Mental Health Exam 3
A client says to the nurse, "You are the best nurse I've ever met. I want you to remember me." What is an appropriate response by the nurse?
"Are you thinking of suicide?"
A client with bipolar disorder begins taking lithium 300 mg four times a day. After 3 days of therapy, the client says, "My hands are shaking." The best response by the nurse is which of the following?
"Fine motor tremors are an early effect of lithium therapy that usually subsides in a few weeks."
The nurse observes that a client with depression sat at a table with 2 other clients during lunch. The best feedback the nurse could give the client is which of the following?
"I see you were sitting with others at lunch today."
The nurse is teaching a newly diagnosed patient about her diagnosis of schizophrenia with her family in attendance. Which of the following statements would indicate that the education provided to her family has been effective?
"Our only solace is finding that we are not the cause of her disorder."
Side effects of MAOIs
- Common: hypotension, sedation/weakness/fatigue, muscle cramps, changes in cardiac rhythm, urinary hesitancy/constipation, weight gain, sexual dysfunction - Serious: hypertensive crisis (medical emergency, s/sx: severe occipital headache, marked increase in BP, palpitations/chest pain, nuchal rigidity, nausea/vomiting, fever/sweating
When educating a client who is starting a new antipsychotic medication, which educational tool(s) should be incorporated?
-sugar-free beverages can be helpful for dry mouth -to avoid orthostatic hypotension, it is best to rise slowly from a sitting position -It is a good idea to apply sun screen before going outdoors.
What is the safe serum lithium level for maintenance and safety?
0.5 to 1.5
Which of the following would be most appropriate for the treatment of mania associated with bipolar disorder? A. Lithium B. Fluoxetine C. Citalopram D. Venlafaxine
A. Lithium Rationale: Lithium is an antimanic agent, which would be most appropriate for treating a manic patient with bipolar disorder. o Fluoxetine/ Prozac (SSRI), citalopram/Celexa (SSRI), and venlafaxine/Effexor(SNRI) are antidepressants.
Amantadine, Clonidine
Aids in hunger cessation, metabolic management. Antiviral effective for impulse control SE: dizziness, nausea, headache, constipation
Which of the following would indicate an increased suicidal risk?
An abrupt improvement in mood. Calling family members to make amends. Statements such as "Everything will be better soon".
Is the following statement true or false? When discussing personality disorders, the term treatment resistant refers to a lack of response to medications prescribed.
Answer to Question #1 False Rationale: Although a personality disorder is a psychiatric diagnosis, it is important to remember that it is not an illness with treatable symptoms in the way other mental disorders are. The term treatment resistant refers to the fact that it is difficult to change a person's personality. Changes occur slowly and over time. It is true that there is no "magic pill" that will result in a change in someone's personality for the better.
Transient psychotic symptoms that occur with borderline personality disorder are most likely treated with which of the following?
Antipsychotics
A 31-year-old patient newly diagnosed with schizophrenia asks the nurse about the difference between conventional and atypical antipsychotic medications. What is the best response by the nurse:
Atypical antipsychotics are both dopamine and serotonin antagonists, and conventional antipsychotics are only dopamine antagonists.
Which of the following would a nurse expect to assess in a patient with antisocial personality disorder? A. Overwhelming empathy B. High self-esteem C. Manipulative behaviors D. Pervasive suspiciousness
C. Manipulative behaviors Rationale: A patient with antisocial personality disorder typically exhibits manipulative behaviors, lack of empathy, and low self-esteem. o Suspiciousness would be assessed in a patient with paranoid personality disorder.
seasonal affective disorder
Controversial disorder in which a person experiences depression during winter months and improved mood during spring. Can be treated using phototherapy, using bright light and high levels of negative ions.
Which of the following would be considered a neurologic side effect of antipsychotic therapy? A. Blurred vision B. Agranulocytosis C. Sedation D. Tardive dyskinesia
D. Tardive dyskinesia Rationale: Tardive dyskinesia is a neurologic side effect of antipsychotic therapy. o Blurred vision, sedation, and agranulocytosis are nonneurologic side effects.
When interviewing any client with a personality disorder, the nurse would assess for which of the following?
Disruption in some aspects of his or her life.
What are the most common types of side effects from SSRIs?
Dizziness, drowsiness, dry mouth
Which of the following would be appropriate for a client with mania?
Drawing a picture Modeling clay Stretching exercises
Side effects of antipsychotics
Drowsiness, dizziness Dry mouth, constipation Increased appetite, weight gain ECG changes Extrapyramidal symptoms Hyperglycemia and diabetes
Haldol SE
EPS--involuntary muscle spasms usually of neck and shoulders
The nurse would assess for which of the following characteristics in a client with narcissistic personality disorder?
Entitlement
The nurse working with a client with antisocial personality disorder would expect which of the following behaviors?I
Exploitation of other clients Seeking special privileges Superficial friendliness towards others
Is the following statement true or false? A patient with narcissistic personality disorder typically likes to be the center of attention.
False Rationale: Being the center of attention is a finding typically associated with a patient with a histrionic personality disorder.
Is the following statement true or false? Positive symptoms of schizophrenia include a flat affect and social withdrawal.
False Rationale: Flat affect and social withdrawal are negative symptoms of schizophrenia.
Is the following statement true or false? The nurse should confront a patient's delusions
False Rationale: When a patient is experiencing delusions, the nurse should focus on the reality and not confront or reinforce the patient's delusions
Is the following statement true or false? When dealing with a patient who is suicidal, the nurse needs to assume a dependent role.
False Rationale: When dealing with a patient who is suicidal, the nurse must take an authoritative role.
Which of the following underlying emotions is commonly seen in an avoidant personality disorder?
Fear
Which of the following typifies the speech of a person in the acute phase of mania?
Flight of ideas
SE of Depakote
GI issues--upset, heartburn, indigestion, diarrhea
When working with a client with a personality disorder, the nurse would expect to assess which of the following?
Impaired interpersonal relationships Inability to empathize with others Minimal insight
Clients with a shizotypal personality disorder are most likely to benefit from which of the following nursing interventions?
Improving community functioning
Side effects of SSRIs and SNRIs
Insomnia, agitation, headache, weight loss, sexual dysfunction, serotonin syndrome
Mania
It is a distinct period during which the mood is abnormally and persistently elevated, expansive, or irritable. Typically lasts about 1 week, but may last longer.
What is the rationale for a person taking lithium to have enough water and salt in his/her diet?
Lithium is a salt that has greater affinity for receptor sites than sodium chloride (table salt).
When working with a client with a narcissistic personality disorder, the nurse would use which of the following approaches?
Matter-of-fact
The nurse observes that a client with bipolar disorder is pacing the hall, talking loudly and rapidly, and using elaborate hand gestures. The nurse concludes that the client is demonstrating which of the following?
Psychomotor agitation
restructuring vs. reframing
Reframing is the general change in a person's mindset, whether it be a positive or negative change. ... In this way, cognitive restructuring is a particular instance of cognitive reframing. Distortions are exaggerated and typically negative thoughts not supported by a rational thought process.
The nurse is planning to discharge a client taking clozapine (Clozaril). Which of the following is most important to include in discharge teaching?
Remind the client that they will need to go to the lab to have blood drawn for a WBC count.
Nursing Diagnoses Related to Schizophrenia
Risk for other-directed violence Risk for suicide Disturbed thought processes Disturned sensory perception Disturbed personal Identity Impaired Verbal Communication
latency of response
Seen when clients take up to 30 seconds to respond to a question.
substance-induced depressive or bipolar disorder
Significant disturbance in mood that is a direct physiologic consequence of ingested substances such as alcohol, other drugs, or toxins
side effects of lithium
Tremor, hypothyroidism, nephrogenic diabetes insipidus, fetal cardiac defects
Is the following statement true or false? Patients with depression often exhibit anhedonia
True Rationale: Anhedonia refers to the loss of any sense of pleasure from activities that a person formerly enjoyed. This is a manifestation of depression.
Is the following statement true or false? Depression is most commonly associated with suicide.
True Rationale: Depression is considered the most common diagnosis that results in suicide
electroconvulsive therapy (ECT)
a biomedical treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions. Used to treat severe depression in those who do not respond to antidepressants or who experience intolerable side effects.
cyclothymic disorder
a disorder marked by numerous periods of hypomanic symptoms and mild depressive symptoms without loss of social or occupational functioning
obsessive-compulsive disorder (OCD)
a pattern of preoccupation with perfectionism, mental and interpersonal control, orderliness at the expense of flexibility, openness, and efficiency.
borderline personality disorder
a personality disorder characterized by lack of stability in interpersonal relationships, self-image, and emotion; impulsivity; angry outbursts; intense fear of abandonment; recurring suicidal gestures
hypomania
abnormally and persistently elevated, expansive, or irritable mood and some other milder symptoms of mania
The most important short-term goal for the client who tries to manipulate others would be to...
acknowledge own behavior
This emotion may occur in patients diagnosed with bipolar disorder and/or schizophrenia, and can commonly be described as feeling both the desire to live and die, or may be expressed as passive-aggressive behaviors. What is this commonly referred to as:
ambivalence
positive symptoms of schizophrenia
ambivalence associative looseness delusions echopraxia flight of ideas hallucinations ideas of reference perseveration bizarre behavior
SE of Ambien, Lunesta
amnesia poor motor coordination slurred speech increased impulsivity
Which of the following are considered to be negative symptoms of schizophrenia?
anhedonia social withdrawal also: alogia apathy blunted affected asociality catatonia flat affect avolition or lack of volition inattention
Trileptal SE
blurry or doubled vision, sleepiness, poor muscle coordination, tremor
Passive-Aggressive behavior
characterized by a negative attitude and a pervasive pattern of passive resistance to demands for adequate social and occupational performance.
narcissistic personality disorder
characterized by a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy
Dependent personality disorder
characterized by an excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation. Persons with this disorder often seek treatment for anxious, depressed, or somatic symptoms.
schizoid personality disorder
characterized by detachment from social relationships and a restricted range of emotional expression in interpersonal settings.
Histrionic personality disorder
characterized by excessive emotionality and attention seeking. Clients usually seek treatment for depression, unexplained physical problems, and difficulties in relationships.
Paranoid Personality Disorder
characterized by pervasive mistrust and suspiciousness of others
dysthymic disorder
chronic, persistent mood disturbance characterized by symptoms such as insomnia, loss of appetite, decreased energy, low self-esteem, difficulty concentration, and feelings of sadness and hopelessness that are milder than those of depression
SE of Ativan, Klonopin, Valium, Xanax
confusion blurred vision muscle weakness headache sedation slurred speech tremor muscle spasms
SE of Clonidine/Tenex/Amantadine
constipation fatigue dry mouth diarrhea blood pressure changes
Seroquel SE
constipation, dizziness, sedation, upset stomach
Cogentin
controls EPS caused by antipsychotics SE: weakness, low blood pressure, constipation, decreased sweating
Propranolol
controls tremors caused by anticonvulsants SE: dizziness, fatigue, nervousness, cold extremities, low BP
Cognitive restructuring techniques include all the following
decatastrophizing positive self-talk reframing
personality
defined as an ingrained enduring pattern of behaving and relating to self, others, and the environment
Non-suicidal self-injury involves:
deliberate, intentional cutting, burning, scraping, hitting, or interference with wound healing. Persons who engage in self-mutilation often report reasons of alleviation of negative emotions, self-punishment, seeking attention, or escaping a situation or responsibility
A patient in a mental health facility claims that his neck is stuck to one side, and his eyes present to be exhibiting an oculogyric crisis. The nurse checks his chart and notes that he has been taking chlorpromazine (Thorazine) for 2 weeks. After alerting the doctor, the following PRN medication has been ordered for the client. Which one should the nurse administer?
diphenhydramine (Benadryl) 25 mg IM, PRN
mania
distinct period during which mood is abnormally and persistently elevated, expansive, or irritable
SE of Ritalin/Adderall/Concerta
dizziness insomnia weight loss palpitations nervousness
Interventions the nurse can take when dealing with a patient having delusions
do not openly confront the delusion or argue with the client establish and maintain reality for client use distracting techniques teach the client positive self-talk, positive thinking, and to ignore delusional beliefs
Tegretol SE
drowsiness, blurred vision, fatigue, nausea, dizziness
SE of Wellbutrin
dry mouth headache increased sweating N/V, constipation anxiety fatigue blurred vision
SE of Trazodone, Benadryl, Melatonin
dry mouth nervousness nausea photosensitivity priapism (prolonged erection)
SE of thorazine
dry mouth, dizziness, nasal congestion
Common Side effects of antidepressants
dry mouth, nausea, wt. loss or gain, nervousness, dizziness, headache, weakness, fatigue, diarrhea, blurred vision, rash, sweating, insomnia, cold hands and feet
emotional lability
emotions are unstable and can fluctuate
Abilify SE
headache, dizziness, blurred vision, weakness
Interventions for clients experiencing hallucinations
help present and maintain reality by frequent contact and communication with client elicit description of hallucination to protect the client and others. the nurse's understanding of the hallucination helps him or her know how to calm or reassure the client. engage client in reality based activities such as card playing, occupational therapy, or listening to music
Prazosin
helps with flashbacks, nightmares, etc. associated w/PTSD SE: blurred vision, upset stomach, tinnitus, headache, loss of appetite
Difference b/w mania and hypomania
hypomanic episodes do not impair the person's ability to function (they might even be quite productive) and there are no psychotic features (delusions, hallucinations)
difference b/w mania and hypomania
hypomanic epsidoes do not impair the person's ability to function, and can in fact make the person quite productive, and there are no psychotic features (delusions and hallucinations)
psychomotor agitation
increased body movements and thoughts (pacing, accelerated thinking, argumentativeness.
extrapyramidal symptoms
involuntary fine motor tremors, rigidity, uncontrollable restlessness, acute dystonia.
Major Depressive Disorder (MDD)
involves 2 or more weeks of a sad mood or lack of interest in life activities with at least four other symptoms of depression such as anhedonia, changes in wt., sleep, energy, concentration, decision making, self-esteem, goals.
Bipolar disorder
involves extreme mood swings from episodes of mania to episodes of depression
anergia
lack of energy
When assessing a new patient, the nurse notes that the patient hesitates approx. 20-25 seconds before responding to any of the questions being asked. This can be referred to as having:
latency of response.
SE of Straterra
lightheadedness heartburn fatigue vomiting decreased appetite
anhedonia
losing any sense of pleasure from activities formerly enjoyed
Lamictal SE
muscle aches, weight loss, insomnia, Stevens-Johnson's syndrome
euthymic mood
normal range of mood, implying absence of depressed or elevated mood
Bipolar II
one or more major depressive episodes accompanied by at least one hypomanic episodes
Bipolar II disorder
one or more major depressive episodes accompanied by at least one hypomanic episodes
Bipolar I
one or more manic or mixed episodes usually accompanied by major depressive episodes
Bipolar I disorder
one or more manic or mixed episodes usually accompanied by major depressive episodes
Hypomania
period of abnormally and persistently elevated, expansive, or irritable mood and some other milder symptom of mania.
mood disorders (affective disorders)
pervasive alterations in emotions that are manifested by depression, mania, or both.
Depressive Behavior
pervasive pattern of depressive cognitions and behaviors in various contexts. It occurs more often in people with relatives who have MDD
DDAVP
prevents and controls bed wetting SE: upset stomach, headache, nasal congestion, stomach pains
Flight of Ideas
racing, often unconnected thoughts
flight of ideas
racing, often unconnected thoughts
The overall goal of psychotic rehabilitation is for the client to gain...
recovery from the illness
seasonal affective disorder (SAD)
recurrent depressive episodes in a seasonal pattern
Pre-Menstrual Dysphoric Disorder (PMDD)
recurrent, moderate psychological and physical symptoms that occur during the week before menses and resolve with menstruation. labile mood, irritability, increased interpersonal conflict, difficulty concentrating, feeling overwhelmed or unable to cope, feelings of anxiety, tension, hopelessness
ruminate
repeatedly going over the same thoughts
post-partum psychosis
severe and debilitating psychiatric illness with acute onset in the days following childbirth. s/s begin with fatigue, sadness, emotional lability, poor memory, and confusion and progress to delusions, hallucinations, poor insight and judgement, loss of contact with reality.
Prodromal symptoms
sleep difficulties change in appetite loss of energy and interest odd speech hearing voices peculiar behavior Inappropriate expression of feelings paucity of speech ideas of reference feelings of unreality
psychomotor retardation
slow body movements, slow cognitive processing, and slow verbal interaction
avoidant personality disoder
social discomfort and reticence, low self-esteem, hypersensitivity to negative evaluation
post partum depression
symptoms are consistent with those of depression with onset within 4 weeks of delivery
kindling
the snowball-like effect seen when minor seizure activity seems to build up into more frequent and severe seizures
Synthroid
treatment for hypothyroidism caused by lithium SE: heart palpitations, nervousness, weight loss, increased appetite
Psychotherapy
treatment involving psychological techniques; consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth
SE of lithium
tremor fatigue increased thirst weight gain hypothyroidism
Risperdal SE
tremors, lactation in females and enlarged breasts in males
Pressured speech
unrelenting, rapid, often loud talking without pauses
pressured speech
unrelenting, rapid, often loud talking without pauses
Lithium
used to treat bipolar depression. lithium can stabilize bipolar disorder by reducing the degree and frequency of cycling or eliminating manic episodes
Zyprexa SE
weight gain, increased feelings of hunger
seasonal affective disorder (SAD)
winter depression or fall onset. people experience increased sleep, appetite, and carbohydrate cravings, weight gain, interpersonal conflict, irritability, and heaviness in the extremities beginning in late autumn and abating in spring and summer.