Contemporary Nursing 6th Edition Chapters 8,9,, Townsend: Chapter 18: Anxiety, Obsessive-Compulsive, and Related Disorders (Nursing II), Mental Health Nursing- Medications, Essentials of Psychiatric Mental Health Nursing, 8th Edition Chapter 15, Town...
diffuse axonal injury (DAI)
A decreased LOC, increased ICP, decortication or decerebration, and global cerebral edema are clinical signs of what?
Somatic delusion
A delusion whose main content pertains to the appearance or functioning of one's body.
C and D. • Consistently use the client's name in the interaction. • Provide the client with structured activities. Continued reality-based orientation is necessary, so it's appropriate to use the client's name in any interaction. Structured activities can help the client refocus and resolve his delusion. The nurse shouldn't contribute to the delusion by going along with the situation. Logical arguments and an as-needed medication aren't likely to change the client's beliefs.
A delusional client approaches a nurse, stating, "I am the Easter Bunny," and insisting that the nurse refer to him as such. The belief appears to be fixed and unchanging. Which nursing interventions should the nurse implement when working with this client? Select all that apply. a) Logically point out why the client couldn't be the Easter Bunny. b) Provide an as-needed medication. c) Consistently use the client's name in the interaction. d) Provide the client with structured activities. e) Smile at the humor of the situation. f) Agree that the client is the Easter Bunny.
A - Beginning to question his or her own altered perceptions by seeking input from staff is highly desirable.
A desired outcome for a client diagnosed with schizophrenia who has a nursing diagnosis of Disturbed sensory perception: auditory hallucinations related to neurobiological dysfunction would be that the client will A. ask for validation of reality. B. describe content of hallucinations. C. demonstrate a cool, aloof demeanor. D. identify prodromal symptoms of disorder.
schizophrenia desired outcome ANSWER = A Beginning to question his or her own altered perceptions by seeking input from staff is highly desirable.
A desired outcome for a client diagnosed with schizophrenia who has a nursing diagnosis of Disturbed sensory perception: auditory hallucinations related to neurobiological dysfunction would be that the client will A. ask for validation of reality. B. describe content of hallucinations. C. demonstrate a cool, aloof demeanor. D. identify prodromal symptoms of disorder.
narcissistic personality disorder
A disorder characterized by a pervasive pattern of grandiosity, need for admiration, and lack of empathy for others
borderline personality disorder
A disorder characterized by disordered images of self, impulsive and unpredictable behavior, marked shifts in mood, and instability in relationships with others.
Outbursts and Self Harm
Appear to be efforts to manipulate others or attract attention... - BUT, result from unconscious processes!
positive
Are abnormal movements a positive or negative symptom of schizophrenia?
positive
Are agitation and anxiety positive or negative symptoms of schizophrenia?
positive
Are delusions a positive or negative symptom of schizophrenia?
positive
Are disorganized thoughts and speech considered positive or negative symptoms of schizophrenia?
positive
Are hallucinations a positive or negative symptom of schizophrenia?
negative
Are poor thought processes positive or negative symptoms of schizophrenia?
Anti-parkinsonian meds? ABCs...
Artane, Benadryl, and Cogentin (A,B,C) These help with the terrible EPS symptoms if used quick enough. Not all pt's received these quickly and therefore have permanent side effects.
Buspirone (Buspar)
Azaspirodec-anedione Partial agonist of 5-HT receptor, 2 agonist/antagonist Neurotransmitter effect unknown: serotonin, norepinephrine and dopamine Delayed Onset (10-14days) Used for long term TX GAD Does not cause physical dependence/tolerance
None addictive anxiolytics
Azaspirodec-anedione Antidepressants: SSRI or SNRI Anti-hypertensives - Betablockers & Alpha agonists Anti-histamine
Nursing interventions for the client with schizophrenia or other psychotic disorder are aimed at
Decreasing anxiety and establishing trust Assisting client to define and test reality Encouraging interaction with others Ensuring safety of client and others Meeting client's self-care needs Promoting adaptive family coping
SSRIs
First-line treatment for anxiety disorders, OCD, and BDD
Acute dystonia
Involves severe muscle spasms, particularly of the back, neck, tongue, and face
negative
Is alogia a positive or negative symptom of schizophrenia?
negative
Is anhedonia a positive or negative symptom of schizophrenia?
negative
Is apathy as positive or negative symptom of schizophrenia?
positive
Is associative looseness a positive or negative symptom of schizophrenia?
positive
Is bizarre behavior a positive or negative symptom of schizophrenia?
Acute, usually lasting no more than a few weeks to a few months.
Is crisis considered an acute or chronic situation?
negative
Is little or no functional speech a positive or negative symptom of schizophrenia?
positive
Is paranoia a positive or negative symptom of schizophrenia?
negative
Is poor judgment a positive or negative symptom of schizophrenia?
negative
Is the lack of ability to perform ADLs a positive or negative symptom of schizophrenia?
B. Buspirone must be taken daily to be effective."
Janet has a diagnosis of generalized anxiety disorder. Her physician has prescribed buspirone 15 mg daily. Janet says to her nurse, "Why do I have to take this every day? My friend's doctor ordered Xanax for her, and she only takes it when she's feeling anxious." Which of the following would be an appropriate response by the nurse? A. "Xanax is not effective for generalized anxiety disorder." B. "Buspirone must be taken daily to be effective." C. "I will ask the doctor if he will change your dose of buspirone to prn so that you don't have to take it every day." D. "Your friend really should be taking the Xanax every day."
C. Fluoxetine (Prozac)
Joanie is a new pt at the mental health clinic. She has been diagnosed with body dysmorphic disorder. Which of the following medication is the psychiatric nurse practitioner most likely to prescribe for Joanie? A. Alprazolam (Xanax) B. Diazepam (Valium) C. Fluoxetine (Prozac) D. Olanzapine (Zyprexa)
Waxy flexibility
Keeps arm in the position the nurse left it after taking blood pressure. Assumed this position for hours. Passive yielding of all movable parts of the body to any effort made at placing them in certain positions
Religiosity
Kneels to pray in front of water fountain; prays during group therapy and during other group activities.
Phase II: Prodromal Phase
Lasts from a few weeks to a few years Deterioration in role functioning and social withdrawal Substantial functional impairment Sleep disturbance, anxiety, irritability Depressed mood, poor concentration, fatigue Perceptual abnormalities, ideas of reference, and suspiciousness herald onset of psychosis
D - vulnerability The progression is vulnerability, perception of event as a threat, arousal, and then uneasiness and anxiety.
Nurses coping with angry clients may find it helpful to remember that anger and aggression begin as feelings of A. isolation. B. confidence. C. competence. D. vulnerability.
Adaptation is maladaptive.
Pathological depression occurs when _____is maladaptive
benztropine (Cogentin) patient teaching:
Patient should report urinary hesitancy/retention/dysuria. Patient should not discontinue product abruptly. Dizziness may occur.
Schizoaffective disorder
Patient that has schizo behaviors along w/ a mood disorder (bipolar/mania).
Avoidant
Even though people with _______ disorder desire to have close personal relationships, their fear of being rejected keeps them from developing social relations.
People with histrionic disorder are driven by an all-consuming need for approval and a desperate striving to be conspicuous. They are flighty by nature.
Even though people with this disorder seem to be popular, extroverted, and attractive, they are secretly driven by what feelings?
avolition
Reduced motivation and spontaneous activity
Priority focus for schizo pt?
Stay one meds Keep note that it takes several weeks to take effect of + sympt
1. Focus on the current crisis and how it can be alleviated. 2. Note how the clients reaction to the crisis could be changed. 3. Work to establish self-worth. 4. Introduce positive thinking and alternatives.
Suicide crisis counseling should include which interventions?
A visible manifestation of behavioral change that lasts for several weeks.
What is the best clue to depression in adolescence?
Adjustment disorder = difficulties with stress reactions to more "normal" events, rather than a trauma that is outside of the normal human experience.
What is the difference between PTSD and Adjustment Disorder?
Fear involves cognition-the intellectual appraisal of a threatening stimulus while anxiety is the emotional response to that stimulus.
What is the difference between fear and anxiety?
weight (kg) ________________ height (m)2 [squared]
What is the formula for measuring BMI?
To manipulate the environment so that all aspects of the client's hospital experience are considered therapeutic.
What is the goal of Mileu therapy?
immediate crisis resolution = focused to restore the person to his pre-crisis level of functioning.
What is the goal of crisis intervention?
restore nutritional status
What is the immediate, first goal of treatment in eating disorders?
Thought to increase levels of biogenic amines
What is the mechanism of action for electroconvulsive therapy?
The skills of adaptive coping, interaction, and relationship skills
What skills are the client expected to learn during Milieu therapy?
Reality therapy
What type of therapy focuses on assisting the client with meeting present needs?
Neologism
When I get out of the hospital, I'm going to buy me a sprongle." Made-up words that have meaning only to the person who invents them
strike
a work stoppage caused by the refusal of a large portion of employees to perform work; usually takes place to enforce demands relating to employment conditions on their employer or to protest unfair labor practices. Sympathy strike occurs when one union stops work to support the strike of another union
extrapyramidal effects tx = benztropine= blocks cholinergic activity in the CNS. Anxiety doesn't cause extrapyramidal effects. Overactivity of acetylcholine and lower levels of dopamine are the causes of extrapyramidal effects. Benztropine doesn't increase norepinephrine in the CNS
antipsyc comp.
benztropine (Cogentin) side effects
anxiety, restlessness, irritability, delusions, hallucinations
fMRI Koenigsberg
React more strongly and rapidly (hypersensitivity) - Visual processing - Amygdala - Superior temporal gyrus
Fx of Typicals
dopaminergic blockers with various affinity for cholinergic, α-adrenergic, and histaminic receptors
clonidine (Catapres) side effects:
drowsiness, sedation, headache, fatigue, CHF
Fx anticholinergics meds?
drugs of choice to treat extrapyramidal symptoms associated with antipsychotic medications.
The mimicking of movements of another, a positive symptom in schizophrenia
echopraxia
donepezil (Aricept) action:
elevates acetylcholine in cerebral cortex by slowing degradation of acetylcholine. Does not alter underlying dementia.
clonidine (Catapres) contraindications:
epidural bleeding disorders, anticoagulants.
bulimia nervosa
episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time, followed by inappropriate compensatory behaviors to rid the body of the excess calories
perceptual distortions
errors in perceptual judgment that arise from inaccuracies in any part of the perceptual process
bulimia
excessive, insatiable appetite
Phase IV - Residual
experience periods of remission. "They're bad, then they're good again."
what bulimia severity level does this describe: 14 or more inappropriate compensatory behaviors per week
extreme
what level of severity for binge-eating specifiers: 14 or more binge eating episodes per week
extreme
malpractice
failure of professional to meet the standard of conduct that a reasonable and prudent member of his or her profession would exercise in similar circumstances that results in harm. The professional's misconduct is unintentional
negligence
failure to act in a manner that an ordinary, prudent person, (either a layperson, or professional) would act in similar circumstances, resulting in harm. The failure to act in a reasonable and prudent manner is unitentional
True/false Anoreixa is NOT life threatening
false -it is....
Somatic delusion
false belief that one's appearance or part of one's body is diseased or altered
delusions
false fixed beliefs that cannot be corrected by reasoning
Hallucinations
false sensory experiences, such as seeing something in the absence of an external visual stimulus
Obesity is listed in in the DSM 5 as a eating disorder.
false!!! Obesity is not listed as its own disorder; however, it is associated with multiple disorders
Pica true/false For pica, young adult onset is more common.
false, childhood onset is more common for Pica
parental attitudes and family functioning are examples of what type of risk factor?
family factors
persistent disturbances of eating or eating-related behavior resulting in altered consumption or absorption of food that significantly impairs physical health or psychosocial functioning
feeding & eating disorders
thought insertion, a positive symptom of schizophrenia
feeling that one's thoughts are not one's own or that they were inserted into one's mind
Depersonalization
feelings of unreality
Binge-eating disorder is ___x more likely in _____________. (males or females)
females
bulimia nervosa is much more common in males or females?
females
Norepinephrine
fight or flight, causes arousal and anxiety
advertise
give info, to promote goods or services
recovery = 4 major dimensions
health home purpose community
Intervention phase
helps pt to clarify the problem/ determine what pt believes precipitated the crisis. This is during the _______ phase.
Anti-hypertensives
hydroxyzine (Vistaril) diphenhydramine (Benadryl)
phenobarbital (Luminal) contraindications;
hypersensitivity to barbiturates, porphyria, hepatic/respiratory disease
values
ideas of life, customs, and ways of behaving that society regards as desirable
Volition
impairment in the ability to initiate goal-directed activity Emotional ambivalence: coexistence of opposite emotions toward same object, person, or situation Deterioration in appearance: impaired personal grooming and self-care activities
what type of remission is this for anorexia: after full criteria for condition were previously met
in partial remission
what type of remission, partial or full? after full criteria for condition previously met, some, but not all, of criteria have been met for a sustained period of time
in partial remission
what type of remission is this for anorexia: - after full criteria for condition were previously met, criteria has NOT been met for a sustained period of time
in remission
what type of remission, partial or full? - after full criteria for condition were previously met, criteria has not been met for a sustained period of time
in remission
Anhedonia schiz
inability to experience pleasure
Agonist-drugs
increase neurotransmitter activity by direct stimulation of the specific receptor
Neurotransmitter effect of benzodiazepine
increases receptor affinity for GABA
SNRI Neurotransmitter effect
inhibit reuptake of serotonin, norepinephrine and mild dopamine
clonidine (Catapres) action:
inhibits sympathetic vasomotor center in the CNS & reduces blood pressure, pulse rate, and cardiac output.
Pica has a higher prevalence in those with dx of __________________ ____________________.
intellectual disorder
Rumination disorder has a higher prevalence in those with ____________ _____________/
intellectual disorder
Neologisms
invented or distorted words. Seen in schizophrenia and aphasia
hallucinations +
involve perceiving a sensory experience for which no external stimulus exists
what type of challenge to tx eating disorders does this describe ? - the development of eating disorders is rarely about food
lack of insight
what type of challenge to tx eating disorders does this describe ? - intrinsically reinforced by the weight loss, b/c it feels good to them - may deny the existence of the problem, or the severity of it
lack of motivation to change
statue
law enacted by a legislative body; separate from judge-made or common law
common law
law that is created through the decision of judges as opposed to laws enacted by legislative bodies (Congress)
licensing laws
laws that establish the qualifications for obtaining and maintaining a license to perform particular services. Persons and institutions may be required to obtain a license to provide particular health care services
learning theory factors: Negative reinforcement leads to the reduction in an advertise experience, thereby reinforcing and resulting in repetition of the behavior.
learning theory as it explains predisposing factors of stress disorders.
immunity
legal doctrine by which a person is protected from a lawsuit for negligent act or an institution is protected from a suit for negligent acts of its employees
resipsa loquitor
legal doctrine to cases in which the provider (ex. physician) had exclusive control of events that resulted in the patients injury; the injury would not have occurred ordinarily without a negligent act; a Latin phrase meaning " the things speaks for itself"
PTSD and Acute Stress Disorder difference
length of symptoms. ASD symptoms last for up to one month.
dejection
lowness of spirits; sadness; depression
Antidepressants: SSRIs
luoxetine (Prozac) sertraline (Zoloft) paroxetine (Paxil) citalopram (Celexa) fluvoxamine (Luvox) escitalopram (Lexapro)
neologisms
made-up words (or idiosyncratic uses of existing words) that have meaning for the patient but a different or nonexistent meaning to others
adjustment disorder
maladaptive reaction to a stressor
sociocultural risk factors for eating disorders: - __________ influences - social ____________ - peer pressure and attitudes about weight - teasing - activities that have an emphasis on beauty or _____________
media pressure fitness
Carbamate derivative/tranquilizer
meprobamate (Miltown, Equanil)
what bulimia severity level does this describe: 1-3 inappropriate compensatory behaviors per week
mild
what level of severity for binge-eating specifiers: 1-3 binge eating episodes per week
mild
Constricted affect
mild reduction in the range and intensity of emotional expression.
clonidine (Catapres) use:
mild to moderate hypertension; ADHD; severe pain in cancer patients via epidural. Also for opioid withdrawal.
echolalia, a positive symptom of schizophrenia
mimicry or imitation of the speech of another person
Self-Esteem Development
mirrors self-worth mostly from feedback from authority figures
illusions +
misperceptions or misinterpretations of a real experience
what bulimia severity level does this describe: 4-7 inappropriate compensatory behaviors per week
moderate
what level of severity for binge-eating specifiers: 4-7 binge eating episodes per week
moderate
damages
monetary compensation the court orders paid to a person who has sustained a loss or injury to his or her person or property through the misconduct (intentional or unintentional)
Unipolar disorder (major depression)
mood disorder loss of interest in life, lasts at least 2 weeks ECT is option DRUGS: tricyclic antidepressants atypical antidepressants MAOIs (tyramine --> hypertensive crisis) SSRIs mood stabilizers
Epidemiology of Anxiety
most common of all psychiatric illnesses, probable r/t predisposition More common in women than men Minority children and children from low socioeconomic environments are at risk
Benzodiazepine
most common type med used for the acute anxiety state diazepam (Valium) chlordiazepoxide (Librium) clonazepam (Klonopin) lorazepam (Ativan) alprazolam (Xanax )
Challenges of tx eating disorders: - lack of _______________________ to change - Lack of _________________
motivation insight
Akathisia (s/s in Extrapyramidal symptoms (antipsychotic meds = typically occurs 2-5 days post N.O.)
motor restlessness
a pronounced slowing of movement, a positive symptom of schizophrenia
motor retardation
criminal negligence
negligence that indicates "reckless and wanton"disregard for the safety, well-being, or life of an individual; behavior that demonstrates a complete disregard for for another such death is likely
binge eating and inappropriate compensatory beahviors both occur on avg, ___________ for _____________ months
once a week for 3 months
maudsley approach
one of the few evidence-based treatment options for the treatment of teens with anorexia nervosa. This approach actively involves the family in each step of the process conducted in 3 phases
Naloxone (Narcan) classification:
opioid antagonist, antidote
which personal risk factor is most associated with anorexia?
perfectionism
obessive-compulsive features often prominent with anorexia: - ____________ - preoccupied thoughts of food, body. shape/wt, exercise - collect recipes or __________ food -- concerned with eating in public, strong desire to control their environment, limited social spontinaity, overly
perfectionist hoard
emotional tone
person experiences a sense of well-being versus depression and anxiety
autonomy
personal freedom and right to make choices
Intervention phase
phase of crisis intervention will the nurse guide the client through a problem solving process?
Pica eating substances inappropriate to developmental individuals
pica
Pica can occur in females during ______________________.
pregnancy
Benztropine, trihexyphenidyl, or amantadine are ordered for treatment of Parkinson-type symptoms. Diphenhydramine provides rapid relief for dystonia. Propranolol relieves akathisia. Haloperidol can cause Parkinson-type symptoms
prevent Parkinson-type symptoms
risk managment
process of identifying, analyzing, and controlling risks posed to patients; involves human factor and incident analysis, changes in systems operations, and loss control prevention
anorexia
prolonged loss of appetite
positive symptom of schizophrenia
pronounced slowing of movement
mood disorders (affective disorders)
psychological disorders characterized by emotional extremes
Anorexia rarely begins before _______ or after age _____.
puberty or after 40
Defined in the context of nonconsensual activity and involving any penetration of the vagina or anus with any object or body part or the oral penetration by a sex organ of another person
rape
Diphenhydramine provides rapid relief for dystonia.
rapid relief for dystonia.
Binge-eating episodes associated with at least 3: - eat much more _____________ than normal - eat until ____________________ full - eat large amounts of food when not physically hungry - eating alone because of feeling __________ by how much one is eating - feeling disgusted with oneself, ____________, or very guilty
rapidly uncomfortably embarrassed depressed
adjustment disorder
reaction to specific life event
binge eating disorder (BED)
recurrent episodes of eating significantly more than most people would eat in a similar period of time under similar circumstances, and these episodes occur at least once a week and for 3 months
panic disorder
recurrent panic attacks onset = unpredictable manifested by intense apprehension, fear, or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort May or may not be accompanied by agoraphobia
sentinel event
as defined by The Joint Commission, and unintended adverse outcome that results in death, paralysis, coma, or other major permanent loss of function. Examples of sentinel events include patient suicide while in a licensed health care facility, surgical procedure on the wrong organ or body side, or a patient fall
Assessment phase
asking pt to describe the event that precipitated the crisis?
Naloxone (Narcan) nursing implications
assess for withdrawal symptoms. If respirations are less than 10/min, consider administering naloxone.
avoidant/restrictive ______________/__________________ Food Intake Disorder is a disturbance NOT better explained by lack of available food or for culturally sanctioned practice
avoidant/restrictive
avoidant/restrictive With this feeding/eating disorder people do not necessarily have to loose weight or unhappy with body
avoidant/restrictive food intake disorder
avolition = loss of motivation
avolition
antipsychotic medications exert what on the central nervous system (CNS)
depress CNS by blocking the postsynaptic transmission of dopamine, serotonin, and norepinephrine.
ASD symptoms = last for up to one month.
difference between PTSD and Acute Stress Disorder?
Apathy
disinterest in the environment
Schizoid
distant, uninterested and unsympathetic in manner
aloofness
distant, uninterested and unsympathetic in manner
concrete thinking, a positive symptom of schizophrenia
refers to an impaired ability to think abstractly
Serotonin
regulates sleep, arousal, mood, coordination and judgment. Decreased levels causes depression. Increase levels causes anxiety states
Propranolol relieves akathisia
relieves akathisia
echopraxia
repeating movements that are observed
alogia, or poverty of speech, a positive symptom of schizophrenia
represented by a lack of spontaneous comments and overly brief responses
cognitive retardation
represented by delays in responding to questions or difficulty finishing one's thoughts
utilitarianism
the best decision is one that brings about the greatest good for most people
plaintiff
the complaining person in a lawsuit; the person who claims he or she was injured by the acts of another
ethics acculturation
the didactic and experimental process of developing ethical reasoning abilities as part of ongoing professional preparation
Affect
the feeling state or emotional tone Inappropriate affect: emotions are incongruent with the circumstances Bland: weak emotional tone Flat: appears to be void of emotional tone Apathy: disinterest in the environment
Anhedonia
the inability to experience pleasure. A particularly distressing symptom that complels some clients to attempt suicide.
defendant
the individual who is named in a person's (plaintiff's) complaint as responsible for an injury; the person who the plaintiff claims committed a negligent act or malpractice
Schizoaffective
the main symptoms are the psychotic features first and mood disorder comes in and out.
patient advocacy
the nurse and the nursing professions powerful voice at the local, state, and national levels in supporting policies that protect consumers and enhance accountability for qualitly by promoting safer health care systems
Somatic Delusional Disorder
the person has a medical condition or physical defect for which no medical cause can be found
Reuptake
the process by which the presynaptic terminal of a neuron reabsorbs the neurotransmitter it has previously secreted in conveying an impulse to another neuron.
arbitration
the process of negotiation sanctioned in the U.S. by the Labor Board. It is the method used for formal talks between management and labor within modern business, industry, or service organization, Binding arbitration means that all parties must obey the arbitraior's recommendations
collective bargaining
the process whereby workers organize under the representation of a union in order a share of degree of power with management to determine selected aspects of the conditions of employment
persecution
this belief often takes the form of a plot by people in power
Phase II - Prodromal
this phase precedes the full blown disease. Start to show evident symptoms and early signs of psychosis. Lasts from a few weeks to a few years Deterioration in role functioning and social withdrawal Substantial functional impairment Sleep disturbance, anxiety, irritability Depressed mood, poor concentration, fatigue Perceptual abnormalities, ideas of reference, and suspiciousness herald onset of psychosis
denote
to indicate
Naloxone (Narcan) interactions:
tramadol overdose will increase seizures
PTSD, biological aspects involved ?
traumatic event causes body to produce opioid peptides, which result in increased feelings of control and comfort. When the stressor terminates, the individual may experience opioid withdrawal.
Benztropine
treats the extrapyramidal effects induced by antipsychotics blocks cholinergic activity in the CNS. Anxiety doesn't cause extrapyramidal effects. Overactivity of acetylcholine and lower levels of dopamine are the causes of extrapyramidal effects. Benztropine doesn't increase norepinephrine in the CNS
Pica True/flase Eating behavior for Pica is NOT part of culture or socially normative practice
true
bulimia disturbance does NOT occur during episodes of anorexia
true
substance abuse disorders and eating disorders = same part of the brain is affected that regulates self control/award (impulsivity)
true
true/false with binge-eating disorder there is marked distress from binge eating.
true
circumstantiality
unnecessary and often tedious details in one's conversation
The individual who experiences numerous failures learns to give up trying.
Describe learned helplessness.
bulimia or anorexia?! - depression, fear of gaining weight, anxiety, dizzines, shame, low self esteem
anorexia
bulimia or anorexia?! hair thins and gets brittle
anorexia
bulimia or anorexia?! low potassium, magnesium and sodium
anorexia
characterized by a pursuit of thinness that leads to self-starvation
anorexia
phenobarbital (Luminal) action:
decreases impulse transmission; increases seizure threshold at cerebral cortex level.
Erotomanic type
delusional person believes one of higher status loves them
Onset of benzodiazepine
depends on which are rapid acting .5 to 2 hours
21% of women and 13% of men will become clinically depressed
Typically, do men or women have a higher incidence of depression?
intense fear of gaining weight or becoming fat, persistent behavior that interferes with wt gain even though wt gain is already sig low
anorexia
these comorbidites are for what eating disorder: - substance use - OCD - anxiety - depression - bipolar
anorexia
restrict energy intake resulting in significantly low body wt in context of age, sex, developmental trajectory and physical health
anorexia nervosa
Dissociation
"Learned helplessness" find ways to mentally get out of abusive environment - Self-harm, isolation
Marsha Linehan
"Pioneer of DBT" - Has BPD herself! - Turned CBT into DBT because patients feel invalidated by "changing faulty beliefs"
Amanda Wang at the Wedding
"Self harm made me stop feeling crazy" - Quickly went from high to low - Misery was temporarily relieved by self harm (choking)
Relationships with BPD
"The diagnosis is in the relationships" - Emotional storms are frequent and intense - May be aware they are overreacting, but emotions are too forceful to control! - If you're in a relationship with someone with BPD, you know!
D - has a high potential for other-directed violence The client's offers to fight are suggestive of a high potential for violence. Clients may have coping skills that are adequate for day-to-day events in their lives but are overwhelmed by the stresses of illness or hospitalization. Other clients may have a pattern of maladaptive coping, which is marginally effective and consists of a set of coping strategies that have been developed to meet unusual or extraordinary situations.
"This food is garbage! I'll fight anyone who says it's not!" The nurse's most relevant assessment is that the client A. is upset with the quality of the food. B. is getting rid of tension in a harmless way. C. is frustrated by limits imposed by hospitalization. D. has a high potential for other-directed violence.
Tricyclic Antidepressants
* Raise the level of epinephrine and serotonin in the brain by slowing the rate at which they are reabsorbed by nerve cells. * SIDE EFFECTS: anticholinergic in nature (dry mouth, constipation), blurred vision, dizziness, drowsiness, tachycardia, dysrhythmias, hypotension, increased suicide risks the first few weeks of therapy THE MEDS: Amitriptyline (Elavil) Nortriptyline (Pamelor) Imipramine (Tofranil)
Antipsychotics
*Typicals*: dopaminergic blockers with various affinity for cholinergic, α-adrenergic, and histaminic receptors *Atypicals*: weak dopamine antagonists; potent 5HT2A antagonists; also exhibit antagonism for cholinergic, histaminic, and adrenergic receptors
DBT Success
- 1/2 suicide attempts - Reduced emergency room and impatient visits - After 10 years of therapy, 88% no longer met the criteria for BPD!
Prevalence
- 2% general population - 75% female - Most common personality disorder - HERITABLE (5x more likely to have BPD if a 1st degree relative has it)
Inborn Biological Temperament
- 52-68%: affective dysregulation (temperament), impulsivity, interpersonal hypersensitivity - Hyperaware of subtle emotion faces (nervous system!) - Intensely reactive to moods of others (nervous system!)
DSM-V Diagnostic Criteria
- Avoid imagined abandonment! - Alternating between extremes of idealization and devaluation - Impulsivity in 2 areas that are self-damaging (Ex. spending, sex, recklessness) - Suicidal behaviors, gestures, threats - Instability due to marked reactivity of mood - Intense anger and difficulty controlling it
Emotional Instability
- Fear being alone, yet push people away - Low self esteem, distorted self-image, frequent mood swings - Risky and destructive behavior, frequent outbursts, suicide - Difficult to treat, often fail to respond to treatment
Dialectical Behavior Therapy
- Helps... CORE - feel better about themselves! Self-worth - Identify thoughts, beliefs, and assumptions that make life problematic - Work through problems in relationships with others Families often involved so they can help
Anterior Insula Roles
- Low activity here when attempting to monitor disgusting/uncomfortable interactions - Difficulty perceiving trust - feel like they cant trust anyone (BPD don't use insula to trust!)
Main Difference between BPD and Bipolar?
- No lengthy cycles of highs and lows (bipolar cycles much longer) - Rapid mood swings (24 hours, range from euphoria to suicidal ideas)
Course of Disorder
- Often emerge in childhood/adulthood (commonly due to abuse or neglect) - High suicide rates - Better prognosis WITHOUT childhood trauma
Characteristics of BPD
- Pervasive instability in mood, relationships, and behavior - Unusual sensitivity - Difficulty controlling emotions - Impulsive decisions - Self-loathing, anxiety, and dread
Why is it difficult to treat?
- Variable symptoms - May seem normal much of the time! - Comorbid with depression, bipolar disorder, substance abuse, eating disorders (COMMON!)
Name at least 5 personal risk factors for eating disorders:
- weight - puberty/matruation - body image disturbance - restricted eating - perfectionism - stress - poor coping skills - substance abuse -history of abuse
Dry mouth Blurred vision Urinary retention
. Which anticholinergic effects may occur in a client who is on risperidone therapy? Select all that apply.
name the 3 main types of eating disorders:
. anorexia . bulimia - binge eating
S&S of EPS?
1). Tremors, shuffling gait, drooling, muscular rigidity, akathisia (restlessness) 2). Tardive dyskinesia-bizarre facial and tongue movements 3). Dystonia-spasms of face , arms, legs, and neck 4). Oculogyric crisis- eyes roll back in head
Lorazepam (Ativan) daily dosage range (mg):
1-2
Onset of anti-hypertensives
1-2 hours peak
Haloperidol (Haldol) daily dosage range (mg):
1-4 (increase dosage cautiously)
7 Domains of Complex Trauma
1. Attachment (uncertainty about reliability and predictability) 2. Biology (sensorimotor problems) 3. Emotional regulation (easily-aroused, high-intensity emotions) 4. Dissociation 5. Poor impulse modulation 6. Cognition (difficulties in attention regulation) 7. Self-concept (lack sense of self, low self-esteem)
What causes BPD (3)
1. Inborn biologic temperament 2. Psychological factors 3. Social/cultural factors
Diagnostic Criteria Subdivided into 4 Factors
1. Interpersonal hypersensitivity 2. Affect (emotional) dysregulation 3. Behavioral dyscontrol (impulsivity) 4. Disturbed self
Other types of Psychotherapy (2)
1. Transference focused psychotherapy 2. Mentalization based therapy (MBD)
Unconscious Processes in BPD
1. Unusual tendency to pick up on subtle facial cues 2. Hyperactive emotional responses
Anorexia nervosa affects females to males ____:_____
10:1
Current severity for anorexia - Mild: BMI > 17 - Mod: BMI 16-_________ - Severe: BMI: _____- 15.99 - Extreme: BMI: <________
16.99 15 15
Binge-eating disorder occurs on avg _____ x a week for ___ months
1x a week 3 months
Onset of carbamate derivative/tranquilizer
2hours, metabolite half-life up to 2+ days
psychosis preffered drug
2nd gen atypical antipsychotics
psychoses and negative psychotic symptoms tx?
2nd gen atypical antipsychotics = #1/ more effective tx
Social/Cultural Factors
Society which is fast-paced, highly mobile, and where family situations may be unstable due to divorce, economic factors, or other pressures on caregivers
Binge-eating disorder occurs in 1 in _______ adults
35!!
Zolpidem (Ambien) daily dosage range (mg):
5
Donepezil (Aricept) daily dosage range (mg):
5-10 milligrams
Trazadone (Desyrel) daily dosage range (mg):
50
2nd generation (atypical) antipsychotics
= more effective at resolving negative psychotic symptoms?
antipsychotics 2nd gen
= more effective at resolving negative psychotic symptoms?
A client diagnosed with schizophrenia experiences identity confusion and communicates with the nurse using echolalia. What is the client attempting to do by using this form of speech? a) Identify with the person speaking b) Imitate the nurse's movements c) Alleviate alogia d) Alleviate avolition
A Echolalia is a parrot-like repetition of overheard words or fragments of speech. It is an attempt by the client to identify with the person who is speaking.
A client, diagnosed with paranoid schizophrenia, states, "My roommate is plotting to have others kill me." Which is the appropriate nursing response? a) "I find that hard to believe." b) "What would make you think such a thing?" c) "I know your roommate. He would do no such thing." d) "I can see why you feel that way."
A This client is experiencing a persecutory delusion. This nursing response is an example of "voicing doubt," which expresses uncertainty as to the reality of the client's perceptions. This is an appropriate therapeutic communication technique in dealing with clients who are experiencing delusional thinking.
thought deletion, a positive symptom of schizophrenia
A belief that one's thoughts have been taken or are missing
civil law
A category of law (tort law) that deals with conduct considered unacceptable. It is based on societal expectations regarding interpersonal conduct. Common cause of civil litigation include professional malpractice, negligence, and assault and battery
A. Clients with antisocial personality act out feelings without consideration for the rights of others. They feel no remorse for their antisocial acts.
A client arrested for an assault in which he savagely beat a classmate states, "The guy deserved everything he got." The behaviors described are most consistent with the clinical picture of A. antisocial personality disorder. B. borderline personality disorder. C. schizotypal personality disorder. D. narcissistic personality disorder.
"You seem to have some feelings about hitting your wife." Explanation: The client is feeling remorse about hitting his wife. It is best to make a comment that will help him focus on his feelings and express them. Reflecting what the client has said is a good technique to accomplish these goals. Suggesting the client ask his wife or explore the issue in family therapy is inappropriate because it gives advice and ignores the client's underlying feelings. Saying, "It would depend on how much she really cares for you," is inappropriate because it ignores the client's feelings and reinforces the negative aspects, such as the shamefulness, of the behavior.
A client ashamedly tells the nurse that he hit his wife while intoxicated and asks the nurse if his wife will ever forgive him. The nurse should reply to the client by saying: a) "You seem to have some feelings about hitting your wife." b) "Perhaps you could ask her and find out." c) "It would depend on how much she really cares for you." d) "That's something you can explore in family therapy."
a - granulocytopenia Clozapine can cause life-threatening neutropenia or granulocytopenia. To detect this adverse reaction, a WBC count should be performed weekly. Hepatitis, infection, and systemic dermatitis aren't adverse reactions to clozapine therapy.
A client begins clozapine therapy after several other antipsychotic agents fail to relieve her psychotic symptoms. The nurse instructs her to return for weekly white blood cell (WBC) counts to assess for which adverse reaction? a) Granulocytopenia b) Hepatitis c) Systemic dermatitis d) Infection
A - flight of ideas Flight of ideas describes a thought pattern in which a client moves rapidly from one topic to the next with some connection. Looseness of association describes a pattern in which ideas lack an apparent logical connection to one another. Tangential thoughts seem to be related but miss the point. A client who talks around a subject and includes a lot of unnecessary information is exhibiting circumstantial thinking.
A client changes topics quickly while relating past psychiatric history. This client's pattern of thinking is called: a) flight of ideas b) looseness of association c) tangential thoughts d) circumstantial thinking
D - Delusions of grandeur provide the client with an exaggerated sense of self-esteem that is unrelated to the client's actual achievements. Other, less grandiose, religious delusions may provide comfort or meaning for the client. Delusions of persecution are frequently related to safety issues. Delusions may also be related to sexual issues.
A client claims to have a "special mission from God". The nurse incorporates this religious delusion of grandeur into the client's plan of care based on the understanding that the primary purpose of such a delusion is to provide which of the following? a) Comfort. b) Safety. c) Sexual outlet. d) Self-esteem.
A - "I need to keep my appointment here at the clinic this week for a blood test." Mandatory weekly white blood cell counts are used to detect developing agranulocytosis, which can be fatal and occurs in 1% to 2% of clients taking clozapine. This medication is associated with a risk of seizures; this risk is dose-dependent, meaning that it increases with moderate to high doses (600 to 900 mg/day). While the need to call the doctor in 2 weeks may be true, it does not reflect an understanding of the medication. Use of alcohol is contraindicated. Use of over-the-counter medications is contraindicated.
A client comes to the mental health clinic 2 days after being discharged from the hospital. The client was given a 1-week supply of clozapine. Which client statement indicates an accurate understanding of the nurse's teaching about this medication? a) "I need to keep my appointment here at the clinic this week for a blood test." b) "I can drink alcohol with this medication." c) "I can take over-the-counter sleeping medication if I have trouble sleeping." d) "I need to call my doctor in 2 weeks for a checkup."
ANSWER = 3. This would be the most appropriate intervention because it allows the staff to have input into resolving the problem. When staff have input into resolving the situation, then there is ownership of the problem. 1. The feelings of the staff are not a violation of the client's rights. Refusing to care for the client is a violation of the client's rights. 2. Transferring the client to the medical unit solves the problem for the critical care unit, but the client's behavior should be addressed by the health-care team. This is not the most appropriate intervention for the nurse manager. 4. One nurse cannot be on duty 24 hours a day. The nurse manager should try to allow the staff to identify options to address the client's behavior.
A client diagnosed with AIDS dementia is angry and yells at everyone entering the room. None of the critical care staff wants to be assigned to this client. Which intervention would be most appropriate for the nurse manager to use in resolving this situation? 1. Explain that this attitude is a violation of the client's rights. 2. Request the HCP to transfer the client to the medical unit. 3. Discuss some possible options with the nursing staff. 4. Try to find a nurse who does not mind being assigned to the client.
A " I will be continuing to follow the care plan for the patient." Obsessive-compulsive personality disorder has the key factor of perfectionism with a focus on orderliness and control. These individuals get so preoccupied with details and rules that they may not be able to accomplish the tasks. Guard against engaging in power struggles with a client with obsessive-compulsive disorder.
A client diagnosed with obsessive-compulsive personality disorder takes the nurse aside and mentions, "I've observed you interacting with that new patient. You are not approaching him properly. You should be more forceful with him." The best response for the nurse would be A. "I will be continuing to follow the care plan for the patient." B. "I see you are trying to control that patient's therapy as well as your own." C. "Your eye for perfection extends even to my nursing interventions." D. "That patient's care is really of no concern to you or to other clients."
schizophrenia, paranoid schiz ANSWER = C This reply acknowledges the client's reality but offers the nurse's perception that he or she is not experiencing the same thing.
A client diagnosed with paranoid schizophrenia refuses food, stating the voices are saying the food is contaminated and deadly. A therapeutic response for the nurse would be A. "You are safe here in the hospital; nothing bad will happen to you." B. "The voices are wrong about the hospital food. It is not contaminated." C. "I understand that the voices are very real to you, but I do not hear them." D. "Other people are eating the food, and nothing is happening to them."
schizophrenia neologism ANSWER = A A neologism is a newly coined word that has meaning only for the client.
A client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me." The term "volmers" can be assessed as A. a neologism. B. clang association. C. blocking. D. a delusion.
Schizophrenia (residual) ANSWER = C Schizophrenia is considered a neurobiological disorder. The course of schizophrenia involves recurrences. With each relapse further deterioration is noted. Residual schizophrenia refers to the disorder when active phase symptoms are no longer present and the individual is left with two or more of the following symptoms: lack of initiative, social withdrawal, impaired role function, marked speech deficits, and odd beliefs.
A client diagnosed with residual schizophrenia is uninterested in community activities. He lacks initiative, demonstrates both poverty of content of speech and poverty of speech, and seems unable to follow the schedule for taking his antipsychotic medication. The case manager continues to direct his care with the knowledge that his behavior is most likely prompted by A. chronic uncooperativeness. B. personality conflict. C. neural dysfunction. D. dependency needs.
A - The decision to use alcohol is a wish to feel accepted by others. Explanation: The client's decision to drink results in feeling accepted by his peers which increases his self-esteem. Guilt or shame may result later because the client is aware that he should not use alcohol because of his mental illness. The combination of a mental illness and substance abuse results in increased recidivism and treatment complications. It may not be true that the client abused alcohol before developing a mental illness or that the client is compelled to drink because of cognitive difficulties. The client may be predisposed to developing a substance abuse problem and a mental illness because of heredity and biologic factors.
A client diagnosed with schizophrenia and alcohol abuse decides to drink alcohol with his buddies. The nurse interprets this behavior, recognizing which of the following as an underlying dynamic of the client's alcohol use? a) The decision to use alcohol is a wish to feel accepted by others. b) The client abused alcohol before developing a mental illness. c) The client is compelled to drink because of cognitive difficulties. d) The decision to drink increases the client's guilt and shame.
Transient depression
A client exhibiting "the blues," crying, feeling disappointed, tired, and listless might be displaying what type of depression?
1. Open-ended questions and silence are strategies used to encourage clients to discuss their problems. Sharing personal food preferences is not a client-centered intervention. The remaining options are not helpful to the client because they do not encourage the client to express his feelings. The nurse should not offer opinions and should encourage the client to identify the reasons for the behavior. Test-Taking Strategy: Use knowledge of therapeutic communication techniques. First eliminate options that do not support the client's expression of feelings. Any option that is not client-centered should be eliminated next. Focusing on the client's feelings will direct you to the correct option.
A client experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the nurse use to encourage the client to eat? 1. using open-ended questions and silence 2. sharing personal preferences regarding food choices 3. documenting reasons why the client does not want to eat 4. offering opinions about the necessity of adequate nutrition
schiz stable plateau ANSWER = D During the stable plateau phase of schizophrenia, planning is geared toward client and family education and skills training that will help maintain the optimal functioning of schizophrenic individuals in the community.
A client has reached the stable plateau phase of schizophrenia. An appropriate clinical focus for planning would be A. safety and crisis intervention. B. acute symptom stabilization. C. stress and vulnerability assessment. D. social, vocational, and self-care skills.
Haloperidol
A client has severe anhedonia and regression. Which medication aggravates the condition of the client?
Orienting the client toward reality
A client in a psychiatric ward has severe psychotic episodes and talks to self. On assessing the behavior of the client, the nurse talks to the client about place, time, and current activity. What is the nurse trying to do by implementing this intervention?
D - The nurse is using the technique of exploring because she's willing to delve further into the client's concern. She isn't presenting reality or making observations or simply restating. The nurse is encouraging the client to explore his feelings.
A client in an acute care setting tells the nurse, "I don't think I can face going home tomorrow." The nurse replies, "Do you want to talk more about it?" The nurse is using which technique? a)Presenting reality b)Making observations c)Restating d)Exploring
A: Ambivalence refers to strong conflicting attitudes or feelings toward an object, person, goal, or situation evidenced in one instance by the client stating she is going to divorce her husband then stating that she misses and loves him. Autistic thinking is preoccupation with self with little concern for external reality. For example, a client's attention cannot be diverted from examining his hands. Associative looseness is characterized by simultaneous expression of unrelated, or only slightly related, ideas or thoughts. For example, a client states, "We went to a basketball game. Where is my father?" Auditory hallucinations involves hearing sounds, words, or voices not heard by others.
A client in an inpatient psychiatric unit tells the nurse, "I'm going to divorce my no-good husband. I hope he rots in hell. But I miss him so bad. I love him. When's he going to come get me out of here?" The nurse interprets the client's statements as indicative of which of the following? A. Ambivalence B. Autistic thinking C. Associative looseness D. Auditory hallucinations
A - The nurse's highest priority is to ask the client if he is thinking about hurting himself or to assess for suicide. Questioning the client about his sleep pattern, questioning the client about recent stresses, and questioning the client about his feelings about himself are important areas of assessment for the depressed client but not as immediate a priority as assessing the Risk for suicide
A client is admitted to the inpatient psychiatric unit. He is unshaven, has body odor, and has spots on his shirt and pants. He moves slowly, gazes at the floor, and has a flat affect. When assessing the client on admission, the nurse should first ask the client: a) If he is thinking about hurting himself. b) How he feels about himself. c) How he sleeps at night. d) About recent stresses.
B - Bipolar disorder is characterized by mood swings from profound depression to elation and euphoria. Delusions of grandeur accompanied by pressured speech are common symptoms of the manic phase of bipolar disorder. Schizophrenia does not manifest as mood swings from depression to euphoria. Paranoia is characterized by unrealistic suspiciousness and is usually accompanied by grandiosity. OCD is a preoccupation with rituals and rules.
A client is admitted to the psychiatric emergency department. His significant other reports that he has difficulty sleeping, has poor judgment, and is incoherent at times. The client's speech is rapid and loose. He reports being a special messenger from the Messiah. He has a history of depressed mood for which he has been taking an antidepressant. Which diagnosis should the nurse suspect? a) Obsessive-compulsive disorder (OCD) b) Bipolar disorder c) Paranoid personality d) Schizophrenia
A - "It must feel frightening to think someone is trying to hurt you." The nurse should encourage the patient to focus on the feelings the delusions generate; avoid arguing about the content of the delusion. "Why" questions will make the client defensive. Delusions are persistent false beliefs. Nurses should not encourage discussion of delusions.
A client is admitted to the psychiatric unit with schizophrenia. The client verbalizes that, "Someone wants to kill me tonight." Which response is best? a) "It must feel frightening to think someone is trying to hurt you." b) Someone does not know that you have been admitted." c) "Why do you think that?" d) "No one wants to kill you."
C - establish a trusting nurse/client relationship
A client is admitted with paranoid schizophrenia. The client's wife says that he has not slept in 4 nights. Which action by the nurse is most correct? a) introduce the client to other clients on the unit b) encourage the client to sleep c) establish a trusting nurse/client relationship d) assign the client to straighten up the day room
D - After group, ask the client to talk to the nurse about her concerns. Explanation: It is appropriate to talk alone with this client about her feelings. A suspicious client is unlikely to agree to talk about feelings in a group. It is a violation of the client's privacy to reveal a client's problems to group members. The other clients in the group have no reason to apologize, and the nurse should not ask them to do so.
A client is becoming agitated during a discussion group. She states, "I know that all of you hate me." She leaves the group and goes to her room. Which action by the nurse is most therapeutic for the client? a) Ask the client to return to group and share her feelings. b) Ask the group members to apologize to the client individually. c) Explain to group members about the client's problems. d) After group, ask the client to talk to the nurse about her concerns.
D - Clozapine is the one atypical antipsychotic associated with severe anticholinergic adverse effects such as constipation. Consuming fruits would not be the cause of the client's constipation. The client should take clozapine with food to avoid nausea. Getting up slowly indicates that the client understands that postural hypotension may occur with clozapine. The statement about sleepiness indicates that the client understands that sedation may occur with this drug.
A client is being successfully treated with clozapine. Which of the following statements by the client reflects a need for further teaching about managing the drug's adverse effects? a) "I need to take the medicine with food to avoid nausea." b) "I have to get up slowly so I don't get dizzy." c) "Sometimes I have to push myself because I'm sleepy." d) "If I eat too many fruits, I'll get constipated."
D - Haloperidol and lorazepam together decrease hallucinations and agitation, thus decreasing the risk of self-harm. Putting the client in restraints is premature because danger is not imminent. Asking the client to talk about her anger is inappropriate because the client is beyond rational conversation. A room search is appropriate only after the crisis with the client is handled.
A client is hearing voices that are telling her to kill herself. She is demanding a knife to use on her wrists. Which of the following is most appropriate at this time? a) Search the client's room for potential weapons after locking the unit kitchen. b) Put the client in restraints after giving an I.M. dose of p.r.n. medication. c) Ask the client to talk about her anger and what is causing it. d) Give oral p.r.n. doses of haloperidol and lorazepam as ordered.
B - This client's history of delinquency, running away from home, vandalism, and dropping out of school is characteristic of antisocial personality disorder. This maladaptive coping pattern is manifested by a disregard for societal norms of behavior and an inability to relate meaningfully to others. In borderline personality disorder, the client exhibits mood instability, poor self-image, identity disturbance, and labile affect. Obsessive-compulsive disorder is characterized by a preoccupation with impulses and thoughts that the client realizes are senseless but can't control. Narcissistic personality disorder is characterized by a pattern of self-involvement, grandiosity, and demand for constant attention.
A client is remanded by the courts for psychiatric treatment. His police record, which dates to his early teenage years, includes delinquency, running away, auto theft, and vandalism. He dropped out of school at age 16 and has been living on his own since then. His history suggests maladaptive coping, which is associated with: a) obsessive-compulsive personality disorder. b) antisocial personality disorder. c) borderline personality disorder. d) narcissistic personality disorder.
C - The nurse needs to ask the client whether he is going to hurt himself to determine the client's ability to cope with the voices and to assess the client's impulse control. The nurse's assessment will then determine the course of action to take regarding the client's safety. Asking when the client hears the voices and how long the client has heard them is important but not as important as determining whether the client will act on what the voices are saying. Asking "Why are the voices starting again?" would be inappropriate because the client may not know why and may not be able to answer the nurse.
A client lives in a group home and visits the community mental health center regularly. During one visit with the nurse, the client states, "The voices are telling me to hurt myself again." Which of the following questions by the nurse is most important to ask? a) "When do you hear the voices?" b) "Why are the voices starting again?" c) "Are you going to hurt yourself?" d) "How long have you heard the voices?"
Jealous
A client whose husband has schizophrenia states, "My husband attacked me last night, and he suspects me of having an extramarital affair." The nurse concludes that the client's husband is exhibiting which type of delusional disorder?
Emotional lability. This type of behavior illustrates emotional lability, which is a readily changeable or unstable emotional affect. Neologism is using a word when it can have two or more meanings, or a play on words. Confabulation involves replacing memory loss by fantasy to hide confusion; it is unconscious behavior. Flight of ideas refers to a rapid succession of verbal expressions that jump from one topic to another and are only superficially related.
A client receiving dialysis directs profanities at the nurse and then abruptly hangs his head and pleads, "Please forgive me. Something just came over me. Why do I say those things?" The nurse interprets this as which of the following? a) Confabulation. b) Neologism. c) Emotional lability. d) Flight of ideas.
B - An antiparkinsonian agent such as amantadine may be used to control pseudoparkinsonism; diphenhydramine or benztropine may be used to control other extrapyramidal effects. Phenytoin is used to treat seizure activity.
A client receiving fluphenazine decanoate therapy develops pseudoparkinsonism. A physician is likely to order which drug to control this extrapyramidal effect? a) Diphenhydramine b) Amantadine c) Benztropine d) Phenytoin
B - The client is most likely suffering from muscle rigidity caused by haloperidol. I.M. benztropine should be administered to prevent asphyxia or aspiration. Lorazepam treats anxiety, not extrapyramidal effects. Another dose of haloperidol would intensify the severity of the client's reaction.
A client receiving haloperidol reports a stiff jaw and difficulty swallowing. The nurse's first action should be to: a) administer an as-needed dose of haloperidol. b) administer an as-needed dose of benztropine I.M. as ordered. c) reassure the client and administer as-needed lorazepam I.M. d) administer an as-needed dose of benztropine as ordered.
D - The client's disturbed thought process likely reflect this client's paranoid delusions. The nurse should acknowledge that the thoughts are frightening the client. Telling the client the nurse does not see any foreign agents is an appropriate nursing response if the client is having disturbed visual sensory perception and is having visual hallucinations. Telling the client the nurse does not understand what the client means is an appropriate response if the client has impaired verbal communication. Suggesting that a client participate in group activities would be appropriate if the client had a nursing diagnosis of social isolation and was staying in his room.
A client reports having thoughts of being followed by foreign agents who are after his secret papers. Which response by the nurse is most appropriate when responding to the client's disturbed thought process? a) "I'd like you to come to group with me right now." b) "I don't see any foreign agents." c) "I don't know what you mean." d) "I think these thoughts are frightening to you."
Erotomanic
A client tells the nurse, "Brad Pitt is in love with me and often sends me flowers." Which type of delusion does the nurse document for the client based on this statement?
Delusion of control or influence
A client tells the nurse, "I can be active only when this tube light is switched on, and I must sleep whenever the tube light is switched off." Which type of delusion does this behavior of the client indicate?
D. explaining to the client what caused the back-up and suggesting that he has time to go to the coffee shop. Taking time to explain to clients and offering measures that will provide comfort can be helpful in reducing tension and anger associated with waiting.
A client waiting to see the physician is pacing and looking both angry and tense. When it's determined that the client won't be seen for another 30 minutes, the nurse addresses the client's agitation by A. telling the client that pacing will not help the rate at which clients are seen. B. adjusting the appointment schedule to allow the client to be seen next. C. empathizing with the long wait and asking the client if he would mind sitting down until his turn comes. D. explaining to the client what caused the back-up and suggesting that he has time to go to the coffee shop.
A. Stay with the client and reassure safety
A client who is experiencing a panic attack just arrived at the ER. Which is the priority nursing intervention for this client? A. Stay with the client and reassure safety B. Administer a dose of diazepam C. Leave the client alone in a quiet room so that she can calm down. D. Encourage the client to talk about what triggered the attack.
2. The nurse's nonverbal behavior, moving away from the window as the client requests, indicates agreement with the client's false ideas. The client's behavior is likely to be reinforced if the nurse takes steps to agree with the false ideas the client holds.
A client who is neatly dressed and clutching a leather briefcase tightly in his arms scans the adult inpatient unit on his arrival at the hospital and backs away from the window. The client requests that the nurse move away from the window. The nurse recognizes that doing as the client requested is contraindicated for which of the following reasons? 1. The action will make the client feel that the nurse is humoring him 2. The action indicates nonverbal agreement with the client's false ideas 3. The client will think that he will have his way when he wishes 4. The nurse will be demonstrating a lack of composure over the situation
C. Set limits on the amount of time Sandy may engage in the ritualistic behavior.
A client with OCD says to the nurse, "I've been here 4 days now, and I'm feeling better. I feel comfortable on this unit, and I'm not at ill-at-ease with the staff or other pts anymore." In light of this change, which nursing intervention is most appropriate? A. Give attention the to ritualistic behaviors each time they occur and point out their inappropriateness. B. Ignore the ritualistic behaviors, and they will be eliminated for lack of reinforcement. C. Set limits on the amount of time Sandy may engage in the ritualistic behavior. D. Continue to allow Sandy all the time she wants to carry out the ritualistic behavior.
A. Relieves her anxiety
A client with OCD spends many hours each day washing her hands. The most likely reason she washes her hands so much is that it: A. Relieves her anxiety B. Reduced her probability of infection C. Gives her a feeling of control over her life D. Increases her self-concept
Medication noncompliance is a primary cause of exacerbation in chronic mental illnesses. Of the issues listed, medications should be addressed first. Other issues, such as family, marriage, and finances can be addressed as client stabilization is maintained.
A client with a chronic mental illness who does not always take her medications is separated from her husband and receives public assistance funds. She lives with her mother and older sister and manages her own medication. The client's mother is in poor health and also receives public assistance benefits. The client's sister works outside the home, and the client's father is dead. Which of the following issues should the nurse address first? a) Family. b) Medication. c) Marital. d) Financial.
A. A client with borderline personality disorder displays a pervasive pattern of unpredictable behavior, mood, and self-image. His interpersonal relationships may be intense and unstable, and his behavior may be inappropriate and impulsive. Although the client's impaired ability to form relationships may affect his parenting skills, his inability to function as a responsible parent is more typical of antisocial personality disorder. Somatic symptoms characterize avoidant personality disorder. Coldness, detachment, and lack of tender feelings typify schizoid and schizotypal personality disorders
A client with a diagnosis of borderline personality disorder is admitted to the psychiatric unit. The nurse expects the assessment to reveal: a) unpredictable behavior and intense interpersonal relationships. b) coldness, detachment, and lack of tender feelings. c) inability to function as a responsible parent. d) somatic symptoms.
D - Document the presence and amount of fluid The clear drainage (cerebrospinal rhiorrhea) may result from a basal skull fracture caused by leakage of cerebrospinal fluid. The nurse should document the finding. Most leaks will close spontaneously. Compressing the nares will obstruct the drainage flow. It is inappropriate to tilt the head back, which would allow the fluid to drain down the throat. It is not necessary to administer an antihistamine because the drainage may not be from postnasal drip
A client with a head injury begins to have clear drainage from the nose. The nurse should: a) Tilt the head back at a 30-degree angle. b) Compress the nares for 10 seconds. c) Administer an antihistamine for postnasal drip. d) Document the presence and amount of fluid.
The client has vermiform tongue movements.
A client with a psychiatric illness is on pimozide (Orap) therapy. On assessment of the client after a few weeks, the primary health-care provider instructs the nurse to stop administering the drug. What could be the reason for withdrawing the drug?
Seek clarification from the client
A client with a psychiatric illness tells the nurse, "It is very cold. I am cold and bold. The gold has been sold." Which intervention would the nurse implement in this situation?
A. Shortly after phenothiazine administration, a quieting and calming effect occurs, but the client is easily aroused, alert, and responsive and has good motor coordination.
A client with a tentative diagnosis of psychosis is admitted to the psychiatric unit. A physician orders the phenothiazine thioridazine 50 mg by mouth three times per day. Phenothiazines differ from central nervous system (CNS) depressants in their sedative effects by producing: a) a calming effect from which the client is easily aroused. b) greater sedation than CNS depressants. c) deeper sleep than CNS depressants. d) more prolonged sedative effects, making the client more difficult to arouse.
A - "You had to wait. Can we talk about how this is making you feel right now?" This response may defuse the client's anger by helping to maintain a therapeutic relationship and addressing the client's feelings. Telling the client that if the situation was an emergency involving him other clients would have to wait wouldn't address the client's anger. Apologizing is incorrect because a client with a borderline personality disorder blames others for things that happen; apologizing reinforces his misconception that someone is at fault. The nurse can't promise that a delay will never occur again because such matters are beyond her control.
A client with borderline personality disorder becomes angry when he is told that his psychotherapy session with the nurse will be delayed 30 minutes because of an emergency. When the session finally begins, the client expresses anger. Which response by the nurse is most helpful in dealing with the client's anger? a) "You had to wait. Can we talk about how this is making you feel right now?" b) "If it had been your emergency, I would have made the other client wait." c) "I know it's frustrating to wait. I'm sorry this happened." d) "I really care about you, and I'll never let this happen again."
Hallucinations
A client with schizophrenia says, "Something is always crawling inside my wrist. Can you please take it out?" Which symptom does this behavior of the client indicate?
"I won't eat this food. I know it is poisoned
After assessing a client with a psychiatric illness, the nurse concludes that the client is experiencing paranoia. Which client response is most consistent with paranoia?
B - Dystonia, a common extrapyramidal reaction to fluphenazine decanoate, manifests as muscle spasms in the tongue, face, neck, back, and sometimes the legs. Akinesia refers to decreased or absent movement; akathisia, to restlessness or inability to sit still; and tardive dyskinesia, to abnormal muscle movements, particularly around the mouth.
A client with chronic schizophrenia receives 20 mg of fluphenazine decanoate by I.M. injection. Three days later, the client has muscle contractions that contort his neck. This client is exhibiting which extrapyramidal reaction? a) Akinesia b) Dystonia c) Akathisia d) Tardive dyskinesia
d) hallucination. Reason: Auditory hallucination, in which one hears voices when no external stimuli exist, is common in schizophrenic clients. Such behaviors as laughing, yelling, and talking to oneself suggest such a hallucination. Delusions, also common in schizophrenia, are false beliefs or ideas that arise without external stimuli. Clients with schizophrenia may exhibit looseness of association, a pattern of thinking and communicating in which ideas aren't clearly linked to one another. Illusion is a less severe perceptual disturbance in which the client misinterprets actual external stimuli. Illusions are rarely associated with schizophrenia.
A client with chronic undifferentiated schizophrenia is admitted to the psychiatric unit of a local hospital. During the next several days, the client is seen laughing, yelling, and talking to himself. This behavior is characteristic of: a) delusion. b) looseness of association. c) illusion. d) hallucination.
d - Auditory hallucination, in which one hears voices when no external stimuli exist, is common in schizophrenic clients. Such behaviors as laughing, yelling, and talking to oneself suggest such a hallucination. Delusions, also common in schizophrenia, are false beliefs or ideas that arise without external stimuli. Clients with schizophrenia may exhibit looseness of association, a pattern of thinking and communicating in which ideas aren't clearly linked to one another. Illusion is a less severe perceptual disturbance in which the client misinterprets actual external stimuli. Illusions are rarely associated with schizophrenia.
A client with chronic undifferentiated schizophrenia is admitted to the psychiatric unit of a local hospital. During the next several days, the client is seen laughing, yelling, and talking to himself. This behavior is characteristic of: a)delusion. b)looseness of association. c)illusion. d)hallucination.
ANSWER = A Reaction formation is a defense mechanism in which a person assumes an attitude that contradicts an impulse or a wish that he harbors. The belief that one's thoughts can control other people and events is called "magical thinking." Persistent thoughts and discussion of a particular idea or subject are called "rumination." Use of an act to negate a previous act is called "undoing."
A client with obsessive-compulsive disorder may use reaction formation as a defense mechanism to cope with anxiety and stress. What typically occurs in reaction formation? a) The client assumes an attitude that contradicts an impulse he harbors. b) The client believes his thoughts can control other people and events. c) The client persistently thinks and talks about a particular idea or subject. d) The client uses a specific act to negate a previous act.
A - Sharing a benign, nonthreatening, personal fact or feeling helps the nurse establish rapport with the client and encourages the client to confide in her. The nurse can't know how the client feels. Telling the client otherwise would justify the suspicions of a paranoid client; furthermore, the client relies on the nurse to interpret reality. The nurse stating that she worries when people talk about her is incorrect because the statement focuses on the nurse's feelings, not the client's. Saying it's normal not to trust anyone wouldn't help establish rapport or encourage the client to confide in the nurse.
A client with paranoid personality disorder is admitted to a psychiatric facility. Which remark by the nurse would best establish rapport and encourage the client to confide in her? a) "I get upset once in a while, too." b) "I know just how you feel. I'd feel the same way in your situation." c) "At times, it's normal not to trust anyone." d) "I worry, too, when I think people are talking about me."
C - "This subject seems to be troubling you. Let's walk to the activity room." This remark distracts the client from the delusion by engaging him in a less-threatening or more-comforting activity at the first sign of anxiety. The nurse should reinforce reality and discourage the client's false belief. The other options focus on the content of the delusion rather than on the meaning, feeling, or distress it evokes.
A client with schizophrenia and delusions tells a nurse, "There is a man wearing a red coat who's out to get me." The client exhibits increasing anxiety when focusing on the delusion. Which response by the nurse is appropriate? a) "There is no need to be concerned about a man who isn't even real." b) "Describe the man who's out to get you. What does he look like?" c) "This subject seems to be troubling you. Let's walk to the activity room." d) "There is no reason to be afraid of that man. This hospital is very secure."
associative looseness
A client with schizophrenia is having an acute exacerbation of symptoms. The client states, "Black cats and black hats. Where does the time go?" What symptom of schizophrenia is the client demonstrating?
schizophrenia is having an acute exacerbation of symptoms D - "What's the connection between cats, hats, and time?" Explanation: The client is demonstrating loose associations. Therefore, the nurse needs to clarify the meaning of and the connection between ideas. The nurse's statement about Halloween makes the assumption that the client is talking about Halloween from the mention of black cats and black hats. Asking if the client has a black cat is not helpful. The statement about time going faster ignores the client's statement entirely.
A client with schizophrenia is having an acute exacerbation of symptoms. The client states, "Black cats and black hats. Where does the time go?" Which of the following would be most important for the nurse to say? a) "Halloween is getting close, isn't it." b) "Time certainly does go faster these days." c) "Do you have a black cat?" d) "What's the connection between cats, hats, and time?"
A and B - Sore throat and fever Sore throat, fever, and sudden onset of other flulike symptoms are signs of agranulocytosis, a condition in which an insufficient number of granulocytes (a type of white blood cell [WBC]) causes the individual to be susceptible to infection. The client's WBC count should be monitored at least weekly throughout the course of treatment. Pill-rolling movements can occur in clients experiencing adverse extrapyramidal effects associated with antipsychotic medication that has been ordered for much longer than a medication, such as clozapine. Polyuria and polydipsia are common adverse effects of lithium therapy. Orthostatic hypotension is an adverse effect of tricyclic antidepressant therapy.
A client with schizophrenia is taking the atypical antipsychotic medication clozapine. Which signs and symptoms indicate the presence of adverse effects associated with this medication? Select all that apply. a) Pill-rolling movements b) Sore throat c) Polyuria d) Fever e) Polydipsia f) Orthostatic hypotension
"Even though the voices are real to you, I am unable to hear any voices speaking."
A client with schizophrenia says to the nurse, "A divine voice coming from space is always telling me to go to New York." What is the best response of the nurse in this situation?
C - Because the client can live in an apartment setting, further development of independent functioning and the skills to gain as much independence as he is capable of need to be fostered, including getting out and developing new friendships. Arranging for participation in day treatment is most beneficial at this time. Family visits and daily nursing visits do not encourage the client to do this. Making an appointment for 2 weeks later puts the client's needs off. Lack of social relationships is not a sufficient reason for rehospitalization.
A client with schizophrenia tells the nurse that he doesn't go out much because he doesn't have anywhere to go and he doesn't know anyone in the apartment where he's staying. Which of the following actions is most beneficial for the client at this time? a) Thinking about the need for rehospitalization for the client. b) Encouraging him to call his family to visit more often. c) Arranging for the client to attend day treatment at the clinic. d) Making an appointment for the client to see the nurse daily for 2 weeks.
The client has an auditory type of hallucination. The client has a gustatory type of hallucination.
A client with schizophrenia tells the nurse, "When I eat this pungent ice cream, I hear the voice of god." What does the nurse infer from this statement by the client? Select all that apply.
Borderline personality disorder
A client with this type of personality disorder exhibits mood instability, poor self-image, identity disturbance, and labile effect.
Neologisms Associative looseness
A client writes, "My kolege konducts unikornth festewel evry year. I vant this buk for studying." Which symptoms would the nurse document in the client record after reading this writing? Select all that apply.
Antipsychotic meds = arrange blood draw/ wbc count C - Antipsychotic medications may cause agranulocytosis, the first manifestation of which may be a sore throat and flulike symptoms.
A client, who has been receiving antipsychotic medication for 6 weeks, tells the nurse that the hallucinations are nearly gone and that concentration has improved. When the client reports flulike symptoms including a fever and a very sore throat, the nurse should A. suggest that the client take something for her fever and get extra rest. B. advise the physician that the client should be admitted to the hospital. C. arrange for the client to have blood drawn for a white blood cell count. D. consider recommending a change of antipsychotic medication.
prolonged exposure therapy
A cognitive-behavioral treatment for PTSD that involves repeatedly exposing individuals to stimuli that remind them of their past trauma in order to alter their fear networks.
derealization
A false perception that the environment has changed
depersonalization
A feeling that one is somehow different or unreal or has lost his identity
cognitive retardation, a positive symptom of schizophrenia
A generalized slowing in the pace of thinking
Flat affect
A neg symptom, appears to be void of emotional tone
A - "I am a new nurse." Reality orientation addresses a client's concern without reinforcing delusion. Nontherapeutic defensiveness will reinforce the delusion and should be avoided. b - Does not address the client's concern about who the nurse is. May be interpreted as a threat c - Inappropriate use of reflection. Reinforces delusion.
A new nurse in the psychiatric unit is administering medication, and a client yells at the nurse, "You are a spy with poison pills!" Which response is best? a) "I am a new nurse." b) "This is your medication, which you have to take." c) Is it your feeling that I am trying to poison you?" d) "I am not a spy."
c - Verify that the infant has urinated. Reason: Normal serum potassium levels are 3.5-4.5 Meq/L. Elevated potassium levels can cause life threatening cardiac arrhythmias. The nurse must verify that the client has the ability to clear potassium through urination before administering the drug. Infants with pyloric stenosis frequently have low potassium levels due to vomiting. A level of 3.4Meq/l is not unexpected and should be corrected with the ordered fluids. The lab value does not need to be redrawn as the findings are consistent with the infant's condition.
A newborn admitted with pyloric stenosis is lethargic and has poor skin turgor. The primary care provider has ordered I.V. fluids of dextrose water with sodium and potassium. The baby's admission potassium level is 3.4Meq/ L. The nurse should: a) Notify the primary care provider. b) Administer the ordered fluids. c) Verify that the infant has urinated. d) Have the potassium level redrawn.
4. It is critical for the nurse to ensure the safety of others by knowing who the client might think needs elimination. Asking the client to explain what she means or discuss her concerns at the group session are possible interventions for later in the client's hospital stay. Wearing appropriate clothing while hospitalized is generally a unit expectation for all clients.
A newly admitted client describes her mission in life as one of saving her son by eliminating the "provocative sluts" of the world. There are several attractive young women on the unit. What should the nurse do first? 1. Ask the client for her definition of "provocative sluts" 2. Ask the young female clients on the unit to dress less provocatively 3. Ask the client to discuss her concerns in the next group session 4. Ask the client to inform the staff if she has negative thoughts about other clients
A - Administer lorazepam or haloperidol The client's anxiety as reflected in rapid pacing and clang associations is rising as a result of his paranoid delusions. Administering the Ativan and Haldol will help the anxiety and delusions. He is not threatening others at this point, so seclusion, restraints, and asking clients to leave the area is not necessary
A newly admitted client diagnosed with paranoid schizophrenia is pacing rapidly and wringing his hands. He states that another client is out to get him. Then he says, "Protect me, select me, reject me." The nurse should next: a)Administer his oral PRN lorazepam (Ativan) and haloperidol (Haldol). b)Place the client in temporary seclusion before he has a chance to hurt others. c)Call the primary health care provider for a prescription for restraints. d)Ask the other clients to leave the immediate area.
B - Respect need for social isolation. Schizoid personality disorder has the primary feature of emotional detachment. Individuals do not seek out or enjoy close relationships. They are reclusive, avoidant, and uncooperative. They do not do well with resocialization.
A newly admitted client has an axis II diagnosis of schizoid personality disorder. The nursing intervention of highest priority will be to A. set firm limits on behavior. B. respect need for social isolation. C. encourage expression of feelings. D. involve in milieu and group activities.
C. Moving to the rear of the staff group. There is no need for the nurse to stand her ground to save face. The goal is to deescalate the situation. When the client makes a request that can be met without compromising safety, granting the request is acceptable.
A nurse attempts to intervene verbally when an angry client initially threatens to throw a chair but quickly focuses the anger toward the nurse. Several staff members gather behind the nurse, but then the client shouts, "I will calm down when that nurse isn't in my face." The nurse best demonstrates the ability to help the client deescalate by A. continuing to manage the situation personally. B. telling the client, "It isn't safe for me to leave the room." C. moving to the rear of the staff group. D. apologizing for upsetting the client.
schizophrenia ANSWER = B A flexible care plan is needed for any client who behaves in a suspicious, withdrawn, or regressed manner or who has a thought disorder. Because such a client communicates at different levels and at different times and is sometimes in control of himself, the nurse must be able to adjust nursing care as the situation warrants, such as offering the medication again after waiting for a short period of time. Forcing the client to take the medication now and calling the client honey may anger the client
A nurse caring for a client diagnosed with schizophrenia should perform which of the following interventions when the client becomes suspicious and refuses to take his medication? a) Attempt to coax the client into taking the medication by calling him honey b) Wait for a short time and then attempt to administer the medication c) Document that the client is noncompliant d) Tell the client he must take the medication now
ANSWER = B. Wait for a short time and then attempt to administer the medication Explanation: A flexible care plan is needed for any client who behaves in a suspicious, withdrawn, or regressed manner or who has a thought disorder. Because such a client communicates at different levels and at different times and is sometimes in control of himself, the nurse must be able to adjust nursing care as the situation warrants, such as offering the medication again after waiting for a short period of time. Forcing the client to take the medication now and calling the client honey may anger the client.
A nurse caring for a client diagnosed with schizophrenia should perform which of the following interventions when the client becomes suspicious and refuses to take his medication? a) Document that the client is noncompliant b) Wait for a short time and then attempt to administer the medication c) Tell the client he must take the medication now d) Attempt to coax the client into taking the medication by calling him honey
C. Personality patterns persist unmodified over long periods of time. Inflexible and maladaptive responses to stress are characteristic of individuals with a personality disorder.
A nurse caring for a client who has been diagnosed with a personality disorder should expect that the client will exhibit A. frequent episodes of psychosis. B. constant involvement with the needs of significant others. C. inflexible and maladaptive responses to stress. D. abnormal ego functioning.
A - The most appropriate response by the nurse is "How do you feel when you see the creatures?" The client is experiencing a delusion, a false belief that has no basis in reality. When the client experiences a delusion, it is important to acknowledge the delusion and to ask the client to describe it and how it makes them feel. These actions help identify the type of delusions so that the correct intervention can be implemented while establishing trust. If asked, the nurse should point out that they are not experiencing the same stimuli but should not argue with the client
A nurse caring for a client with schizophrenia goes into the client's room to administer medication. While looking out the window at the trees, the client remarks, "That school across the street has creatures in it that are waiting for me." Which of the following is the most appropriate response by the nurse? a) "How do you feel when you see the creatures?" b) "You are delusional." c) "It is time for your medication now." d) "The creatures will not hurt you."
C - "How do you feel when you see the creatures?" Explanation: The most appropriate response by the nurse is "How do you feel when you see the creatures?" The client is experiencing a delusion, a false belief that has no basis in reality. When the client experiences a delusion, it is important to acknowledge the delusion and to ask the client to describe it and how it makes them feel. These actions help identify the type of delusions so that the correct intervention can be implemented while establishing trust. If asked, the nurse should point out that they are not experiencing the same stimuli but should not argue with the client.
A nurse caring for a client with schizophrenia goes into the client's room to administer medication. While looking out the window at the trees, the client remarks, "That school across the street has creatures in it that are waiting for me." Which of the following is the most appropriate response by the nurse? a) "It is time for your medication now." b) "The creatures will not hurt you." c) "How do you feel when you see the creatures?" d) "You are delusional."
Schizoid Personality disorder.
What disorder is characterized by a profound defect in the ability to form personal relationships, displaying a lifelong pattern of withdrawal?
B - low seizure threshold Explanation: Antipsychotic medications affect brain neurotransmitters in a way that lowers the seizure threshold and can, therefore, increase the risk of seizure activity. Antipsychotics don't affect insulin production or coagulation time. Heart failure isn't an adverse effect of antipsychotic agents.
A nurse is aware that antipsychotic medications may cause: a) increased coagulation time. b) lower seizure threshold. c) increased risk of heart failure. d) increased insulin production.
Neurosyphilis Hyperparathyroidism Temporal lobe epilepsy
What general medical conditions may cause psychotic symptoms? Select all that apply.
D - The mother's behavior does not indicate that she understands the seriousness of her son's condition; she must be educated about her son's diagnosis and how his illness is managed. The nurse is in a key position to provide such education by explaining about the client's medication and the need for careful monitoring. Telling the mother that she must talk with the physician dismisses the mother's concerns and deflects an opportunity to develop a therapeutic relationship. Stating that the son is a danger to other people might unnecessarily alarm the mother and does not provide sufficient information about his diagnosis. There is no indication that any legal restrictions or orders are in place.
A nurse is caring for a 17-year-old adolescent brought to the hospital by police in an agitated state after attempting to stab his mother. He is diagnosed with schizophrenia. After receiving haloperidol LA, the client stabilizes. His mother states that he is been troubled in the past, but is basically a good boy. She asks if she may take her son home now that he is better. Which response by the nurse is appropriate? a) "You'll need to discuss your concerns with the physician on duty." b) "A legal decision must be made before your son may go home." c) "The physician has determined that your son may be a danger to other people." d) "Your son is taking a very powerful medication and needs careful monitoring."
A - Collaborating with the physician to make a referral to social services helps the client by creating a plan and providing support. Additionally, by law, the nurse or nursing supervisor must report the suspected abuse to the police, and follow up with a written report. Although confrontation can be used therapeutically, this action will most likely provoke anger in the suspected abuser. Questioning the client in front of her spouse does not allow her the privacy required to address this issue and may place her in greater danger. If the woman is not in imminent danger, there is no need to call hospital security.
A nurse is caring for a client with bruises on her face and arms. Her husband refuses to leave the client's bedside and answers all of the questions for the client. Which intervention by the nurse would be most appropriate? a) Collaborate with the physician to make a referral to social services. b) Question the woman in front of her husband. c) Tell the husband that he must leave because he is intimidating the client. d) Contact hospital security to escort the husband from the hospital.
B - By acknowledging that the client hears voices, the nurse conveys her acceptance of him. By letting the client know that she doesn't hear the voices, the nurse avoids reinforcing his hallucination. The nurse shouldn't touch a client with schizophrenia without advance warning. A hallucinating client may believe that the touch is a threat or act of aggression and respond violently. Being alone in his room encourages the client to withdraw and may promote more hallucinations. The nurse should provide an activity to distract the client. By asking the client what the voices are saying, the nurse is reinforcing the hallucination. The nurse should focus on the client's feelings rather than the content of the hallucination.
A nurse is caring for a client with schizophrenia who experiences auditory hallucinations. The client appears to be listening to someone who isn't visible. He gestures, shouts angrily, and stops shouting in mid-sentence. Which nursing intervention is appropriate? a) Ask the client to describe what the voices are saying. b) Acknowledge that the client is hearing voices but make it clear that the nurse doesn't hear these voices. c) Approach the client and touch him to get his attention. d) Encourage the client to go to his room where he'll experience fewer distractions.
C - Schizophrenia is associated with difficulty forming relationships with a marked inability to trust others a (split personality) is a failure to integrate various aspects of one's identity, memory, and consciousness b - compulsion is an irrational drive d (acting-out behaviors) expressing unconsciousness feelings or conflicts through actions
A nurse is caring for a client with schizophrenia. The nurse identifies which is the primary problem? a) split personality b) acting in a compulsive way c) difficulty forming relationships d) acting-out behaviors
The client's inability to make a simple decision
After assessing a client with schizophrenia, the nurse concludes that the client is experiencing emotional ambivalence. Which behaviors of the client support the nurse's assessment?
C - Risk for other-directed violence Such characteristics as suspiciousness, anxiety, and hallucinations put the client with schizophrenia at risk for violence toward himself or others. Imbalanced nutrition: Less than body requirements, Compromised family coping, and Impaired verbal communication are also appropriate nursing diagnoses but should be addressed after the safety of the client and those around him has been established. **NURSING DIAGNOSES THAT, IF UNTREATED, RESULT IN HARM TO THE PATIENT OR OTHERS HAVE THE HIGHEST PRIORITIES!!!
A nurse is planning care for a client with a diagnosis of schizophrenia who has been admitted to the psychiatric unit. Which nursing diagnosis should receive the highest priority? a) Impaired verbal communication b) Imbalanced nutrition: Less than body requirements c) Risk for other-directed violence d) Compromised family coping
C - The client must be informed of the activity and when it will occur. Giving choices isn't desirable because the client can be manipulative or refuse to do anything. Negotiation and preparation wouldn't be therapeutic because this type of client might not want to perform the activity.
A nurse is providing care to a client with schizophrenia who exhibits extreme negativism. To help the client meet his basic needs, the nurse should: a) prepare the client ahead of time for the activity. b) negotiate a time when the client will perform activities. c) tell the client specifically and concisely what needs to be done. d) ask the client which activity he would prefer to do first.
C - All systems in the managed care delivery model reflect the values of efficiency and effectiveness. Different plans may have different values underlying the delivery of care. However, they all reflect the business plan values of efficiency and effectiveness. Their values are reflected in the decision making and the policy development of the organization. Value conflicts between cost-effectiveness and respectful care may be seen.
A nurse is working within the managed care delivery model. Which of the following is true regarding managed care? a) Their values are not reflected in the decision making. b) There are no conflicts between cost-effectiveness and respectful care. c) All systems reflect the values of efficiency and effectiveness. d) All plans have the same values underlying the delivery of care.
A - A liquid phenothiazine preparation will produce effects in 2 to 4 hours. The onset with tablets is unpredictable.
A nurse knows that a physician has ordered the liquid form of the drug chlorpromazine rather than the tablet form because the liquid: a) has a more predictable onset of action. b) has a longer duration of action. c) produces fewer drug interactions. d) produces fewer anticholinergic effects.
C - benztropine Benztropine, trihexyphenidyl, or amantadine are ordered for treatment of Parkinson-type symptoms. Diphenhydramine provides rapid relief for dystonia. Propranolol relieves akathisia. Haloperidol can cause Parkinson-type symptoms
A nurse must administer a medication to reverse or prevent Parkinson-type symptoms in a client receiving an antipsychotic. The medication the client will likely receive is: a) haloperidol. b) diphenhydramine. c) benztropine. d) propranolol.
A - Becoming overinvolved and being protective and indulgent Finding an approach for helping clients with personality disorders who have overwhelming needs can be challenging for caregivers. For example, a borderline female client may briefly idealize her male nurse on the inpatient unit, telling staff and clients alike that she is "the luckiest client because she has the best nurse in the hospital." The rest of the team initially realizes that this behavior is an exaggeration, and they have a neutral response. But after days of constant dramatic praise, some members of the team may start to feel inadequate and jealous of the nurse. They begin to make critical remarks about minor events to prove that the nurse is not perfect. Open communication in staff meetings and ongoing clinical supervision are important aspects of self-care for the nurse working with these clients to maintain objectivity.
A nurse who is idealized by a client is at risk for A. becoming overinvolved and being protective and indulgent. B. becoming indecisive about planned interventions. C. developing a prejudicial, blaming orientation. D. stringent enforcement of boundaries and limits.
A - Delegation must be clear and precise. The nurse-manager must assign responsibility, identify the task to be accomplished, explain the necessary outcomes, and define the time frame available to complete the work. The remaining options don't clearly define the work to be done, don't clearly assign responsibility or specify desired outcomes, or establish a time frame for completion of the task.
A nurse-manager has decided to delegate responsibility for the review and revision of the surgical unit's client-education materials. Which statement illustrates the best method of delegation? a) Ask the two most proficient staff nurses to form a task force to review and revise client-education materials within the next 6 weeks. Have these nurses solicit input from clients and staff members. b) Ask the assistant manager to develop a plan for the review and revision of client-education materials. c) Tell the nursing staff that the client education materials need revision. Ask the staff to select people to review the materials and make suggestions for change. d) Tell the nursing staff they're responsible for the review and revision and welcome their recommendations for improving the materials.
D - Every nurse who provides client care should provide client education. Nurses must work together to establish the best methods of educating clients. The most appropriate response is to contact the facility's nurse-manager, not the nursing staff. Evaluating client education in only the surgeon's office doesn't consider the entire client education process and all of the staff providing it. Client education is an important nursing responsibility and every complaint deserves attention.
A nurse-manager in the office of a group of surgeons has received complaints from discharged clients about inadequate instructions for performing home care. Knowing the importance of good, timely client education, the nurse-manager should take which steps? a) Because none of the clients suffered any serious damage, the nurse-manager can safely ignore their complaints. b) Review and revise the way client education is conducted in the surgeons' office. c) Inform the nurses who work in the facility that client education should be implemented as soon as the client is admitted to either the hospital or the outpatient surgical center. d) Work with the surgeons' staff and the nursing staff in the hospital and outpatient surgical center to evaluate current client education practices and make revisions as needed.
schizophrenia NI ANSWER = B By knowing what behaviors signal impending relapse, interventions can be quickly invoked when the behaviors occur. The earlier the intervention, the greater the likelihood that a recurrence can be averted.
A nursing intervention designed to help a schizophrenic client manage relapse is to A. schedule the client to attend group therapy that includes those who have relapsed. B. teach the client and family about behaviors associated with relapse. C. remind the client of the need to return for periodic blood draws to minimize the risk for relapse. D. help the client and family adapt to the stigma of chronic mental illness and periodic relapses.
A - As many as four different generations are in the workplace today. Each generation has its own way of responding to the work environment, and they have different expectations of their employer and co-workers. To determine the cause of conflict, the manager should assess the generational characteristics of the nurses employed on the unit to see if this is a possible contributing factor. The other options might occur at some point, but without understanding the nature of the problem is unlikely to resolve it.
A nursing manager notices discord among the nursing staff on the unit. Which action would be most helpful? A. Compile data on the different generations working on the unit. B. Have a series of staff meetings focusing on professionalism at work. Incorrect C. Single some nurses out as informal leaders to set a good example. D. Try to separate the conflicting groups from each other, if possible.
A., D, E, and G a) Place the patient in seclusion for 1 hour to allow him to de-escalate. d) Explore with the patient how he was feeling as worked with the music player. e) Point out the consequences of such behavior and note that it cannot be tolerated. g) Encourage the patient to recognize signs of mounting tension and seek assistance.
A patient becomes frustrated and angry when trying to get his MP3 player and headset to function properly and angrily throws it across the room, nearly hitting a peer with it. Which intervention(s) would be the most therapeutic? Select all that apply. a. Place the patient in seclusion for 1 hour to allow him to de-escalate. b. Tell the patient that any further outbursts will result in a loss of privileges. c. Offer to help the patient learn how to operate his music player and headset. d. Explore with the patient how he was feeling as he worked with the music player. e. Point out the consequences of such behavior and note that it cannot be tolerated. f. Limit the patient's exposure to frustrating experiences until he attains improved coping skills. g. Encourage the patient to recognize signs of mounting tension and seek assistance.
Obsessive-compulsive personality disorder
A person with _____ disorder tends to hold on to worn-out or worthless items and hoard money to ward off future catastrophes.
avoidant personality disorder
A personality disorder in which the central characteristics are an extreme sensitivity to rejection and robust avoidance of interpersonal situations
D, E, F. • Closely monitor vital signs, especially temperature. • Provide the client with the opportunity to pace. • Provide the client with hard candy. Neuroleptic malignant syndrome is a life-threatening adverse extrapyramidal effect of antipsychotic medications such as haloperidol. It is associated with a rapid increase in temperature. The most common adverse extrapyramidal effect, akathisia, is a form of psychomotor restlessness that can often be relieved by pacing. Haloperidol and the anticholinergic medications that are provided to alleviate its extrapyramidal effects can result in dry mouth. Providing the client with hard candy to suck on can help alleviate this problem. Haloperidol is not given subQ and does not affect blood glucose level. Urticaria is not usually associated with haloperidol administration.
A physician starts a client on the antipsychotic medication haloperidol-LA. The nurse is aware that this medication has adverse extrapyramidal effects. Which nursing measures should be taken during haloperidol administration? Select all that apply. a) Monitor blood glucose levels. b) Review subcutaneous (subQ) injection technique. c) Monitor the client for signs and symptoms of urticaria. d) Provide the client with the opportunity to pace. e) Closely monitor vital signs, especially temperature. f) Provide the client with hard candy.
Psychotropic medications
A psychoactive drug that changes brain function and alters perception, mood, consciousness or behavior. Antianxiety medications AKA- Anxiolytics
alogia, or poverty of speech, a positive symptom of schizophrenia
A reduction in spontaneity or volume of speech
alogia, or poverty of speech
A reduction in spontaneity or volume of speech, represented by a lack of spontaneous comments and overly brief responses.
thought blocking, a positive symptom of schizophrenia
A reduction in the amount of thinking
affective blunting
A reduction in the expression, range, and intensity of affect
C
A staff nurse on the unit has a great deal of influence on others' opinions and actions. What type of power does this nurse have? A. Information B. Legitimate C. Referent D. Reward
C
A student nurse is learning about different theories of management. Which of the following is a correct description of a management theory? A. Behavioral: Manager sets strict rules, with defined rewards and punishments for action Incorrect B. Bureaucratic: Manager decides how procedures will be done on a unit C. Contingency: Manager makes decisions after considering what motivates people D. Systems: Manager makes decisions without considering the impact on the entire facility
rape-trauma syndrome
A syndrome characterized by an acute phase and a long-term reorganization process that occurs after an actual or attempted sexual assault. Each phase has separate symptoms.
antisocial personality disorder
A syndrome in which a person lacks the capacity to relate to others, does not experience discomfort in inflicting or observing pain in others, and may manipulate others for personal gain
grievance
A term associated with a negative workplace event that results in an allegation by an employee that he or she has not been treated fairly and equitably.Grievances can occur in union and non-union settings. In a union setting is arises when two parties (employee and manager) interpret contract provisions differently. They often involve job security or safety, which is a union priority, or job performance or discipline, which is a management priority
Cognitive Theory
A theory of human development that focuses on changes in how people think over time. According to this theory, our thoughts shape our attitudes, beliefs, and behaviors.
ANSWER = 3. The triage nurse's first intervention is to address the client's physiologic needs, which means to assess for any type of trauma or injury. 1. The client may or may not want the police notified, but this is not the triage nurse's first intervention. The triage nurse should first care for the client. 2. The SANE nurse is a nurse who is specialized in caring for clients who have been raped. The SANE nurse is able to spend time with the client, is knowledgeable of legal issues, and would be an appropriate intervention, but it is not the triage nurse's first intervention 4. The client can complete the admission form while in the room; the triage nurse's first intervention should be to care for the client, not paperwork. MAKE NURSING DECISIONS: When the question asks which intervention to implement first, the test taker should determine whether any of the options concern the physiologic needs of the client and then apply Maslow's Hierarchy of Needs to find the correct answer. Remember, physiologic needs take priority over all other needs
A woman comes to the emergency department (ED) and tells the triage nurse she was raped by two men. The woman is crying, disheveled, and has bruises on her face. Which action should the triage nurse implement first? 1. Ask the client whether she wants the police department notified. 2. Notify a Sexual Assault Nurse Examiner (SANE) to see the client. 3. Request an ED nurse to take the client to a room and assess for injuries. 4. Assist the client to complete the emergency department admission form.
1. This child has been abused, and until Child Protective Services have been notified, the nurse should not share any information with the child's father. 2. The Health Insurance Portability and Accountability Act (HIPAA) considers parents the "personal representative" of the minor child with the right to information. However, there are exceptions to this rule, including when the provider reasonably believes that the minor may be a victim of abuse or neglect by the parents/guardians. This statement is the nurse's best response. 3. Because the mother is accusing the father of the abuse, this is not an appropriate response 4. The social worker must adhere to HIPAA regulations; therefore; referring the father to the social worker will not help the father find out how is son is doing. MAKING NURSING DECISIONS: The nurse is responsible for knowing and complying with local, state, and federal standards of care
A young child, Joey, was admitted to the pediatric unit with a fractured jaw, bruises, and multiple cigarette burns to the arms. The mother reported the father hurt the child. A man comes to the nurse's station saying, "I am Joey's father, can you tell me how he is doing?" Which statement is the nurse's best response? 1. "Your son has a fractured jaw and some bruises but he is doing fine." 2. "I am sorry I cannot give you any information about your son." 3. "You should go talk to your wife about your son's condition." 4. "The social worker can discuss your son's condition with you."
Counter transference.
AJ, a mental health nurse, begins to give advice, attempts to "rescue the client", and promotes the client's dependence. This is __________
Does not talk
Mutism
Benzodiazepines (anxiolytics):
Prescribed for short-term treatment only; not for patients with substance use problems (see p.148)
What med has high risk of agranulocytosisf?
Clozapine/Clozaril - Can cause fatal blood disorder that can drop a patient's WBC to extremely low levels. A baseline WBC & ANC must be taken before initiation of tx w/ clozapine and then weekly for the first 6 mos.
Atypical Psych Meds
Clozaril/clozapine - Atypical (weekly blood draws) Cogentin - used for dystonia & oculogyric crisis (eye rolling) Risperdal - atypical antipsych (hypotensive effects)
Family involvement
Prevent/delay relapse Help keep client in community Psychoeducational programs
clonidine (Catapres) interactions:
AV block may occur with use of verapamil or diltiazem. Life-threatening elevations of BP with use of tricyclics or beta-blockers.
mood disorders (affective disorders)
Abnormal disturbances in emotion or mood, including bipolar disorder and unipolar disorder.
cognitive theory r/t PTSD = may develop when a person's fundamental beliefs are invalidated, the trauma cannot be understood, and helplessness and hopelessness prevail.
According to cognitive theory, what are some predisposing factors?
A loss is internalized and becomes directed toward the ego.
According to psychoanalytic theory, what is a predisposing factor for depression?
Anticonvulsants
Action not clear. Affects GABA receptors, which casuses a calming effect. Are used to stabilize the manic episodes in bipolar disorder. The Meds: Carbamazepine (Tegretol) Lamotrigine (Lamictal) Valporic Acid (Depakote) Side effects: nausea, vomiting, indigestion, drowsiness, dizziness, prolonged bleeding, headache, confusion These meds should NOT be stopped abruptly These patients should avoid ETOH (ALCOHOL!) Therapeutic Blood Levels: +Tegretol: 6-12 mcg/ml +Depakene & Depakote: 50-100 mcg/ml
Phase III - Schizophrenia
Active phase of the disorder. Must have 2+ of the follwing: Delusions - false beliefs Hallucinations - hearing/seeing/feeling things Disorganized speech Grossly disorganized/catatonic beh Neg symptoms
Extrapyramidal symptoms (antipsychotic meds = typically occurs 2-5 days post N.O.)
Acute dystonia Akathisia Parkinsonism Tardive dyskinesia
acute dystonia (s/s in Extrapyramidal symptoms (antipsychotic meds = typically occurs 2-5 days post N.O.)
Acute, often painful, sustained contraction of muscles, usually of the head and neck
Adjustment disorders may present with other maladaptive disorders such as depressed mood, anxiety, disturbance of conduct, disturbance of emotions, or a combination of these.
Adjustment disorders may present with other maladaptive disorders. examples:
Constricted affect
Affect type that represents mild reduction in the range and intensity of emotional expression.
paranoid personality disorder
What is a "pervasive, persistent, and inappropriate mistrust of others, characterized by being suspicious of others' motives"?
B - find out more about the client's rationale for her decision to stop treatment. The nurse needs more information about the client's decision before deciding what intervention is most appropriate. Judgmental responses could make it difficult for the client to return for treatment should she want to do so. Telling the client that this is a bad decision that she will regret is inappropriate because the nurse is making an assumption. Warning the client that abuse commonly stops when one partner is involved in treatment may be true for some clients. However, until the nurse determines the basis for the client's decision, this type of response is an assumption and therefore inappropriate. Reminding the client about her duty to protect the children would be appropriate if the client had talked about episodes of current abuse by her partner and the fear that her children might be hurt by him.
After months of counseling, a client abused by her husband tells the nurse that she has decided to stop treatment. There has been no abuse during this time, and she feels better able to cope with the needs of her husband and children. In discussing this decision with the client, the nurse should: a) Remind the client of her duty to protect her children by continuing treatment. b) Find out more about the client's rationale for her decision to stop treatment. c) Warn the client that abuse commonly stops when one partner is in treatment, only to begin again later. d) Tell the client that this is a bad decision that she will regret in the future.
Haloperidol (Haldol) is for treatment of:
Agitation, aggression, hallucinations, thought disturbances, wandering
agoraphobia
An abnormal fear of open or public places
Historical Aspects of Anxiety
Anxiety was once identified by its physiological symptoms, focusing largely on the cardiovascular system. Freud was the first to associate anxiety with neurotic behaviors. For many years, anxiety disorders were viewed as purely psychological or purely biological in nature
A, B, and E a) Label the behavior as undesirable, and explore with Alicia more effective ways to meet her needs. b) By role-playing, demonstrate other approaches Alicia could use to meet her needs. e) Explain that such behavior is unacceptable, and give Alicia specific examples of consequences that will be enacted if the behavior continues.
Alicia, a 31-year-old patient, is flirting with a peer. She is overheard asking him to convince staff to give her privileges to leave the inpatient mental health unit. Later she offers you a backrub in exchange for receiving her 10:00 p.m. Xanax an hour early. Which response(s) to such behaviors would be most therapeutic? Select all that apply. a. Label the behavior as undesirable, and explore with Alicia more effective ways to meet her needs. b. By role-playing, demonstrate other approaches Alicia could use to meet her needs. c. Advise the other patients that Alicia is being manipulative and that they should ignore her when she behaves this way. d. Bargain with Alicia to determine a reasonable compromise regarding how much of such behavior is acceptable before she crosses the line. e. Explain that such behavior is unacceptable, and give Alicia specific examples of consequences that will be enacted if the behavior continues. f. Ignore the behavior for the time being so Alicia will find it unrewarding and in turn seek other, and hopefully more adaptive, ways to meet her needs.
erotomanic
Although he barely knew her, Patti insisted that Eric would marry her if only his current wife would stop interfering. What type of delusion is Patti experiencing?
B. When the client begins to become abusive, leave the room promising to return in 20 minutes when he has regained control. The nurse is using behavioral techniques to reinforce desirable behavior (spending time with the client when he is calm) and limit reinforcement of undesirable behavior (leaving when he is acting out anger).
An angry client frequently loses patience with the nurses and shouts at them while they perform a complicated dressing change. Which plan could they create to intervene effectively in this behavior? A. Tell him they will not change his dressing if he is going to abuse them. B. When the client begins to become abusive, leave the room promising to return in 20 minutes when he has regained control. C. Assure him they will complete the dressing change as quickly as possible. D. Explain that they are professionals and unused to being shouted at by people they are trying to help.
Anticholinergic effect
An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system Anticholinergics inhibit parasympathetic nerve impulses by selectively blocking the binding of the Neurotransmitter acetylcholine to its receptor in nerve cells
personality disorder
An enduring pattern of experience and behavior that deviates significantly from the expectations within the individual's culture.
religiosity, a positive symptom of schizophrenia
An excessive preoccupation with religious themes
command hallucinations
An individual hearing voices that direct the person to take action
contrecoup
An injury to parts of the brain located on the side opposite that of the primary injury
assault
An intentional threat designed to make the victim fearful; produces reasonable apprehension of harm
Unipolar disorder (major depression)
Anhedonia, lack of motivation, feelings of worthlessness, decreased sex drive, insomnia, and recurrent thoughts for at least 2 weeks, representing a change from previous level of function, describes what disorder?
A. Awareness training, B. Competing response training, C. Social support
Annie has trichotillomania. She is receiving treatment at the mental health clinic with habit-reversal therapy. Which of the following elements would be included in this therapy? (Select all that apply) A. Awareness training B. Competing response training C. Social Support D. Hypnotherapy E. Aversive therapy
17.0 < 15
Anorexia nervosa is characterized by a BMI of ________. In extreme cases, the BMI can be as low as _______.
Beta Blockers
Another type of anti-anxiety medication. Not a benzo. USED PRN. PROPRANOLOL (Inderal) (common one) *Typically used to treat heart conditions and hypertension, but sometimes used to control "performance anxiety" CHECK PATIENT'S BP and PULSE before administering
disulfiram (Antabuse) classification:
Anti-alcoholic
Lorazepam (Ativan) classification:
Antianxiety (benzodiazepine)
Side effects of antipsychotics
Anticholinergic effects Nausea; GI upset Skin rash Sedation Orthostatic hypotension Photosensitivity Hormonal effects ECG changes Hypersalivation Weight gain Hyperglycemia/diabetes Increased risk of mortality in elderly clients with dementia Reduction in seizure threshold Agranulocytosis Extrapyramidal symptoms Tardive dyskinesia Neuroleptic malignant syndrome
phenobarbital (Luminal) classification:
Anticonvulsant. Controlled substance Schedule IV
Trazadone (Desyrel) classification:
Antidepressant (heterocyclic)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Antidepressant. Blocks the reabsorption of serotonin. THE MEDS: fluoxetine (Prozac) sertraline (Zoloft) paroxetine (Paxil) escitalopram (Lexapro) citalopram (Celexa) fluvoxamine (Luvox) Side effects: excitation, n & v, decreased libido, anorexia & weight loss, increased suicide risk first few weeks of therapy Intrusive experiences (flashbacks, avoidance, and numbing)
clonidine (Catapres) classification:
Antihypertensive
Haloperidol (Haldol) classification:
Antipsychotic
antipsychotic medications may cause: low seizure threshold
Antipsychotic medications affect brain neurotransmitters in a way that lowers the seizure threshold and can, therefore, increase the risk of seizure activity. Antipsychotics don't affect insulin production or coagulation time. Heart failure isn't an adverse effect of antipsychotic agents.
Lorazepam (Ativan) is for treatment of:
Anxiety
Blood elevations of lactate. Pg 533
What is a biochemical abnormality associated with panic disorder?
A - Asking the client who "they" are when he is fearful helps the nurse understand his behavior and is least demanding of the client. The client is unlikely to accept statements that indicate that no one will see the nurse. The client is unlikely to accept statements that there is no reason to be afraid. Asking the client what will happen if someone sees the nurse is also unlikely to be acceptable and validates the client's delusion.
As the nurse stands near the window in the client's room, the client shouts, "Come away from the window! They'll see you!" Which of the following responses by the nurse would be best? a) "Who are 'they'?" b) "You have no reason to be afraid." c) "What will happen if they do see me?" d) "No one will see me."
trazadone (Desyrel) nursing implications:
Assess BP lying and standing; take pulse every 4 hours. If systolic BP drops 20 mm Hg, hold product and notify prescriber.
haloperidol (Haldol) nursing implications:
Assess BP standing and lying; take pulse and respirations every 4 hours during initial treatment. Watch for hyperthermia, muscle rigidity, altered mental status.
Donepezil (Aricept) nursing implications:
Assess BP, hypo or hypertension, heart rate, mental status, and GI status.
lorazepam (Ativan) nursing implications:
Assess anxiety, mental status, sleeping pattern, physical dependency or withdrawal symptoms.
benztropine (Cogentin) nursing implications:
Assess for Parkinsonism: EPS, shuffling gait, muscle rigidity, involuntary movements, loss of balance.
clonidine (Catapres) nursing implications
Assess for hypertension & report significant changes. Assess for opiate withdrawal such as fever, diarrhea, nausea, vomiting, shivering, dilated pupils.
disulfiram (Antabuse) nursing implications:
Assess if patient has had alcohol in the past 12 hours. Never give this product to a patient in a state of alcohol intoxication.
phenobarbital (Luminal) nursing implications:
Assess mental status, fever, sore throat, bruising rash, jaundice; Assess type and duration of seizures.
zolpidem (Ambien) nursing implications:
Assess mental status, mood, and suicidal thoughts/behaviors.
Nursing Process
Assessment Diagnosis Planning Implementation Evaluation
Ages 44-65
At what age range is the gender difference less pronounced for the incidence of depression?
< 19 20-24.9 25.0-29.9 > 30
BMI levels: underweight normal overweight obese
Disturbed Sense of Self
BPD person doesn't have a sense of themselves, apart from what other people think of them! - We have a personal identity - they do not! - No sense of self causes psychic pain - at any moment, anyone can make you feel badly
Ideas of reference
Barbara believes that the birds sing when she walks down the street just for her. Which type of delusion is Barbara experiencing?
Learning Theory
Based on the idea that changes in behavior result more from experience and less from our personality or how we think or feel about a situation.
Erikson's stage of dev that the schizo pt is usually "stuck" in?
Being that the illness tends to start during the teen to early 20s, leaving most unable to return to normal young adult lives: go to school, find a job or marry and have children. Identity v confusion: 12-18 Intimacy v isolation: 19-40
erotomanic
Believing that another person desires you romantically
persecution, a type of delusion
Believing that one is being singled out for harm by others
jealousy, a type of delusion
Believing that one's mate is unfaithful
magical thinking, a positive symptom of schizophrenia
Believing that one's thoughts or actions can affect others
somatic delusions
Believing that the body is changing in unusual ways
B B A primary coping style used by patients with BPD is called splitting. Splitting is the inability to incorporate positive and negative aspects of oneself or others into a whole image. The individual may tend to idealize another person (friend, lover, health care professional) at the start of a new relationship and hope that this person will meet all of his or her needs. At the first disappointment or frustration, however, the individual quickly shifts to devaluation, despising the other person. The other options do not describe splitting, which is a primary coping style of patients with BPD.
Belinda is a 24-year-old patient with borderline personality disorder (BPD). She is admitted to the inpatient psychiatric unit following a suicide attempt. You are caring for Belinda. Which of the following statements by Belinda illustrates a primary coping style of persons with BPD? A. "My provider says I might get out of here tomorrow. Do you think I'm ready to go?" B. "Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here." C. "I will never again speak to any of my messed up family members. I know that this will help me be more functional." D. "I promise I am not feeling suicidal. I won't hurt myself."
addictive anxiolytics
Benzodiazepines Carbamate derivative/tranquilizer
Comorbidity
Eating disorders, substance use disorders, and anxiety disorders often comorbid! - Parasuicidal and suicidal behavior
ANSWER = C, blocking cholinergic activity in the CNS. Benztropine blocks cholinergic activity in the CNS. Anxiety doesn't cause extrapyramidal effects. Overactivity of acetylcholine and lower levels of dopamine are the causes of extrapyramidal effects. Benztropine doesn't increase norepinephrine in the CNS
Benztropine is used to treat the extrapyramidal effects induced by antipsychotics. This drug exerts its effect by: a) increasing the level of acetylcholine in the CNS. b) decreasing the anxiety causing muscle rigidity. c) blocking cholinergic activity in the central nervous system (CNS). d) increasing norepinephrine in the CNS.
C - Benztropine blocks cholinergic activity in the CNS. Anxiety doesn't cause extrapyramidal effects. Overactivity of acetylcholine and lower levels of dopamine are the causes of extrapyramidal effects. Benztropine doesn't increase norepinephrine in the CNS.
Benztropine is used to treat the extrapyramidal effects induced by antipsychotics. This drug exerts its effect by: a) increasing the level of acetylcholine in the CNS. b) increasing norepinephrine in the CNS. c) blocking cholinergic activity in the central nervous system (CNS). d) decreasing the anxiety causing muscle rigidity.
Schizotypal
Bizarre or odd patterns in behavior Odd beliefs or magical thinking that influences behavior Uses unusual words (vague, metaphorical) Inappropriate or constricted affect
Atypical Antipsychotics
Block multiple dopamine & serotonin receptors. The MEDS: clozapine (Clozaril) (lowers WBC count (agranulocytosis), monitor blood work every 1-2 weeks) risperidone (Risperdal) planzapine (Zyprexa) aripiprazole (Abilify) Paliperidone (Invenga) *Treatment-resistant PTSD*
Monoamine Oxidase Inhibitors (MAOIs)
Block the action of monoamine oxidase and prevent breakdown of norepinephrine and serotonin. The MEDS: Phenelzine (Nardil) tranylcypromine (Parnate) isocarboxazid (Marplan) Side effects: anticholinergic effects, dry mouth, orthostatic hypotension, headache DO NOT TAKE THESE MEDS WITH NASAL DECONGESTANTS or with FOOD CONTAINING high levels of TYRAMINE (a precursor to norepinephrine) AVOID THESE FOODS: AGED CHEESE, AVACADOS, YOGURT, SOUR CREAM, CHICKEN & BEEF LIVERS (DAMMIT!), pickled herring, corned beef, bean pods, bananas, raisins, figs, smoked & processed meat, yeast supplements, chocolate (NOOOOOOOOO!), MSG, soy sauce, beer, red wines, & caffeine (depressed just reading these!) Hypertensive crisis & DEATH can occur if patient cosumes these foods. Signs: stiff neck, nausea, vomiting When this med is stopped, wait @ WEEKS before starting any new meds. *Panic attacks*
schizotypal personality disorder
Cluster A (odd or eccentric) personality disorder involving a pervasive pattern of interpersonal deficits featuring acute discomfort with, and reduced capacity for, close relationships, as well as cognitive or perceptual distortions and eccentricities of behavior.
Control
Brian covered his apartment walls with aluminum foil to block governmental efforts to control his thoughts. Which type of delusion is Brian experiencing?
Donepezil (Aricept) is for treatment of:
Cognitive impairment
A client who has been taking chlorpromazine (Thorazine) for several months presents in the ED with extrapyramidal symptoms (EPS) of restlessness, drooling, and tremors. What medication will the nurse expect the physician to order? a) Paroxetine (Paxil) b) Carbamazepine (Tegretol) c) Benztropine (Cogentin) d) Lorazepam (Ativan)
C Benztropine is an anticholinergic medication that blocks cholinergic activity in the central nervous system, which is responsible for EPS. Anticholinergics are the drugs of choice to treat extrapyramidal symptoms associated with antipsychotic medications.
The client hears the word "match." The client replies, "A match. I like matches. They are the light of the world. God will light the world. Let your light so shine." Which communication pattern does the nurse identify? a) Word salad b) Clang association c) Loose association d) Ideas of reference
C Loose association is characterized by communication in which ideas shift from one unrelated topic to another. The situation in the question represents this communication pattern.
Mentalization Based Therapy (MBT)
Combines indvidual and group therapy - Emphasizes learning to recognize own mental states and those of others (called MENTALIZING)
CBT --> DBT
CBT tries to re-frame thoughts- to BPD feels like criticism, invalidating! - DBT makes it more gentle - DBT adds mindfulness, to move mind away from tumultuous inner thoughts - self-soothing techniques! VALIDATION!
Side effects of benzodiazepines
CNS depression, difficulty breathing** Dependence- physiological psychological (addiction) DWD- dizziness, weakness, & drowsiness BLSC: blurred vision, lack of coordination, slurred speech Confusion
Naloxone (Narcan) contraindications
CV disease, opioid dependency, seizure disorder, drug dependency, hepatic disease
Complex Trauma
Can lead to behavioral characteristics - Like PTSD, except WORSE - Not only a consequence of 1 traumatic event, not a small child - More complex than PTSD!
No; hyperpyretic crisis, convulsions, and death can occur with MAO inhibitors.
Can tricyclics be safely used concurrently with an MAOI?
Catatonic Features Specifier
Catatonic features may be associated with other psychotic disorders, such as brief psychotic disorder, schizophreniform disorder, schizophrenia, schizoaffective disorder, and substance-induced psychotic disorder Symptoms of catatonic disorder include: Stupor and muscle rigidity or excessive, purposeless motor activity Waxy flexibility, negativism, echolalia, echopraxia
What antipsychotic requires frequent lab draws for WBCs?
Clorazil b/c it can cause "agranulocytosis" (decreased WBC). How will you know if you pt. has agranulocytosis? They will have fever, sore throat, and malaise!
C. Narcissistic clients give the impression of being invulnerable and superior to others to protect their fragile self-esteem.
Characteristic behaviors the nurse will assess in the narcissistic client are A. dramatic expression of emotion, being easily led. B. perfectionism and preoccupation with detail. C. grandiose, exploitive, and rage-filled behavior. D. angry, highly suspicious, aloof, withdrawn behavior.
A. Antisocial clients have no conscience. Their sense of right and wrong is impaired, and they tend to do whatever serves them best without consideration for the rights or feelings of others.
Characteristics the nurse will assess in the client diagnosed with antisocial personality disorder are A. deceitfulness, impulsiveness, and lack of empathy. B. perfectionism, preoccupation with detail, and verbosity. C. avoidance of interpersonal contact and preoccupation with being criticized. D. a need for others to assume responsibility for decision making and seeking nurture.
Adjustment disorder
Childhood trauma, dependency, or arrested development may be predisposing symptoms for which disorder?
Obsessive-compulsive personality disorder
Children reared by parents who impose strict standards of conduct, and learn what they must NOT do rather than learning how to achieve praise and recognition, tend to develop which personality disorder?
Dependent
Children with overprotective parents, or who are strongly attached to one caregiver to the exclusion of all others, are predisposed to develop which personality disorder?
benztropine (Cogentin) classification:
Cholinergic blocker; antiparkinson's agent
Donepezil (Aricept) classification:
Cholinesterase inhibitor
nonphenothiazines and phenothiazines
Classes of conventional antipsychotics
phenothiazines and nonphenothiazines
Classes of conventional antipsychotics
Minor (GCS 13-15) Moderate (GCS 9-12) Severe (GCS 3-8)
Classifications of brain injury
C - Impaired social interaction For a client who has difficulty in relationships and is very manipulative, the nursing diagnosis of impaired social interaction would be used.
Clients demonstrating characteristics of personality disorders have various self-defeating behaviors and interpersonal problems despite having near-normal ego functioning and intact reality testing. A nursing diagnosis that addresses this sort of interpersonal dysfunction is A. spiritual distress. B. defensive coping. C. impaired social interaction. D. disturbed sensory perception.
lorazepam (Ativan) contraindications:
Closed-angle glaucoma, psychosis, history of drug abuse, COPD, or sleep apnea.
trazadone (Desyrel) contraindications:
Contraindicated in suicidal patients, severe depression, increased intraocular pressure, urinary retention
To deal with a client's hallucinations therapeutically, which nursing intervention should be implemented? a) Reinforce the perceptual distortions until the client develops new defenses b) Provide an unstructured environment c) Avoid making connections between anxiety-producing situations and hallucinations d) Distract the client's attention
D The nurse should first empathize with the client by focusing on feelings generated by the hallucination, present objective reality, and then distract or redirect the client to reality-based activities.
The treatment does not help with homelessness and substance abuse problems in the client.
What is a drawback associated with Assertive Community Treatment (ACT)?
Nursing interventions for the client with schizophrenia or other psychotic disorder
Decreasing anxiety and establishing trust Assisting client to define and test reality Encouraging interaction with others Ensuring safety of client and others Meeting client's self-care needs Promoting adaptive family coping
Group Therapies
DBT skills groups, MBT groups, self-help groups - Support, network of supportive peers
Side effects of carbamate derivative/tranquilizer
DWD+H- dizziness. weakness, drowsiness,+ headache, GI Upset, nausea, vomiting, Diarrhea NAR- nervous, anxious & restless Serious must report immediately: confusion, shortness of breath numbness/tingling/swelling arms & legs Dependence potential combined with ETOH
Side effects of antidepressants
DWD- dizziness, weakness, & drowsiness. SPIN- Sleep problems insomnia, nightmare GI Upset- nausea, dry mouth, constipation NAR- Nervousness, agitation, or restlessness SD - sexual dysfunction
somatic delusion
David said his heart had stopped and was rotting away. What is David experiencing?
emotional abuse
Depriving an individual of a nurturing atmosphere in which he or she can thrive, learn, and develop
Diff b/w delusion v hallucination?
Delusions - false beliefs Hallucinations - hearing/seeing/feeling things
"When I speak, presidents and kings listen."
Delusions of grandeur. irrational ideas regarding their own worth, talent, knowledge or power.
positive symptoms of schizophrenia
Delusions of reference, delusions of persecution, delusions of grandeur, thought broadcasting, though insertion, hallucinations, disorganized thought, disorganized behaviour, catatonia
Positive symptoms
Delusions: false personal beliefs Religiosity: excessive demonstration of obsession with religious ideas and behavior Paranoia: extreme suspiciousness of others Magical thinking: ideas that one's thoughts or behaviors have control over specific situations *Form of thought* Associative looseness (also called loose association): shift of ideas from one unrelated topic to another Neologisms: made-up words that have meaning only to the person who invents them Concrete thinking: literal interpretations of the environment Clang associations: choice of words is governed by sound (often rhyming)
Trazadone (Desyrel) is for treatment of:
Depression and insomnia
Norepinephrine, serotonin, and dopamine
Depression has been linked to a deficiency of which three neurotransmitters?
Negative symptoms of Schizophrenia
Difficult to treat and respond less well to anti-psychotics than + symptoms, but are also the most destructive b/c they render the pt inert and unmotivated.
Stimulants
Directly stimulate the CNS, used to promote alertness, diminish appetite, combat narcolepsy. Also used to treat ADHD The Meds: methylphenidate (Ritalin) Side effects: increased or irregular heart rate, hypertension, hyperactivity, dry mouth, hand tremor, rapid speech, diaphoresis, confusion, depression, seizures, suicidal ideation, insomnia DO NOT GIVE TO PATIENTS WITH ALCOHOLISM, MANIA or display suicidal or homicidal thoughts DO NOT USE with heart disease or glaucoma MAY impair judgement, drive with caution DO NOT USE with MAOIs ( may cause hypertensive crisis) Take at least 6 hours before sleep to avoid sleep disturbances
Inappropriate affect
Display of emotions that are unsuited to the situation; a symptom of schizophrenia.
Trazadone (Desyrel) side effects:
Dizziness, drowsiness, dry mouth, blurred vision, GI upset
anticholinergic side effects
Dizziness, headaches, excitement, cough, urinary retention, dry mouth, irritability, delayed GI motility
Donepezil (Aricept) contraindications:
Do not use with history of ulcers, GI bleeding, hepatic disease, bladder obstruction, asthma/COPD, or seizures.
Neurotransmitters effect on anti-hypertensives
Dopaminergic Agonist
John G. Gunderson, MD
Drawn to BPD, understood suffering - Developed compassionate psych treatment for women with BPD - In-patient and out-patient
Lorazepam (Ativan) side effects:
Drowsiness, dizziness, GI upset, hypotension, tolerance, dependence
anticonvulsant drugs
Drugs commonly used to treat epilepsy that suppress the rapid and excessive firing of neurons and are used as mood stabilizers
Haloperidol (Haldol) side effects:
Dry mouth, blurred vision, orthostatic hypotension, extrapyramidal symptoms, sedation
A - The client is exhibiting symptoms of becoming catatonic and unable to care for himself, and needs immediate evaluation and possible hospitalization. A sleep aid is not sufficient to treat this client. The client's worsening condition dictates action without waiting for a clinic appointment. An increase in medication may be indicated, but hospitalization is required first for safety.
During a home visit, the nurse discovers that the client is less verbal, less active, less responsive to directions, severely anxious, and more stuporous. The nurse interprets these findings to indicate that the client needs? a) Immediate medical evaluation. b) A sleep aid. c) An increase in medication. d) A clinic appointment.
C - Suggesting to set a time for a more detailed discussion acknowledges that the charge nurse is concerned about what the new graduate has told her and provides an opportunity to explore and address the problem at a more appropriate time. Telling the new nurse to breathe deeply when she feels anxious doesn't help her address the underlying issue. Although stress-reduction courses may ultimately prove useful, suggesting them at this time is impersonal and doesn't respond to the nurse's needs. Telling the new nurse to ignore situations that she can't change discounts the fact that the new nurse has identified a problem and is seeking an answer.
During an extremely busy shift on the psychiatric unit, a newly graduated nurse approaches the charge nurse and states, "I'm having a hard time taking care of mentally ill people. What can I do to handle this stress?" The charge nurse's best response is: a) "Try to take some deep breaths whenever you feel anxious." b) "Just ignore situations you can't change." c) "Maybe we could schedule a time to discuss this further." d) "Maybe you should attend some stress-reduction courses."
"It's time for lunch, it's time for lunch."
During the assessment of a client with psychiatric illness, the nurse finds that the client is experiencing echolalia. Which of the client's responses supports the nurse's finding?
stable plateau phase of schizophrenia
During the stable plateau phase of schizophrenia, planning is geared toward client and family education and skills training that will help maintain the optimal functioning of schizophrenic individuals in the community.
Orientation phase
During which phase are assessment data gathered and a client database is formed?
Planning of therapeutic intervention phase
During which phase are goals set for crisis resolution?
Evaluation phase
During which phase does the nurse ask if positive behavioral changes occurred?
Working phase
During which phase is client change promoted?
Termination phase
During which phase might members of a group discuss previous losses and the emotions of loss?
Spring and fall
During which seasons of the year are affective disorders more prevalent?
A client diagnosed with schizophrenia experiences identity confusion and communicates with the nurse using echolalia. What is the client attempting to do by using this form of speech?
Echolalia is a parrot-like repetition of overheard words or fragments of speech. It is an attempt by the client to identify with the person who is speaking.
Psychodynamic theory of Panic and GAD
Ego unable to intervene between id and superego Overuse or ineffective use of ego defense mechanisms results in maladaptive responses S. Freud to anxiety
disulfiram (Antabuse) interactions:
Elavil, anticoagulants, Flagyl, Dilantin
What did BPD used to be?
Emotional fragility and irrationality, but not severe enough to be psychotic (border between neurosis and psychosis) - Appear psychotic at times of extreme stress
The ability to see beyond outward behavior and understand the situation from the client's point of view.
Empathy
Therapeutic effect may not be seen for as long as 4 weeks.
What is an important fact for patient and family teaching regarding the use of TCAs?
A - Acknowledging the client's statement and then telling him that bombs aren't in the elevator is the most therapeutic response because it orients the client to reality. Asking why the client thinks a bomb is in the elevator and stating that the client said the same thing the day before are condescending responses. Telling the client to follow group rules sounds punitive and could embarrass the client.
Every day for the past 2 weeks, a client with schizophrenia has stood during group therapy and screamed, "Get out of here right now! The elevator bombs are going to explode in 3 minutes!" The next time this happens, how should the nurse respond? a) "I know you think there are bombs in the elevator, but there aren't." b) "Why do you think there is a bomb in the elevator?" c) "That is the same thing you said in yesterday's session." d) "If you have something to say, you must do it according to our group rules."
Social Anxiety Disorder (social phobia)
Excessive fear of situations in which the affected person might do something embarrassing or be evaluated negatively by others.
Acute dystonia Akathisia Parkinsonism Tardive dyskinesia
Extrapyramidal symptoms
bulimia and binge-eating disorder = false
False; Pica is the only eating disorder that can have a dual diagnosis
Cognitive theory of Panic and GAD
Faulty, distorted, or counterproductive thinking patterns result in anxiety that is maintained by mistaken or dysfunctional appraisal of a situation
Agoraphobia
Fear of being in places or situations from which escape might be difficult or in which help might not be available in the event of panic-like symptoms or other incapacitating symptoms.
Specific phobia
Fear of specific objects or situations that could conceivably cause harm, but the person's reaction to them is excessive, unreasonable, and inappropriate. Exposure to the phobic object produces overwhelming symptoms of panic, including palpitations, sweating, dizziness, and difficulty breathing.
Transference Focused Psychotherapy (TFP)
Focuses on relationship with therapist - Emphasizes experiences of anger
Tyramine
Foods containing ______amino acid can cause serious interactions with MAOIs.
D - Although all the actions indicate improvement, the ability to initiate simple activities without directions indicates the most improvement in the catatonic behaviors. Moving all extremities occasionally, walking with the nurse to the client's room, and responding to verbal directions to eat represent single steps toward the client initiating her own actions.
For the client with catatonic behaviors, which of the following should the nurse use to determine that the medication administered as needed has been most effective in the long term? a) The client can move all extremities occasionally. b) The client walks with the nurse to her room. c) The client responds to verbal directions to eat. d) The client initiates simple activities without directions.
Similarities between BPD and Bipolar Disorder?
Frequently misdiagnosed! - When not experiencing symptoms, both often appear very functional or even exceptional!
Premorbid phase of Schizo is...
Function normal Has family hx of mental illness Shy, antisocial
Side effects of Buspirone (Buspar)
GI Upset: Nausea, diarrhea, constipation, dry mouth DWD- dizziness, weakness, & drowsiness. Headache, blurred vision SPIN- sleep problems: insomnia, nightmares, feeling tired
Side effects of anti-hypertensives
GU/GU upset: Nausea and vomiting, difficult urination DMSE -dry mouth, skin, or eyes Confusion, drowsiness, dizziness. Restlessness or moodiness (in children) Blurred vision
GABA
Gamma-aminobutyric acid, inhibits neurotransmitters action in the brain
Biological aspects of Panic and GADs
Genetics Neuroanatomical Biochemical Neurochemical
Rapport
Getting acquainted and establishing ____ is the primary task in relationship development.
Parkinsonism (s/s in Extrapyramidal symptoms (antipsychotic meds = typically occurs 2-5 days post N.O.)
Having tremor, muscle rigidity, stooped posture, and a shuffling gait.
Zolpidem (Ambien) side effects:
Headache, drowsiness, dizziness, GI upset
temporal lobe
Hearing is controlled by the a) occipital lobe b) brain stem c) temporal lobe d) frontal lobe
Nafazodone
Hepatic failure can be caused by which drug?
the individual does not engage in behaviors to rid the body of the excess calories
How does BED differ from bulimia nervos
Adjustment disorder s/s = within 3 months of the stressor + lasts no longer than 6 months.
How long do symptoms last with adjustment disorder?
Via a tapering dose under the HCP supervision. Never stop taking these drugs abruptly.
How should any antidepressant medication be stopped?
Does the client demonstrate progression in the grief process? Does the client set realistic goals for the future?
How would the nurse evaluate a client's outcomes for treatment of adjustment disorder?
trazadone (Desyrel) interactions:
Hyperpyretic crisis, seizures, hypertensive episode with MAOIs. Do not use within 14 days of trazodone. Toxicity with other SSRIs, SNRIs, or methylene blue (IV)
Overlapping Characteristics of BPD and Bipolar II
Impulsivity, affective instability, inappropriate anger, recurrent suicidality, unstable relationships - Much more overlaps, than doesn't!
An opportunity for therapeutic intervention.
In Milieu therapy, every interaction is ________.
Environment and behavior.
In Milieu therapy, the client owns his or her own _______ and _______.
supportive psychotherapy
In __________, the therapist encourages the client to explore unresolved conflicts and to recognize the maladaptive eating behaviors as defense mechanisms used to ease the emotional pain
standard of care
In civil cases, the legal criteria against which nurse's (and physician's) conduct is compared to determine whether a negligent act or malpractice occurred; commonly defined as the knowledge and skill that an ordinary, reasonably prudent person would possess and exercise in the same or similar circumstances
Responsible behavior.
In reality therapy, the therapist serves as a positive role model for _____ ______.
control
In this type of delusion a person believes that another person, group of people, or external force controls thoughts, feelings, impulses, or behavior
Laissez-faire style
In which leadership style is no strategy clearly defined, and the focus is undetermined?
C: The potential for problems in adjusting after a rape will be increased when those around the victim treat her as though she is to blame for the rape, especially when she already may feel some guilt and shame about it. A rape victim is likely showing adjustment to her experience when she is upset about her experience, when she seeks out formerly ignored relatives and friends for support, or when she attempts to help other rape victims.
In which of the following instances would the nurse anticipate that a client who has been sexually assaulted will have future adjustment problems and the need for additional counseling? A.When she becomes upset when talking about the rape to anyone. B. When she seeks support from formerly ignored relatives and friends. C. When her parents show shame and suspicion about her part in the rape. D. When her life becomes focused on helping other rape victims like herself.
Orientation phase
In which phase are nursing diagnoses formulated?
Orientation phase
In which phase does the client & nurse develop a plan of action that is realistic for meeting established goals?
Working phase
In which phase does the client/nurse use a problem solving model and overcomes resistance behaviors?
Preinteraction phase
In which phase does the nurse examine his or her own feelings, fears, and anxieties about working with a particular client?
Working phase
In which phase does the nurse help to promote the client's insight and perception of reality?
Orientation (initial) phase
In which phase of group development are members over polite due to a lack of trust?
Orientation (initial) phase
In which phase of group development is the leader expected to ensure that rules established by the group do not interfere with fulfillment of the goals?
Preinteraction phase
In which phase of the therapeutic relationship does the nurse obtain available information from the client's chart or significant other?
Cognitive therapy
In which therapy model is the client taught to control thought distortions that might play a part in mood disorders?
Assertiveness training
In which therapy model will the person respond by respecting one's own rights as well as the rights of others?
B - Guilt and self-blame are common feelings that need to be addressed directly and frequently. The client needs to be reminded periodically that she did not deserve and did not cause the rape. Continually encouraging the client to report the rape pressures the client and is not helpful. In most cases, resuming sexual relations is a difficult process that is not likely to occur quickly. It is not necessarily true that the rapist will be caught, tried, and jailed. Most rapists are not caught or convicted.
In working with a rape victim, which of the following is most important? a) Recommending that the client resume sexual relations with her partner as soon as possible. b) Periodically reminding the client that she did not deserve and did not cause the rape. c) Telling the client that the rapist will eventually be caught, put on trial, and jailed. d) Continuing to encourage the client to report the rape to the legal authorities.
Donepezil (Aricept) interactions:
Increase GI intolerance with use of NSAIDs. Decreases action of anticholinergics.
phenobarbital (Luminal) interactions:
Increase effects with use of CNS depressants, alcohol. Increase in orthostatic hypotension with use of furosemide.
lorazepam (Ativan) interactions:
Increase in lorazepam effects with CNS depressants, alcohol, or disulfiram.
haloperidol (Haldol) interactions:
Increase serotonin syndrome, neuroleptic malignant syndrome with SSRIs and SNRIs
benztropine (Cogentin) interactions:
Increases anticholinergic effect with use of amantadine, antihistamines, and tricyclics.
negative reinforcement
Increasing behaviors by stopping or reducing negative stimuli, such as shock. A negative reinforcer is any stimulus that, when removed after a response, strengthens the response. (Note: negative reinforcement is not punishment.)
Treatment Modalities - Individual vs group therapy
Individual psychotherapy: long-term therapeutic approach; difficult because of client's impairment in interpersonal functioning Group therapy: some success if occurring over the long-term course of the illness; less successful in acute, short-term treatment
Borderline personality
Individuals with _____ personality disorder display a pattern of intense and chaotic relationships with affective instability.
Dependent
Individuals with _______ disorder have a lack of self-confidence, are typically passive, and "suffer" feelings of dejection in silence.
Schizotypal personality disorder
Individuals with this disorder display odd and eccentric behavior, with a bland and apathetic manner.
Psychological Factors
Invalidating environment - Early trauma leads to complex trauma - 40-71% report childhood abuse
Zolpidem (Ambien) is for treatment of:
Insomnia
SSRI and SNRI
Insomnia, agitation, headache, weight loss, sexual dysfunction are side effects commonly associated with which class of drugs?
Donepezil (Aricept) side effects:
Insomnia, dizziness, GI upset, headache
tangentiality
Leaving the main topic to talk about less important information
Of all mental illnesses, schizophrenia probably causes more:
Lengthy hospitalizations Chaos in family life Exorbitant costs to people and governments Fears
1. Do not leave the client alone. 2. Establish a no- harm contract with the client. 3. Establish rapport, and enlist help from family and friends.
List three interventions for the suicidal client.
The client hears the word "match." The client replies, "A match. I like matches. They are the light of the world. God will light the world. Let your light so shine." Which communication pattern does the nurse identify?
Loose association is characterized by communication in which ideas shift from one unrelated topic to another. The situation in the question represents this communication pattern.
Antipsychotics/ neuroleptics
MAJOR TRANQUILIZERS Used to treat bipolar, psychoses, agitation, schizophrenia The Meds: chlorpromazine (Thorazine) Haloperidol (Haldol) Fluphenazine (Prolixin) thioridazine (Mellaril) thiothixine (Navane) trifluoperazine (Trilafon) trifluoperazine (Stelazine) ****They block DOPAMINE RECEPTORS in the brain (which are the immediate precursors to norepinephrine). These affect neurotransmitters that allow for communication between nerve cells. Adverse reactions: hypotension, dizziness, fainting, dry mouth, possible impotence in men, photosensitivity, blood dyscrasias (abnormal values) THERE ARE MORE ADVERSE REACTIONS! SEE NEXT CARD!
Neologisms thought process
Made-up words that typically have only meaning to the individual who uses them. Noted in some type of schizophrenia.
Benzodiazepines
Main type of anti-anxiety medication. Relieves symptoms of anxiety-related disorders quickly. Most popular ones: *Clonazepam (Klonopin) *Alprazolam (Xanax) *Diazepam (Valium) *Lorazepam (Ativan) All addictive. For short term use only. DO NOT STOP ABRUPTLY, patients must be weaned off these meds or they will have SEIZURES.
Buspirone:
Management of anxiety disorders. Non-addictive; excellent for long-term relief of anxiety symptoms, e.g. GAD (e.g. BuSpar) Buspirone hydrochloride (BuSpar) Alleviates anxiety, but works best before benzodiazepines have been tried. Less sedating than benzodiazepines. Does not appear to produce physical or psychological dependence. Requires 3 or more weeks to be effective.
clozapine
Mandatory weekly white blood cell counts are used to detect developing agranulocytosis, which can be fatal and occurs in 1% to 2% of clients taking clozapine. This medication is associated with a risk of seizures; this risk is dose-dependent, meaning that it increases with moderate to high doses (600 to 900 mg/day). While the need to call the doctor in 2 weeks may be true, it does not reflect an understanding of the medication. Use of alcohol is contraindicated. Use of over-the-counter medications is contraindicated.
Long-Term Pharmacologic Management of Opioid Use Disorder
Methadone (Dolophine) Most effective; opioid agonist that blocks the craving. Buprenorphine (Subutex) Blocks the signs and symptoms of opioid withdrawal. Naltrexone (ReVia, Vivitrol) Antagonist that blocks the euphoric effects of opioids. Clonidine (Catapres) Is an effective somatic treatment when combined with naltrexone.
Pervasive Instability
Mood, relationships, behavior
Self-harm and Suicide
Most likely to injure themselves - 10% commit suicide - Linked to dissociative symptoms - Relief from psychic pain? - Flock to doctors often, but lack insight (need help, but do so ineffectively)
flight of ideas, a positive symptom in schizophrenia
Moving rapidly from one thought to the next, making it difficult for others to follow the conversation
D. Ms. T. stays in her home for fear of being in a place from which she cannot escape.
Ms. T has been diagnosed with agoraphobia. Which behavior would be most characteristic of this disorder? A. Ms. T. experiences panic anxiety when she encounters snakes. B. Ms. T refuses to fly in an airplane. C. Ms. T. Will not eat in public places. D. Ms. T. stays in her home for fear of being in a place from which she cannot escape.
Treatment of Alcoholism
N.A.D-now alcohol dies Naltrexone (ReVia, Vivitrol) Reduces or eliminates alcohol craving. Acamprosate (Campral) Helps patient abstain from alcohol. Disulfiram (Antabuse) Alcohol-disulfiram reaction causes unpleasant physical effects. Most reactions last about 30 minutes and are self-limited Occasionally, can be severe included marked tachycardia, hypotension, bradycardia, and cardiac arrest
Offer to remain with the client during activities
NI while for psychiatric pt. reluctant to be w/ friends & expresses a fear of rejection?
Opioid Addiction
Naloxone (Narcan) First choice to treat opioid toxicity Disadvantage: short-acting Nalmefene (Revex) Longer half-life, but prolongs withdrawal Methadone (Dolophine) Detox tool; synthetic opiate that blocks the craving for and effects of heroin.
The client can acknowledge the trauma and its impact; can demonstrate adaptive coping strategies, and has made realistic goals for the future.
Name some outcome goals appropriate for clients with trauma related disorders.
PTSD Causes = Natural or man-made disaster, victim of violent crime, witnessing the violent death of another person
Name some traumatic events that could cause PTSD:
schizotypal
Name these cluster A personality disorders: • Odd, strange; has magical thinking; socially isolated, paranoid, lacks close friends; has schizotypal
1. Assist the client through the grief process. 2. Promote self esteem 3. Encourage client self-control and control over life situation
Name three nursing interventions for the client suffering from depression.
1. Nature of the illness. 2. Management of the illness. 3. Support services
Name three topics for family education relating to depression
nsg dx 1. Post trauma syndrome. 2. Complicated grieving
Name two nursing diagnoses appropriate for trauma related disorders:
1. Reassurance of safety. 2. Decrease in maladaptive symptoms
Name two nursing interventions for this client:
D. Decreased seratonin, increased norepinephrine, and decreased GABA. pg. 530
Neurotransmitters have been implicated in the pathophysiology of anxiety disorders. Select the disturbances that are associated with anxiety disorders: A. Increased seratonin, decreased norepinephrine, and decreased GABA. B. Increased seratonin, decreased norepinephrine, and increased GABA. C. Decreased seratonin, decreased norepinephrine, and decreased GABA. D. Decreased seratonin, increased norepinephrine, and decreased GABA.
Pharmacology
No medication is consistently effective! - SSRI's (antidepressants) - SSNRI's (serotonin and norepinephrine) - Atypical antipsychotics and mood stabilizers? (Lithium, Valproate, etc.) *NOT Benzodiazepines
haloperidol (Haldol) contraindications:
Not for use for patients with coma or Parkinson's disease. Increased mortality in elderly patients with dementia-related psychosis.
zolpidem (Ambien) contraindications:
Not for use in children under 18 years, geriatric patients, anemia, renal/hepatic disease, drug abuse.
benztropine (Cogentin) contraindications:
Not for use in children under 3 years, closed-angle glaucoma, dementia, tardive dyskinesia.
Antidepressants
Not uppers *6-8 weeks to take effect, continued for 6-12 months (or more) THREE main groups of antidepressants: 1.Tricyclic 2.Monoamine Oxidase Inhibitors (MAOIs) MY FAVE!!!!!!!!! 3.Selective Serotonin reuptake inhibitors (SSRIs) Treats Hyperarousal
2, and 4. EPS occurs frequently, especially at the beginning of therapy with haloperidol. A person with Parkinson's disease, seizure disorders, alcoholism, or severe mental depression should not take haloperidol because they are all conditions that affect the CNS. Dementia, seizures, depression, and severe CNS depression are known to occur with the use of haloperidol in these clients. Options 1, 3, and 5 are incorrect. Haloperidol and antacids may be given simultaneously; there are no known interactions between these 2 meds. Haloperidol must be taken as ordered, on a regular schedule. Taking the drug prn will not reduce sx of psychosis because it takes several weeks of regular administration before therapeutic levels are reached. Sustained-release meds should NEVER be crushed. If client cannot take the med, another form should be used.
Nursing implications of the administration of haloperidol (Haldol) to a client exhibiting psychotic behavior include which of the following? Select all that apply. 1. Take 1 hour or 2 hours after antacids. 2. The incidence of extrapyramidal symptoms is high. 3. It is therapeutic if ordered on an as-needed basis. 4. Haldol is contraindicated in Parkinson's disease, seizure disorders, alcoholism, and severe mental depression. 5. Crush the sustained release form for easier swallowing.
Pica Name at least 3 other disorders co morbid with Pica
OCD Austim Exoriation Tricotillomania Schizophrenia Intellectual Disability
Parents and Spouses
Often bear a significant burden - Conjoint sessions with other people - "Stop Walking on Eggshells" book written on how to live with someone with BPD
Psychosis - manifestations
Out of contact w/ reality. *Brief psychotic disorder - sudden onset, lasts less than 1mo and return to full premorbid level. *Subs/Med induced Psych *Psych disorder d/t another med condition
Prazosin (minipress)
PTSD treatment For Nightmares
SNRIs:
Panic disorder (PD), generalized anxiety disorder (GAD), and social affective disorder (SAD)
Histrionic
Parents of children displaying _____ disorder likely had inconsistent parental approval and/or feedback.
Haloperidol can cause Parkinson-type symptoms
Parkinson-type symptoms
depersonalization
People experiencing this may feel that body parts do not belong to them or may sense that their body has drastically changed
Obsessive-compulsive personality disorder
People with _______ personality disorder tend to be rigid about rules and procedures, are preoccupied with details and perfectionism.
They appear cold, aloof, and indifferent to others.
People with schizoid personality disorder display what types of behaviors toward others?
Avoidant
People with which disorder view themselves as socially inept, personally unappealing, or inferior to others?
Borderline Personality Disorder
Personality disorders affect relationships - Most common personality disorder of all!
Narcissistic
Persons with ______ disorder were often pampered and indulged as children, not recognizing that there are consequences to actions.
Narcissistic personality disorder
Persons with _________disorder have an exaggerated sense of self-worth, lacking empathy, and desiring special treatment.
persecution
Peter believed that the Secret Service was planning to kill him by poisoning his food; therefore, he would eat only prepackaged food. Which type of delusion is Peter experiencing?
Phases of Schizophrenia
Phase I Premorbid Phase- social maladjustment, social withdrawal, irritability, and antagonistic thoughts and behavior Phase II Prodromal Phase- certain signs and symptoms that precede the characteristic manifestations of the acute, fully developed illness. Phase III Schizophrenia- active phase of the disorder. Two or more of the following present for a significant amount of time during one month: delusions, hallucinations, social/occupational dysfunction, duration, schizoaffective and mood disorder exclusion, substance/general medical condition exclusion, relationship to a pervasive developmental disorder Phase IV Residual Phase- characterized by periods of remission and exacerbation. A residual phase usually follows an active phase of the illness.
Nursing process.
Phases of crisis intervention closely model the _____.
attempted rape
Physical attempts and verbal threats of rape
Pica eating or nonnutritive, nonfood substances over at least 1 month
Pica
Pica these are medical complications of what eating/feeding disorder: - reaks havick on bowel, distroys intestines, periferate intestines, toxoplasmosis (posioning in blood)
Pica
Pica these disorders are commonly associated with which feeding/eating disorder: - OCD - Autism - Excoriation - Tricotillomania - Schizophrenia - Intellectual Disability
Pica
only eating disorder that can be dual dx with any other eating disorder???
Pica
B. Splitting involves setting up individuals or groups to disagree. While the two parties are busy disagreeing, they are too busy to maintain consistent limits for the manipulative client. The client can enjoy the spectacle and do as he or she pleases.
Playing one staff member against another is an example of A. devaluation. B. splitting. C. impulsiveness. D. social ineptitude.
lorazepam (Ativan) action:
Potentiates the action of GABA, especially in the limbic system and the reticular formation
disulfiram (Antabuse) contraindications:
Pregnancy, breastfeeding, diabetes, thyroid disease, epilepsy, brain damage, or kidney/liver disease
zolpidem (Ambien) action:
Produces CNS depression at limbic, thalamic, and hypothalamic levels of CNS
clonidine (Catapres) patient teaching:
Product may cause drowsiness. Patient must not discontinue produce abruptly or withdrawal symptoms may occur.
_________________ personality factors: - nonconformity - having feminist ideology - high self- esteem - belief that body weight and share are OUT of one's control - self-perception of being thin
Protective
Extrapyramidal symptoms (EPS)
Pseudoparkinsonism Akinesia Akathisia Dystonia Oculogyric crisis Antiparkinson meds may be prescribed to counteract EPS
Temp & antipsychotics?
Pts should avoid expsure to extremes in temps while on these meds
Impulsive Decisions
Quit job, break relationships, flirt with suicide
Implies special feelings on the part of both the client and nurse based on acceptance, friendliness, and nonjudgmental attitude
Rapport
Paranoia
Refuses to eat food that comes on a tray, saying, "They are trying to poison me."
Beta blockers:
Relieve the physical symptoms, as in performance anxiety. Act by attaching to sensors that direct arousal message.
stereotyped behaviors
Repeated motor behaviors that do not serve a logical purpose
echolalia
Repeating of the last words spoken by another
Phase 1 - Premorbid Phase
Social maladjustment Antagonistic thoughts and behavior Shy and withdrawn Poor peer relationships Doing poorly in school Antisocial behavior
B. Individuals with an antisocial personality exhibit a lack of remorse when confronted with the results of their thoughtless, irresponsible behavior toward others.
Research has indicated that the antisocial personality may be characterized by A. social isolation. B. lack of remorse. C. learning difficulties. D. difficulty with reality testing.
MAOIs:
Reserved for treatment-resistant conditions due to risk of life-threatening hypertensive crisis. Recently being used in people with social anxiety disorder (SAD) and rejection sensitivity
recovery
Restoration to former and/or better state or condition.
Buspirone and digoxin
SSRIs may decrease the effect of which two drugs?
jealousy
Sally wrongly accused her spouse of going out with other women. Her proof was that he twice came home from work late (even though his boss explained that everyone had worked late). Is Sally experiencing a delusion and if so, which type?
Tricyclic antidepressants:
Second- or third-line use for PD, GAD, and SAD; clomipramine is effective in obsessive-compulsive disorder (OCD)
Buspirone (BuSpar)
Secondary type of Anti-Anxiety med. NOT A BENZO! This med does NOT give the tranquilizer effect that the benzodiazepines do. BuSpar's action is unknown. *Takes 2 weeks to take effect *Side effects are slurred speech and dizziness
Zolpidem (Ambien) classification:
Sedative-hypnotic (nonbenzodiazepine)
Naloxone (Narcan) side effects:
Seizures, ventricular tachycardia, fibrillation, cardiac arrest
trazadone (Desyrel) action:
Selectively inhibits serotonin uptake by brain; potentiates behavioral changes
Neurotransmitters that affect anxiety disorders:
Serotonin, GABA, Noepinephrine **Note: Serotonin and GABA decreases and Norepinephrine increases in Anxiety Disorders
Neuroleptic Malignant Syndrome
Severe EPS PLUS Hyperpyrexia (high Temp!) Temps can reach 107!! Increased Heart rate, Resp. rate, coma, death! STOP med and call Dr.! rare by potentially fatal complication of tx. Routinely monitor temp. S&S: muscle rigidity, very high fever, tachy, tachypnea. D/C antipsych med. Tx: Parlodel or Dantrium
Yes, because as the patient starts to feel better in the early stage of treatment, he may have more energy to actually follow through with the suicidal ideation.
Should clients taking antidepressants be monitored for a suicide risk, even though they are getting better?
disulfiram (Antabuse) side effects:
Skin rash, acne, mild headache, drowsiness, tiredness, impotence, metallic or garlic taste in the mouth.
Approximately 90% of patients with DAI remain in a persistent vegetative state
Survival rate of DAI
symptoms of panic attack
Sweating, trembling, shaking Shortness of breath, chest pain or discomfort Nausea or abdominal distress Dizziness, chills, or hot flashes Numbness or tingling sensations Derealization or depersonalization Fear of losing control or "going crazy" Fear of dying
negative
Symptoms associated with a loss of normal functioning
A client is admitted with a diagnosis of brief psychotic disorder, with catatonic features. Which symptoms are associated with the catatonic specifier?
Symptoms associated with the catatonic specifier include stupor and muscle rigidity or excessive, purposeless motor activity. Waxy flexibility, negativism, echolalia, and echopraxia are also common behaviors.
Mild depression.
Symptoms of _____depression are associated with normal grieving, such as anger, anxiety, regression, and preoccupation with loss.
Moderate depression
Symptoms of helplessness, powerlessness, difficulty with concentration, and sleep disturbance are associated with _________ depression.
PTSD may be related to the disregulation of many neurotransmitter pathways.
T
trazadone (Desyrel) patient teaching:
Take product at bedtime. Therapeutic effects may take 2-3 weeks. Avoid alcohol and use caution when driving. Suicidal ideation may occur in adolescents/children.
lorazepam (Ativan) teaching:
Teach patient not to take more than prescribed amount, this product may be habit forming. Contraindicated with pregnancy or breastfeeding.
disulfiram (Antabuse) patient teaching:
Teach patient that a reaction may occur for up to 2 weeks after disulfiram has been stopped. Take exactly as prescribed.
zolpidem (Ambien) teaching:
Teach patient that dependence is possible after long-term use. complex sleep-related behaviors may occur like sleep driving/eating. Avoid alcohol.
haloperidol (Haldol) teaching:
Teach patient that orthostatic hypotension occurs often; avoid hazardous activities; avoid abrupt withdrawal of this product.
Donepezil (Aricept) patient teaching:
Teach patient to report side effects such as twitching, N/V, sweating, dizziness. Do not increase or abruptly decrease dose.
phenobarbital (Luminal) patient teaching:
Teach patient to use exactly as ordered, to avoid alcohol and other CNS depressants, to notify HCP if pregnancy is planned or suspected.
B - Continue previous contraceptive use even if you're experiencing amenorrhea. Women may experience amenorrhea, which is reversible, while taking antipsychotics because amenorrhea doesn't indicate cessation of ovulation the client who experiences amenorrhea can still become pregnant. She should be instructed to continue contraceptive use even when experiencing amenorrhea. Dysmenorrhea isn't an adverse effect of antipsychotics, and the depressant effect generally decreases libido.
Teaching for women of childbearing years who are receiving antipsychotic medications includes which statement? a) Amenorrhea is irreversible. b) Continue previous contraceptive use even if you're experiencing amenorrhea. c) Incidence of dysmenorrhea may increase while taking this drug. d) This medication may result in heightened libido.
ANSWER = 3. The nurse should remove the mother from the room and allow her to ventilate her feelings about the accident her son sustained while he was under the influence. 1. The nurse must diffuse the situation and remove the mother from the client's room because a seriously ill client does not need to be yelled at. 2. Hospital security does not need to be called unless the mother refuses to leave the client's room in the critical care unit. 4. The nurse should remove the mother because she is upset and let her ventilate. Telling the mother she must be quiet is condescending, and when someone is upset, telling the person to be quiet is not helpful.
The 18-year-old client is admitted to the critical care unit after a serious motor vehicle accident resulting from driving under the influence. The mother comes to the unit and starts yelling at her son about "driving drunk." Which action should the nurse implement? 1. Allow the mother to continue talking to her son. 2. Notify the hospital security to remove the mother. 3. Escort the mother to a private area and talk to her. 4. Tell the mother if she wants to stay, she must be quiet.
Warning for increased risk of suicide
The FDA has a black box warning relating to the use of antidepressant medications in children, which says:
Selective Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
The MEDS: Effexor Cymbalta Pristiq Side Effects: anxiety, abnormal dreams, dizziness, nervousness
Anti-Manic Agent (calms patients in manic phase) Episodes of Bipolar 1 Disorder
The Med: LITHIUM used for bipolar disorder, calms patient in manic phase Controls flight of ideas, restlessness, etc LITIUM IS A SALT, maintain a diet with NORMAL sodium intake, restricting sodium INCREASES Litium toxicity. Have patients monitor selves for edema, regular weights! Side effects: Thirst, nausea, vomiting, hair loss, tremors, weight gain, hypothyroidism NARROW THERAPEUTIC RANGE INCREASES LIKELIHOOD OF TOXICITY! ******THERAPEUTIC RANGE OF LITHIUM: .5-1.5 mEq/L******
negative symptoms
The absence of something that should be present
contusion
The bruising of the brain tissue within a focal area
C. Clients with borderline disorder can decompensate into psychotic states under stress. Hospitalization is needed at these times.
The client diagnosed with a personality disorder who is most likely to be admitted to a psychiatric unit is one who has A. paranoid personality disorder and is suspicious of his neighbors. B. narcissistic personality disorder and is highly self-important. C. borderline personality disorder and is impulsive. D. dependent personality disorder and clings to her husband.
haloperidol Delusions and agitation respond to antipsychotic medications. Haldol has been used and has proven to be effective in treating these symptoms, so the nurse should anticipate this prescription. (Aricept is prescribed in the early stages of Alzheimer's disease but would not be effective in the late stages.
The client diagnosed with late-stage Alzheimer's disease is agitated and having delusions. Which medication should the nurse anticipate the health-care provider prescribing? 1. the cholinesterase inhibitor donepezil (Aricept) 2. the antipsychotic medication haloperidol (Haldol) 3. the selective serotonin reuptake inhibitor fluoxetine (Prozac) 4. the tricyclic antidepressant amitriptyline (Elavil)
1.The client diagnosed with dementia would be expected to have confusion and disorientation; therefore, the LPN could be assigned this client. This client is not experiencing any potentially life-threatening complication of dementia. 2. The client is experiencing tardive dyskinesia, a potentially life-threatening com-plication of antipsychotic medication. An experienced RN should be assigned to this client. 3. The therapeutic serum level for lithium is0.6 to 1.5 mEq/L. The client's level is toxic, and an experienced RN should care for the client.4. This client is experiencing a potentially life-threatening complication of alcohol withdrawal. An experienced RN should be assigned to this client. MAKING NURSING DECISIONS: The test taker must determine which client is the most stable, which makes this an "except" question. Three clients are either unstable or have potentially life-threatening conditions
The charge nurse is caring for clients in an acute care psychiatric unit. Which client would be most appropriate for the charge nurse to assign to the licensed practical nurse (LPN)? 1. The client diagnosed with dementia who is confused and disoriented. 2. The client diagnosed with schizophrenia who is experiencing tardive dyskinesia. 3. The client diagnosed with bipolar disorder who has a lithium level of 2.0 mEq/L. 4. The client diagnosed with chronic alcoholism who is experiencing delirium tremens
2
The charge nurse is caring for clients in an acute care psychiatric unit. Which client would be most appropriate for the charge nurse to assign to the licensed practical nurse (LPN)? 1. The client diagnosed with dementia who is confused and disoriented. 2. The client diagnosed with schizophrenia who is experiencing tardive dyskinesia. 3. The client diagnosed with bipolar disorder who has a lithium level of 2.0 mEq/L. 4. The client diagnosed with chronic alcoholism who is experiencing delirium tremens.
ANSWER = 2. The first action is to stop the argument from occurring in a public place. The charge nurse should not discuss the UAPs' behavior in public. 1. The nurse should stop the behavior occurring in a public place. The charge nurse can discuss the issue with the UAPs and determine whether the manager should be notified. 3. The second action is to have the UAPs go to a private area before resuming the con- versation. 4. The charge nurse may need to mediate the disagreement; this would be the third step.
The charge nurse observes two UAPs arguing in the hallway. Which action should the nurse implement first in this situation? 1. Tell the manager to check on the UAPs. 2. Instruct the UAPs to stop arguing in the hallway. 3. Have the UAPs go to a private room to talk. 4. Mediate the dispute between the UAPs.
1. The therapeutic serum level for lithium is0.6 to 1.5 mEq/L. Because the client's1.0 mEq/L level is within normal limits, the charge nurse would not need to notify the psychiatric HCP. 2.The WBC count is elevated, which may indicate that the client is experiencing agranulocytosis, a life-threatening com-plication of clozapine. This laboratory data would warrant notifying the psychiatric health-care provider. 3. The client's serum potassium level is within normal limits; therefore, this laboratory data does not warrant notifying the psychiatric health-care provider. 4. This glucose level is slightly elevated but would not warrant notifying the psychiatric health-care provider.
The charge nurse received laboratory data for clients in the psychiatric unit. Which client data warrants notifying the psychiatric health-care provider? 1. The client on lithium (Eskalith) whose serum lithium level is 1.0 mEq/L. 2. The client on clozapine (Clozaril) whose white blood cell count is 13,000. 3. The client on alprazolam (Xanax) whose potassium level is 3.7 mEq/L. 4. The client on quetiapine (Seroquel) whose glucose level is 128 mg/dL.
2 - WBC count.
The client admitted to the psychiatric unit diagnosed with schizophrenia is prescribed clozapine (Cloazaril), an atypical antipsychotic. Which laboratory data should the nurse evaluate? 1. the client's clozapine therapeutic level 2. the client's white blood cell count 3. the client's red blood cell count 4. the client's arterial blood gases
3 - Change position slowly.
The client admitted to the psychiatric unit experiencing hallucinations and delusions is prescribed risperidone (Risperdal), an atypical antipsychotic. Which intervention should the nurse implement? 1. Provide the client with a low tyramine diet 2. Assess the client's respiration for 1 full minute 3. Instruct the client to change positions slowly 4. Monitor the client's intake and output
paranoid personality disorder
The client at an in-patient facility is constantly on guard, hypervigilant, and ready for any real or imagined threat. This client is displaying ________ disorder.
C - has delusions of persecution The client who perceives others to be against him may lash out if he feels threatened.
The client at highest risk for violence directed at others is one who A. has a history of recurrent severe depression. B. is in an alcohol rehabilitation program. C. has delusions of persecution. D. who has somatic symptoms for which no organic basis is found.
3
The client diagnosed with paranoid schizophrenia has been taking haloperidol (Haldol), a conventional antipsychotic, for several years. Which statement indicates the client needs additional teaching concerning this medication? 1. "I know that if I have any rigidity or tremors I must call my HCP." 2. "I eat high-fiber foods and drink extra water during the day." 3. "I am more susceptible to colds and the flu when taking this medication." 4. "This medication will make my hallucinations and delusions go away."
1. Clozaril can promote significant weight gain; therefore, the client should exercise regularly, monitor weight, and reduce caloric intake. 2. Clozaril promotes weight gain, not weight loss. 3. Clozaril does not cause GI distress and can be taken with food OR on an empty stomach. 4. The client should not DECREASE alcohol intake; the client should AVOID alcohol intake COMPLETELY.
The client diagnosed with schizophrenia is prescribed clozapine (Clozaril), an atypical antipsychotic. Which information should the nurse discuss with the client concerning this medication? 1. discuss the need for regular exercise 2. instruct the client to monitor for weight loss 3. tell the client to take the medication with food 4. explain to the client the need to decrease alcohol intake
ANSWER = 3. The nurse should have someone come talk to the client who is in a position to then investigate what happened on the night shift and determine why this happened. The day shift primary nurse does not have this authority. 1. This statement is not supporting the night shift and makes the unit look bad. The nurse should not "bad-mouth" the night shift. 2. The nurse has no idea what happened that delayed answering the call light, it could have been a code or other type of life-threatening situation. The day shift primary nurse may not be able to answer the light in some certain situations and should not falsely reassure the client. 4. This is negating the client's feeling, and theclient does not need to know what wasgoing on in the critical care unit
The client in the critical care unit tells the day shift primary nurse that the night nurse did not answer the call light for almost 1 hour. Which statement would be most appropriate by the day shift primary nurse? 1. "The night shift often has trouble answering the lights promptly." 2. "I am sorry that happened and I will answer your lights promptly today." 3. "I will notify my charge nurse to come and talk to you about the situation." 4. "There might have been an emergency situation so your light was not answered."
Adaptive coping strategies and progression through the grieving process
The client is on his way to recovery when he demonstrates _______ & _______.
patient safety and stabilization
The overall goal for the acute phase of schizophrenia
d - Asocial behavior, anergia, alogia, and affective flattening are some of the negative symptoms of schizophrenia that may improve with risperidone therapy. Abnormal thought form is a positive symptom of schizophrenia. Hallucinations and delusions are positive symptoms of schizophrenia. Bizarre behavior is a positive symptom of schizophrenia.
The client is taking risperidone (Risperdal) to treat the positive and negative symptoms of schizophrenia. Improvement of which of the following negative symptoms indicate the drug is effective? a) Abnormal thought form. b) Hallucinations and delusions. c) Bizarre behavior. d) Asocial behavior and anergia.
ANSWER = 3. The use of restraints and seclusion requires a HCP's order every 24 hours. The nurse must obtain this order first after placing the client in the seclusion room. The nurse can place the client in seclusion for the safety of the client/staff/other clients, but the nurse must then immediately obtain a HCP's order. 1. The nurse must document the client's behavior that prompted the need for seclusion, but it is not the first intervention.2. The day room area should be cleaned up, but it is not the nurse's first intervention. 2. The day room area should be cleaned up, but it is not the nurse's first intervention. 4. The charge nurse should make sure the other clients are not injured, but the first intervention is to keep the client who is acting out safe and legally put into seclusion.
The client on the psychiatric unit is yelling at other clients, throwing furniture, and threatening the staff members. The charge nurse determines the client is at imminent risk for harming the staff/clients and instructs the staff to place the client in seclusion. Which intervention should the charge nurse implement first? 1. Document the client's behavior in the nurse's notes. 2. Instruct the MHWs to clean up the day room area. 3. Obtain a restraint/seclusion order from the HCP. 4. Ensure that none of the other clients were injured.
D. "You're angry and you did well to leave the situation. Let's walk up and down the hall while you tell me about it." The nurse acknowledges and labels the client's emotion and acknowledges his appropriate behavior. Recognizing the client's physiologic arousal, the nurse suggests an activity to decrease anxiety and stays with him. Setting limits on the client's language does not acknowledge his control and does not help the client manage his anxiety. The client needs to engage in physical activity to decrease muscle tension and anxiety. Offering the client medication suggests that he cannot control his behavior. Medication would be used only if other interventions failed to reduce the anxiety level.
The client rushes out of the day room where he has been watching television with other clients. He is hyperventilating, flushed, and his fists are clenched. He states to the nurse, "That bastard! He's just like Tom. I almost hit him." Which of the following would be the nurse's best response? a) "I'm glad you left the situation. Why don't you go to your room and calm down. I'll come in soon to talk." b) "I can see you're angry. Let me get you some Ativan to help you calm down. Then we'll talk about what happened." c) "Even if you're angry, you can't use that language here." d) "You're angry and you did well to leave the situation. Let's walk up and down the hall while you tell me about it."
C - The client's thought process is best defined as a delusion of persecution. An idea of reference assumes that the remarks and behavior of others apply to oneself. An idea of influence refers to the belief that people or objects have control over one's behavior. A delusion of grandeur involves an exaggerated idea of one's importance or identity.
The client thinks he is being followed by foreign agents who are after secret papers in his briefcase. What thought process does this indicate? a) Idea of reference. b) Idea of influence. c) Delusion of persecution. d) Delusion of grandeur.
battery
The harmful or offensive touching of another person
The paranoid person will attack others first, since he has learned to perceive the world as harsh and unkind.
The paranoid person anticipates humiliation and betrayal by others, so he/she ______ first.
C - Stating that God is important in the client's life recognizes the client's cognitive and perceptual disturbances and level of anxiety and acknowledges the client's message in a respectful and neutral manner, while adding that the medicine also will help, clearly and directly states the need for medication. Stating, "God helps those who help themselves" challenges the client. Stating, "God wants you to take your medicine" is deceitful. Stating, "Medicine will help clear your thinking and decrease anxiety" would be helpful to the client later when she is less acutely psychotic and anxious.
The client with a diagnosis of schizophrenia is acutely psychotic and exhibits religious delusions and hallucinations, loose associations, and concrete thinking. When the nurse offers the client her medication, the client states, "I don't need that. God will heal me." The nurse should respond to the client by saying: a) "This medicine will help clear your thoughts and decrease anxiety." b) "God wants you to take your medicine." c) "God is important in your life, but the medicine will help you too." d) "God helps those who help themselves."
C - Lead client to his room and help him dress if he needs assistance. The best nursing action is to lead the client to his room and assist him with putting on his clothes. The client with disorganized behavior needs the nurse's assistance to protect his self-esteem and dignity and to avoid embarrassment. Instructing the client to go to his room to put on his clothes may not be effective because the client may be too disorganized to follow directions. Wrapping a blanket around the client is helpful. Instructing him to be seated for the remainder of group is inappropriate and demeaning. Asking another client to remove his sweater and wrap it around the other client's waist is inappropriate
The client with a diagnosis of schizophrenia walks into group naked. The nurse should: a) Ask a male client to take off his sweater and wrap it around the client's waist. b) Instruct the client to go to his room and to put on some clothes. c) Lead the client to his room and help him dress if he needs assistance. d) Wrap a blanket around him and tell him to be seated for the remainder of group.
True.
The client with paranoid personality disorder perceives attacks, is reluctant to confide in others, and is doubtful of other's trustworthiness. True or false.
3 - reduces positive symptoms and improves negative symptoms
The client with paranoid schizophrenia is prescribed ariprpazole (Abilify), a dopamine system stabilizer (DDS). Which statement best describes the scientific rationale for administering this medication? 1. it decreases the anxiety associated with hallucinations and delusions 2. it increases the dopamine secretion in the brain tissue to improve speech 3. it reduces positive symptoms of schizophrenia and improves negative symptoms 4. it blocks the cholinergic receptor sites in the diseased brain tissue
Administer antianxiety agent. This client is in respiratory alkalosis, which is caused by hyperventilating and could be the result of anxiety, elevated temperature, or pain. The nurse should administer the appropriate medication. Oxygen would not be helpful in treating this client. Sodium bicarbonate is the drug of choice for metabolic acidosis and is an alkaline substance that would increase the client's alkalosis. An antacid would not help treat respiratory alkalosis because it is also an alkaline substance.
The client's arterial blood gas results are pH 7.48, PaO2 98, PCO2 30, and HCO3 24. Which action would be most appropriate for this client? 1. Administer oxygen 10L/min via nasal cannula 2. Administer an antianxiety medication 3. Administer 1 amp of sodium bicarbonate IVP 4. Administer 30 mL of an antacid
Schizoaffective
The clients disorder meets both the criteria for schizophrenia and one of the affective disorders ( depression, mania, or a mixed disorder)
3
The clinical manager assigned the psychiatric nurse a client diagnosed with major depression who attempted suicide and is being discharged tomorrow. Which discharge instruction by the psychiatric nurse would warrant intervention by the clinical manager? 1. The nurse provides the client with phone numbers to call if needing assistance. 2. The nurse makes the client a follow-up appointment in the psychiatric clinic. 3. The nurse gives the client a prescription for a 1-month supply of antidepressants. 4. The nurse tells the client not to take any over-the-counter medications.
ANSWER = 2. The nurse should first ensure the client's safety by having someone stay at the bedside with the client, and then call the HCP, and finally apply mitt restraints. 1. The family may or may not be able to control the client's behavior but the nurse should not ask a family member first. The CCU usually has mandated visiting hours. 3. This is a form of restraint and is against the law unless the nurse has a health care provider's order. This is the least restrictive form of restraint but would not be helpful if the client is pulling at tubes. 4. The nurse must notify the healthcare provider before putting the client in restraints; restraints must be used only in an emergency situation, for a limited time, and for the protection of the client.
The confused client in the critical care unit is attempting to pull out the IV line and the indwelling urinary catheter. Which action should the nurse implement first? 1. Ask a family member to stay with the client. 2. Request the UAP to stay with the client. 3. Place the client in a chest restraint. 4. Notify the HCP to obtain a restraint order.
"It was removed last month, but it is growing again and I will be walking shortly."
The nurse asks a client with schizophrenia, "When was your left leg amputated?" Which response by the client indicates a somatic delusion?
Evaluation phase
The nurse asks the client if he/she can describe a plan of action to deal with future similar stressors. Which phase of crisis intervention is the nurse in?
PTSD Effective tx = Prolonged exposure therapy
What is one treatment modality for PTSD that has good proof of efficacy?
ANSWER = 3. A democratic manager is people oriented and emphasizes efficient group functioning. The environment is open and communication flows both ways, and this includes having meetings to discuss concerns. 1. Autocratic managers use an authoritarian approach to direct the activities of others. 2. Laissez-faire managers maintain a permissive climate with little direction or control. 4. This statement reflects shirking of responsibility, thus letting someone else address the problem, and is not characteristic of a democratic manager.
The critical care unit is having problems with staff members clocking in late and clocking out early from the shift. Which statement by the male charge nurse indicates he has a democratic leadership style? 1. "You cannot clock out 1 minute before your shift is complete." 2. "As long as your work is done you can clock out any time you want." 3. "We are going to have a meeting to discuss the clocking in procedure." 4. "The clinical manager will take care of anyone who clocks out early."
1. Fever, tachycardia, stupor, and incontinence are sx of neuroleptic malignant syndrome (NMS), a potentially fatal adverse effect of antipsychotics that must be diagnosed and treated immediately. Options 2, 3, and 4 are possible adverse reactions, but are not life threatening, and therefore do not need to be reported with the same urgency as sx of NMS.
The development of which symptom (s) in a client taking an antipsychotic must be reported immediately? 1. Fever, tachycardia, stupor, and incontinence 2. Suddenly occurring muscle spasms, especially in the neck and back 3. Sexual dysfunction 4. Leg pains, pacing, an inability to sit still
1. The nurse needs to remove the man from the room so that the nurse can talk to the client and discuss probable abuse. Taking the client to the x-ray department may not rouse suspicion in the man and may allow the client to discuss the situation. 2. This may be needed, but it is not the first intervention. This action may cause the man to get angrier in the emergency room department, or it may cause more problems for the woman if she goes home with him. 3. The nurse could demand the man leave the room, but this action may cause the man's anger to escalate; therefore, the first intervention is to remove the client from the room. 4. The nurse should not allow the man to see the nurse discussing a woman's shelter with the client or providing a client with a brochure. This could cause further anger in the man, especially if the woman goes home with the man.
The emergency department nurse is assessing a female client who has a laceration on the forehead and a black eye. The nurse asks the man who is with the client to please leave the room. The man refuses to leave the room. Which action should the nurse take first? 1. Tell the man the client needs to go to the x-ray department. 2. Notify hospital security and have the man removed from the room. 3. Explain that the man must leave the room while the nurse checks the client. 4. Give the client a brochure with information about a woman's shelter.
b - bald spots on the scalp
The emergency room nurse is performing an assessment on a 7-year-old child with a fractured arm. The child is hesitant to answer questions that the nurse is asking and consistently looks at the parents in a fearful manner. The nurse suspects physical abuse and continues with the assessment procedures. Which assessment finding would most likely assist in verifying the suspicion? a) poor hygiene b) bald spots on the scalp c) lacerations in the anal area d) swelling of the genitals
ANSWER = 2. The nurse should give the manager a chance to discuss the situation before quitting. A temporary problem, such as illness, may be affecting staffing. 1. The nurse should leave if he determines that the staffing is not now or ever will be as it was relayed to him in the interview; however, there may be a temporary situation that can be resolved. 3. This action could cause the manager to think of the new nurse as a troublemaker. 4. The nurse should not discuss this with the charge nurse because this may cause a rift between the charge nurse and the new nurse. The nurse should clarify the staffing situation with the unit manager.
The experienced male nurse has recently taken a position on a medical unit in a community hospital, but after 1 week on the job, he finds that the staffing is not what was discussed during his employment interview. Which approach would be most appropriate for the nurse to take when attempting to resolve the issue? 1. Immediately give a 2-week notice and find a different job. 2. Discuss the situation with the manager who interviewed him. 3. Talk with the other employees about the staffing situation. 4. Tell the charge nurse the staffing is not what was explained to him.
ideas of reference, a type of delusion
The false impression that outside events have special meaning for oneself
B. Structure the ct's schedule so that she has plenty of time for washing her hands.
The initial care plan for a client with OCD who washes her hands obsessively would include which of the following nursing interventions? A. Keep the ct's bathroom locked so she can't wash her hands all the time. B. Structure the ct's schedule so that she has plenty of time for washing her hands. C. Place the ct in isolation until she promises to stop washing her hands so much. D. Explain the ct's behavior to her, since she's probably unaware that it's maladaptive.
4
The male client diagnosed with major depression is returning to the psychiatric unit from a weekend pass with his family. Which intervention should the nurse implement first? 1. Ask the wife for her opinion of how the visit went. 2. Determine whether the client took his medication. 3. Ask the client for his opinion of how the visit went. 4. Check the client for sharps or dangerous objects
1. The first intervention should be to talk to the client and remove him from the day room to the least restrictive environment.Restraining the client is the most restrictive environment. 2. The nurse should first attempt to talk to the client and remove the client from the day room area, not try to remove all the other clients. 3. The client will probably need a prn medication to calm the behavior, but it is not the nurse's first intervention. An intramuscular medication takes at least 30 minutes to become effective. 4. The first intervention is to approach the client calmly and attempt to remove him from the day room. Staff members should not approach the agitated client alone but should be accompanied by other personnel.
The male client diagnosed with paranoid schizophrenia is yelling, talking to himself, and blocking the view of the television. The other clients in the day room are becoming angry. Which action should the nurse take first? 1. Obtain a restraint order from the HCP. 2. Escort the other clients from the day room. 3. Administering an intramuscular (IM) antipsychotic medication. 4. Approach the client calmly along with two MHWs
1. Atypical antipsychotic meds have a lower risk of sexual dysfunction than conventional antipsychotic meds; therefore, if the client experiences impotency, he should call his HCP. This statement does not indicate he understands the medication teaching. 2. Atypical antipsychotic meds DO NOT cause photosensitivity (unlike conventional antipsychotic drugs) This statement does not indicate he understands the medication teaching. 3. Atypical antipsychotics DO NOT cause gynecomastia (inlike conventional antipsychotic drugs). 4. Geodon is well-tolerated, but the most common side effect is difficulty sleeping, perhaps because of the histamine antagonist blockade effect of the drug. This comment indicates the client understands the teaching.
The male client diagnosed with schizophrenia is prescribed ziprasidone (Geodon), an atypical antipsychotic. Which statement to the nurse indicates the client understands the medication teaching? 1. "I need to keep taking this medication even if I become impotent." 2. "I should not go out in the sun without wearing protective clothing." 3. "This medication may cause my breast size to increase." 4. "I may have trouble sleeping when I take this medication."
2
The male client in the psychiatric unit asks the MHW to mail a letter to his family for him. Which action would warrant intervention by the psychiatric nurse? 1. The MHW tells the client to place the letter in the mailbox. 2. The MHW informs the client he cannot send mail to his family. 3. The MHW takes the letter and places it in the unit mailbox. 4. The MHW reports the client mailed a letter at the team meeting.
ANSWER = 2. The nurse should remain calm and try to allow the client to vent his frustrations in a more acceptable manner. The nurse should repeat calmly in a low voice any instructions given to the client. 1. This might be the second statement for the nurse to make if the client does not calm down and discuss the problems with the nurse. Because it could escalate the anger, it should not be the first statement. 3. This statement will escalate the situation and could cause the visitor to lash out at the nurse. 4. This statement will escalate the situation and could cause the visitor to lash out at the nurse.
The male visitor on a medical unit is shouting and making threats about harming the staff because of perceived poor care his loved one has received. Which statement is the nurse's best initial response? 1. "If you don't stop shouting, I will have to call security." 2. "I hear that you are frustrated. Can we discuss the issues calmly?" 3. "Sir, you are disrupting the unit. Calm down or leave the hospital." 4. "This type of behavior is uncalled for and will not resolve anything."
Assessment phase
The nurse asks the client, "What method of coping have you used in the past?" This is during the ______ phase of crisis intervention.
ANSWER = 3. Shared governance is an organizational framework in which the nurse has autonomy over his or her own practice. The nurse is given direct input into the working of the unit. 1. Under shared governance, some nurses become so involved with the management of facilities that they are no longer eligible for representation by a bargaining agent (union), but there are no guarantees. 2. The manager is responsible for disseminating information under a centralized system of organization. 4. Shared governance is a system in which the nurse represents himself or herself
The medical unit is governed by a system of shared governance. Which statement best describes an advantage of this system? 1. It guarantees that unions will not be able to come into the hospital. 2. It makes the manager responsible for sharing information with the staff. 3. It involves staff nurses in the decision-making process of the unit. 4. It is a system used to represent the nurses in labor disputes.
A. psychoeducation about their disorder. This is the most likely INITIAL intervention. Treatment for hoarding disorder is most commonly a combination of cognitive-behavioral therapy and SSRIs. Decreased activity in the cingulate cortex IS associated with hoarding disorder (pg 540) but neuroimaging of the client's brain is unlikely to be ordered to diagnose/treat this disorder.
The mental health nurse practitioner would include what initial intervention in the care of the client with hoarding disorder: A. Psychoeducation about their disorder B. Ordering neuroimaging to determine activity in the cingulate cortex. C. Psychopharmacology including an SSRI D. Cognitive-behavioral therapy
B. "Episodes of panic attacks associated with panic disorder are predictable and often occur on exposure to an anxiety producing situation." Panic disorder is characterized by recurrent panic attacks, the onset of which is UNPREDICTABLE. The symptoms come on unexpectedly, not before or on exposure to a situation that usually causes anxiety. pg. 532
The mental health nurse recognizes the new nurse requires more teaching when she makes this statement about panic disorder: A. " The panic attacks are manifested by intense apprehension, fear or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort." B. "Episodes of panic attacks associated with panic disorder are predictable and often occur on exposure to an anxiety producing situation." C. "Some common symptoms of panic disorder are: palpitations, pounding heart, sweating and sensations of shortness of breath." D. "The average onset of panic disorder is in the late 20s."
A - the less likely it is to be therapeutic. One study reported in the text found that the nurse's response to anger from a client varied according to the interpretation given to the client's anger and to the nurse's self-appraised ability to manage the situation. Only when self-efficacy was perceived as adequate did the nurse move to help the client. When self-efficacy was not seen as adequate, nurses showed a decreased ability to process the client's message and a decreased ability to problem-solve.
The more a nurse's intervention is prompted by emotion A. the less likely it is to be therapeutic. B. the less likely it is to be aggressive. C. the more likely it is to be effective. D. the more likely it is to be empathetic.
Increased levels of Norepinephrine. It's known to mediate arousal, and it causes hyperarousal and anxiety. Seratonin and GABA are believed to be decreased in panic disorder as well.
The neurotransmitter most strongly associated with panic disorder is:
ANSWER = 2. The night supervisor or the unit manager has the authority to require the charge nurse to submit to drug screening. In this case, the supervisor on duty should handle the situation. 1. The new graduate must work under this charge nurse; confronting the nurse would not resolve the issue because the nurse can choose to ignore the new graduate. Someone in authority over the charge nurse must address this situation with the nurse. 3. The new graduate is bound by the nursing practice acts to report potentially unsafe behavior regardless of the position the nurse holds. 4. The nurse educator would not be in a position of authority over the charge nurse. MAKING NURSING DECISIONS: When the nurse is deciding on a course of action involving other staff members, a rule of thumb is this: If the individual the nurse is concerned about is superior in job title to the nurse, then go through the chain of command to the next level of superior. If the individual is subordinate in job title to the nurse, then the nurse should confront the individual.
The new graduate working on a medical unit night shift is concerned that the charge nurse is drinking alcohol on duty. On more than one occasion, the new graduate has smelled alcohol when the charge nurse returns from a break. Which action should the new graduate nurse implement first? 1. Confront the charge nurse with the suspicions. 2. Talk with the night supervisor about the concerns. 3. Ignore the situation unless the nurse cannot do her job. 4. Ask to speak to the nurse educator about the problem.
Inhibit monoamine oxidase, an enzyme that Inactivates norepinephrine, serotonin, and dopamine
What is the action of MAOI medications?
2, 3, and 5. False imprisonment is an act with the intent to confine a person to a specific area. The nurse can be charged with false imprisonment if the nurse prohibits a client from leaving the hospital if the client has been admitted voluntarily and if no agency or legal policies exist for detaining the client. Assault and battery are related to the act of restraining the client in a situation that did not meet criteria for such an intervention. Libel and slander are not applicable here since the nurse did not write or verbally make untrue statement about the client. **Focus on the SUBJECT, legal ramifications of nursing actions r/t hospital admission. Noting the words ADMITTED VOLUNTARILY will assist you in selecting the options r/t inappropriately preventing the client from leaving the hospital; a right to which a voluntarily committed client is entitled. The remaining options do not relate to acts that prevent the client from leaving the hospital.
The nurse calls security and has physical restraints applied when a client who was admitted voluntarily becomes both physically and verbally abusive while demanding to be discharged from the hospital. Which represents the possible legal ramifications for the nurse associated with these interventions? Select all that apply. 1. Libel 2. Battery 3. Assault 4. Slander 5. False imprisonment
A. Clomipramine, a tricyclic antidepressant, as well as SSRIs such as fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and fluvoxamine (Luvox) have been approved for treatment of OCD. Clonidine and propranolol, are anthypertensives that have been used used successful to treat anxiety disorders. Clonazepam and other benzodiazepines are used to treat social anxiety disorder.
The nurse can anticipate a prescription for what medication for the client who was just diagnosed with obsessive compulsive disorder? A. Clomipramine B. Clonidine C. Clonazepam D. Propranolol
The client is exhibiting echopraxia.
The nurse finds that a client is imitating all the hand movements of a family member while communicating. Which does the nurse infer from this behavior?
Histamine blockade
The nurse finds that a client who is on antipsychotic medications is experiencing weight gain and sedation as side effects. What could be the reason for these side effects in this client?
ANSWER = 1. One of the many jobs of a manager is to see that performance evaluations are completed on the staff. 2. The manager should receive input from many sources to make decisions. Some decisions are made for the manager by administration based on costs or any number of other reasons. 3. The nurses retain responsibility for their own actions because they practice under the state's nursing practice act. The manager retains responsibility for the functioning of the unit. 4. The nurse manager attends many meetings pertaining to nursing but attends medical committee meetings only when a nursing issue is being discussed.
The nurse has accepted the position of clinical manager for a medical-surgical unit. Which role is an important aspect of this management position? 1. Evaluate the job performance of the staff. 2. Be the sole decision-maker for the unit. 3. Take responsibility for the staff nurse's actions. 4. Attend the medical staff meetings.
A, B, and D. • "Anxiety and worry causes me to have more voices." • "I can't drink even one or two beers." • "If I am having trouble sleeping or eating, I will call the mental health center." In schizophrenia, the client and the family need to be given teaching in order to manage the illness and to prevent a relapse. In the initial phase of the illness, teaching will need to be continued at the physician's office or the local mental health center. The client needs to understand that difficulty with eating or sleeping or increased anxiety can increase symptoms. Alcohol even in small amounts depresses the CNS and can interfere with pharmacological actions of medications. Reactions to the client's medications like tardive dyskinesia, dystonia, or the other extra-pyramidal side effects may take longer periods of time. The client needs to report any unusual symptoms.
The nurse has given a client with schizophrenia discharge instructions. Which statement by the client would indicate understanding of the teaching? Select all that apply. a) "If I am having trouble sleeping or eating, I will call the mental health center." b) "Anxiety and worry causes me to have more voices." c) "Possible bad effects from the pills only last a few days." d) "I can't drink even one or two beers." e) "I can skip a pill when I am feeling too tired from them."
Inappropriate affect
The nurse is conveying the news of a family member's death to a client with schizophrenia. The client is laughing after listening to the news. What does the nurse infer from the client's behavior?
Erickson's dev levels?
Trust v mistrust: B-18m Autonomy v shame/doubt: 2-3 Init v guilt: 3-5 Indus v inferiority: 6-11 Identity v confusion: 12-18 Intimacy v isolation: 19-40 Generative v stag: 40-65 Ego v despair: 65+
2 - The nurse should contact this client first because the client realizes the voices are telling him to hurt his mother. The nurse should inform this client to come to the clinic immediately, and he should be admitted to a psychiatric unit. 1. The client with a histrionic personality has excessive emotionality and seeks attention. Her saying "something important" must be understood within this context and would not warrant the psychiatric nurse's calling this client first 3. Because the wife called the clinic, the client is being watched and should be safe from killing himself. The nurse should call this client immediately but not before a client who made the phone call and who may be by himself and hearing voices. 4. The nurse should expect the client who is manic not to be sleeping; therefore, this is expected behavior. The nurse should call this client immediately but not before the client who is hearing voices telling him to hurt his mother.
The nurse in the outpatient psychiatric unit is returning phone calls. Which client should the psychiatric nurse call first? 1. The female client diagnosed with histrionic personality who needs to talk to the nurse about something very important. 2. The male client diagnosed with schizophrenia who is hearing voices telling him to hurt his mother. 3. The male client diagnosed with major depression whose wife called and said he was talking about killing himself. 4. The client diagnosed with bipolar disorder who is manic and has not slept for the last 2 days
A - Clients with fixed false beliefs truly believe the content of the delusion. Arguing or explaining will not help as in the other options. Initially the nurse needs to know the content and depth of the delusion while the client is being admitted. Then the nurse needs to focus on how the client feels about the delusion or distract the client from the delusion during the conversation.
The nurse is admitting a client to the psychiatric unit. Suddenly, the client states, "They're all plotting to destroy me. Isn't that true?" Which would be the most appropriate response? a) "Please explain that to me." b) "What reason would people have to want to destroy you?" c) "People here are trying to help you if you will let them." d) "That doesn't make any sense; nurses are helpers, not murderers."
A - The changes suggest that the adolescent's intracranial pressure is increasing. Explanation: Cushing's triad (apnea, bradycardia, and widening pulse pressure) is a hallmark of increasing intracranial pressure, which indicates that the teen's condition is deteriorating
The nurse is assessing an adolescent 1 hour after admission for a head injury. The nurse identifies that there have been changes since the baseline assessment, including apnea, bradycardia, and a widening pulse pressure. What is the primary reason for the nurse to notify the physician? a) The changes suggest that the adolescent's intracranial pressure is increasing. b) The adolescent may be developing a severe infection from the head injury. c) The physician should be notified of any changes in a client's condition. d) Too much pain medication can cause the changes observed by the nurse
ANSWER = B. A client with a dependent personality disorder does not like to be alone and attaches themselves to others emotionally as well as physically. This client can be in relationships in which they are the submissive party. A - The statement regarding not wanting to talk to anyone because the client feels stupid is an example of an avoidant personality disorder. C - When client states, "They all love me!" they are displaying a narcissistic personality disorder. D - A paranoid personality disorder is demonstrated by the comment regarding people staring and talking about them.
The nurse is assigned to care for a client admitted with depression as well as a dependent personality disorder. Which of the following statements by the client is indicative of this personality disorder? a) "I don't want to go in there. Don't want to talk to anyone because anything I say makes them think I'm stupid." b) "Please don't forget to wait for me to go to dinner. I don't want to go by myself." c) "It is hard for me to go and eat dinner when everyone wants to be with me. They all love me!" d) "When I walked out the door, there were all of these people that were staring at me and talking about me."
D - A hallucination is a false sensory perception. It involves all five senses and bodily sensations. Initially, the nurse needs to assess what kind of voices are being heard. That is, are they friendly, commanding, or controlling voices? Acknowledging that the client is experiencing the voices but telling the client that the nurse does not may assist the client to realize that the voices are not real. Then the nurse can focus on the client's feelings or redirect the client on reality by initiating a simple task with the client as coloring as well as other options. When the voices are less severe, then the nurse can do a more thorough assessment of the client's hallucinations and begin to assist the client in learning to deal with the voices.
The nurse is caring for a client on the psychiatric unit. The client states, "The voices are bothering me. They are yelling and telling me stuff. They are really bad." Which of the following responses by the nurse would be most appropriate? a) "Do you hear these voices very often?" b) "Do you have a plan for getting away from the voices?" c) "Try to ignore them and play cards with the others." d) "I do not hear any voices. What are you hearing?"
The client gains conscious control over the hallucinations.
The nurse is caring for a client with schizophrenia who reports auditory hallucinations. The nurse teaches the client to say "Leave me alone" whenever the voices are speaking. What is the specific outcome of this nursing intervention?
4 - Antipsychotic meds lower the seizure threshold, even if the client does not have a seizure disorder. Therefore, the nurse should discuss what to do if the client has a seizure.
The nurse is discussing the prescribed antipsychotic medication with a family member of a client diagnosed with schizophrenia. Which information should the nurse discuss with the family members? 1. explain the need for the family member to give the client the medication 2. encourage the family member to learn cardiopulmonary resuscitation (CPR) 3. discuss the need for the client to participate in a community support group 4. teach the family member what to do in case the client has a seizure
1, 2, 4, and 5. 1. Antipsychotic drugs produce varying degrees of muscarinic cholinergic blockade, including dry mouth, blurred vision, and photophobia. Chewing sugarless gum may help dry mouth. 2. Antipsychotic meds promote orthostatic hypotension by blocking alpha-adrenergic receptors on blood vessels. Therefore, the nurse should teach the client about orthostatic hypotension. 3. The sedative effects of the antipsychotic meds should have subsided by the time the client is discharged. Therefore, this is not an appropriate teaching for discharge. Sedation is common during the early days of treatment, but it subsides within a week or so. 4. Antipsychotics can cause sexual dysfunction in women and men, so this should be discussed by the nurse. 5. Flulike symptoms are a sign of agranulocytosis, which is a rare but serious reaction to antipsychotic meds. In agranulocytosis, the body loses its ability to fight infection.
The nurse is leading a medication group in a psychiatric unit. Which information should the nurse discuss with the clients concerning antipsychotic medications after discharge? Select all that apply. 1. chew sugarless gum to help dry mouth 2. teach the client about orthostatic hypotension 3. explain that medication may cause drowsiness 4. discuss that these medications may cause sexual dysfunction 5. instruct the client to call the HCP if flulike symptoms occur
A, D, and E • Reinforce that the client is not in any danger. • Use a calm voice and simple commands. • Acknowledge the presence of the hallucinations. Using a calm voice, the nurse should reassure that the client is safe. The nurse should not challenge the client; rather, he or she should acknowledge the hallucinatory experience. It is not appropriate to request that the client stop the behavior. Implementing restraints is not warranted at this time. Although the client is agitated, no evidence exists that the client is at risk for harming self or others.
The nurse is monitoring a client who appears to be hallucinating. The client displays paranoid speech content, seems agitated, and gestures at a figure on the television. Which of the following nursing interventions is appropriate? Select all that apply. a) Reinforce that the client is not in any danger. b) In a firm voice, instruct the client to stop the behavior. c) Immediately implement physical restraint procedures. d) Use a calm voice and simple commands. e) Acknowledge the presence of the hallucinations. f) Instruct other team members to ignore the client's behavior.
Sitting in the chair with legs crossed
The nurse is preparing the client with schizophrenia for an examination procedure to assess abnormal involuntary movements. Which action of the client needs correction during examination?
C - Controlling clients helps them feel more comfortable. The statement, "Controlling clients helps them feel more comfortable," does not reflect an understanding of the concept of balance in a therapeutic milieu. Balance is the careful negotiation of the conflict between dependency and independency in a therapeutic milieu. Clients are dependent when admitted to care but are allowed and encouraged to become independent as they are able to assume responsibility for self. Staff may find it easier to care for the client when they can control the client and may feel needed when the client is dependent on them. In a therapeutic milieu, staff do not solve the clients' problems for them. Rather, they work with the clients to gradually allow independent behaviors and decision making. Understanding clients' rights, legal issues, and ethical concerns is crucial for the skilled use of balance.
The nurse is teaching a group of unlicensed personnel new to psychiatry about balance in a therapeutic milieu. Which of the following statements by a member of the group indicates the need for further teaching? a) "Balance includes safe and effective treatment for all clients." b) "We need to think of patients' rights when working with clients." c) "Controlling clients helps them feel more comfortable." d) "We don't fix clients but help them solve their problems."
C - Obtain an order for the client to have a white blood cell count drawn. Explanation: The report of a sore throat may indicate an infection caused by agranulocytosis, a depletion in white blood cells. The way to determine this is by obtaining a white blood cell count. The other options do not get to the cause of the client's concern
The nurse is working in a community mental health clinic. A client who is diagnosed with schizophrenia is taking clozapine and reports of a sore throat. What is the most appropriate action for the nurse to take? a) Suggest that the client drink warm beverages and rest. b) Have the client decrease the daily amount of clozapine by half. c) Obtain an order for the client to have a white blood cell count drawn. d) Encourage the use of saline mouth rinses until the sore throat is gone.
C - The nurse-manager is accountable for what happens on the unit 24 hours per day, 7 days per week. If a serious problem occurs, the nurse-manager should be notified as soon as possible.
The nurse-manager of a 20-bed coronary care unit is off duty when a staff nurse makes a serious medication error. The client, who received an overdose of medication, nearly dies. Which statement accurately reflects the nurse-manager's accountability? a) The nursing supervisor decides to call the off-duty nurse-manager if time permits b) The nurse-manager should be informed when she returns to duty. c) The nursing supervisor will notify the nurse-manager at home. d) The nurse-manager is off duty; therefore, she need not be notified.
self-disclosure A - Ensuring relevance to, and quickly refocusing upon, the client's experience. Explanation: The nurse's self-disclosure should be brief and to the point so that the interaction can be refocused on the client's experience. Because the client is the focus of the nurse-client relationship, the discussion should not dwell on the nurse's own experience.
The nurse is working with a client with depression in a mental health clinic. During the interaction, the nurse uses the technique of self-disclosure. In order for this technique to be therapeutic, which of the following steps must be a priority for the nurse? a) Ensuring relevance to, and quickly refocusing upon, the client's experience b) Asking for the client's perception of what the nurse has revealed c) Allowing the client time to ask questions about the nurse's experience d) Discussing the nurse's experience in detail
Tuberoinfundibular pathway
The nurse observes that a client with a psychotic disorder has frequent hyperthermia and indigestion problems. Which pathway of the brain does the nurse expect to be affected in this client?
Phase II
The nurse observes that a client with osteoarthritis exploits other group members during group activities. On further interaction, the nurse learns that the client thinks that all the staff members are planning to harm him. Which phase of schizophrenia does this behavior of the client indicate?
c) Improve the use of restraint procedures. Reason: Although coordinating documentation, resolving negative feelings, and calming down are goals of debriefing after a restraint, the ultimate outcome is to improve restraint procedures.
The nursing staff has finished restraining a client. In addition to determining whether anyone was injured, the staff is mandated to evaluate the incident to obtain which of the following ultimate outcomes? a)Coordinate documentation of the incident. b)Resolve negative feelings and attitudes. c)Improve the use of restraint procedures. d)Calm down before returning to the other clients.
A - Constipation caused by medication is best managed by diet, fluids, and exercise. Benztropine can increase constipation. However, it may be prescribed for restlessness and stiffness. Restlessness and stiffness should be reported to the primary health care provider. Drowsiness and dizziness are adverse effects of ziprasidone. Clients should not drive if they are experiencing dizziness. Ziprasidone does help improve the negative symptoms of schizophrenia such as avolition.
The parent of a young adult client diagnosed with schizophrenia is asking questions about his son's antipsychotic medication, ziprasidone. Which of the following statements by the father reflects a need for further teaching? a) "I should give him benztropine to help prevent constipation from the ziprasidone." b) "If he experiences restlessness or muscle stiffness, he should tell the doctor." c) "If he becomes dizzy, I'll make sure he doesn't drive." d) "The ziprasidone should help him be more motivated and less withdrawn."
second-generation (atypical) antipsychotics because they result in a lower incidence of serious adverse effects
The preferred drugs for psychosis
positive symptoms
The presence of something that is not normally present
A - Treatment with risperidone typically begins with 1 milligram twice a day for an adult and 0.5 milligram twice a day for an elderly client. Recommended dosages range from 4 to 6 milligrams/day. This dosage is not too high for the client. This dosage is not too low for initial treatment. It is typical for initiation, but the dosage will be increased, not decreased, over 1 week.
The primary care provider prescribes risperidone 1 mg orally, two times a day for a client from a group home admitted to the hospital with severe anti-social behavior.The nurse determines that this dose is: a) Typical when initiating therapy. b) Too high for the client. c) Typical when initiating therapy but it should be tapered down in 1 week. d) Too low for the client.
A. The primary goal of milieu therapy is affect management in a group context.
The primary goal of milieu therapy for clients diagnosed with personality disorders is A. to manage the effect the behavior has on the entire group. B. to provide one-on-one therapy for each member of the milieu. C. to help the client remain uninvolved with other patients. D. to promote a laissez-faire attitude among the staff members.
C - Assess for suicidal and self-mutilating behaviors One of the primary nursing guidelines/interventions for clients with a personality disorder is to assess for suicidal and self-mutilating behaviors, especially during times of stress.
The priority nursing intervention for a client diagnosed with borderline personality disorder is to A. protect other clients from manipulation. B. respect the client's need for social isolation. C. assess for suicidal and self-mutilating behaviors. D. provide clear, consistent limits and boundaries.
3 - administer routine meds
The psychiatric charge nurse is making shift assignments for the admission unit. The staff includes one registered nurse (RN), two LPNs, four MHWs, and a unit secretary. Which assignment would be most appropriate to assign to the LPN? 1. Update the client's individualized care plans. 2. Stay in the lobby area and watch the clients. 3. Administer routine medications to the clients. 4. Transcribe the admission orders for a client.
2
The psychiatric nurse is working in an outpatient mental health clinic. Which client should the nurse intervene with first? 1. The client who had a baby 2 months ago and who is sitting alone and looks dejected. 2. The client whose wife just died and who wants to go to heaven to be with her. 3. The client whose mother brought her to the clinic because the mother thinks the client is anorexic. 4. The client who is rocking compulsively back and forth in a chair by the window
1. The client who is depressed would be expected to look dejected; therefore, the nurse would not need to assess this client first. 2.This client who says he wants to go to heaven to be with his wife may be suicidal and should be assessed first to see whether he has a plan. 3. This client needs to be assessed for anorexia but not before a client who may be suicidal. 4. The nurse should not interrupt a client who is acting compulsively. The nurse should wait until the client finishes the behavior before talking to the client.
The psychiatric nurse is working in an outpatient mental health clinic. Which client should the nurse intervene with first? 1. The client who had a baby 2 months ago and who is sitting alone and looks dejected. 2. The client whose wife just died and who wants to go to heaven to be with her. 3. The client whose mother brought her to the clinic because the mother thinks the client is anorexic. 4. The client who is rocking compulsively back and forth in a chair by the window.
1. This is not correct information; there fore; the nurse should not praise the MHW. 2. The psychiatric nurse should not correct the MHW in front of the client because it will compromise the MHW's authority with the client. 3. The nurse should explain to the MHW that the mental health client retains all of the civil rights afforded to all per-sons, except the right to leave the hospital in the case of involuntary commitments. The client may have phone calls restricted if that is included in the care plan—for example, if the client is calling and threatening the president. 4. This situation does not need to be dis-cussed at the weekly team meeting. The psychiatric nurse can discuss this on a one-to-one basis with the MHW.
The psychiatric nurse overhears an MHW telling a client diagnosed with schizophrenia, "You cannot use the phone while you are here on the unit." Which action should the psychiatric nurse take? 1. Praise the MHW for providing correct information to the client. 2. Tell the MHW this is not correct information in front of the client. 3. Explain to the MHW that the client does not lose any rights. 4. Discuss this situation at the weekly multidisciplinary team meeting.
Schizotypal personality disorder
The speech pattern associated with ________ disorder is often illogical, vague, digressive, or over elaborate.
1, 3, and 5. 1. The nurse should begin a systematic search of the unit after activating the bomb scare emergency plan, and if any suspicious objects are found the nurse should not touch and should notify the bomb squad. 2. The nurse should notify the house supervisor and administration because they are responsible for notifying the police department. 3. The nurse should stay calm and try to keep the caller on the telephone. The nurse should attempt to get as much information from the caller as possible. The nurse can jot a note to someone nearby to initiate the bomb scare procedure. 4. The red emergency levers in hospitals are to notify the fire departments of a fire, not a bomb scare. 5. The nurse should try to transcribe exactly what the caller says; this may help identify who is calling and where a bomb might be placed. MAKING NURSING DECISIONS: The nurse must be knowledgeable of hospital emergency preparedness. Students as well as new employees receive this information in hospital orientations and are responsible for implementing procedures correctly. The NCSBN NCLEX-RN blueprint includes questions on safe and effective care environment.
The staff nurse answers the telephone on a medical unit and the caller tells the nurse that he has planted a bomb in the facility. Which actions should the nurse implement? Select all that apply. 1. Do not touch any suspicious object. 2. Call 911, the emergency response system. 3. Try to get the caller to provide additional information. 4. Immediately pull the red emergency wall lever. 5. Write down exactly what the caller says.
diffuse
The term for a generalized brain injury
focal
The term for a localized brain injury
C - understand the nature of one's problem or situation. Explanation: Insight is the ability to understand a situation or problem and its effect on one's life. Judgment is the ability to make appropriate choices and behave in an appropriate manner. A client may be able to explain the psychiatric diagnosis but may lack the insight to understand the underlying problem and how it's affecting his life.
The terms "judgment" and "insight" are sometimes used incorrectly. Insight is the ability to: a) control inappropriate impulses. b) explain one's psychiatric diagnosis. c) understand the nature of one's problem or situation. d) make appropriate choices.
abuse
The wrong or improper use of action toward another individual that results in injury, damage, maltreatment, or corruption
the second-generation (atypical) antipsychotics
These antipsychotics result in a lower incidence of serious adverse effects
Extrapyramidal Symptoms (EPS) (more adverse reactions from antipsychotics/neuroleptics)
These types of symptoms appear to be dose related and are the most frightening to patient: 1. Dystonia: difficult or bad muscle tone in head & neck, swallowing problems, tongue sticks out 2.Akathisia- inability to sit down. restlessness. 3. Pseudo-Parkinsonism: side effects like tremors & "stiff face" that resemble Parkinson's disease. Occur a few weeks to a few months after therapy. May be controlled by anti-Parkinsonism med. 4.Tardive Dyskinesia: rhythimical, involuntary movements of tongue, face, mouth, jaw, trunk, extremities. No effective tratment. 5.NEUROLEPTIC MALIGNANT SYNDROME (NMS): uncommon reaction to neuroleptics, but could cause death. Muscle rigidity, hyperpyrexia (fever), fluctuations in BP, altered or loss of consciousness. NEEDS IMMEDIATE MEDICAL CARE!
Somatic Type of Delusion
They believe they have some type of general medical condition
Catatonic Disorder Associated with Another Medical Condition
This diagnosis is made when the catatonic symptoms are directly attributable to the physiological consequences of a general medical condition
Antisocial Personality disorder
This disorder is a pattern of socially irresponsible behavior reflecting a general disregard for the rights of others.
Histrionic personality disorder
This disorder is characterized by colorful, dramatic, and extroverted behavior in emotional people.
magical thinking, a positive symptom of schizophrenia
This disorder of thinking that can occur in people with schizophrenia is common in children
Dependent personality disorder
This disorder shows a pervasive and excessive need to be taken care of, and these clients have difficulty making everyday decisions without excessive advice from others.
zolpidem (Ambien) interactions:
This drug will increase the action of both alcohol and CNS depressants.
haloperidol (Haldol) action:
This drug works to decrease abnormal excitement in the brain.
phase 3 of the maudley approach
This phase focuses on assisting the adolescent to develop a healthy self-identity
phase 2 of the maudley approach
This phase is focused on giving the adolescent back his/her control over maintaining the body weight
phase 1 of the maudley approach
This phase is focused on weight restoration and in this phase the parents are actively engaged in establishing the rules and guidelines around eating
disulfiram (Antabuse) action:
This product causes unpleasant effects when alcohol is consumed. It discourages drinking alcohol.
Typical Psych Meds
Thorazine, Haldol & Prolixin
Positive symptoms of Schizophrenia
Those associated w/ normal brain structures on a CT and relatively good responses to treatment.
perpetrator
Those who initiate violence
The primary goals of Program of Assertive Community Treatment (PACT) are
To meet basic needs and enhance quality of life To improve role functioning To enhance independent living To lessen family burden of providing care To decrease debilitating symptoms of mental illness To minimize recurrent acute episodes of the illness
Priapism
Trazadone is associated with which side effect?
benztropine (Cogentin) use:
Treats Parkinson's symptoms, EPS associated with neuroleptic products, acute dystonic reactions.
False. This disorder is more common among the first-degree relatives of people with schizophrenia.
True or false. Evidence suggests that schizotypal personality disorder is not affected by having a first-degree relative with schizophrenia.
False. Schizoid personality disorder predisposes the person to have little need or desire for emotional ties, preferring to work in isolation.
True or false. People with schizoid personality disorder have a strong desire for emotional ties, even though they appear shy or anxious.
False. Narcissistic individuals have fragile self-esteem and changeable moods.
True or false. Persons with narcissistic personality disorder display optimistic and relaxed mood because they have a healthy self-esteem.
False, there is an inverse relationship between social class and report of depressive symptoms.
True or false? Social class has no affect on the report of depressive symptoms.
A feeling of confidence in another person's presence, reliability, veracity, and desire to provide assistance.
Trust
phenobarbital (Luminal) use:
Used for all forms of epilepsy, status epilepticus, febrile seizures
Antipsychotics
Used to decrease agitation and psychotic symptoms of schizophrenia and other psychotic disorders
disulfiram (Antabuse) use:
Used to treat chronic alcoholism.
Hypertensive crisis
What adverse side effect can occur with the use of clonidine?
Dry mouth, sedation, nausea
What anticholinergic side effects are common to antidepressant medications?
Mortality, permanent memory loss, and brain damage.
What are adverse risks associated with electroconvulsive therapy?
Blurred vision, constipation, urinary retention, hypotension, weight gain, photosensitivity, arrhythmia
What are common side effects of tricyclics and heterocyclics?
A closed head injury
What are contusions usually associated with?
Temporary memory loss and confusion
What are side effects of electroconvulsive therapy?
PTSD s/s = Recurrent nightmares/ amnesia to aspects of the event, survivors guilt, high level of anxiety or arousal. s/s appear 3 months of the trauma, or a delay of months or years
What are some characteristic symptoms of PTSD?
Providing a blanket or food, keeping promises, being honest, ensuring confidentiality.
What are some examples of trust-building interventions which a nurse can perform?
Anger, aggressiveness, delinquency, social withdrawal, substance abuse
What are some symptoms of adolescence depression?
Feeding problems, tantrums, phobias, aggressive or clinging behavior, excessive worrying
What are some symptoms of childhood depression?
Negative expectations of the environment, self, and the future.
What are three cognitive distortions that serve as the basis for depression?
Antidepressant medication, electro convulsive therapy, and psychosocial therapies
What are three treatments of depression in the elderly patient?
Experiences of a loss of "significant other" during the first 6 months of life can predispose the person to lifelong periods of depression.
What can be the outcome after an early object loss?
An alteration in mood (affect) that is expressed by feelings of sadness, despair, and pessimism.
What is depression?
Gunshot wounds, not drug overdose.
What is the most common cause of death among suicide victims?
BED
What is the most common eating disorder?
Perception of abandonment by parents or close friends.
What is the most common precipitant to adolescent suicide?
becomes a part of the persons life situation and therapist gives guidance and support to help mobilize the resources.
What is the role of the intervener during crisis intervention?
This occurs when the client unconsciously displaces to the nurse feelings formed toward a person from his or her past.
What is transference?
PTSD Development= More than half of all individuals will experience trauma, but less than 10% will develop PTSD
What percentage of individuals are likely to develop PTSD?
B. Smile and call the client by name. Getting the client's attention by calling his or her name is necessary. Smiling is necessary to convey the lack of a threat.
When a client diagnosed with a cognitive deficit experiences a catastrophic reaction, the priority intervention is to A. decrease sensory stimuli. B. smile and call the client by name. C. take the client to the bathroom. D. calmly ask the client what's wrong.
schizophrenia, paranoid schiz ANSWER = D This response focuses on the client's feelings and neither directly supports the delusion nor denies the client's experience. Option A gives global reassurance. Option B encourages elaboration about the delusion. Option C asks for information that the client will likely be unable to answer.
When a client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me," an appropriate response for the nurse would be A. "You are safe here. This is a locked unit, and no one can get in." B. "I do not believe I understand the word volmers. Tell me more about them." C. "Why do you think someone or something is going to harm you?" D. "It must be frightening to think something is going to harm you."
A - The nurse should first determine if the client is suicidal. If the client is suicidal, it is crucial to know what the client plans to do. The seriousness of intent to die would determine the level of suicidal precautions required to maintain safety. Understanding about access to means for suicide is more important as the client is preparing for discharge.
When assessing a hospitalized client diagnosed with Major Depression and Borderline Personality Disorder, the nurse should ask the client about which of the following first? a) Suicidal thoughts. b) Access to pills and weapons. c) Suicidal plans. d) Seriousness of the client's intent to die.
Mixed type delusion
When delusions are prominent, but no single theme is predominant
abuse
When directed towards another, includes acts of misuse, deceit, or exploitation
B - Client must take benztropine as ordered to prevent sx from returning. An oral anticholinergic agent such as benztropine is commonly ordered to control and prevent the return of symptoms. Dystonic reactions are typically acute and reversible. Dystonic reactions can be life-threatening when airway patency is compromised. Lecturing the client about buying drugs on the street isn't appropriate.
When discharging a client after treatment for a dystonic reaction, an emergency department nurse must ensure that the client understands: a) although uncomfortable, this reaction isn't serious. b) the client must take benztropine as ordered to prevent a return of symptoms. c) results of treatment are rapid and dramatic but may not last. d) the client shouldn't buy drugs on the street.
D - When the child's injuries are inconsistent with the history given or if the injuries couldn't have occurred naturally or accidentally because of the child's age and developmental stage, the emergency department nurse should suspect child abuse. Consistent explanations for the injury typically don't indicate child abuse. Child abuse occurs in all socioeconomic groups. Parents may argue and be demanding because of the stress of their child's injury.
When interviewing the parents of an injured child, which sign is the strongest indicator that child abuse may be a problem? a) The family is poor and the mother and father aren't married. b) The parents offer consistent explanations for the injury. c) The parents are argumentative and demanding with personnel. d) The injury isn't consistent with the child's history or age.
Orientation phase
When is trust established, and nurse/client formulate a contract for intervention?
B - difficulty controlling aggression Parents of an abused child have difficulty controlling their aggressive behaviors. They may blame the child or others for the injury, may not ask questions about treatment, and may not know developmental information.
When obtaining a nursing history from parents who are suspected of abusing their child, which of the following characteristics about the parents should the nurse particularly assess? a) Ability to relate the child's developmental achievements. b) Difficulty with controlling aggression. c) Attentiveness to the child's needs. d) Self-blame for the injury to the child.
Client safety
When planning nursing interventions, what aspect should be a priority?
C: The milieu should provide an atmosphere that fosters growth, change, and self-responsibility. Therefore, the nurse needs to accept behavior as meaningful and motivated. Staff interventions should also be flexible, open, and encourage clients to achieve their own potential. Using psychotropic drugs is only one component of therapeutic milieu. Other components include nurse-client interaction, therapeutic groups, recreation, and client-staff treatment meetings. Independent, not dependent, behavior is fostered and supported to promote the client to assume responsibility for self. Meeting one's own needs while helping clients meet their needs is inappropriate for the nurse or the staff in a therapeutic milieu. The nurse focuses on the client's needs without expecting personal needs to be met.
When providing a therapeutic milieu for clients, which of the following would be most appropriate? A. Using psychotropic drugs primarily. B. Fostering dependent client behavior. C. Accepting behavior as meaningful and motivated. D. Meeting one's own needs while helping clients meet their needs
A - Mood shifts, impulsivity, & splitting Borderline personality disorder has the central characteristic of instability in affect, identity, and relationships. Borderline individuals desperately seek relationships to avoid feeling abandoned, but they often drive others away with excessive demands, impulsive behavior, or uncontrolled anger. Their frequent use of the defense of splitting strains personal relationships and creates turmoil in health care settings.
When providing care for a client diagnosed with borderline personality disorder, the nurse will need to consider strategies for dealing with the client's A. mood shifts, impulsivity, and splitting. B. grief, anger, and social isolation. C. altered sensory perceptions and suspicion. D. perfectionism and preoccupation with detail.
Article by Koenigsberg
When shown unpleasant images. - Low/no activity in anterior cingulate cortex (which regulates emotion) - Underactive intraparietal sulcus (which directs visual attention) Weaker neurological "brakes" on emotional reactions - inability to distract themselves!
A. Personality disorders are deeply ingrained and pervasive. Clients with personality disorders find it very difficult, if not nearly impossible, to change. Change proceeds very slowly.
Which statement is descriptive of clients with a personality disorder? A. They are resistant to behavioral change. B. They have an ability to tolerate frustration and pain. C. They usually seek help to change maladaptive behaviors. D. They have little difficulty forming satisfying and intimate relationships.
C - help the client reframe the anger-producing situation De-escalation occurs more quickly with this strategy than when other approaches are used.
When working with an angry client, it is best to A. encourage the client to fully explore and express his or her anger. B. help the client deny and repress the feelings of anger. C. help the client reframe the anger-producing situation. D. ignore the client's anger and change the subject.
Dry mouth
Which anticholinergic effects may occur in a client who is on risperidone therapy? Select all that apply.
Tremors
Which are the anticholinergic side effects associated with novel antipsychotic medications?
Echolalia Associative looseness
Which are the positive symptoms of schizophrenia? Select all that apply.
4 - the client denies having auditory hallucinations
Which assessment data indicates the atypical antipsychotic quetiapine (Seroquel) is effective for the client diagnosed with paranoid schizophrenia? 1. the client does not exhibit any tremors or rigidity 2. the client reports a "2" on an anxiety scale of 1-10 3. the family reports the client is sleeping all night 4. the client denies having auditory hallucinations
D - Interdependence The characteristics for the diagnosis of ineffective coping include crisis, high levels of anxiety, anger, and aggression; child, elder, or spouse abuse; and difficulty in relationships and manipulation. Interdependence would not be considered a symptom for ineffective coping.
Which behavior would be inconsistent with defining characteristics for the nursing diagnosis of ineffective coping? A. Difficulty in relationships B. High levels of anxiety C. Manipulation D. Interdependence
MAOI
Which class of drugs can produce hypertensive crisis as a side effect?
A client who is on clozapine therapy A client who is on olanzapine therapy
Which client has a high risk of weight gain and a low risk of extrapyramidal effects? Select all that apply.
A 68-year-old client with neurocognitive disorder (NCD)
Which client is at a high risk for death due to antipsychotic therapy?
A client with delusions
Which client would respond with greater efficacy to antipsychotic drugs?
B - Flat affect (the lack of facial or behavioral manifestations of emotion) is related to disorganized schizophrenia. Other characteristics of disorganized schizophrenia include incoherence, loose associations, and disorganized behavior. Paranoid residual type schizophrenia is characterized by odd beliefs, unusual perceptions, and systematized delusions. Waxy flexibility, or maintaining the position the client is placed in, is seen in catatonic schizophrenia.
Which condition or characteristic is related to the cluster of symptoms associated with disorganized schizophrenia? a)Odd beliefs b)Flat affect c)Waxy flexibility d)Systematized delusions
1. 1-100 mg
Which daily dose range of haloperidol would a primary health-care provider prescribe to a client with schizophrenia?
To improve reality testing and sense of cohesiveness
Which describes the purpose of group therapy?
Avoidant personality disorder
Which disorder is characterized by being extremely sensitive to rejection, leading a socially withdrawn life, and extremely shy?
schizotypal personality disorder
Which disorder is characterized by having an inner world that is more rewarding that the real world?
Histrionic Personality disorder
Which disorder may be related to the theory of heightened noradrenergic activity and decreased serotonergic activity?
Absence of psychomotor activity
Which does the catatonia specifier stupor indicate?
A - The exact mechanism of antipsychotic medication action is unknown, but these drugs appear to depress the CNS by blocking the transmission of three neurotransmitters: dopamine, serotonin, and norepinephrine. Antipsychotics don't sedate the CNS by stimulating serotonin, and they don't stimulate neurotransmitter action or acetylcholine release.
Which effects do most antipsychotic medications exert on the central nervous system (CNS)? a) They depress the CNS by blocking the postsynaptic transmission of dopamine, serotonin, and norepinephrine. b) They stimulate the CNS by blocking postsynaptic dopamine, norepinephrine, and serotonin receptors. c) They sedate the CNS by stimulating serotonin at the synaptic cleft. d) They depress the CNS by stimulating the release of acetylcholine.
A - They depress the CNS by blocking the postsynaptic transmission of dopamine, serotonin, and norepinephrine. Explanation: The exact mechanism of antipsychotic medication action is unknown, but these drugs appear to depress the CNS by blocking the transmission of three neurotransmitters: dopamine, serotonin, and norepinephrine. Antipsychotics don't sedate the CNS by stimulating serotonin, and they don't stimulate neurotransmitter action or acetylcholine release.
Which effects do most antipsychotic medications exert on the central nervous system (CNS)? B a) They depress the CNS by blocking the postsynaptic transmission of dopamine, serotonin, and norepinephrine. b) They stimulate the CNS by blocking postsynaptic dopamine, norepinephrine, and serotonin receptors. c) They sedate the CNS by stimulating serotonin at the synaptic cleft. d) They depress the CNS by stimulating the release of acetylcholine.
Continuous signs of disturbance for 7 months
Which finding in a client acts as a diagnostic criterion for schizophrenia?
The client is very shy and withdrawn.
Which finding in the client in the psychiatric ward enables the nurse to reach the conclusion that the client is in the premorbid phase of schizophrenia?
Gatekeeper (maintenance role)
Which group member encourages acceptance of and participation by all members of the group?
Initiator (task role)
Which group member outlines the task at hand?
Blocker (personal role)
Which group member resists group efforts, and demonstrates rigid behaviors that impede group progress?
Harmonizer (maintenance role)
Which group member tries to minimize tension within the group by intervening in conflict?
1. Caffeine-containing substances will negate the effects of antipsychotic medication; therefore, the client should drink caffeine-free beverages such as decaffeinated coffee and tea and caffeine-free colas.
Which information should the nurse discuss with the client diagnosed with schizophrenia who is prescribed an antipsychotic medication? 1. drink decaffeinated coffee and tea 2. decrease the dietary intake of salt 3. eat six small, high-protein meals a day 4. limit alcohol intake to one glass of wine a day
B, C, and D • Contact the prescriber before taking over-the-counter preparations. • Change positions slowly to prevent orthostatic hypotension. • Avoid becoming overheated or dehydrated during therapy. The nurse should instruct the client to avoid becoming overheated or dehydrated during therapy to prevent neuroleptic malignant syndrome. He or she also should tell the client to contact the prescriber before taking over-the-counter preparations and to change positions slowly to prevent orthostatic hypotension. The client should have an eye examination every 6 months to check for cataract formation. Dry mouth is a common adverse effect of therapy that can be alleviated with ice chips, drinks, or sugarless hard candy; this effect does not need to be reported immediately.
Which instructions should the nurse include when teaching a client about quetiapine therapy? Select all that apply. a) Report dry mouth immediately. b) Avoid becoming overheated or dehydrated during therapy. c) Change positions slowly to prevent orthostatic hypotension. d) Contact the prescriber before taking over-the-counter preparations. e) Have an annual eye examination to check for cataract formation.
Have sugarless candies and frequent sips of water Do not drive a vehicle
Which instructions would the nurse provide to a client who is undergoing antipsychotic therapy to overcome anticholinergic effects? Select all that apply.
A - Defusing the situation by laughing or making a joke of the challenge. Ridiculing a client should always be avoided. The other options are constructive approaches to deescalation.
Which intervention strategy should be avoided by staff working with a client who is shouting and flailing his arms? A. Defusing the situation by laughing or making a joke of the challenge B. Saying "Let's go to your room to talk about this" C. Moving a few staff close together as a group to provide a show of force Incorrect D. Allowing one staff person to speak to the client while others provide support
Use the same staff as much as possible
Which intervention would the nurse perform while caring for a client with schizophrenia who has an altered thought process and extreme suspiciousness?
Serving family-style servings of food to the client Performing mouth checks on the client when necessary
Which interventions would the nurse implement while caring for a client with altered thought process? Select all that apply.
A - At this time in the United States, there are no specifically FDA-approved medications for treating personality disorders. Prescribers are using the medications "off- label" until evidence-based pharmacotherapies are proven to be safe and effective. There is evidence that mood stabilizers, antidepressants, and atypical antipsychotics are helpful in specific personality disorders. Pharmacologic evidence is lacking for the treatment of persons with narcissistic and obsessive-compulsive personality disorders. Although patients with personality disorders usually do not like taking medicine unless it calms them down and are fearful about taking something over which they have no control, providers do attempt to mediate symptoms with psychotropic agents for improved quality of life.
Which is true of pharmacological therapies for treatment of personality disorders? A. Although there are no FDA-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident. B. Research has shown that currently available psychotropic drugs have not been shown to be effective in treating personality disorders. C. Patients with narcissistic personality disorder and obsessive-compulsive personality disorder have shown the most benefit from the use of antianxiety medications along with use of selective serotonin reuptake inhibitors. D. Patients with personality disorders have been shown to be resistant to accepting medication, and as a result most providers do not prescribe psychotropic drugs to these patients.
Amantadine
Which medication would the nurse prepare to administer to reverse extrapyramidal effects associated with antipsychotic therapy?
Ziprasidone Risperidone Aripiprazole
Which medications are the most potent antagonists of the serotonin-type 2A receptors? Select all that apply.
Psychiatrist
Which member of the IDT serves as the leader of the team and is responsible for diagnosis and treatment of mental disorders?
Occupational therapist
Which member of the IDT works with clients to develop independence with ADLs?
Psychiatric registered nurse
Which member of the psychiatric treatment team provides ongoing assessment and focuses on one-to-one relationship development?
B - Low serotonin levels have been implicated in several research studies as being a factor in impulsive aggression.
Which neurotransmitter imbalance has been shown to be related to impulsive aggression? A. Low levels of ã-aminobutyric acid B. Low levels of serotonin C. High levels of dopamine D. High levels of acetylcholine
C - The nurse would specifically use supportive confrontation with the client to point out discrepancies between what the client states and what actually exists to increase responsibility for self. Limit setting and consistency also may be used. However, limit setting helps the client control unacceptable behavior and consistency helps reduce the frequency of negative behaviors; they do not point out discrepancies. Rationalization is typically used by the client, not the nurse, to blame others, make excuses, and provide alibis for self-centered behaviors.
Which of the following approaches is most appropriate to use with a client diagnosed with a narcissistic personality disorder when discrepancies exist between what the client states and what actually exists? a) Limit setting. b) Consistency. c) Supportive confrontation. d) Rationalization.
D, E, and G. APD is the most studied and researched personality disorder. Rigidity and inflexible standards describe obsessive-compulsive personality disorder. Magical thinking describes schizotypal personality disorder. People with APD usually present with depression or because of the consequences of their behaviors, not because they care about the effects of their actions on others.
Which of the following are true of antisocial personality disorder (APD)? (select all that apply): A. It is the least studied of the personality disorders. B. It is characterized by rigidity and inflexible standards of self and others. C. Persons with APD display magical thinking. D. Persons with APD are concerned with personal pleasure and power. E. It is characterized by deceitfulness, disregard for others, and manipulation. F. Persons with APD usually present for treatment because of awareness of how their behavior is affecting others. G. Frontal lobe dysfunction is a brain change identified in APD.
Democratic leadership style
Which style of group leadership fosters group problem solving and unlimited member participation?
Autocratic leadership style
Which style of group leadership fosters low individual motivation, creativity, and commitment?
The feeling of being spied on The feeling of being poisoned The feeling of being plotted against
Which symptoms in a client indicate the persecutory type of delusional disorder? Select all that apply.
negative symptoms tend to be more persistent and crippling because they reduce motivation and limit social and vocational success. They often prevent a patient with schizophrenia from living independently, holding down a job, & enjoying life.
Which symptoms of schizophrenia tend to be more crippling, the positive or negative symptoms?
Orienter
Which task group member maintains direction within the group?
C: The client needs to ventilate and discuss feelings of anger and sadness with the nurse to decrease behaviors of self-harm. Other alternatives such as punching the pillow may be helpful to the client in expressing anger and rage. Staying in her room when feeling overwhelmed is inappropriate because it will not help the client understand herself or her feelings. Additionally, doing so will not foster growth in autonomy and responsibility for self. Leaving the group to pace when anxious and angry is inappropriate because it will not help the client understand herself or her feelings. Additionally, doing so will not foster growth in autonomy and responsibility for self. Asking for prescribed medications when feeling out of control will not help the client to understand herself or her feelings and will not foster growth in autonomy and responsibility for self.
Which of the following expected outcomes would the nurse judge as therapeutic and realistic for a female client with major depression and borderline personality disorder who is hospitalized for self-mutilation and threats of suicide? A. The client will stay in her room when overwhelmed by feelings. B. The client will leave the group to pace when feeling anxious and angry. C. The client will appropriately verbalize anger and sad feelings to the nurse. D. The client asks the nurse for a prescribed medication when feeling out of control
D. Narcissistic personality disorder is associated body dysmorphic disorder. Associated symptoms of hoarding disorder include: perfectionism, indecisiveness, anxiety, depression, distractibility, and difficulty planning and organizing.
Which of the following is not a common traits/symptom of hoarding disorder? A. Perfectionism B. Indecisiveness C. Distractibility D. narcissistic personality disorder
C. Facing her fear in gradual step progression
Which of the following is the most appropriate therapy for a client with agoraphobia? A. 10 mg Valium qid B. Group therapy with other agoraphobics C. Facing her fear in gradual step progression D. Hypnosis
Schizoid personality disorder leads people to assume that relationships are not valuable or worth pursuing.
Which personality disorder may be linked to a childhood that is bleak, cold, and lacking empathy or nurturing?
Termination phase
Which phase focuses on evaluation of goal attainment?
Religiosity
Which positive symptoms of schizophrenia affect the content of thoughts in a client? Select all that apply.
N-methyl-D-aspartate(NMDA)
Which receptor is activated by the neurotransmitter glycine?
Orthostatic hypotension
Which side effect associated with antipsychotics occurs due to the blockade of alpha1-adrenergic receptors?
ANSWER = 1. This situation should be addressed first because the charge nurse is responsible for family/client complaints. If the family contacts the administration, the charge nurse must be aware of the situation. 2. The evaluation needs to be completed, but it does not take priority over handling an irate family member. 3. The charge nurse could assign this task to another nurse or ward clerk. Dealing appropriately with an irate family member takes priority over calling the laboratory. 4. The charge nurse could assign this task to another nurse or ward clerk. Dealing appropriately with an irate family member takes priority over transferring a client.
Which situation should the charge nurse in the critical care unit address first after receiving the shift report? 1. Talk to the family member who is irate over their loved one's nursing care. 2. Complete the 90-day probationary evaluation for a new ICU graduate intern. 3. Call the laboratory concerning the type and cross match for a client who needs blood. 4. Arrange for a client to be transferred to the telemetry step-down unit
ANSWER = 1. This nurse should be sent to the medical unit because, with 18 months' experience, the nurse is familiar with the hospital routine and would be helpful to the medical unit but is not the most experienced ICU nurse on duty. 2. The nurse who is still orienting to the unit should not be sent to the medical unit. The nurse in orientation should be kept with the nurse preceptor. 3. The nurse who is new to the hospital should not be sent to a new unit with which he or she is unfamiliar. 4. The nurse with 12 years' experience should be kept on in the ICU because his or her expertise would be more helpful for client care than a nurse with 18 months' experience.
Which staff nurse should the charge nurse in the critical care unit send to the medical unit? 1. The nurse who has worked in the unit for 18 months. 2. The nurse who is orienting to the critical care unit. 3. The nurse who has been working at the hospital for 2 months. 4. The nurse who has 12 years' experience in this ICU unit.
D - HTN, diminished activity levels, and head injury increase the risk of dementia.
Which statement about dementia is accurate? a. The majority of people over age 85 are affected by dementia. b. Disorientation is the dominant and most disruptive symptom of dementia. c. People with early dementia do not tend to be distressed by symptoms. d. Hypertension, diminished activity levels, and head injury increase the risk of dementia.
"I see aliens every morning."
Which statement indicates that a client hallucinates?
3 or 4?
Which task would be inappropriate for the psychiatric charge nurse to delegate to the MHW? 1. Instruct the MHW to escort the client to the multidisciplinary team meeting. 2. Ask the MHW to stay in the day room and watch the clients. 3. Tell the MHW to take care of the client on a 1-to-1 suicide watch. 4. Request the MHW to draw blood for a serum carbamazepine (Tegretol) level.
4
Which task would be most appropriate for the psychiatric nurse to delegate to the MHW? 1. Request the MHW to take the client with lithium toxicity to the emergency room. 2. Have the MHW sit with a client diagnosed with bulimia for 1 hour after the meal. 3. Encourage the MHW to teach the client how to express his or her anger in a positive way. 4. Ask the MHW to sit with the client while the client talks to his mother on the telephone.
Reality therapy
Which therapy does not dwell on past failures, but helps the client look forward to a change in behavior?
Behavior therapy
Which therapy helps manage the suspicious nature of a client with schizophrenia?
Reality therapy
Which therapy model equates accepting responsibility for one's behavior with mental health?
Cognitive therapy
Which therapy model focuses on changing automatic thoughts that contribute to the distorted affect?
Assertiveness training
Which therapy model helps individuals feel better about themselves by encouraging them to stand up for their own basic human rights?
Community support programs
Which treatment strategy emphasizes vocational expectations and sheltered workshops that provide rehabilitation to a client with schizophrenia?
Hypothalamic-pituitary-adrenocortical axis & TSH (thyroid gland)
Which two endocrine pathways can affect a person's depressed mood?
Severe depression, as evidenced by a general slowing down of the entire body and absence of communication.
Which type of depression included symptoms of major depressive disorder and bipolar depression?
Dysthymic disorder
Which type of depressive disorder has no evidence of psychotic symptoms, has a depressed mood for most of the day, more days than not, and at least 2 years?
Major depressive disorder
Which type of depressive disorder has no history of manic behavior and symptoms have been present for at least 2 weeks?
Be honest Keep all promises Use the same staff as much as possible
Which would the nurse do to promote the development of trust in a highly suspicious client? Select all that apply.
Instruct the client to chew sugar-free gum Administer clonidine, as prescribed
While assessing a client with a psychiatric disorder, the nurse finds that the client is salivating excessively. The nurse finds clozapine in the client's prescriptions. Which nursing interventions would be beneficial to the client in this situation? Select all that apply.
Phase IV
While assessing a client with psychiatric illness, the nurse finds that the client is unable to work and build relationships with friends. The nurse also finds that the client has a very weak emotional tone and is expressionless. Which phase of schizophrenia is the client experiencing?
Why will many clinicians not treat people with BPD?
While bright and charming, they are so difficult to treat and irritating! - Abruptly stop therapy - Explode in anger at clinicians - Sue clinicians for betrayal and abandonment
pt. is in active psychotic phase.
While caring for a client with a psychotic disorder, the client has severe delusions, hallucinations, and frequent derailment. What does the nurse infer from these findings?
The client will have decreased suspiciousness.
While caring for a client with paranoia, the nurse implements the family-style serving of food to the client. What does the nurse expect out of this intervention?
Regression
While caring for a client with schizophrenia, the client says to the nurse, "Will you come every day to feed me because I don't know how to eat?" What does this behavior indicate?
Use a calm attitude with the client Engage the client in activities like punching a bag Maintain a low level of lighting and simple decor in the client's room
While caring for a client with schizophrenia, the nurse finds that the client has aggressive body language, catatonic excitement, and command hallucinations. Which interventions would the nurse implement to ensure the safety of this client? Select all that apply.
Circumstantiality
While communicating with a client who has schizophrenia, the nurse is making numerous interruptions to keep the client involved in the conversation. Which symptom of the client is the basis for the nurse's intervention?
"I am Superman."
While communicating with a client, the nurse finds that the client is having a delusion of grandeur. Which statement of the client supports the nurse's conclusion?
amenorrhea is associated with what eating disorder
anorexia
binge eat/purging type is a subtype for what? (self induced vomitting, misuse of laxatives, diuretics, enemas)
anorexia
D - Caregiver role strain The nurse recognizes the mother's feelings of being overwhelmed with the issues concerning the management of her daughter at home as caregiver role strain. Anxiety, fear, and sleep disturbances all contribute to caregiver role strain. The nurse should help the mother elicit the support of other family members or friends, continue with psychoeducation, and help the family connect with the Alliance for the Mentally Ill for support, reassurance, and education.
While conducting a home visit for a client diagnosed with schizophrenia discharged 1 week ago, the client's mother tearfully states, "I can hardly sleep because I'm so worried about my daughter. I'm afraid to leave her alone in the house. What if something should happen while I'm gone?" Which of the following problems related to the caregiver would be the most inclusive one for the nurse to incorporate into the client's plan of care? a) Disturbed sleep pattern. b) Fear. c) Anxiety. d) Caregiver role strain.
B: Battered women commonly deny being abused because they are afraid that they are somehow to blame or deserving of their situation. It is a myth that battered women are masochistic and gain pleasure from abuse. Most battered women want to believe that the abuse will stop, especially during the honeymoon phase when the abuser is apologetic. Handling the problem when she is feeling better is an oversimplification of the dynamics of partner abuse and is not what the victim is concerned with or expressing in her statement. The statement in the scenario reflects denial of the abuse.
While examining a female client who comes to the emergency department complaining of a fever and a sore throat, the nurse assesses many bruises in various stages of healing. The client states, "This fever made me so confused and clumsy, I fell several times." Suspecting abuse, the nurse interprets this statement as indicating behavior most probably due to which of the following? A. Gaining pleasure from being abused. B. Fearing she is to blame for her plight. C. Believing her illness will end the abuse. D. Thinking she can handle the problem when feeling better
Delusion Explanation: A delusion is a false belief that has no basis in reality. Although anxiety can increase delusional responses, it isn't considered the primary symptom. Projection is falsely attributing one's unacceptable feelings to another person. Hallucinations, which characterize most psychoses, are perceptual disorders of the five senses; the client may see, taste, feel, smell, or hear something in the absence of external stimulation
While looking out the window at trees, a client with schizophrenia remarks, "That school across the street has creatures in it that are waiting for me." Which term best describes what the creatures represent? a) Delusion b) Anxiety attack c) Hallucination d) Projection
Instruct the client to rise slowly when going from sitting to standing.
While monitoring the bp of a client who is on antipsychotic therapy, the nurse finds that the client has orthostatic hypotension. Which nursing intervention is beneficial for the client in this situation?
Haloperidol
While reviewing the laboratory reports of a client with a psychotic disorder, the nurse finds abnormally high levels of prolactin in the blood. Which medication in the client's prescription might be the cause of this finding?
Waxy flexibility
While taking the blood pressure of a client with schizophrenia, the nurse positions the client's arm outward. After 2 hours, the nurse finds that the client is still sitting in the same position with the arm extended. What does this behavior indicate?
Due to the high risks of adverse, potentially fatal, drug-drug and drug-food interactions.
Why are MAOIs usually not the first choice medication for treatment of depression?
diffuse axonal injury (DAI)
Widespread axonal damage occurring after a mild, moderate, or severe TBI
D. Presented with massive exposure to a variety of stimuli associated with the phobic object/situation.
With implosion therapy, a client with phobic anxiety would be: A. Taught relaxation exercises. B. Subjected to graded intensities of the fear C. Instructed to stop the therapeutic session as soon as anxiety is experienced. D. Presented with massive exposure to a variety of stimuli associated with the phobic object/situation.
ideas of reference
With this type of delusion, a person perceives events as relating to them when they are not
Autism
Withdrawal inward into one's own fantasy world.
bulimia or anorexia?! periods stop, problems growing, trouble getting prego; if prego higher risk of c-section, baby with LBW, post postpartum depression
anorexia
cognitive behavior therapy (CBT), dialectical behavior therapy (DBT)
____________ & _______________ have demonstrated benefits in clients with anorexia nervosa, bulimia nervosa, and BED.
obesity
____________ is defines as a BMI greater than 30.
premorbid phase of schizophrenia
a client has schizoid and schizotypal personalities. The nurse concludes that the client in is which phase of schizophrenia?
picketing
a form of protest in which people (called picketers) congregate outside a place of work or location where an event is taking place. Often this is done in an attempt to dissuade others from going in ("crossing the picket line"), but it can also be done to draw public to a cause
mediation
a form of settling disputes that involves a trained person who listens to all parties and makes recommendations. Such mediaions is generally not legally binding
union
a group of workers who band together to accomplish goals related to conditions of employment
word salad
a jumble of words that is meaningless to the listener—and perhaps to the speaker as well—because of an extreme level of disorganization
gross negligence
a legal concept that means extreme carelessness showing willful or reckless disregard for the consequences to a person(patient)
histrionic personality disorder
a personality disorder characterized by a pattern of excessive emotionality and attention seeking
Avoidant personality disorder
a personality disorder characterized by inhibition in scial situations; feelings of inadequacy; oversensitivity to criticism
disclosure
a process in which the patient's primary provider (physician or advanced practice nurse) gives the patient, and when applicable, family members, complete information about unanticipated adverse outcomes of treatment and care.
body image
a subjective concept of one's physical appearance based on the personal perceptions of self and the reactions of others
comparative negligence
a type of liability in which damages may be apportioned among two or more defendants in a malpractice case. The extent of liability depends on the defendants relative contribution to the patient's injury
executive functioning
ability to set priorities or make decisions
Other neurotransmitters are:
acetylcholine dopamine glutamate histamine
A rape in which the perpetrator is known to, and presumably trusted by, the person who is raped
acquaintance (or date) rape
Residual schizophrenia refers to the disorder when active phase symptoms are no longer present and the individual is left with two or more of the following symptoms:
active phase symptoms are no longer present and the individual is left with two or more of the following symptoms: lack of initiative, social withdrawal, impaired role function, marked speech deficits, and odd beliefs.
alogia = poverty of thought
alogia
gastroplasty
also known as stomach stapling; is a form of bariatric surgery for weight control. This procedure involves using a band and staples to create a small stomach pouch.
thought blocking, a positive symptom of schizophrenia
an abrupt stoppage of thought that derails conversation
adjustment disorder
an emotional disturbance caused by ongoing stressors within the range of common experience
anxiety
an emotional response In anticipation of danger source = largely unknown or unrecognized. necessary force for survival. not the same as stress subjective emotional response to stressor distinguished from fear in that anxiety is an emotional process, whereas fear is a cognitive one
accountability
an ethical duty stating that one should be answerable legally, morally, ethically, or socially for one's activities; being responsible for one's actions; a sense of duty in performing nursing tasks and activities
veracity
an ethical duty to tell the truth
beneficence
an ethical principle stating that one should do good and prevent or avoid doing harm
nonmalefience
an ethical principle stating the duty not to inflict harm
deontology
an ethical theory stating that moral rule is binding
Stressor
an external pressure that is brought to bear on the individual
paranoia, a positive symptom of schizophrenia
an irrational fear of others, ranging from mild to profound
anhedonia = inability to experience pleasure or joy
anhedonia
denoting
be a sign of; indicate
liability
being legally responsible for harm caused to another person or property as a result of one's actions;compensation for harm normally is paid in monetary damages
Somatic delusion
belief that something highly unusual is happening to one's body or internal organs
Somatic delusions example:
believes that his body is changing in an unusual way, such as growing a third arm
Neurotransmitter effects of Carbamate derivative/tranquilizer
binds to GABA receptors
what is a new eating disorder to the DSM-5
binge eating disorder
these are the co-morbidities for what eating disorder: bipolar depression anxiety
binge eating disorder & bulimia
characterized by regular binging but do not engage in purging behaviors
binge-eating
recurrent episodes of binge eating; eating in short period of time an amount that is larger than what most would eat in a similar period - sense of lack of control over eating during episodes
binge-eating disorder
Tardive dyskinesia
bizarre facial and tongue movements, stiff neck and difficulty swallowing.
SSRI Neurotransmitter effect
block reuptake of serotonin into presynaptic nerve terminal
benztropine (Cogentin) action:
blockade of central acetylcholine receptors; balances cholinergic activity.
case law
body of written opinions created by judges in federal and state appellate cases; also known as judge made law and common law
bulimia or anorexia?! - anemia and other blood problems
both
bulimia or anorexia?! - cavities, tooth enamal erosion, gum disease, teeth sensitvity to hot and cold foods
bulimia
bulimia or anorexia?! - dehydration, low potassium, magnesium and sodium
bulimia
bulimia or anorexia?! -stomach ulcers, can rupture, delayed emptying
bulimia
characterized by a cycle of binging followed by extreme behaviors to prevent weight gain such as purging
bulimia
recurrent episodes of binge eating - eating in short pd of time an amount that is larger than what most would eat in a similar pd - sense of lack of control over eating during the episode - purging after
bulimia
recurrent inappropriate compensatory behaviors in order to prevent wt gain such as self induced vomitting
bulimia
comorbidies for what eating disorder: - bipolar - depression - anxiety
bulimia and binge-eating disorder!
binge eating disorder is more similar to what other eating disorder?
bulimia, except with binge eating there is no purging after so people usually more overweight.
A pronounced increase or decrease in the rate and amount of movement, a positive symptom of schizophrenia
catatonia
Antagonist-drugs
cause receptor blockade resulting in a reduction of the transmission and decreased neurotransmitter activity
anorexia nervosa
characterized by a morbid fear of obesity symptoms: gross distortion of body image, preoccupation with food, and refusal to eat
clang association
choosing words based on their sound rather than their meaning, often rhyming or having a similar beginning sound ("On the track .... have a Big Mac"; "Click, clack, clutch, close").
Symptoms of GAD
chronic, unrealistic, and excessive anxiety and worry
PTSD 1st drug choice/drug class = SSRI medications, like paroxetine (Paxil)
class of drugs are the first choice for treating PSTD?
The client develops self-esteem.
client always always wants to be alone due to a lack of trust in other individuals. While caring for the client, the nurse plans to recognize and encourage the client's voluntary interaction with others. What outcome does the nurse expect out of this intervention?
ideas of reference
client's inaccurate interpretation that general events are personally directed to him or her, such as hearing a speech on the news and believing the message has personal meaning
epidural hemotoma
collection of blood between the dura and the inner surface of the skull, producing compression of the dura matter and thus of the brain
phenobarbital (Luminal) side effects:
coma, suicidal ideation, drowsiness, agranulocytosis, megabloblastic anemia
bulimia and binge-eating disorder!
comorbidies for what eating disorder: - bipolar - depression - anxiety
Naloxone (Narcan) action:
competes with opioids at opiate receptor sites
ruminaiton disorder Do those with rumination disorder try and conceal and hide their disorder or do they seek attention
conceal/hide it they don't feel in control, so don't like to eat in public
Anti- depressants, antipsychotics and antihistamine that can produce anticholinergic effects
confusion blurred vision Constipation dry mouth dizziness difficulty urination
psychotic phase of schizophrenia
consists of delusions; hallucinations; disorganized speech; and bizarre behavior , thought process, and content
what type of remission is this for anorexia: - low body weight has not been sustained for some time
criterion A, partial remission
what type of remission is this for anorexia: - intense fear of gaining weight or becoming fat or behavior that interferes with with weigt gain
criterion B, partial remission
what type of remission is this for anorexia: - disturbances in self-perception of weight and shape sitll not met
criterion C, partial remission
Name that disorder: eating or feeding disturbance resulting in person failing to meet appropriate nutritional and or energy needs - significant __________ loss - significant nutritional deficiency - dependence on enteral feeding or ______ nutritional supplements - marked interference with psychosocial functioning
restrictive food intake disorder weight oral
Regression
retreat to an earlier level of development. Sometimes she would not even get up to go to the bathroom and instead soiled herself in an infantile manner.
Naloxone (Narcan) use:
reverses respiratory depression induced by opioids
Clang associations
rhyming words
ruminaiton disorder repeated regurgitation of food over at least 1 month
ruminaiton disorder
ruminaiton disorder repeated regurgitation NOT attributeable to another GI or medical condition; eating disturbance NOT occuring with another eating disorder
rumination disorder
word salad, a positive symptom of schizophrenia
schizophasia
Schizoaffective
schizophrenia + mood disorder
ethics
science or study of moral values
atypical antipsychotics aka
second gen (atypical) antipsychotics
what bulimia severity level does this describe: 8-13 inappropriate compensatory behaviors per week
severe
what level of severity for binge-eating specifiers: 8-13 binge eating episodes per week
severe
Associative looseness (loose association)
shift of ideas from one unrelated topic to another
derailment
shifting from one unrelated subject to another, without following any one line of thought to conclusion
crisis
sudden event in one's life disturbing homeostasis which usual coping mechanisms cannot resolve the problem.
gastric bypass
surgical procedure in which the stomach is divided into a small upper pouch and a much larger lower "remnant" pouch and then the small intestine is rearranged to connect to both.
neuroleptic
term used to indicate drugs that have effects on the nervous system, especially that have Parkinson-like adverse effects on posture and body movement
negative symptoms of schizophrenia
the absence of appropriate behaviors (expressionless faces, rigid bodies)
Onset of antidepressants
varies 2-4-6 wks
Antidepressants: SNRIs
venlafaxine (Effexor) duloxetine (Cymbalta)
Fx of atypicals
weak dopamine antagonists; potent 5HT2A antagonists; also exhibit antagonism for cholinergic, histaminic, and adrenergic receptors
russell's sign
when individuals develop calluses on the dorsal of their hands (knuckles) secondary to long-term repeated self-induced vomiting
Naloxone (Narcan) teaching:
when patient is lucid, teach about reasons for and expected results of this product.
purging
when someone used self-induced vomiting, use of laxatives/diuretics, or enemas to rid themselves of excessive calories
nihilistic delusion
when the individual has a false idea that the self, part of self others or the world is nonexistent ("the world no longer exists," "i have no heart" or "when you dont have a brain, you dont need brain medicine"
Personality/psychoological factors with eating disorder: - sensor of self __________ based on _______ - use food as a means to feel in __________ - _______ thinking - perfectionism - poor ___________ control - inadequate coping skills
worth weight control rigid impulse
advance directive
written or verbal instructions created by the patient describing specific wishes about medical care in the event they becomes incapacitated or incompetent, Examples include living wills and durable power of attorney
