Mental Health Exam #2

c.) Learned helplessness Learned helplessness results in depression when the client feels no control over the outcome of a situation. None of the other options demonstrate these feelings.

A depressed client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse should identify this cognitive distortion as what response? a.)Discounting positive attributes b.) Catatonia c.) Learned helplessness d.) Self-blame

c.) "I still feel bad about my sister dying of cancer. I should have done more for her!" Guilt is a common accompaniment to depression. A person may ruminate over present or past failings. Praying and reading the Bible describes a coping mechanism; the other responses do not describe a common accompaniment to depression.

A 38-year-old client is admitted with major depression. Which statement made by the client alerts the nurse to a common accompaniment to depression? a.) "I still pray and read my Bible every day." b.) "I've heard others say that depression is a sign of weakness." c.) "I still feel bad about my sister dying of cancer. I should have done more for her!" d.) "My mother wants to move in with me, but I want to independent."

b.) Repression Repression is a defense mechanism that excludes unwanted or unpleasant experiences, emotions, or ideas from conscious awareness. This is not the outcome of any of the other options.

A 20-year-old was sexually molested at age 10, but he can no longer remember the incident. Which ego defense mechanism is in use? a.) Projection b.) Repression c.) Displacement d.) Reaction formation

b.) Encouraging the client to take slow, deep breaths Slow diaphragmatic breathing can induce relaxation and reduce symptoms of anxiety. Often the nurse has to tell the client to "breathe with me" and keep the client focused on the task. The slower breathing also reduces the threat of hypercapnia with its attendant symptoms. The client needs help to regain composure and stabilize vital signs; the only option that addresses these issues is the correct option.

A client experiencing a panic attack keeps repeating, "I'm dying, I can't breathe.". What action by the nurse should be most therapeutic initially? a.) Asking the client what he means when he says, "I am dying." b.) Encouraging the client to take slow, deep breaths c.) Offering an explanation about why the symptoms are occurring d.) Verbalizing mild disapproval of the anxious behavior

d.) severe Severe anxiety is characterized by feelings of falling apart and impending doom, impaired cognition, and severe somatic symptoms such as headache and pounding heart. Mild and moderate levels of anxiety do not demonstrate these feels while panic is even more intense than the scenario implies.

A client frantically reports to the nurse that "You have got to help me! Something terrible is happening. I can't think. My heart is pounding, and my head is throbbing." The nurse should assess the client at what level of anxiety? a.) mild b.) panic c.) moderate d.) severe

b.) Being unable to work for the last 12 months GAD is characterized by symptomatology that lasts 6 months or longer. None of the other descriptions would support the diagnosis.

A client is diagnosed with generalized anxiety disorder (GAD). The nursing assessment supports this diagnosis when the client reports which information? a.) Repeated verbalizing prayers results in a relaxed feeling b.) Being unable to work for the last 12 months c.) Eating in public makes the client extremely uncomfortable d.) Symptoms started right after being robbed at gunpoint

c.) fruit and cottage cheese plate Fruit and cottage cheese do not contain tyramine. Avocados, fermented food such as sauerkraut, processed meat, and organ meat, contain tyramine. Monoamine oxidase inhibitors inhibit the breakdown of tyramine, which can lead to high blood pressure, a hypertensive crisis, and eventually a cerebrovascular accident. This information makes the other options incorrect.

A client prescribed a monoamine oxidase inhibitor (MOA) has a pass to go out to lunch. Given a choice of the following entrees, what can the client safely eat? a.) kielbasa and sauerkraut b.) avocado salad plate c.) fruit and cottage cheese plate d.) liver and onion sandwich

a.) Explain the high possibility of an adverse reaction Serotonin malignant syndrome is a possibility if St. John's wort is taken with other antidepressants. None of the other options are relevant to the situation.

A client prescribed a selective serotonin reuptake inhibitor mentions taking the medication along with the St. John's wort daily. What information should the nurse provide the client regarding this practice? a.) Explain the high possibility of an adverse reaction b.) Agreeing that this will help the client to remember the medications c.) Caution the client to drink several glasses of water daily d.) Suggest that the client also use a sun lamp daily.

b.) "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." This describes symptoms of serotonin syndrome, a life-threatening complication of SRRI medication. The other options are incorrect because the client should be wearing sunscreen to avoid sunburn, may take over-the-counter medications if sanctioned by the provider, and would not have been educated to report increased thirst and urination as a side effect of fluoxetine.

A client prescribed fluoxetine demonstrates an understanding of the medication teaching when making which statement? a.) "I will not take any over-the-counter medication while on the fluoxetine." b.) "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." c.) "I will report increased thirst and urination to my provider." d.) "I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction."

d.) "What things have you done in the past that helped you feel more comfortable?" Because the client is not able to think through the problem and arrive at an action that would lower anxiety, the nurse can assist by asking what has worked in the past. Often what has been helpful in the past can be used again. While distraction may be helpful in some situations, it is not the initial intervention.

A client who is demonstrating a moderate level of anxiety tells the nurse, "I am so anxious, and I do not know what to do." Which response should the nurse make initially? a.) "Try not to think about the feelings and sensations you're experiencing." b.) "Let's try to focus on that adorable little granddaughter of yours." c.) "Why don't you sit down over there and work on that jigsaw puzzle?" d.) "What things have you done in the past that helped you feel more comfortable?"

a.) Psychomotor agitation These behaviors describe the psychomotor agitation sometimes seen in clients with the agitated type of depression. None of the other options are associated so directly with these behaviors.

A depressed client is noted to pace most of the time, pull at her clothes, and wring her hands. These behaviors are consistent with which term? a.) Psychomotor agitation b.) Senile dementia c.) Central serotonin syndrome d.) Hypertensive crisis

b.) "Let's look at what you just said that you can 'never do anything right.'" Cognitive distortions can be refuted by examining them, but to examine them the nurse must gain the client's willingness to participate. None of the other options examines the underlying cause of the feeling.

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

a.) Denial Denial involves escaping unpleasant reality by ignoring its existence. This is not the outcome of any of the other options.

A man continues to speak of his wife as though she were still alive, 3 years after her death. This behavior suggests the use of which ego defense mechanism? a.) Denial b.) Undoing c.) Suppression d.) Altruism

a.) "Depression is seen in people of all ages, from childhood to old age." Depression can occur at any age. Children, adolescents, adults, and the elderly may all experience depression.

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

b.) Reaction formation Reaction formation keeps unacceptable feelings or behaviors out of awareness by developing the opposite behavior or emotion. This behavior is not associated with any of the other options.

A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, and "burns" money that could be better spent to feed the poor is demonstrating which ego defense mechanism? a.) Projection b.) Reaction formation c.) Rationalization d.) Undoing

c.) Fear of impending doom The feelings of terror present during a panic attack are so severe that normal function is suspended, the perceptual field is severely limited, and misinterpretation of reality may occur. None of the other symptoms are associated with a panic attack.

A symptom commonly associated with panic attacks? a.) Apathy b.) Obsessions c.) Fear of impending doom d.) Fever

d.) A recurrent, persistent thought or impulse Obsessions are thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind. None of the remaining statements are accurate when defining the term obsession

An obsession is defined as what? a.) Thinking of an action and immediately taking the action b.) An intense irrational fear of an object or situation c.) A recurrent behavior performed in the same manner d.) A recurrent, persistent thought or impulse

1.) Always evaluate the patient's risk of harm to self or others. Overt hostility is highly correlated with suicide. 2.) Major depressive disorder may be secondary to many other disorders and medications. -A thorough medical and neurological examination helps determine if the depression is primary or secondary to another disorder. Evaluate whether: • The patient is psychotic • The patient has taken drugs or alcohol • Medical conditions are present • The patient has a history of a comorbid psychiatric syndrome, such as an eating disorder, borderline personality disorder, or anxiety disorder. 3.) Assess the patient's history of depression, what past treatments worked and did not work, and stressors that may have contributed to this episode. 4.) Assess support systems, family, significant others, and the need for information and referrals.

Assessment box for a patient with Depression?

Behavior: When people experience hypomania, they have voracious appetites for social engagement, spending, and activity, even indiscriminate sex. Constant activity and a reduced need for sleep prevent proper rest. Although short periods of sleep are possible, some patients may not sleep for several days in a row. This nonstop physical activity and the lack of sleep and food can lead to physical exhaustion and worsening of mania. Being manic means being busy during all hours of the day and night, furthering grandiose plans and wild schemes. To the person experiencing mania, no aspirations are too high and no distances are too far. Distractibility is a hallmark symptom of mania. People with mania lose their focus and go from one activity or place to another. Individuals experiencing mania may be manipulative, profane, fault finding, and skilled at detecting and then exploiting others' vulnerabilities. They constantly push limits. -People often emerge from a manic state startled and confused by the shambles of their lives.

Assessment of Behavior for Bipolar disorder?

Mood: The euphoric mood associated with mania is unstable. During this euphoric period, patients may experience intense feelings of well-being, being "cheerful in a beautiful world," or becoming "one with God." The overly joyous mood may seem out of proportion to what is going on, and cheerfulness may be inappropriate for the circumstances, considering that patients are full of energy with little or no sleep. -People experiencing a manic state may laugh, joke, and talk in a continuous stream with uninhibited familiarity. -The euphoric mood associated with mania is unstable because this mood may change quickly to irritation and anger when the person is frustrated. The irritability and belligerence may be short-lived, or it may become the prominent feature of the manic phase of bipolar disorder.

Assessment of Mood for Bipolar disorder?

d.) Self-deprecating ideation Depressed clients never feel good about themselves. They have a negative, self-deprecating view of the world. This characteristic is not associated with any of the other options.

Assessment of the thought processes of a client diagnosed with depression is most likely to reveal what characteristic? a.) Sexual preoccupation b.) Good memory and concentration c.) Delusions of persecution d.) Self-deprecating ideation

c.) Negative processing of information Beck is a cognitive theorist who developed the theory of the cognitive triad of three automatic thoughts responsible for people becoming depressed: (1) a negative, self-deprecating view of oneself; (2) a pessimistic view of the world; and (3) the belief that negative reinforcement will continue. None of the other options are related to this theory.

Beck's cognitive theory suggests that the etiology of depression is related to what factor? a.) Serotonin circuit dysfunction b.) Sleep abnormalities c.) Negative processing of information d.) S belief that one has no control over outcomes

1.) Intervention: When a patient is silent, use the technique of making observations: "There are many new pictures on the wall." "You are wearing your new shoes." 1.) Rationale: When a patient is not ready to talk, direct questions can raise the patient's anxiety level and frustrate the nurse. Pointing to commonalities in the environment draws the patient into and reinforces reality. 2.) Intervention: Use simple, concrete words. 2.) Rationale: Slowed thinking and difficulty concentrating impair comprehension. 3.) Intervention: Allow time for the patient to respond. 3.) Rationale: Slowed thinking necessitates time to formulate a response. 4.) Intervention: Listen for covert messages, and ask about suicide plans. 4.) Rationale: People often experience relief and decrease in feelings of isolation when they share thoughts of suicide. 5.) Intervention: Avoid platitudes such as "Things will look up" or "Everyone gets down once in a while." 5.) Rationale: Platitudes tend to minimize the patient's feelings and can increase feelings of guilt and worthlessness because the patient cannot "look up" or "snap out of it."

Communication techniques for a patient with Depression?

B.) Panic level anxiety Panic level anxiety is the most extreme level and results in markedly disturbed thinking greater than in any of the other options.

Delusionary thinking is a characteristic of which form of anxiety? A.) Chronic anxiety B.) Panic level anxiety C.) Severe anxiety D.) Acute anxiety

d.) At least 2 years Dysthymia is a chronic condition that by definition has to have existed for longer than 2 years. None of the other options present a sufficient time period.

Dysthymia cannot be diagnosed unless it has existed for what period of time? a.) At least 6 months b.) At least 1 year c.) At least 3 months d.) At least 2 years

-The most dangerous aspect of major depressive disorder is a preoccupation with death. -A patient may fantasize about her funeral or experience recurring dreams about death. Beyond these passive fantasies are thoughts of wanting to die. As a whole, all these negativistic thoughts are referred to as suicidal ideation. -These thoughts may be relatively mild and fleeting or persistent and involve a plan. Suicidal ideation, especially those in which the patient has a plan and the means to carry the plan out, represents an emergency requiring immediate intervention -Suicidal thoughts are a major reason for hospitalization for patients with major depression. Patients with major depressive disorder should always be evaluated for suicidal ideation. -Risk for suicide is increased when depression is accompanied by hopelessness, substance use problems, a recent loss or separation, a history of past suicide attempts, and acute suicidal ideation. -The following statements and questions help set the stage for assessing suicide potential: • "You said you are depressed. Tell me what that is like for you." • "When you feel depressed, what sort of thoughts do you have?" • "Have you had thoughts about ending your life?" • "Do you have a plan?" • "Do you have the means to carry out your plan?" • "Is there anything that would prevent you from carrying out your plan?"

Evaluating risk for harm for a depressed patient?

b.) They often involve some degree of self-deception Most ego defense mechanisms, with the exception of the mature defenses, alter the individual's perception of reality to produce varying degrees of self-deception. This information helps eliminate the other options as the correct statement.

Generally, which statement regarding ego defense mechanisms is true? a.) They seldom make the person more comfortable b.) They often involve some degree of self-deception c.) They are usually effective in resolving conflicts d.) They are rarely used by mentally healthy people

A basic premise of the recovery model of mental illness is that individuals exercise personal control of treatment based on individual goals. -Within this model, health teaching is paramount because it allows patients to make informed choices. -Health teaching points include: • Depression is an illness beyond a person's voluntary control. • Although it is beyond voluntary control, depression can be managed through medication and lifestyle. • Chronic illness management depends in large part on understanding personal signs and symptoms of relapse. • Illness management depends on understanding the role of medication and possible medication side effects. • Long-term management works best if the patient receives psychotherapy along with medication. • Identifying and coping with the stress of interpersonal relationships—whether they are familial, social, or occupational—are key to stable illness management. Including the family in discharge planning is also important. It helps the patient by: • Increasing the family's understanding and acceptance of the family member with depression during the aftercare period • Increasing the patient's use of aftercare facilities in the community • Contributing to higher overall adjustment in the patient after discharge

Health Teaching and Promotion for a Patient with Depression?

a.) Panic attacks with agoraphobia Panic disorder with agoraphobia is characterized by recurrent panic attacks combined with agoraphobia. Agoraphobia involves intense, excessive anxiety about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available if a panic attack occurred. None of the other options are associated with this form of anxiety.

Inability to leave one's home because of avoidance of severe anxiety suggests the existence of which anxiety disorder? a.) Panic attacks with agoraphobia b.) Posttraumatic stress response c.) Obsessive-compulsive disorder d.) Generalized anxiety disorder

Priority diagnosis: Anxiety (moderate) related to situational event or psychological stress, as evidenced by increase in vital signs, moderate discomfort, narrowing of perceptual field, and selective inattention. -Help the patient identify anxiety. "Are you comfortable right now?": It is important to validate observations with the patient, name the anxiety, and start to work with the patient to lower anxiety. -Anticipate anxiety-provoking situations: Escalation of anxiety to a more disorganizing level is prevented. -Use nonverbal language to demonstrate interest (e.g., lean forward, maintain eye contact, nod your head): Verbal and nonverbal messages should be consistent. The presence of an interested person provides a stabilizing focus. -Encourage the patient to talk about feelings and concerns: When concerns are stated aloud, problems can be discussed and feelings of isolation decreased. -Avoid closing off avenues of communication that are important to the patient: Focus on the patient's concerns. When staff anxiety increases, changing the topic or offering advice is common but leaves the person isolated. -Ask questions to clarify what is being said. "I'm not sure what you mean. Give me an example.": Increased anxiety results in the scattering of thoughts. Clarification helps patients to identify their thoughts and feelings. -Help the patient to identify thoughts or feelings before the onset of anxiety. "What were you thinking right before you started to feel anxious?": The patient is helped to identify thoughts and feelings, and problem solving is facilitated. -Encourage problem solving with the patient: Encouraging patients to explore alternatives increases their sense of control and decreases anxiety. -Help the patient to develop alternative solutions to a problem through role-play or modeling behaviors: The patient is encouraged to try out alternative behaviors and solutions. -Explore behaviors that have worked to relieve the patient's anxiety in the past: The patient is encouraged to mobilize successful coping mechanisms and strengths. -Provide outlets for working off excess energy (e.g., walking, playing ping-pong, dancing, exercising): Physical activity can provide relief of built-up tension, increase muscle tone, and increase endorphin levels.

Interventions for Mild to Moderate Anxiety?

-Maintain a calm manner: Anxiety is communicated interpersonally. The quiet calm of the nurse can serve to calm the patient. The presence of anxiety can escalate anxiety in the patient. -Always remain with the person experiencing an acute, severe, or panic level of anxiety: Alone with immense anxiety, a person feels abandoned. A caring face may be the patient's only contact with reality when confusion becomes overwhelming. -Minimize environmental stimuli: Move to a quieter setting, and stay with the patient. Helps to minimize further escalation of the patient's anxiety. -Use clear and simple statements and repetition: A person experiencing a severe to panic level of anxiety has difficulty concentrating and processing information. -Use a low-pitched voice; speak slowly: A high-pitched voice can convey anxiety. Low pitch can decrease anxiety. -Reinforce reality if distortions occur (e.g., seeing objects that are not there or hearing voices when no one is present): Anxiety can be reduced by focusing on and validating what is going on in the environment. -Listen for themes in communication: In severe to panic levels of anxiety, verbal communication themes may be the only indication of the patient's thoughts or feelings. -Attend to physical and safety needs when necessary (e.g., need for warmth, fluids, elimination, pain relief, family contact): High levels of anxiety may obscure the patient's awareness of physical needs. -Because safety is an overall goal, physical limits may have to be set. Speak in a firm, authoritative voice: "You may not hit anyone here. If you can't control yourself, we will help you.": A person who is out of control is often terrorized. Staff must offer the patient and others protection from destructive and self-destructive impulses. -Provide opportunities for exercise (e.g., walk with nurse, punching bag, ping-pong game): Physical activity helps channel and dissipate tension and may temporarily lower anxiety. -When a person is constantly moving or pacing, offer high-calorie fluids: Dehydration and exhaustion must be prevented. -Assess need for medication or seclusion after other interventions have been tried and have been unsuccessful: Exhaustion and physical harm to self and others must be prevented.

Interventions for Severe to Panic Levels of Anxiety?

-Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) are considered a first line of defense in most anxiety-related disorders. They include paroxetine (Paxil), fluoxetine (Prozac), escitalopram (Lexapro), and sertraline (Zoloft). Venlafaxine (Effexor), a serotonin norepinephrine reuptake inhibitor (SNRI), is another first line of defense used in the treatment of several anxiety disorders. Another SNRI, duloxetine (Cymbalta), is effective in the treatment of generalized anxiety disorder. -Antianxiety drugs: Antianxiety drugs are often used to treat the somatic and psychological symptoms of anxiety disorders. When moderate or severe anxiety is reduced, patients are better able to participate in the treatment of their underlying problems. Benzodiazepines are most commonly used because they have a quick onset of action. However, owing to the potential for dependence, these medications should be used only for short periods of time, or until other medications or treatments reduce symptoms. -Buspirone (BuSpar) is an alternative antianxiety medication that does not cause dependence, but it takes 2 to 4 weeks for it to reach its full effect. The drug may be used for long-term treatment and should be taken regularly. Side effects include dizziness, nausea, headache, nervousness, lightheadedness, and excitement. -Other classes of medications used to treat anxiety disorders include beta blockers, antihistamines, anticonvulsants, and antipsychotics. These agents are often added if the first course of treatment is ineffective.

Medications for Anxiety?

1.) Caution the patient about the following: -Not to change the dose or frequency of medication without consulting the prescriber. -These medications may make it unsafe to handle mechanical equipment (e.g., cars, saws, and machinery). -Avoid using both alcoholic beverages and antianxiety medications, as this may lead to unsafe depressant effects. -Avoid drinking beverages containing caffeine because they will decrease the desired effects of the drug. -Review prescription medications and doses that may cause or increase anxiety (e.g., thyroid hormones, steroids, decongestants). 2.) Discuss with the prescriber the risks to the fetus and the risk of untreated anxiety disorders should pregnancy occur or be considered. 3.) Discuss breastfeeding with the prescriber because these drugs are excreted in breast milk and could have adverse effects on the infant. 4.) Teach the patient that: -Quitting a benzodiazepine after the first month of daily use may cause withdrawal symptoms such as insomnia, irritability, nervousness, dry mouth, tremors, convulsions, and confusion. -Medications should be taken with or shortly after meals or snacks to reduce gastrointestinal discomfort. -Drug interactions can occur: For example, antacids may delay absorption; cimetidine interferes with metabolism of benzodiazepines, causing increased sedation; central nervous system depressants, such as alcohol and barbiturates, cause increased sedation.

Patient Teaching for Antianxiety Drugs?

• Lithium is a mood stabilizer and helps prevent relapse. It is important to continue taking the drug even after the current episode subsides. • Lithium is not addictive. • It is important to monitor lithium blood levels closely until a therapeutic level is reached. After this level is reached, continued monitoring will be required to prevent toxicity. You will need more frequent blood level monitoring at first, then once every several months after that. • It is important to maintain a consistent fluid intake (1500-3000 mL/day or six 12-oz glasses of fluid). • Sodium intake can affect lithium levels. High sodium intake leads to lower levels of lithium and less therapeutic effect. Low sodium intake leads to higher lithium levels, which could produce toxicity. Aim for consistency in sodium intake. • You should stop taking lithium if you have excessive diarrhea, vomiting, or sweating. All of these symptoms can lead to dehydration and increase blood lithium to toxic levels. Inform your care provider if you have any of these problems. • Let your prescriber know if you take diuretics (water pills). • Talk to your prescriber about having your thyroid, parathyroid, and renal function checked periodically due to risk for hypothyroidism, hyperthyroidism, hyperparathyroidism, and decreased kidney function. • Don't take over-the-counter medicines without checking with your prescriber. Even non-steroidal anti-inflammatory drugs (e.g., ibuprofen, naproxen) may influence lithium levels. • Take lithium with meals to avoid stomach irritation. • In the first week, you may gain up to 5 pounds of water weight. Additional weight gain may occur, particularly with females. Discuss how much weight gain is acceptable with your prescriber. • Groups are available to provide support for people with bipolar disorder and their families. A local self-help group is [provide a name and telephone number]. • You can find out more information by calling [provide a name and telephone number]. • Keep a list of side effects and toxic effects handy, along with the name and number of a contact person • If lithium is to be discontinued, the dosage will be tapered gradually to minimize the risk of relapse.

Patient and Family Teaching: Lithium Therapy?

D.) Moderate When moderate anxiety is present, the individual's perceptual field is reduced and the client is not able to see the entire picture of events. This is not an initial characteristic of any of the other levels of anxiety.

Selective inattention is first noted when experiencing which level of anxiety? A.) Mild B.) Panic C.) Severe D.) Moderate

d.) Not allowing the client to wash hands after touching a "dirty" object Response prevention is a technique by which the client is prevented from engaging in the compulsive ritual. A form of behavior therapy, response prevention is never undertaken without physician approval. None of the other options reflect accurate information regarding this form of therapy.

The plan of care for a client who has elaborate washing rituals specifies that response prevention is to be used. Which scenario is an example of response prevention? a.) Telling the client that he or she must relax whenever tension mounts b.) Not allowing the client to seek reassurance from staff c.) Having the client repeatedly touch "dirty" objects d.) Not allowing the client to wash hands after touching a "dirty" object

c.) Justifies illogical ideas and feelings Rationalization involves justifying illogical or unreasonable ideas or feelings by developing logical explanations that satisfy the teller and the listener. None of the other options present with this behavior.

The record mentions states that the client habitually relies on rationalization. The nurse might expect the client to present with what behavior? a.) Behaves in ways that are the opposite of his or her feelings b.) Misses appointments c.) Justifies illogical ideas and feelings d.) Makes jokes to relieve tension

Several medications: have FDA approval for the treatment of OCD. -Most of these drugs are SSRIs, including fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). -Another approved drug, clomipramine (Anafranil), is part of one of the older classes called tricyclic antidepressants. -While every medication used for OCD may not have FDA approval, they are still commonly prescribed. This includes other SSRIs and the SNRI venlafaxine (Effexor). -Antipsychotic medications are sometimes used in conjunction with antidepressants to reduce severe symptoms. There are few biological treatments available to disrupt the course of an OCD: -Surgery has been used for those most severely affected. Gamma knife surgery is used to purposely cause irreversible damage, or a lesion, in a specific area of the brain, thus disconnecting overactive circuits or regions. -A reversible surgical treatment used for OCD is deep brain stimulation (DBS). The FDA approved DBS as an adjunct to medications in treatment-resistant OCD in adults who have failed at least three SSRI trials. Psychological Therapies: -Exposure and response prevention: This first-line cognitive-behavioral intervention is used for obsessive-compulsive behaviors. -First, the patient is exposed to stimuli that trigger the specific OCD symptoms. For patients with contamination fears, this might involve having them touch a doorknob or faucet handle. Patients then prevent themselves from performing the compulsive ritual of handwashing. The patient learns that anxiety does subside even when the ritual is not completed. After trying this in the office, the patient learns to set time limits at home to gradually lengthen the time between rituals until the urge fades away. • Flooding: This method exposes the patient to a large amount of an undesirable stimulus in an effort to extinguish the response. -The patient learns through prolonged exposure that survival is possible and that anxiety diminishes spontaneously. -For example, an obsessive patient who usually touches objects with a paper towel may be forced to touch objects with a bare hand for 1 hour. By the end of that period, the anxiety level is expected to be lower.

Treatment for O-C disorders?

Are the stringing together of words because of their rhyming sounds, without regard to their meaning

What are Clang associations?

-Are automatic coping styles that protect people from anxiety and enable them to maintain their self-image by blocking feelings, conflicts, and memories. -Although they operate all the time, defense mechanisms are not always apparent to the individual using them.

What are Defense Mechanisms?

is a continuous flow of accelerated speech with abrupt changes from topic to topic. -The speech is usually based on understandable associations or plays on words. -At times, the attentive listener can keep up with the flow of words, even though direction changes from moment to moment. Speech is rapid, verbose, and circumstantial. -When the condition is severe, speech may be disorganized and incoherent. The incessant talking often includes joking, puns, and teasing

What are Flight of ideas?

-Are manifested by a highly inflated self-regard. It is apparent in both the ideas expressed and the person's behavior. People with mania may exaggerate their achievements or importance, state that they know famous people, or believe they have great powers. -Religious ("I am the Messiah"), science fiction ("I was abducted"), and supernatural ("I am possessed by my dead father") themes are common in grandiose delusions. -Sometimes it is difficult to distinguish fact from fiction ("I made an absolute fortune during the real estate crash of 2008").

What are Grandiose delusions?

represent the disordered way that a person is processing information. -Thoughts are only loosely connected to each other in the person's conversation. -For example, a patient may say, "The sky's the limit now that I have money. I took a flight, you know, from Kennedy. Drinking beer is a belly full of bags."

What are Loose associations?

-Mood stabilizers refer to classes of drugs used to treat symptoms associated with bipolar disorder. The original intent of the term "mood stabilizers" was to indicate that these drugs were effective in the treatment of both mania and depression. While all of the medications in this category are effective in treating mania, not all of them do well in treating depression. -LITHIUM: Onset of action is usually within 10 to 21 days. Because the onset of action is so slow, it is usually supplemented in the early phases of treatment by second-generation antipsychotics, anticonvulsants, or antianxiety medications. -Main concern is seizure activity. If you think someone is Lithium toxic (>2), give salty snack, then call provider -A target range for a 12-hour serum trough level is 0.8-1.2 mEq/L. A greater clinical benefit for acute mania may be found in a level of 1.0-1.2 mEq/L

What are Mood Stabilizers?

Vegetative signs of depression refer to alterations in those activities necessary to support physical life and growth (e.g., eating, elimination, sleeping, and sex). -Appetite changes: vary in individuals experiencing depression. Appetite loss is common, and sometimes patients can lose up to 5% of their body weight in less than a month. Other patients find they eat more often and complain of weight gain. -Changes in bowel habits: are common. Constipation is seen most frequently in patients with psychomotor retardation. Diarrhea occurs less frequently, often in conjunction with psychomotor agitation or anxiety. -Sleep pattern disturbance: is a hallmark sign of depression. Often, people experience insomnia, wake frequently, and have a total reduction in sleep, especially deep-stage sleep. Waking at 3 or 4 a.m. and then staying awake is common, as is sleeping for short periods only. The light sleep of a person with depression tends to prolong the agony of depression over a 24-hour period. For some, sleep is increased (hypersomnia) and provides an escape from painful feelings. In any event, sleep is rarely restful or refreshing. -Sexual interest declines (loss of libido): during depression. Some men experience impotence. A decreased or absent interest in sex occurs in both men and women, which can further complicate marital and social relationships.

What are Vegetative Symptoms?

-Stressors can be Physiological or Psychological Six Mediators of the Stress Response: Perception, Individual temperament, Social support, Support groups, Culture, and Spirituality and Religion -Perception: The way that we perceive stressors is affected by factors such as age, gender, culture, life experience, and lifestyle. All of these factors may work to either lessen or increase the degree of emotional or physical influence and the sequelae (consequence or result) of stress. -Individual Temperament: These perceptions are colored by a variety of factors, including genetic structure and vulnerability, childhood experiences, coping strategies, and personal outlook on life and the world. All these factors combine to form a unique personality with specific strengths and vulnerabilities. -Social Support: Strong social support from significant others can enhance mental and physical health and act as a substantial buffer against distress. -Support Groups: The proliferation of self-help groups attests to the need for social supports. Many of the support groups currently available are for people going through similar stressful life events. -Culture: Each culture not only emphasizes certain problems of living more than others but also interprets emotional problems differently. -Spirituality and Religion: Spirituality and religious affiliation help people cope with stress.

What are mediators of the stress response?

• Female gender • Adverse childhood experiences • Stressful life events • First-degree family members with major depressive disorder • Neuroticism (a negative personality trait characterized by anxiety, fear, moodiness, worry, envy, frustration, jealousy, and loneliness) • Other disorders, such as substance use, anxiety, and personality disorders • Chronic or disabling medical conditions

What are the Primary Risk Factors for Depression?

b.) Suicidal ideation Suicidal thoughts are a major reason for hospitalization for clients with major depression. It is imperative to intervene with such clients to keep them safe from self-harm. The other options describe symptoms of major depression but aren't by themselves the major reason for hospitalization.

What is the major reason for the hospitalization of a depressed client? a.) Inability to go to work b.) Suicidal ideation c.) Psychomotor agitation d.) Loss of appetite

Signs and Symptoms, Nursing Diagnoses, and Outcomes for Bulimia Nervosa

What is this image depicting?

Sleep: • 7-9 h of sleep is recommended. • Try going to sleep 30-60 min early each night for a few weeks. • Sleeping later in the morning is not helpful and can disrupt body rhythms. • Invest in a tracker that can monitor sleep and make adjustments based on the data it provides. Exercise (Aerobic): • 150 min a week (about 20 min a day) of moderate-intensity aerobic activity such as walking is recommended. • Reduces chronic and acute stress • Decreases levels of anxiety, depression, and sensitivity to stress • Decreases muscle tension and increases endorphin levels • Exercise at least 3 h before bedtime to prevent sleep disruption Reduction or Cessation of Caffeine Intake: • No more than four cups of coffee or colas are recommended for anyone. • Overuse or sensitivity may cause insomnia, nervousness, restlessness, irritability, stomach upset, rapid heartbeat, muscle tremors, and shakiness. • Slowly wean off coffee, tea, colas, and chocolate drinks. Music: • Listening to familiar music promotes relaxation. • Rates of healing may be improved with music. • Music can decrease agitation and confusion in older adults. • Quality of life in hospice settings is enhanced by music. Pets: • Can bring joy and reduce stress • May provide real social support • Alleviate medical problems aggravated by stress Massage: • Slows the heart rate and relaxes the body • Improves alertness by reducing anxiety

What are some effective stress busters?

Psychiatric problems that are known to benefit from relaxation techniques include anxiety, depression, insomnia, and nightmares 1.) Through the use of sensitive instrumentation, biofeedback provides immediate and exact information regarding muscle activity, brain waves, skin temperature, heart rate, blood pressure, and other bodily functions. Indicators of the particular internal physiological process are detected and amplified by a sensitive recording device 2.) researchers found that the most common relaxation technique used in the United States was deep-breathing exercises 3.) With guided imagery, people are taught to focus on pleasant images to replace negative or stressful feelings. This focus diverts a person from less positive thoughts or obsessions, resulting in a refreshed outlook. Guided imagery may be self-directed, accessed online, or led by a practitioner. 4.) Progressive relaxation or progressive muscle relaxation- The premise behind progressive relaxation is that because anxiety results in tense muscles, one way to decrease anxiety is to relax muscle contraction. This is accomplished by deliberately tensing groups of muscles (beginning with feet and ending with face or vice versa) as tightly as possible for about 8 seconds and then releasing the tension you have created. 5.) Meditation is a discipline for training the mind to develop greater calm and then using that calm to bring penetrative insight into one's experience. Meditation can be used to help people tap into their deep inner resources for healing, calm their minds, and help them operate more efficiently in the world. It can help people develop strategies to cope with stress, make sensible adaptive choices under pressure, and feel more engaged in life. 6.) Being mindful includes being in the moment by paying attention to what is going on around you—what you are seeing, feeling, and hearing.

What are some relaxation techniques?

Bipolar I: -Most severe form -Highest mortality rate of the three -At least 1 manic episode -S/S of manic episode: happy, most excited, most optimistic, feel euphoric and energized, eat and sleep little (if at all), in perpetual motion, feel so powerful and important that they take horrific chances and engage in hazardous activities -As mania intensifies; Psychosis occurs (hallucinations (auditory), delusions, and dramatically disturbed thoughts) Bipolar II: -At least 1 hypomanic episode -S/S are less severe than manic episode in Bipolar Disorder 1 -At least 1 major depressive episode -Hypomania refers to a low-level and less dramatic mania. The hypomania of bipolar II disorder tends to be euphoric and often increases functioning. Like mania, hypomania is accompanied by excessive activity and energy for at least 4 days and involves at least three of the behaviors listed under Criterion B in the DSM-5. Unlike mania, psychosis is never present with hypomania. Psychotic symptoms may, however, accompany the depressive side of the disorder. -bipolar II disorder is believed to be underdiagnosed and is often mistaken for major depressive disorder or personality disorders when it actually may be the most common form of bipolar disorder.

What are the Bipolar disorder symptoms?

Anorexia Nervosa: Intense fear of weight gain -Distorted body image -Restricted calories with significantly low BMI -Subtypes: Restricting (no consistent bulimic features) -Binge/eating/purging type (primarily restriction, some bulimic behaviors) Bulimia Nervosa: Recurrent episodes of uncontrollable binging -Inappropriate compensatory behaviors: vomiting, laxatives, diuretics, or exercise -Self-image largely influenced by body image Binge Eating: Recurrent episodes of uncontrollable binging without compensatory behaviors -Binging episodes induce guilt, depression, embarrassment, or disgust

What are the Characteristics of Eating Problems?

Communication: -Use firm and calm approach: "John, come with me. Eat this sandwich." -Use short and concise explanations or statements. -Be consistent in approach and expectations. -Identify expectations in simple, concrete terms with consequences. Example: "John, do not yell at or hit Peter. If you cannot control yourself, we will help you." Or "The seclusion room will help you feel less out of control and prevent harm to yourself and others." -Hear and act on legitimate complaints. -Firmly redirect energy into more appropriate and constructive channels.

What are the Interventions for Mania: COMMUNICATION?

Structure in a Safe Milieu: -Maintain low level of stimuli in patient's environment (e.g., away from bright lights, loud noises, and people). -Provide structured solitary activities with nurse or aide. -Provide frequent high-calorie fluids. -Encourage frequent rest periods. -Redirect aggressive behavior. -In acute mania, use as needed medication, seclusion, and/or restraint to minimize physical harm. -Observe for signs of lithium toxicity. -Store valuables in hospital safe until rational judgment returns.

What are the Interventions for Mania: STRUCTURE IN A SAFE MILIEU?

-Respiratory: Chronic obstructive pulmonary disease; Pulmonary embolism; Asthma; Hypoxia; Pulmonary edema -Cardiovascular: Angina pectoris; Arrhythmias; Congestive heart failure; Hypertension; Hypotension; Mitral valve prolapse -Endocrine: Hyperthyroidism; Hypoglycemia; Pheochromocytoma; Carcinoid syndrome; Hypercortisolism -Neurological: Delirium; Essential tremor; Complex partial seizures; Parkinson's disease; Akathisia; Otoneurological disorders; Post Concussion syndrome -Metabolic: Hypercalcemia; Hyperkalemia; Hyponatremia; Porphyria

What are the Medical Cause of Anxiety?

Effects of stress on the body

What is this picture depicting?

The Outcomes for mania

What is this picture depicting?

-Children who have a genetic and biological risk of developing bipolar disorder are most vulnerable in bad environments. -Stressful family life and adverse life events may result in a more severe course of illness in these individuals. -Childhood adversity in the form of physical, sexual, and emotional abuse and emotional neglect are significantly associated with bipolar disorder. -Some evidence suggests that bipolar disorders are more prevalent in adults who had high intelligence quotients (IQs), particularly verbally, as children. -With bipolar disorder, functional imaging techniques reveal dysfunction in the prefrontal cortical region, the region associated with executive decision making, personality expression, and social behavior. wass -Dysfunction is also evident in the hippocampus, which is primarily associated with memory, and the amygdala, which is associated with memory, decision making, and emotion.

What are the Risk factors for Bipolar- Biological/Environmental?

Individuals with anorexia nervosa have an intense fear of gaining weight. -Whereas healthy controls experience great satisfaction or comfort following the consumption of foods and in the presence of fullness, an individual coping with anorexia may experience fear, anxiety, panic, or depression. -Purging is a type of compensatory behavior. -Although most of us think of self-induced vomiting when we hear the word purging, it also refers to excessive exercise, the use of laxatives or stimulants, or of thyroid medications aimed at decreasing weight. -Anorexia nervosa is difficult to treat. Even when remission is achieved, the 1-year relapse rate is approximately 50%. Even after 4 years, up to 40% of patients continue to meet some criteria for anorexia.

What are the findings of Anorexia?

Mild, Moderate, Severe, and Panic

What are the four levels of anxiety?

Elimination: -Offer fluids and foods that are high in fiber. Evaluate need for laxative. Encourage patient to go to the bathroom.

What are the interventions for Mania: ELIMINATION?

Hygiene: -Encourage appropriate clothing choices. -Give step-by-step reminders for hygiene and dress. "Here is your razor. Shave the left side ... now the right side. Here is your toothbrush. Put the toothpaste on the brush."...

What are the interventions for Mania: HYGIENE?

Nutrition: -Monitor intake, output, and vital signs. -Offer frequent, high-calorie protein drinks and finger foods (e.g., sandwiches, fruit, milkshakes). -Frequently remind patient to eat. "Tom, finish your milkshake." "Taylor, eat this banana."

What are the interventions for Mania: NUTRITION?

Sleep: -Encourage frequent rest periods during the day. -Keep patient in areas of low stimulation. -At night, provide warm baths, soothing music, and medication when indicated. Avoid caffeine.

What are the interventions for Mania: SLEEP?

Teamwork: • Collaborate with other members of the healthcare team to develop treatment plan. • Involve patients and/or significant others in the treatment plan. • Work with a team to set a target weight. • Consult with a dietitian to determine caloric intake necessary to attain and/or maintain target weight. • Encourage patients to discuss food preferences with dietitians. • Meet with the healthcare team on a regular basis to evaluate the patient's progress. Monitoring: • Monitor objective measures such as vital signs and electrolyte levels as needed. • Weigh on a routine basis at the same time of day and after urinating. • Monitor daily caloric intake and intake and output of fluids. • Encourage self-monitoring of daily caloric intake. • Observe patients during and after meals and snacks. • Accompany the patient to the bathroom during designated observation times following meals and snacks. • Limit time spent in the bathroom. • Monitor physical activity to reduce excessive exercise. Support: • Use motivational interviewing and contracting with the patient to increase ownership of healthcare goals. • Provide reinforcement for weight gain and behaviors that promote weight gain. • Provide education regarding relaxation techniques. • Use counseling to discuss feelings as the patient integrates new eating behaviors, changing body image, and lifestyle changes. • Encourage patient use of daily logs to record feelings and circumstances surrounding eating disordered behavior. • Assist the patient and significant others, as appropriate, to examine and resolve personal issues that may contribute to the eating disorder. • Assist patients to develop a self-esteem that is compatible with a healthy body weight. Promote Increasing Independence: • Allow opportunity to make limited choices about meal planning and movement as weight gain progresses in a desirable manner. • Initiate maintenance phase of treatment when patient has achieved target weight and has consistently shown desired eating behaviors for designated period of time. • Place responsibility for choices about eating and physical activity with patients, as appropriate. • Institute a treatment program and follow-up care (medical, counseling) for home management.

What are the interventions for eating disorders?

-Headache -Anxiety -Depression -Increased BP -Increased HR -Increased risk for an MI -Decreased immune response -Decreased libido -Erectile dysfunction -Irregular menstrual cycle -Infertility -Fight or flight -Risk for CVA -Insomnia -Increased or decreased appetite -Rapid breathing -Increased blood glucose -Digestive problems -Back aches

What are the physical effects of stress?

-Usually begins in adolescence or early adulthood. -There is a 15% to 50% risk that an individual with this disorder will subsequently develop bipolar I or bipolar II disorder. -A major risk factor for developing cyclothymic disorder is having a first-degree relative—parent, sibling, or child—with bipolar I.

What are the risk factors for Cyclothymic disorder?

-Normal to slightly low weight: Excessive caloric intake with purging, excessive exercising -Dental caries, tooth erosion: Vomiting (HCl reflux over enamel) -Parotid swelling: Increased serum amylase levels -Gastric dilation, rupture: Binge eating -Calluses, scars on hand (Russell sign): Self-induced vomiting -Peripheral edema: Rebound fluid, especially if diuretic used -Muscle weakening: Electrolyte imbalance -Abnormal laboratory values (electrolyte imbalance, hypokalemia, hyponatremia): Purging: vomiting, laxative and/or diuretic use -Cardiovascular abnormalities (cardiomyopathy, electrocardiographic changes): Electrolyte imbalance—can lead to death -Cardiac failure (cardiomyopathy): Ipecac intoxication -Seizure: Purging via self-induced vomiting: lowers seizure threshold

What are the signs and symptoms of Bulimia Nervosa?

-Is a noninvasive treatment modality. -rTMS uses MRI-strength magnetic pulses to stimulate focal areas of the cerebral cortex. -In 2008, the FDA approved the use of rTMS to alleviate symptoms of mildly treatment-resistant depression. Treatment-resistant depression refers to people who have been unresponsive to at least one medication trial.

What is the Brain Stimulation Therapy: Repetitive transcranial magnetic stimulation (rTMS)?

-Originated as a treatment for epilepsy. Clinicians noted that in addition to decreasing seizures, VNS also seemed to improve mood in a population that normally experiences higher rates of depression. -Electrical stimulation of the vagus nerve results in boosting the level of neurotransmitters, thereby improving mood and also enhancing the action of antidepressants. -The efficacy of VNS in treating depression is still being established. -Other potential applications of VNS include anxiety, obesity, and pain.

What is the Brain Stimulation Therapy: Vagus Nerve Stimulation (VNS)?

Binge-eating Disorder: -Use of SSRIs at or near the high end of the dosage range to treat binge-eating disorder. -Bariatric surgery is a controversial option for the treatment of obesity due to binge-eating disorder. -CBT, dialectical behavior therapy, and IPT have all been associated with reductions in binge frequency Bulimia Nervosa: -Fluoxetine (Prozac), an SSRI antidepressant, is the only FDA-approved medication for the treatment of bulimia nervosa in adult patients. -Psychiatric-mental health advanced practice registered nurses are qualified to use the evidence-based CBT, which is considered a first-line treatment for bulimia. Anorexia Nervosa: -There are no drugs approved by the US Food and Drug Administration (FDA) for the treatment of anorexia nervosa. -Patients may benefit from integrative approaches that can be used in conjunction with traditional eating disorder treatment. These approaches include yoga, massage, acupuncture, or bright light therapy. -Insight-oriented individual therapy, where patients are encouraged to learn more about themselves, has been demonstrated to be effective. Family approaches, especially family-based treatment (F-BT), have been demonstrated to be more effective than individual therapy. F-BT is an outpatient 6- to 12-week treatment that helps parents disrupt their child's starvation and excessive exercise and encourage the child to develop a more constructive approach to weight. -Advanced practice nurses may provide adolescents with anorexia nervosa with adolescent-focused therapy (AFT). This model focuses on self-monitoring of eating and weight gain that is supported by the therapeutic relationship with the nurse or other advanced practice therapist. -Cognitive behavioral therapy (CBT), which helps to identify automatic negative thoughts and to challenge them, has also been used with success in this population.

What are the treatments for eating disorders?

Appearance: -Grooming, dressing, and personal hygiene may be markedly neglected. -The patient may make intermittent or even no eye contact. -Posture tends to be slumped or hunched with head low and shoulders forward. Behavior: -Anergia- an abnormal lack of energy, may result in psychomotor retardation, in which movements are extremely slow, facial expressions are decreased, and gaze is fixed. -Vegetative signs of depression refer to alterations in those activities necessary to support physical life and growth (e.g., eating, elimination, sleeping, and sex). -Appetite loss is common, and sometimes patients can lose up to 5% of their body weight in less than a month. Other patients find they eat more often and complain of weight gain. -Changes in bowel habits are common. Constipation is seen most frequently in patients with psychomotor retardation. -Sleep pattern disturbance is a hallmark sign of depression. Often, people experience insomnia, wake frequently, and have a total reduction in sleep, especially deep-stage sleep. For some, sleep is increased (hypersomnia) and provides an escape from painful feelings. In any event, sleep is rarely restful or refreshing. -Sexual interest declines (loss of libido) during depression. Some men experience impotence. Mood: -Is a term that describes a general emotional condition or state that can last an extended amount of time. -Asking such questions as "How do you feel?" along with observing facial cues, voice tone, and posture can help you determine this general emotional condition in your patient. Feelings and Emotions: -In contrast to mood, feelings and emotions are more specific and can come and go quickly. They tend to be related to, and flow from, the mood. -Feelings include worthlessness, guilt, helplessness, hopelessness, and anger. Affect: -Is the outward representation of a person's internal state and is an objective finding based on the nurse's assessment. -Feelings of hopelessness and despair are reflected in the person's affect. Affect can be described as congruent with mood, that is, sad face and depressed mood. Patients with major depressive disorder commonly exhibit the following types of affect: • Constricted affect refers to a reduction in the range and intensity of normal of expression. • Blunted (or shallow) affect is more severe than constricted and represents a significant decrease in emotional reactivity. • Flat affect is no or nearly no emotional expression or reactivity. Speech: -When patients are experiencing an episode of major depressive disorder, they tend to speak slowly and softly. -Other characteristics of speech include monotone and lack of spontaneity. Thought Processes: -The patient may describe their thinking as slow. Responses may be slow or absent. -During a conversation, you may have to repeat questions or comments in order to prompt the patient for a response. In severe depression, a person may become mute. Thought Content and Perceptions: -In profound depression, psychotic features—delusions and/or hallucinations—may be present. They may be mood-congruent and focus on depressive themes, mood-incongruent without depressive themes, or a combination of both. -An example of a depressive delusional thought is, "I am responsible for Elvis Presley's death. I worked in a factory that made pill molds. Elvis died from an overdose. I deserve to die." -Hallucinations, usually auditory, might be something like hearing critical voices, "You're not good enough" or "Your family deserves better." -Psychosis increases the risk for suicide, self-harm, and other-directed violence. Insight and Judgment: -During a depressive episode, a person's ability to solve problems and think clearly is negatively affected. -Judgment, or the ability to make reasonable decisions, is poor. Cognitive Changes: -Major depressive disorder usually results in a decreased ability to think or concentrate and indecisiveness. -This set of symptoms may be the primary mediator of functional impairment. -These changes include deficits in attention, short-term and working memory, verbal and nonverbal learning, problem solving, processing speed, and auditory and visual processing. Cognitive deficits may linger even after successful treatment for the disorder and result in continued functional impairment.

What areas should be assessed for a depressed patient?

c.) Depression may occur prior to onset of anxiety In many instances, major depression may occur prior to the onset of panic disorder or may occur at the same time. Clinicians and researchers have clearly shown that anxiety disorders frequently co-occur with other psychiatric problems. Major depression often co-occurs and produces a greater impairment with poorer response to treatment.

What can be said about the comorbidity of anxiety disorders? a.) Substance abuse disorders rarely coexist with anxiety disorders b.) Anxiety disorders virtually never coexist with mood disorder c.) Depression may occur prior to onset of anxiety d.) Anxiety disorders generally exist alone

c.) Altruism and sublimation Altruism and sublimation are known as mature defenses. They cannot be used in unhealthy ways. Altruism results in resolving emotional conflicts by meeting the needs of others, and sublimation substitutes socially acceptable activity for unacceptable impulses. This statement is not true of the other options.

What defense mechanisms can only be used in healthy ways? a.) Idealization and splitting b.) Suppression and humor c.) Altruism and sublimation d.) Reaction formation and denial

-False assumptions about the importance of appearance, fear of rejection by others, perfectionism, and the conviction of being disfigured lead to overwhelming emotions of disgust, shame, and depression. -Patients are frequently concerned with their skin, hair, nose, stomach, teeth, weight, and breasts/chest. -Men tend to be concerned with body build and the appearance of their genitals. -Women focus on the appearance of their skin, stomach, weight, breasts, buttocks, thighs, legs, hips, and toes. -Often, the patient keeps the disorder secret for many years. The disorder is chronic and response to treatment is limited. Suicide risk is high in this population. -Individuals with this disorder often come from homes where they were subjected to abuse and neglect. -Body dysmorphic disorder seems to be related to OCD, because first-degree relatives often share those conditions. The most common comorbid disorder is major depressive disorder, which usually comes on after body dysmorphic disorder. Social anxiety disorder, OCD, and substance use disorders are also seen with this disorder.

What is Body dysmorphic disorder?

is adding unnecessary details when communicating with others. Unlike some of the other verbal derailments, the person eventually gets to the point

What is Circumstantial speech?

Major depressive disorder, or major depression, is characterized by a persistently depressed mood lasting for a minimum of 2 weeks. -The length of a depressive episode may be 5 to 6 months -People experience a recurrence within the first year about 50% of the time and within a lifetime up to 85% of the time.

What is Major Depressive Disorder?

-Mild anxiety occurs in the normal experience of everyday living and allows an individual to perceive reality in sharp focus. -A person experiencing a mild level of anxiety sees, hears, and grasps more information, and problem solving becomes more effective. -Physical symptoms may include slight discomfort, restlessness, irritability, or mild tension-relieving behaviors (e.g., nail biting, foot or finger tapping, fidgeting).

What is Mild Anxiety?

-Moderate Anxiety As anxiety increases, the perceptual field narrows, and some details are excluded from observation. -The person experiencing moderate anxiety sees, hears, and grasps less information and may demonstrate selective inattention, where only certain things in the environment are seen or heard unless they are pointed out. -The ability to think clearly is hampered, but learning and problem solving can still take place, though not at an optimal level. -Sympathetic nervous system symptoms begin to kick in at this level. -The individual may experience tension, a pounding heart, increased pulse and respiratory rates, perspiration, and mild somatic symptoms (e.g., gastric discomfort, headache, urinary urgency). Voice tremors and shaking may be noticed. Mild or moderate anxiety levels can be constructive because anxiety may be a signal that something in the person's life needs attention or is dangerous.

What is Moderate Anxiety?

c.) Fear is a response to a specific danger; anxiety is a response to an unknown danger Fear is a response to an objective danger; anxiety is a response to a subjective danger. This information helps identify the correct option.

What is the major distinction between fear and anxiety? a.) Fear enables constructive action; anxiety is dysfunctional b.) Fear is a universal experience; anxiety is neurotic c.) Fear is a response to a specific danger; anxiety is a response to an unknown danger d.) Fear is a psychological experience; anxiety is a physiological experience

-Are a group of related disorders that all have obsessive-compulsive characteristics. -Obsessions are thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind even though the individual attempts to do so. Obsessions often seem senseless to the individual who experiences them (they are said to be ego dystonic), and their presence causes severe anxiety. -Compulsions are ritualistic behaviors individuals feel driven to perform in an attempt to reduce anxiety or prevent an imagined calamity. Performing the compulsive act temporarily reduces anxiety, but because the relief is only temporary, the compulsive act must be repeated again and again. -At the pathological end of the continuum is obsessive-compulsive disorder (OCD), with symptoms that occur on a daily basis and may involve issues of sexuality, violence, contamination, illness, or death. -Pathological obsessions or compulsions cause marked distress to individuals who often feel humiliation and shame regarding these behaviors. The rituals are time-consuming and interfere with normal routines, social activities, and relationships with others. -Severe OCD occupies so much of the individual's mental process that the performance of cognitive tasks is impaired. -Sexual and physical abuse or trauma in childhood increase the risk of this disorder. Some children develop OCD along with a postinfectious autoimmune syndrome. Genetics are strongly associated with this disorder. First-degree relatives have twice the risk. Early-onset OCD results in a 10 times greater risk of the disorder appearing in first-degree relatives.

What is Obsessive-compulsive disorder?

-Worst level of anxiety -Panic: is the most extreme level of anxiety and results in markedly dysregulated behavior. -Someone in a state of panic is unable to process what is going on in the environment and may lose touch with reality. -The behavior that results may be manifested as pacing, running, shouting, screaming, or withdrawal. -Hallucinations, which are false sensory perceptions, such as seeing something that is not really there or hearing voices, may be experienced. -Physical behavior may become erratic, uncoordinated, and impulsive. -Automatic behaviors are used to reduce and relieve anxiety, although such efforts may be ineffective. Acute panic may lead to exhaustion.

What is Panic?

-Are also disturbingly common. For example, people may think that God is punishing them, that the FBI is spying on them, or that the mayor is harassing them. -Sensory perceptions may become altered as the mania escalates, and hallucinations may occur. Rarely, patients may resort to violence in retaliation for this imagined persecution.

What is Persecutory delusions?

is fast, ranging from rapid to frenetic, conveying an inappropriate sense of urgency. As the name implies, the speech is pressured—if normal speech is analogous to the flow of a garden hose, then pressured speech is like the stream from a fire hose. -This type of speech tends to be loud, rapid, and incoherent. Individuals may talk nonstop and usually have no interest in feedback or conversation.

What is Pressured Speech?

This syndrome is thought to be related to overactivation of the central serotonin receptors caused by either too high a dose or interaction with other drugs. -The symptoms are many: abdominal pain, diarrhea, sweating, fever, tachycardia, elevated blood pressure, altered mental state (delirium), myoclonus (muscle spasms), increased motor activity, irritability, hostility, and mood change. -Severe manifestations can induce hyperpyrexia (excessively high fever), cardiovascular shock, or death. -The risk of this syndrome seems to be greatest when an SSRI is administered in combination with a second serotonin-enhancing agent, such as a monoamine oxidase inhibitor (MAOI). A patient should discontinue all SSRIs for 2 to 5 weeks before starting an MAOI. Interventions: • Remove offending agent(s) • Initiate symptomatic treatment • Serotonin-receptor blockade with cyproheptadine, methysergide, propranolol • Cooling blankets, chlorpromazine for hyperthermia • Dantrolene, diazepam for muscle rigidity or rigors • Anticonvulsants • Artificial ventilation • Induction of paralysis

What is Serotonin Syndrome?

-Severe Anxiety: The perceptual field of a person experiencing severe anxiety is greatly reduced. -A person with severe anxiety may focus on one particular detail or on many scattered details and have difficulty noticing what is going on in the environment, even when another person points it out. -Learning and problem solving are not possible at this level, and the person may be dazed and confused. -Behavior is automatic and aimed at reducing or relieving anxiety. -Somatic symptoms (e.g., headache, nausea, dizziness, insomnia) often increase. Trembling and a pounding heart are common, and the person may experience hyperventilation and a sense of impending doom or dread.

What is Severe Anxiety?

is similar to circumstantial speech with one key difference. When people think tangentially, they lose the point that they were trying to make and never find it again. -Awareness of losing the point indicates less thought disturbance: "Sorry I'm so scattered; I've got a lot on my mind" indicates insight. The degree of tangentiality also helps identify how serious the thought disturbance is. Often, a common word connects sentences

What is Tangential speech?

d.) Client demonstrates effective coping strategies Option A is the only desirable outcome listed for this diagnosis.

What is a possible outcome criterion for a client diagnosed with anxiety disorder? a.) Client reports reduced hallucinations b.) Client demonstrates persistent avoidance behaviors c.) Client reports feelings of tension and fatigue d.) Client demonstrates effective coping strategies

-Is a treatment whereby electrodes are surgically implanted into specific areas of the brain to stimulate those regions identified to be underactive in depression. This treatment is considered to be invasive, but reversible. -DBS has FDA approval for Parkinson disease, and it has been approved for humanitarian use in treatment-resistant obsessive-compulsive disorder. It is used off-label in major depressive disorder.

What is the Brain Stimulation Therapy: Deep brain stimulation (DBS)?

-Despite being a highly effective somatic (physical) treatment for psychiatric disorders, ECT has a bad reputation. -This may be due, in part, to past practices of restraining a conscious individual while having a full-blown seizure induced. -In fact, before paralytic drugs, more than 30% of ECT patients experienced compression fractures of the spine. -Given the current sophistication of anesthetic and paralytic agents, ECT is actually not dramatic at all. -ECT has FDA approval for depressive symptoms associated with major depressive disorder or bipolar disorder in patients aged 13 years and older.

What is the Brain Stimulation Therapy: Electroconvulsive therapy?

• Tell the patient and family to avoid certain foods (especially those that are aged, cured, or ripened) and all medications (especially cold remedies) unless prescribed by and discussed with the patient's primary care provider. • Give the patient a wallet card describing the monoamine oxidase inhibitor (MAOI) regimen. • Instruct the patient to avoid Asian restaurants (sherry, brewer's yeast, and other contraindicated products may be used). • Tell the patient to go to the emergency department immediately if he or she has a severe headache. • Ideally, blood pressure should be monitored during the first 6 weeks of treatment (for both hypotensive and hypertensive effects). • After the MAOI is stopped, instruct the patient that dietary and drug restrictions should be maintained for 14 days.

What patient teaching should be done for MAOIs?

• May cause sexual dysfunction or lack of sex drive. Inform nurse or primary care provider if this occurs. • May cause insomnia, anxiety, and nervousness. Inform nurse or primary care provider if this occurs. • May interact with other medications. Tell the primary care provider about other medications the patient is taking (e.g., digoxin, warfarin). Selective serotonin reuptake inhibitors (SSRIs) should not be taken within 14 days of the last dose of a monoamine oxidase inhibitor. • No over-the-counter drug should be taken without first notifying the primary care provider. • Common side effects include fatigue, nausea, diarrhea, dry mouth, dizziness, tremor, and sexual dysfunction or lack of sex drive. • Because of the potential for drowsiness and dizziness, patients should not drive or operate machinery until these side effects are ruled out. • Alcohol should be avoided. • Liver and renal function tests should be performed and blood counts checked periodically. • Medication should not be discontinued abruptly. If side effects become bothersome, the patient should ask the primary care provider about changing to a different drug. Abrupt cessation can lead to serotonin withdrawal.

What patient teaching should be done for SSRI's?

c.) Depression is commonly seen in individuals with medical disorders Depression commonly accompanies medical disorders especially those that result in chronic pain. The other options are false statements.

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

c.) No pleasure from previously enjoyed activities Anhedonia is the term used to suggest the lack of the ability to experience pleasure. The remaining options are not reflective of the term.

When the clinician mentions that a client has anhedonia, the nurse can expect that the client will demonstrate what behavior? a.) Difficulty with tasks requiring fine motor skills b.) A weight loss from anorexia c.) No pleasure from previously enjoyed activities d.) Poor retention of recent events

d.) The client may be at high risk for self-harm Overt hostility is highly correlated with suicide; therefore the client may be considered high risk, and appropriate precautions should be taken. The other responses are incorrect with no evidence to support them.

When the nurse asks whether a client is having any thoughts of suicide, the client becomes angry and defensive, shouting, "I'm sick of you people! All you ever do is ask me the same question over and over. Get out of here!" What fact concerning hostility should the nurse's response be based upon? a.) The client is probably experiencing transference. b.) The client may be angry at someone else and projecting that anger to staff. c.) The client is getting better and is able to be assertive d.) The client may be at high risk for self-harm

d.) Waiting quietly for the client to reply Depressed clients think slowly and take long periods to formulate answers and respond. The nurse must be prepared to wait for a reply.

When the nurse remarks to a depressed client, "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to implement which intervention? a.) Prompting the client if the reply is slow b.) Reviewing the client's medical record to support the client's response c.) Repeating the question if the client does not answer promptly d.) Waiting quietly for the client to reply

d.) Onset of action is from 1 to 3 weeks or longer A drawback of antidepressant drugs is that improvement in mood may take 1 to 3 weeks or longer. None of the other options provide correct information regarding antidepressant medications.

Which statement about antidepressant medications, in general, can serve as a basis for client and family teaching? a.) They tend to be more effective for men b.) They often cause the client to have diurnal variation. c.) Recent memory impairment is commonly observed d.) Onset of action is from 1 to 3 weeks or longer

b.) "I would like to sit with you for 15 minutes now and again this afternoon." Spending time with the client without making demands is a good way to show acceptance. While not inappropriate, the other options are less accepting.

Which statement would best show acceptance of a depressed, mute client? a.) "It is important for you to share your thoughts with someone who can help you evaluate your thinking." b.) "I would like to sit with you for 15 minutes now and again this afternoon." c.) "Each day we will spend time together to talk about things that are bothering you." d.) "I will be spending time with you each day to try to improve your mood."

b.) Cognitive restructuring The purpose of cognitive restructuring is to change the individual's negative view of an event or a situation to a view that remains consistent with the facts but that is more positive. This is not necessarily true of any of the other options.

Working to help the client view an occurrence in a more positive light is referred to by which term? a.) Flooding b.) Cognitive restructuring c.) Desensitization d.) Response prevention