stabilizer

The process by which grief is resolved

Mourning

Technique to distract a client that is hearing "voices"

Music!

Intermittent tremor or twitching

Myoclonus

Absence of things that are normally present. These manifestations are more difficult to treat successfully than positive symptoms.

Negative symptoms

Making up new words

Neologisms

Name 2 atypical antipsychotics

Risperidone (risperidal) Olanzapine (zyprexa) Quetiapine (seroquel) Aripiprazole (abilify) Ziprazadone (geodon) Clozapine (clozaril)

Some examples of this class of medications include *risperidone, clozapine,* olanzapine, paliperidone, and quetiapine.

Second and third generation (atypical) antipsychotics

Which category of medications are often chosen as first-line treatment for schizophrenia?

Second-generation (atypical) antipsychotics

Benzodiazepines are _____.

Sedatives

A score from 0 to 2 on the SAD PERSONS scale would propose which clinical action?

Send home with follow-up

Low ____ levels have been noted among individuals who have committed suicide.

Serotonin

Some symptoms of this condition include dilated pupils, myoclonus and hyperthermia (>106)

Serotonin toxicity

The fixed, false belief that one's bodily functioning, sensation, or appearance is grossly abnormal. Ex. "My internal organs have turned to stone."

Somatic delusion

What life threatening S/E of Lamictal should the nurse educate the patient regarding?

Steven Johnson Syndrome

A score from 5 to 6 on the SAD PERSONS scale would propose which clinical action?

Strongly consider hospitalization, depending on confidence in the follow-up arrangement

Motionless for long periods of time, coma-like

Stupor

Mood is a ____ experience of feelings, whereas affect is an _____ reflection of feelings.

Subjective. Objective.

Examples include: "No one will miss me."; "I have nothing left to live for."; "I'd be better off dead."

Overt cues

An extrapyramidal adverse effect characterized by manifestations such as shuffling gait, bradykinesia, drooling, and stooped posture.

Parkisonism

Characteristics of mania.

Perceptual disturbances, such as racing thoughts, grandiose delusions, difficulty concentrating, impulsivity, and lack of insight. Also, impaired functional status.

A resting tremor

Pinrolling

Manifestation of things that are not normally present. These are the most easily identified manifestations.

Positive symptoms

A tendency to speak rapidly and frenziedly, as if motivated by an urgency not apparent to the listener.

Pressured speech

A defense mechanism in which you attribute your own repressed thoughts to someone else

Projection

Name 2 types of extrapyramidal effects

Pseudo-parkinsonism Akathesia Dystonia Tardive dyskinesia

Restlessness, pacing, finger tapping. A physical finding of depression.

Psychomotor agitation

Slowed physical movement and slumped posture. A physical finding of depression.

Psychomotor retardation

A syndrome of neurocognitive symptoms that impairs cognitive capacity leading to deficits of perception, functioning, and social relatedness.

Psychosis

_____ classically manifests as delusions, hallucinations, and/or disorganized thinking, regardless of age

Psychosis

Four or more episodes of hypomania or acute mania within 1 year.

Rapid cycling

Thought and speech of a person that strays markedly from the original discussion, yet is, in some manner, related to the original discussion -i.e. "touches on" a topic or word within the discussion.

Tangential thought/speech

An irreversible finding characterized by involuntary movements of extremities caused by antipsychotic medication. The movements start with the tongue and face, such as lip smacking and tongue fasciculations, and progress to involuntary movements of the arms, legs, and trunk.

Tardive dyskinesia

Who is the greatest expert on a patient's mood?

The patient

The belief that one's thoughts are being aired to the outside world.

Thought broadcasting

Believes that others' thoughts are being inserted into his mind

Thought insertion

The belief that one's thoughts are being placed into one's mind by outside people or influences.

Thought insertion

Believes that her thoughts have been removed from her mind by an outside agency.

Thought withdrawal

What antidepressant has been found to be an effective non dependence forming sleep aid?

Trazadone

Name 1 classification of anti-depressants

Tricyclics MAOI SSRI Atypical antidepressants SNRIs

What is 1 medication used for extrapyramidal side effects?

Trihexyphenidyl (artane) Benzatropine mesylate (congentin) Diphenhydramine (benadryl) Amantadine (symmetrel)

True or false: Antipsychotic medications decrease the seizure threshold, making seizures a greater risk in clients who have an existing seizure disorder.

True

More than ____ as many people die by suicide each yeah than by homicide.

Twice

Name 1 anticonvulsant that is also used as a mood stabilizer

Valproic acid (depakote) Carbamazepine (tegretol) Lamotrigine (lamictal)

Survivors repeatedly want to reunite with the person who died in some way, and may even want to die themselves in order to be with their loved one. Normal expression of grief.

Yearnings

The lethality assessment scale ranges from no predictable risk of immediate suicide to a very high risk of imminent suicide. What are the score ranges?

1 (No risk) to 5 (very high risk)

What three questions should be asked when conducting a lethality assessment?

(1) Is there a specific plan with details? (2) How lethal is the proposed method? (3) Is there access to the planned method?

Five EARLY signs of lithium toxicity.

1. Diarrhea 2. Vomiting 3. Drowsiness 4. Muscular weakness 5. Lack of coordination

Which neurotransmitters of the brain are disturbed with a mood disorder? (3)

1. Dopamine 2. Norepinephrine 3. Serotonin

The neurobiology of psychosis involves the dysregulation of these three neurotramitters.

1. Dopamine 2. Serotonin 3. Glutamate

List 6 manifestations of anticholinergic effects.

1. Dry mouth 2. Blurred vision 3. Photophobia 4. Urinary hesitancy or retention 5. Constipation 6. Tachycardia

What are the three extrapyramidal adverse effects of antipsychotic medication?

1. Dystonia 2. Parkinsonism 3. Akasthsia

Which two populations are at greatest risk for a mood disorder?

1. Females 2. Individuals in the second and sixth decades of life

What are some symptoms of complicated grief?

1. Grief lasting more than 2-6 months 2. Persistent feeling of hopelessness 3. Maladaptive behaviors

List the four positive symptoms of psychotic disorders.

1. Hallucinations 2. Delusions 3. Alterations in speech 4. Bizarre behavior

What are the four most common first-generation antipsychotics used to mainly treat POSITIVE psychotic symptoms?

1. Haloperidol 2. Loxapine 3. Chlorpromazine 4. Fluphenazine

One potentially fatal side effect of antipsychotic medication is Neuroleptic Malignant Syndrome. What are some manifestations of NMS? (3)

1. Hyperthermia, or sudden high fever 2. Muscle rigidity 3. Diaphoresis

What are 5 individual risk factors of interpersonal violence?

1. Impaired physical and/or mental health 2. Use or misuse of substances or alcohol abuse 3. Migration, acculturation 4. Unemployment 5. Economic stress

List some complications of second and third generation antipsychotics.

1. Metabolic syndrome (Including weight gain and new onset of DM, as well as dyslipidemia) 2. Orthostatic hypotension 3. Anticholinergic effects 4. Sedation 5. Mild EPS (More prominent with first generation) 6. Sexual dysfunction

Nursing considerations for a patient taking an anxiolytic (benzodiazepines).

1. Observe for CNS depression (Sedation, decrease cognitive function) 2. Don't take with alcohol! Increases CNS depression. 3. Avoid driving and operating heavy machinery. 4. Taper dosage!!

Nursing considerations before administering antipsychotic treatment. (2)

1. Obtain a baseline ECG and potassium level prior to treatment due to the increased risk of severe dysrhythmias, such as a prolonged QT interval. 2. Assess baseline liver function due to the increased risk of liver impairment.

List two common effects of TCAs.

1. Orthostatic hypotension 2. Anticholinergic effects

What are some mild side effects of antipsychotic medication? (4)

1. Orthostatic hypotension 2. Sedation 3. Sexual dysfunction 4. Photosensitivity

List three behavioral responses relating to interpersonal violence.

1. Passive behavior 2. Assertive behavior 3. Aggressive behavior

What are four nursing diagnoses for someone who is exhibiting aggression or violence towards others?

1. Potential for violence, other directed 2. Ineffective individual coping 3. Anxiety 4. Chronic low self-esteem; Situational low self esteem

List 6 risk factors for psychosis.

1. Preexisting personality disorder 1. Substance or alcohol abuse 3. Child abuse 4. Complications associated with pregnancy and birth 5. Genetic variations 6. Physiological factors such as sleep deprivation

List some signs and symptoms of complicated grief.

1. Prolonged symptoms lasting 2 to 6 months or longer. 2. Persistent feelings of hopelessness 3. Completely withdrawn or fears of being alone 4. Inability to work, create, or feel emotion or positive states of mind 5. Maladaptive behaviors such as substance abuse or promiscuity 6. Recurrent nightmares 7. Exhaustion from lack of sleep 8. Prolonged depression 9. Self neglect

List 5 second-generation/atypical antipsychotics that generally treat both positive and negative symptoms.

1. Risperidone 2. Olanzapine 3. Quetiapine 4. Ziprasidone 5. Clozapine

Describe SAD PERSONS.

1. Sex-male. 2. Age-over 65, in twenties/adolescence (14-24). 3. Depression. 4. Prior history-nearly 80% of suicides preceded by attempts. 5. Ethanol abuse. 6. Rational thinking loss-psychosis/command hallucinations. 7. Support system loss. 8. Organized plan-has plan to commit suicide, way to do it, believes means to be lethal. 9. No significant other. 10. Sickness-terminal illness

List some lower risk (soft) methods of suicide. (3)

1. Slashing one's wrists 2. Inhaling natural gas 3. Ingesting pills

List 6 risk factors for developing a mood disorder.

1. Stress 2. Early trauma 3. Neglect 4. Abuse 5. Family history 6. Substance dependence

What are some manifestations of grief?

1. Troubling breathing 2. Trouble sleeping 3. Loss of appetite 4. Trembling, shakiness, dry mouth, nausea, muscle weakness.

List some high risk (hard) methods of suicide. (5)

1. Using a gun 2. Jumping off a high place 3. Hanging 4. Poisoning with carbon monoxide 5. Staging a car crash

Some clients with psychotic disorders take a mood stabilizer or benzodiazepine to treat the anxiety clients with psychotic disorders often feel, as well as some of the positive and negative symptoms. What are three common anti anxiety medications?

1. Valproate 2. Lamotrigine 3. Lorazepam

What are some adverse effects of second generation antipsychotics?

1. Weight gain 2. Agitation, dizziness, sedation, sleep disruption 3. AGRANULOCYTOSIS

Examples of disturbed vegetative functioning. (3)

1. eating 2. sleeping 3. menstruation

A client with schizophrenia has been started on medication therapy with clozapine (Clozaril). A nurse assesses the results of which laboratory study to monitor for adverse effect related to this medication? A. White blood cell. B. Platelet count. C. Liver function studies. D. Random blood sugar.

A (Agranulocytosis may be experienced by the client taking clozapine which can be monitored by evaluating the white blood cell count. Options B, C, and D are not related specifically to the use of the medication.)

The morning after he was admitted, a suicidal client wishes to use the cordless electric razor the staff took from his suitcase the night before. The nurse should a. allow him to use the razor under staff supervision. b. tell him he must use a safety razor provided by the unit. c. suggest that this would be a good time to grow a beard. d. give him the razor and ask him to return it when he is finished.

A (Because the razor is cordless, independent use is relatively safe.)

A client who has been taking buspirone (BuSpar) for two months returns to the clinic for a follow-up. The nurse determines that the medication is effective if there is an absent display of? A. Feelings of panic, fear, and uneasiness. B. Thought broadcasting or delusions. C. Paranoid and suicidal thought process. D. Alcohol withdrawal symptoms.

A (Buspirone (BuSpar) is used to treat symptoms of anxiety, such as fear, tension, irritability, dizziness, pounding heartbeat, and other physical symptoms.)

A client with depression who has been taking amitriptyline for three months returns to the clinic for a follow-up. The nurse observes the client in which of the following symptoms? A. Suicidal thoughts. B. Lack of energy. C. Loss of interest in personal appearance. D. Neglect of responsibilities.

A (Clients may have thoughts about suicide when taking an antidepressant such as amitriptyline, especially clients younger than 24 years old. Options B, C, and D are signs of depressions but are most likely improved as the treatment goes on.)

If a suicidal client is to be treated outside the hospital, which intervention would be of high priority? a. Have the client identify three people to call if he is overwhelmed by hopelessness. b. Make sure the client has food enough to last for 2 to 3 days. c. Arrange for a police visit every 24 hours. d. Provide a 1-week supply of antidepressant medication.

A (For suicidal clients treated in the community, establishing a network of individuals to whom the client may turn if the suicidal urge becomes great is important.)

Which behavior would be most characteristic of a client during a manic episode? a. Going rapidly from one activity to another b. Taking frequent rest periods and naps during the day c. Being unwilling to leave home to see other people d. Watching others intently and talking little

A (Hyperactivity and distractibility are basic to manic episodes.)

Nurses should assess the lethality of the client's plan for suicide. What factor would be irrelevant to that assessment? a. How long the client has been suicidal b. Whether the plan has specific details c. Whether the method is one that causes death quickly d. Whether the client has the means to implement the plan

A (Lethality refers to how deadly a plan is. The length of time a client has been suicidal has nothing to do with the lethality of the plan)

To plan care for a manic client the nurse must consider that lithium cannot be started until a. the physical examination and laboratory tests are analyzed. b. the initial doses of antipsychotic medication have brought behavior under control. c. seclusion has proven ineffective as a means of controlling assaultive behavior. d. electroconvulsive therapy can be scheduled to coincide with lithium administration.

A (Lithium should not be given to clients with impaired renal or thyroid function. A thorough physical examination and various laboratory tests are necessary to rule out other organic causes for the behavior and to ensure that the lithium can be excreted normally.)

The first-line drug used to treat mania is a. lithium carbonate (Lithium). b. carbamazepine (Tegretol). c. lamotrigine (Lamictal). d. clonazepam (Klonopin).

A (Lithium, a mood stabilizer, is the first-line drug for use in treating bipolar disorder.)

An acute phase nursing intervention aimed at reducing hyperactivity is redirecting the client to a. write in a diary b. exercise in the gym c. direct unit activities d. orient a new client to the unit

A (Manic clients often respond well to the invitation to write. They will fill reams of paper. While writing they are less physically active.)

When a client reports that lithium causes an upset stomach, the nurse suggests taking the medication: a. with meals b. with an antacid c. 30 minutes before meals d. 2 hours after meals

A (Many clients find that taking lithium with or shortly after meals minimizes gastric distress.)

What action should the nurse take on learning that a manic client's serum lithium level is 1.8 mEq/L? a. Withhold medication and notify the physician. b. Continue to administer medication as ordered. c. Advise the client to limit fluids for 12 hours. d. Advise the client to curtail salt intake for 24 hours.

A (The client's lithium level has exceeded desirable limits. Additional doses of the medication should be withheld and the physician notified.)

Which side effects of lithium can be expected at therapeutic levels? a. Fine hand tremor and polyuria b. Nausea and thirst c. Coarse hand tremor and gastrointestinal upset d. Ataxia and hypotension

A (The fact that fine hand tremor and polyuria are present at therapeutic levels is quite annoying to some clients. These and other side effects are factors in noncompliance.)

A nurse on an acute care unit is providing postoperative care to an older adult client who develops delirium. Which of the following actions should the nurse take? a. Request a prescription for an antianxiety medication. b. Provide the client with a stimulating activity prior to bedtime c. Keep the lights in the client's room dim at night d. Encourage the client to make decisions about her daily routine

A (The nurse should request a prescription for an anti anxiety medication for a client who develops delirium. Administration of a PRN anti anxiety medication can decrease her anxiety and agitation. The nurse should maintain a low-stimuatlion environment for the client to decrease disorientation due to overstimulation. The nurse should keep the client's room well-lit. Adequate lighting can help her to remain orientated to place upon waking up at night and will provide safety if she becomes ambulatory. The nurse should provide the client with a consistent routine and limit her need to make decisions. These actions will decrease disorientation and anxiety.)

A nurse is caring for a client who has schizophrenia. The client spends a great deal of time repeating rhyming syllables such as, "Me, see, bee, tree." The nurse recognized that the client is demonstrating which of the following positive manifestations of schizophrenia? a. Clang association b. Echolalia c. Magical thinking d. Word salad

A (The stringing and repeating of words together because of their rhyming sounds is called clang association. Clang association is a positive manifestation of schizophrenia.)

A nurse working in an acute mental health facility is caring for a 35-year-old female client who has manifestations of depression. The client lives at home with her partner and young children. She currently smokes and has a history of chronic asthma. Which of the following factors put the client at risk for depression? (Select all that apply.) a. Age b. Gender c. History of chronic asthma d. Smoking e. Being married

A B C D

A charge nurse is discussing manifestations of schizophrenia with a newly licensed nurse. Which of the following manifestation should the charge nurse identify as being effectively treated by first-generation antipsychotics? (Select all that apply.) a. Auditory hallucinations b. Withdrawal from social situations c. Delusions of grandeur d. Severe agitation e. Anhedonia

A C D (First-generation antipsychotics primarily treat positive symptoms of schizophrenia. Positive symptoms include hallucinations, delusional thoughts, alterations in speech, and behavioral effects such as agitation.)

A nurse is completing an admission assessment for a client who has schizophrenia. Which of the following findings should the nurse document as positive symptoms? (Select all that apply.) a. Auditory hallucination b. Lack of motivation c. Use of clang associations d. Delusion of persecution e. Constantly waving arms f. Flat affect

A C D E

A nurse is assessing a client who has major depressive disorder. The nurse should identify which of the following client statements as an overt comment about suicide? (Select all that apply.) a. "My family will be better off if I'm dead." b. "The stress in my life is too much to handle." c. "I wish my life was over." d. "I don't feel like I can ever be happy again." e. "If I kill myself then my problems will go away."

A C E (Overt comments are in which the client directly talks about suicide or dying.)

A patient has been admitted with major depressive disorder. What typical signs and symptoms would the nurse expect to assess? (Select all that apply.) a. Poor eye contact b. Increased fever c. Appetite changes d. Increased white blood cell count e. Slowed speech

A C E (Typical signs of depression include sleep disturbance; poor eye contact; loss of interest in events; guilt; decreased energy, speech, and concentration; appetite changes; and slowed motor movements. Increased fever and white blood cell count are indicative of infection, not depression.)

Which of the following describe the symptoms of the manic phase of bipolar disorder? (select all that apply): Select all that apply. a. Excessive energy b. Fatigue and increased sleep c. Low self-esteem d. Pressured speech e. Purposeless movement f. Racing thoughts g. Withdrawal from environment h. Distractibility

A D E F H

What is the number one risk factor for future interpersonal violence?

A history of violence!

Manifestations of bipolar disorder can mimic expected findings of which disorder?

ADHD (This is why it is more difficult to diagnose bipolar disorder in children.)

How do you assess for shaken baby syndrome? (3)

1. Assess for respiratory distress 2. Assess for bulging fontanels 3. Look for an increase in head circumference -Any bruising on an infant before age 6 months is suspicious.

Some examples of this category of medication are *chlorpromazine, haloperidol,* fluphenazine, loxapine, thioridazine, thiothixene, perphenazine, trifluoperazine

First-generation antipsychotics

Moving rapidly from one thought to the next, making it difficult for others to follow the conversation.

Flight of ideas

The most common SSRI

Fluoxetine

Name 2 SSRIs

Fluoxetine (Prozac) Paroxetine (Paxil) Sertraline (Zoloft) Citalopram (Celexa) Escitapram (Lexapro)

Dysfunction of the _____ leads to impaired judgement, poor decision making, personality changes, and aggressive outbursts.

Frontal cortex

Which part of the brain generates thought and purposeful behavior?

Frontal cortex

A depressed client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can identify this cognitive distortion as an example of a. self-blame. b. catatonia. c. learned helplessness. d. discounting positive attributes.

C (Learned helplessness results in depression when the client feels no control over the outcome of a situation.)

The suicide intervention that has the greatest impact on a client's safety is: a. educating visitors about potentially dangerous gifts b. restricting the client from potentially dangerous areas of the unit c. one-on-one observation by the staff d. removal of personal items that might prove harmful

C (One-on-one observation allows for constant supervision, which minimizes the client's opportunities to cause self-harm.)

A nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and a flat affect. The nurse should anticipate a prescription of which of the following medications? a. Chlorpromazine b. Thiothixene c. Risperidone d. Haloperidol

C (Second-generation antipsychotics, such as risperidone, are effective in treating negative symptoms of shizophrenia, such as lack of grooming and flat affect. The rest of the answers are examples of first-generation medication, used primarily to treat positive symptoms such as hallucinations.)

A patient has been prescribed a selective serotonin reuptake inhibitor (SSRI) antidepressant. After taking the new medication, the patient states, "This medication isn't working. I don't feel any different." What is the best response by the nurse? a. "I will call your care provider. Perhaps you need a different medication." b. "Don't worry. We can try taking it at a different time of day to help it work better." c. "It usually takes a few weeks for you to notice improvement from this medication." d. "Your life is much better now. You will feel better soon."

C (Seeing a response to antidepressants takes 3 to 6 weeks. No change in medication is indicated at this point of treatment, because there is no report of adverse effects from the medication. If nausea is present, taking the medication with food may help, but this is not reported by the patient, so a change in administration time is not needed. Telling a depressed patient that his or her life is better does not acknowledge the patient's feelings.)

A family member of a patient diagnosed with bipolar disorder asks what behaviors would indicate the beginnings of a manic phase. What is the best response by the nurse? a. "The person may sleep more, have trouble completing hygiene needs, and have a poor appetite." b. "The person may have sudden spikes in blood pressure and crave foods that are sweet or salty." c. "The person may have excess energy, talk a lot, feel restless, and spend too much money." d. "The person may experience decreased energy and interest in activities beginning in the winter months."

C (Signs that a person is cycling into a manic phase include sleeping and eating less and having increased energy and racing thoughts, increased impulsivity, and increased spending behaviors. Blood pressure may increase related to increased activity, but increased blood pressure and food cravings alone are not indicative of mania. Increased sleep and poor appetite and hygiene are indicative of depression. Decreased energy in winter seasons is indicative of seasonal affective disorder related to decreased sunlight.)

A nurse is assessing a client who has been taking an antipsychotic medication for 6 years and the provider has started tapering off the dosage. The nurse should monitor the client for which of the following manifestations of tradeoff dyskinesia? a. Muscular weakness b. Muscle spasms c. Involuntary tongue protrusion d. Uncontrolled rolling of the eyes

C (Tardive dyskinesia begins with mouth and facial movements and then progresses to involve other muscle groups. All clients receiving antipsychotic therapy for months to years are at risk. This adverse effect is potentially irreversible and discontinuing the drug rarely relieves these manifestations.)

A nurse notes that a client with schizophrenia and receiving an antipsychotic medication is having uncontrolled movement of the lips and tongue. The nurse determines that the client is experiencing? A. Hypertensive crisis. B. Parkinsonism. C. Tardive dyskinesia. D. Neuroleptic malignant syndrome.

C (Tardive dyskinesia is characterized by uncontrollable involuntary movements of the body and extremities (especially of the face, lips, mouth, tongue, arms or legs). Option A: Hypertensive crisis occurs from the use of MAOIs. Option B: Parkinsonism is characterize by tremor, slow movement, impaired speech or muscle stiffness. Option D: Neuroleptic malignant syndrome is a life-threatening condition caused by an adverse reaction to antipsychotic drugs. Symptoms include high fever, sweating, unstable blood pressure, stupor, muscular rigidity, and autonomic dysfunction.)

A nurse enters a client's room and observes that the client is agitated and pacing rapidly. The client looks at the nurse and says, "Back off. Leave me alone." Which of the following statements should the nurse make? a. "I demand that you calm down now. Your behavior is unacceptable." b. "I will close the door to provide privacy, and you can tell me what is bothering you." c. I will give you space if you calm down. Tell me what is causing you to feel so tense." d. "I will leave you alone for a few minutes while you try to control yourself."

C (The nurse should stay at a safe distance and remain calm while stressing the importance of maintaining control. The nurse should use verbal de-escalation techniques while determining the client's needs and respecting the client's personal space.)

Which room placement would be best for a client experiencing a manic episode? a. A shared room with a client with dementia b. A single room near the unit activities area c. A single room near the nurses' station d. A shared room away from the unit entrance

C (The room placement that provides a nonstimulating environment is best. Nearness to the nurses' station means close supervision can be provided.)

A depressed client is noted to pace most of the time, pull at her clothes, and wring her hands. These behaviors are consistent with a. senile dementia. b. hypertensive crisis. c. psychomotor agitation. d. central serotonin syndrome.

C (These behaviors describe the psychomotor agitation sometimes seen in clients with the agitated type of depression.)

What is 1 S/S of serotonin syndrome?

Confusion Disorientation Agitation Diarrhea Tachycardia Hallucinations Fever Poor coordination Elevated BP Vomiting

What is the therapeutic range for a serum lithium level?

0.5-1.5

What is the narrow therapeutic index for lithium?

0.8-1.4 mEq/L, toxic range starts at 1.5

People with schizophrenia are ___ times more likely to commit suicide compared to people who are not schizophrenic.

50

What is the therapeutic range for a serum depakote level?

50-120

Schizophrenia is characterized by psychotic thinking or behavior present for at least ___ months.

6

Three SEVERE symptoms of lithium toxicity.

1. Ataxia 2. Tinnitus 3. Blurred vision

What are some complications of first-generation antipsychotics, such as Hadol/Haloperidol?

1. AGRANULOCYTOSIS 2. Anticholinergic effects 3. Extrapyramidal side effects

List 5 negative symptoms of psychotic disorders.

1. Affect 2. Alogia 3. Anergia 4. Anhedonia 5. Avolition

Four signs of affective instability (mood disturbance)

1. Agitation 2. Sadness 3. Elation (Great happiness) 4. Blunting (Showing little to no emotion, monotone voice, unusually brief responses)

Two nursing considerations for a client taking a first generation antipsychotic, such as haloperidol or chlorpromazine.

1. Anticholinergic effects: To minimize, recommend chewing sugarless gum, eating foods high in fiber, and drink 2 to 3 L of fluid a day. 2. Educate client about postural hypotension.

What are some behavioral cues that would give the indication a client may be about to become violent? (5)

1. Clenched jaw or fists 2. Dilated pupils 3. Intense staring 4. Flushing of face and neck 5. Pacing

Blocking dopamine may cause these three side effects.

1. Cog wheeling 2. Pin rolling 3. Drooling

Give some examples of mental disorders in which aggression often occurs.

1. Conduct disorder 2. Delusional disorder (Thought pattern variance) 3. Dementia 4. Substance abuse 5. Schizophrenia

What are the 5 stages of death and dying, according to Kubler-Ross?

1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance

A client with a history of repeated suicidal attempts refuses to participate in a no-suicide contract. What intensity of nursing observation should be instituted? a. Constant 24-hour, one-to-one observation at arm's length b. One-to-one observation while client is awake c. Every 15-minute observation around the clock d. Seclusion with 15-minute observation

A

Schizophrenia accounts for ___ __ ___ of the homeless population.

30 to 50%

A client with depression is taking phenelzine (Nardil). The nurse advises the client to avoid consuming which foods while taking the medication A. Crackers. B. Vegetable salad. C. Oatmeal. D. Yogurt.

D (Phenelzine (Nardil) is a monoamine oxidase (MAO) inhibitor. The client should avoid eating tyramine-rich foods such as chocolate, alcoholic beverages, aged cheese, yogurt, processed meats, and fruits such as raisins, avocados, bananas, or figs.)

A depressed, socially withdrawn client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can best begin to attack this cognitive distortion by a. suggesting, "Let's look at what you just said, that you can 'never do anything right.'" b. querying, "Tell me what things you think you are not able to do correctly." c. asking, "Is this part of the reason you think no one likes you?" d. saying, "That is the most unrealistic thing I have ever heard."

A

A nurse is caring for an adult client who has injuries resulting from intimate partner abuse. The client does not wish to report the violence to law enforcement authorities. Which of the following nursing actions is the highest priority? a. Advise the client about the location of women's shelters. b. Encourage the client to participate in a support group for survivors of abuse. c. Implement case management to coordinate community and social services. d. Educate the client about the use of stress management techniques.

A

A nurse working on an acute mental health unit is admitting a client who has major depressive disorder and comorbid anxiety disorder. Which of the following actions is the nurse's priority? a. Placing the client on one-to-one observation b. Assisting the client to perform ADLs c. Encouraging the client to participate in counseling d. Teaching the client about medication adverse effects

A

Which ethnicities have the highest rate of suicide?

American Indian and Alaskan Native

Dysfunction of which part of the brain can affect emotion and behavior and cause outbursts of fear, anger, rage and hyper sexuality?

Amygdala (Limbic system)

Which part of the brain regulates emotion, memory storage, and information processing?

Amygdala (Limbic system)

A nurse is caring for a client who just received a terminal diagnosis of cancer. Which of the following initial reactions should the nurse expect from the client? a. Bargaining b. Depression c. Denial d. Anger

C

A nurse is providing teaching to a client who has a new prescription for chlorpromazine. Which of the following statements should the nurse make? a. This medication is a tricyclic antidepressant and will improve your mood. b. This medication is an opioid antagonist that blocks the pleasurable effects of alcohol. c. This medication is an antipsychotic that controls the manifestations of schizophrenia. d. This medication is a cholinesterase inhibitor that slows the progression of dementia.

C

A nurse is teaching a newly licensed nurse about the use of electroconvulsive therapy (ECT) for the treatment of bipolar disorder. Which of the following statements by the newly licensed nurse indicates understanding? a. "ECT is the recommended initial treatment for bipolar disorder." b. "ECT is contraindicated for clients who has suicidal ideation." c. "ECT is effective for clients who are experiencing severe mania." d. "ECT is prescribed to prevent relapse of bipolar disorder."

C

Assessment of the thought processes of a client diagnosed with depression is most likely to reveal a. good memory and concentration. b. delusions of persecution. c. self-deprecatory ideation. d. sexual preoccupation.

C

Tyler is a 31-year-old patient admitted with acute mania. He tells the staff and the other patients that he is on a secret mission given to him by the President of the United States to monitor citizens for terrorist activity. He states, "I am the only one he trusts, because I am the best!" For documentation purposes you know that this behavior is referred to as: a. unpredictability. b. rapid cycling. c. grandiosity. d. flight of ideas.

C

A nurse is planning a menu for a client who has bipolar disorder and is experiencing an acute manic episode. Which of the following meals should the nurse provide for this client? a. Spaghetti and meat balls, a salad, and apple pie b. Beef and vegetable stew, rice, and vanilla pudding c. Chicken nuggets, crackers with cheese sticks, and a cookie d. Broiled fish fillets, stewed tomatoes, and ice cream

C (A nurse who is caring for a client who is in the manic phase of bipolar disorder should provide him with high-calorie finger foods that can be carried and are relatively easy to manipulate. This meal is a good choice for a client who is hyperactive and has a short attention span who might not sit down to eat.)

A nurse is providing discharge teaching for a client who has schizophrenia and a new prescription for iloperidone. Which of the following client statements indicates understanding of the teaching? a. "I will be able to stop taking this medication as soon as I feel better." b. "If I feel drowsy during the day, I will stop taking this medication and call my provider." c. "I will be careful not to gain too much weight while taking this medication." d. "This medication is highly addictive and must be withdrawn slowly."

C (Antipsychotic medications, such as iloperidone, have a big risk for significant weight gain. Antipsychotic medications are not considered addictive, and it is not necessary to titrate iloperidone when discontinuing treatment.)

You are working with Ava, another student nurse on the psychiatric unit. She tells you she doesn't want to ask her patient about suicidal ideation because "It might put ideas in her head about suicide." Your best response would be: a. "I'm glad you are thinking that way. She may not have thought of suicide before, and we don't want to introduce that." b. "You are right; however, because of professional liability, we have to ask that question." c. "Actually, it's a myth that asking about suicide puts ideas into someone's head." d. "If I were you, I'd ask Dr. Carmichael to talk to the patient about that subject."

C (Asking about suicidal thoughts does not "give person ideas" and is, in fact, a professional responsibility similar to asking about chest pain in cardiac conditions. Talking openly leads to a decrease in isolation and can increase problem-solving alternatives for living. Patients have usually been already thinking about suicide; it is a myth that bringing up the topic will somehow cause someone to become suicidal. Liability is not the reason we ask patients about suicidal thoughts or plan; it is for patient safety. Asking the physician to speak to the patient on that subject does not educate the student regarding the need for asking about suicidal ideation and abdicates professional and ethical responsibility for keeping the patient safe.)

A manic client tells a nurse "Bud. Crud. Dud. I'm a real stud! You'd like what I have to offer. Let's go to my room." The best approach for the nurse to use would be a. "What an offensive thing to suggest!" b. "I don't have sex with clients." c. "It's time to work on your art project." d. "Let's walk down to the seclusion room."

C (Distractibility works as the nurse's friend. Rather than discuss the invitation, the nurse may be more effective by redirecting the client.)

A score from 3 to 4 on the SAD PERSONS scale would propose which clinical action?

Close follow up; consider hospitalization

A confused person's tendency to make up a response to a question when he or she cannot remember the answer

Cofabulation

Which therapy assists the client to identify and change negative behavior and thought patterns?

Cognitive behavioral therapy

The form of muscle rigidity characteristic of tremor in which muscles move with slight hesitations, in a pattern of ratcheting movement that resembles that of a wheel.

Cogwheeling

What type of hallucination is it called when you're hearing voices that say something like, "The world would be better without you."

Command hallucinations

This disorder involves making animals and committing crimes to pets.

Conduct disorder

The client has at least 2 years of repeated hypomanic manifestations that do not meet the criteria for hypomania espies alternating with minor depressive episodes.

Cyclothymic disorder

A charge nurse is leading a peer group discussion about family and community violence. Which of the following statements by a member of the group indicates an understanding of teaching? a. "Children older than 3 are a t greater risk for abuse." b. "Substance use disorder does not increase the risk for violence." c. "Entering an intimate relationship increases the risk for violence." d. "Pregnancy increases the risk for violence toward the intimate partner."

D

A nurse in a mental health clinic is assessing a client who has a history of mania. Which of the following findings indicates that the client is experiencing a relapse? a. Weight gain b. Ritualistic behavior c. Anhedonia d. Pressured speech

D

A nurse is assessing a client who has schizophrenia. The client states, "I need to get my gummamoshu from by my house." The nurse recognizes this statement as an example of which of the following? a. Flight of ideas b. Echolalia c. Preservation d. Neologism

D

Tyler is being discharged home to his family. Which of the following is important teaching to include for the patient and the family to recognize possible signs of impending mania? a. Increased appetite b. Decreased social interaction c. Increased attention to bodily functions d. Decreased sleep

D (Changes in sleep patterns are especially important because they usually precede mania. Even a single night of unexplainable sleep loss can be taken as an early warning of impending mania. The other options do not indicate impending mania.)

Dysthymia (persistent depressive disorder) cannot be diagnosed unless it has existed for a. at least 3 months. b. at least 6 months. c. at least 1 year. d. at least 2 years.

D (Dysthymia is a chronic condition that by definition has to have existed for longer than 2 years.)

A bipolar client tells the nurse, "I have the finest tenor voice in the world. The three tenors who do all those TV concerts are going to retire because they can't compete with me." The nurse would make the assessment that the client is displaying a. flight of ideas. b. distractibility. c. limit testing. d. grandiosity.

D (Exaggerated belief in one's own importance, identity, or capabilities is seen with grandiosity.)

A nurse in an acute mental health facility is caring for a client who has bipolar disorder. Which of the following is the priority nursing action? a. Set consistent limits for expected client behavior. b. Administer prescribed medications as scheduled. c. Provide the client with step-by-step instructions during hygiene activities. d. Monitor the client for escalating behavior.

D (Monitoring for escalating behavior addresses the client's priority need for safety and is therefore the priority nursing action.)

What types of side effects of antipsychotic medications do cogentin (benztropine) and benadryl (diphenhydramine) target?

Extrapyramidal side effects

A variety of signs and symptoms, including muscular rigidity, tremors, drooling, shuffling gait, restlessness, peculiar involuntary postures, and many other neurological disturbances. Often a side-effect of antipsychotic medications.

Extrapyramidal syndrome (EPS)