Psych Test #2

Little interest or pleasure in doing things

1.

feeling down depressed or hopeless

2.

trouble staying or falling asleep, or sleeping too much

3.

feeling tired or having little energy

4.

poor appetite or over eating

5.

feeling bad about yourself - or that you are a failure or have let yourself or your family down

6.

Trouble concentrating on things, such as reading thenewspaper or watching television

7.

Moving or speaking so slowly that other people couldhave noticed. Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual

8.

Thoughts that you would be better off dead, or of hurting yourself in some way

9.

I will accompany you to the bathroom

A client on an in-patient psychiatric unit has been diagnosed with bulimia nervosa. The client states, "I am going to the bathroom and will be back in a few minutes." Which nursing response is most appropriate?

hallucinations and delusions

A nurse is assigned the care of four patients who are detoxing from alcohol. Which symptom is the nurses highest priority?

Panic!

A parent is shopping with a 5-year-old child in a large, busy urban mall. The parent suddenly realizes the child is missing. Which level of anxiety would likely result?

Listen, redirect the patient to his or her feelings, explore issue with staff

A patient states that unit staff members have been avoiding him or her since an attempt to self-mutilate. The psychiatric and mental health nurse's most appropriate intervention is to:

Collaborate with the patient to reduce the amount of time he or she engages in ritualistic behaviors

A patient who is admitted to the psychiatric unit with a diagnosis of obsessive-compulsive disorder spends a significant amount of time during the day and night washing his or her hands. On the third hospital day, the patient reports feeling better and more comfortable with the staff and other patients. The psychiatric and mental health nurse knows that the most appropriate nursing intervention is to:

I will walk with you to the dining room and sit with you while you eat

A patient who was admitted yesterday with an adjustment disorder and depressed mood has not left his or her room. The psychiatric and mental health nurse's most appropriate intervention at meal time today is to respond:

constricted

A person has recently abused morphine. The persons pupils would be...

Optimum functioning in the least restrictive environment

A short-term goal for a patient with Alzheimer's disease is:

Remain with the client

A woman comes into the emergency department in a severe state of anxiety following a car accident. The mo st important nursing intervention is to:

delirium

Acute onset of disordered thinking is most associated with

It takes approx.. two to four weeks for depression to lessen and side effects will dimisnish

After taking an antidepressant for about a week, a patient reports constipation and dizziness, with no improvement in mood. The psychiatric and mental health nurse informs the patient:

When was your last menstrual period?

An adolescent female is brought to the school nurse after fainting during gym class. She is grossly underweight, wears baggy clothes, and has dry skin. She complains of feeling cold despite wearing two sweaters. To further assess for an eating disorder, the nurse should ask:

So what if that kid was hurt? I should have beaten him more

An adolescent with a conduct disorder is taken to the principals office after assaulting and injuring another student. Which comment is he likely to make?

stay with them (safety) Physical and nutrition (less than body requirements) May need medical and nutritional implementation

Anorexia, bulimia, binging...

cluster b- sociopath - antagonistic, disrespectful, manipulative, high risk, disregard for responsibility and others, impulsive, lack of empathy, superficial, shallow, everything is an act conduct disorder is a precursor

Antisocial

Cluster C- low self esteem in social situations feelings of inferiority doesn't want to mix with new people peer or parent criticism history

Avoidant

cluster B personality disorder: In a constant state of crisis, promiscuous, unable to tolerate anxiety-causing situations, afraid of being alone, and having intense but brief relationships impulsive and antagonistic intolerant of being alone chronic feelings of emptiness (from abandonment as a child) inappropriate anger or rage self harming behavior

Borderline

Odd or Eccentric Paranoid Schizoid Schizotypal

Cluster A-

Dramatic, erratic, overly emotional Narcissistic Histrionic Antisocial Borderline

Cluster B-

anxious fearful thinking Dependent Obsessive compulsive Avoidant

Cluster C -

: fast onset, acute, caused by something else

Delirium

Use distraction and redirection (don't get into power struggle) set boundaries

Demanding patient in the day hall...

Cluster C - insecure, early experience which hurt independence (childhood illness) problems in functioning clingy, stay in bad relationships

Dependent

improvement in speech, dress, energy, sleep, eating..

Evaluation of improving from manic episode

patient is creating this...

Factitious disorder -

Cluster B - provacative and flirtacious impulsive and low agreeableness 3-5 years old overly attracted to opposite sex parent they do not think they need help

Histrionic

Peripheral Edema

Hypoalbuminemia in a patient with an eating disorder would produce which assessment finding?

conduct disorder oppositional defiance disorder

Impulse disorders:

Highest level of functioning possible

Intervention for dementia / alzheimers:

0.8-1.2 (therapeutic level)

Lithium levels

8-9 cups a day 2-3 grams salt a day replace fluids after sweating

Lithium teaching:

: tyramine and other serotonin meds (some cough meds incrase serotonin) cheese and wine salami : tyramine

MAOI - contraindication:

Cluster B, arrogant, self important, strains relationships, attention seeking

Narcissistic

sleep disorder

Narcolepsy is a type of..

Encourage the use of learned relaxation techniques

Nurse Winona educates the family about symptom management for when the patient with Bipolar Disorder, Mania becomes upset or anxious. Which of the following would Nurse Winona state is helpful?

Cluster C - rigid, no insight about their own inflexible behavior, excessive parental criticism control shame, try to control his/her environment perfectionism

Obsessive compulsive

They don't have lack of empathy, don't harm animals or people, may not do well in school

Oppositional defiant disorder -

Cluster A, Pervasive Distrust and Suspiciousness, projection is major defense mechanism, doesn't think anything is wrong with them, often grew up in rage and anger household anxious about being harmed

Paranoid

Warn them about any medications that have alcohol in them

Patient who is on antibuse:

Teach them resources.... AA Set up with groups

Patient with history of alcoholism -

obsessive - compulsive

Perfectionism is a trait likely to be evident in a person with which personality disorder?

Risk for violence or injury towards others

Priority diagnoses for antisocial personality disorder:

Risk for injury - invincible feeling, pacing, jumping, street corner Nutritional deficit - not eating not drinking, CV issues Encourage fluids and food (high protein, finger foods)

Priority nursing diagnoses - MANIA

Cluster A, does not seek out friends, not affected by approval or rejection, may have been raised in cold neglectful home.

Schizoid

Cluster A, odd beliefs, magical thinking in physics, genetically linked to schizophrenia, overly detailed and abstract, extreme anxiety, rambles...

Schizotypal

Have real (body) symptoms Really feel stomach ache.. really vomiting... true chest pain...

Somatic symptom disorders:

Dual diagnosis / comorbidities include major mental illness

Substance related and addiction -

Nonstop physical activity and poor nutritional intake

The nurse assesses a client with the admitting diagnosis of Bipolar Disorder, Mania. The symptom presented by the client that requires the nurse's immediate intervention is the client's:

I should call the doctor if my spouse shakes badly

The psychiatric and mental health nurse knows that the patient's spouse clearly understands the side effects of lithium carbonate (Eskalith), when he or she says:

lithium goes down

Too much salt -

salt

What effects lithium level?

Set limits, have one staff member for main use...

What to do for cluster b :

we lose ability to learn, we make bad decisions, we get tunnel vision

When anxiety goes up -

Provides an organized, structured environment

When planning inpatient psychotherapeutic activities for a patient who has antisocial personality disorder, the psychiatric and mental health nurse:

Trazodone

Which medication for insomnia is classified as an antidepressant rather than a hypnotic?

Frequent angry outburst noted toward peers and staff

Which of the following client behaviors documented in Gio's chart would validate the nursing diagnosis of Risk for other-directed violence?

Munchausen Syndrome by Proxy

Which problem does NOT fit the group? A. Conversion Disorder B. Illness Anxiety Disorder C. Munchausen Syndrome by Proxy D. Somatic Symptom Disorder

Kicks in quicker, helps with agitation, helps with hyperactivity (promotes slowing down to eat and sleep) It's a 2nd gen antipsychotic

Why are we using Zyprexa (lanzapine)

Can trigger manic episode - watch the mood

Worried about antidepressants with bipolar:

stabilization (protect from injury) begin meds safety and physical needs (nutrition)

acute

set limits and boundaries let patient know the behavior is inappropriate

agitated patient in a room with other patients -

might have constipation, diarrhea, dizziness (Gets better)

antidepressants take a few weeks to take effect but...

full blown mania and severe depression Outlandish, bright colors, fast speech, euphoric, cheerful, happy, over the top, agitation...

bipolar type 1

hypomania and severe depression

bipolar type 2

yes - they have depression too

can you use PHQ-9 for bipolar?

childhood disorder, - leads to antisocial, Lack of empathy, don't care for rules or norms

conduct disorder:

begin to get better, groups, therapy

continuation

know all 9...

depression: or anxiety (though there is one for anxiety also) assessment for suicide ( (9) for depression and suicide sleep, eating, activity, concentration, hopeless..

SSRI: zoloft, prozac, paxil

first line for depression

lasts months, daily excessive worry

generalized anxiety

acute continuation maintenance

goals to expect for patient in different stages of recovery -

slow taper them down...

if a patient has rituals due to OCD what should you encourage?

clear the day hall (have everyone else go to rooms)

if bipolar patient escalates around other people in day hall,

do they have a plan

if they say yes to the suicide question - what is the important thing to ask?

teach coping skills

main intervention with somatic

implement resources for discharge

maintenance -

seizures

major medical complication for alcohol withdrawal

check mouths (cheeking) check the levels (blood work) behaviors start coming back.. not sleeping / not eating / mania

patients don't want to take medications...

dilated

pupils on cocaine

constricted

pupils on opiates

helps with sleep and eating

remeron: atypical

wait a few weeks.

sexual dysfunction can be a side effect of antidepressants

lithium gets toxic

too little salt -

1.5 or greater

toxic lithium level

Tremors, N/V, sweating, imbalance, ataxia

toxic lithium signs

Every system is effected.

what is effects on alcohol?

stay with them.

what should you do if your patient is in a panic state?

mild

which anxiety level is healthy?

B

which cluster is manipulative?

obsessive compulsive

who is Rigid, inflexible, easily upset if things aren't controlled -