Mental Health Unit 3 Exam: Eating Disorders & Schizophrenia

A client prescribed clozapine (Clozaril) 12.5 mg qam and 50 mg qhs. Clozapine (Clozaril) is available in 25-mg tablets. How many tablets would be administered daily? ___tablets.

2.5 tablets

catatonic schizophrenia

A type of schizophrenia marked by striking motor disturbances, ranging from muscular rigidity to random motor activity.

Dystonia treatment

Benadryl (Diphenhydramine) 25-50 mg IM/IV/PO Cogentin

Akathisia treatment

Propranolol (Inderal)-sedating effect Lorazepam (Ativan) Diazepam (Valium)

Concrete thinking

Thinking grounded in immediate experience rather than abstraction. There is an overemphasis on specific detail as opposed to general and abstract concepts.

Which individual would be at highest risk for obesity? a. a poor black woman b. a rich white woman c. a rich white man d. a well-educated black man

a. a poor black woman

Purging

engaging in behaviors such as vomiting or misusing laxatives to rid the body of food

(Positive Symptoms) Alterations in perception Hallucinations (false/distorted sensory experience)

-May occur in any of the 5 senses -Signs of hallucinations -Most common: Auditory -Command hallucinations (Safety is priority) Other alterations in perception: -Boundary difficulties (dissociative sx) -Depersonalization (disconnected from themselves, physically) -De-realization (distortion from external environment)

Schizophrenia Assessment Guidelines

-Physical needs -Safety -Negative Sx: SANS (Scale for assessment) -Positive Sx: SAPS -Co-occuring disorders/substance abuse -Medications & Compliance -Family response & dynamics/Support system -Global Assessment of Functioning (psycho, social, occupation levels of functioning)

When one fraternal twin has been diagnosed with schizophrenia, the other twin has approximately a ____% chance of developing the disease.

15%

A client is prescribed risperidone (Risperdal) 4 mg bid. After the client is caught cheeking medications, liquid medication is prescribed. The label reads 0.5 mg/ml. How many milliliters would be administered daily? ____mL.

16 ml

For the past year, a client has received haloperidol (Haldol). The nurse administering the client's next dose notes a twitch on the right side of the client's face and tongue movements. Which nursing intervention takes priority? 1. Administer haloperidol (Haldol) along with benztropine (Cogentin) 1 mg IM PRN per order. 2. Assess for other signs of hyperglycemia resulting from the use of the haloperidol (Haldol). 3. Check the client's temperature, and assess mental status. 4. Hold the haloperidol (Haldol), and call the physician.

4. Hold the haloperidol (Haldol), and call the physician

When one identical twin has been diagnosed with schizophrenia, the other twin has approximately a ____% chance of developing the disease

50%

Extrapyramidal symptoms (Antipsychotics) more common with Typical

Acute dystonic reaction (within 1 hour) -head, neck or eyes contracture -Opisthotonus -Oculogyric crisis Pseudo Parkinsonism (can take months) -shuffle gait, tremor, pin rolling Tardive dyskinesia (can take years) -inability to sit still -permenant -ingrezza (valbenazine) -face/limbs/trunk -AIMS (abnormal involuntary movement scale)

Parkinsonism treatment

Artane (Trihexyphenidyl) Cogentin (Benztropine) 1-2 mg IM/IV/PO Symmetrel (Amantadine Hydro)

What should the nurse's reaction be to the patient who begins looking at the ceiling and talking to himself?

Ask about hallucinations Command hallucinations-SAFETY concerns

ideas of reference delusion

Belief that cues in external are uniquely related to them (Jesus talks to me through TV characters)

Schizophrenia Cognitive Symptoms

Disorganized thinking -distractibility -memory deficits -learning deficits -abstract thinking

Side effects of antipsychotics (Typical & Atypical)

Dystonia Akathisia or Tardive dyskinesia Neuroleptic malignant syndrome Hyperprolactinemia Autonomic nervous system-related effects (anticholinergic)

Conventional Antipsychotic Drugs (Typical)

Impacts the amount of dopamine Tx: positive symptoms Chlorpromazine (Thorazin) Fluphenazine (Prolixin) Haloperidol (Haldol) - photosensativity Loxapine Molindone Perphenazine Pimozide Prochlorperazine Thiothixene (Novane) Thioridazine (Mellaril Trifluoperazine (Stelazine)

Anorexia nervosa

Intense irrational beliefs about their shape and weight, and they engage in self-starvation, express intense fear of gaining weight, and have a disturbance in self-evaluation of weight and its importance; females with anorexia often experience amenorrhea, although this is no longer a criterion for diagnosis.

Neologisms

Made-up words that typically have only meaning to the individual who uses them. "gloatation" scrumtrulescent" "malamante"

Schizophrenia Intervention: Psychotherapy

PACT -Team approach, they go to the patient vs patient going to them Family Therapy Cognitive Behavioral Therapy -Change thinking Social Skills Training -ex: how to use cell phone, shopping etc.

Symptoms of Schizophrenia

Positive Sx: -Hallucinations -Delusions -Disorganized speech -Bizarre behavior Cognitive Sx: -Inattention -Easily distracted -Impaired memory -Poor problem solving skills -Poor decisions -Ilogical thinking -Impaired judgement Negative Sx: -Blunted affect -Poverty of thought (alogia) -Loss of motivation (avolition) -Inability to experience pleasure or joy (ahnedonia) Depressed and other Mood Sx: -Dysphoria -Suicidality -Hopelessness All dimensions alter the individuals: -Ability to work -Interpersonal relationships -self-care abilities -social functioning -Quality of life

All-or-nothing thinking

Reasoning is absolute and extreme, in mutually exclusive terms of black or white, good or bad. "If I have one Popsicle, I must eat five." "If I allow myself to gain weight, I'll blow up like a balloon."

What is meant by secondary gain?

Secondary gain can be a component of any disease. If a patient's disease allows him/her to miss work, gains him/her sympathy, or avoids a jail sentence, these would be examples of secondary gain. These may, but need not be, recognized by the patient. Secondary gains assist in drawing attention to the patient.

Catastrophizing

The consequences of an event are magnified. "If I gain weight, my weekend will be ruined." "When people say I look better, I know they think I'm fat."

Neuroleptic Malignant Syndrome

a potentially fatal hyperpyrexia with temp of over 104, looks like EPS except for temp, Severe stiffness, HTN, Tachycardia, Diaphoresis

Psychosis

a psychological disorder in which a person loses contact with reality, experiencing irrational ideas and distorted perceptions

A patient tells the RN that people from MARS are going to invade the earth. Which response by the RN is most therapeutic? a. "There are no people living on MARS." b. "What do you mean when you say they are going to invade the earth?" c. "I know you believe the earth will be invaded but there's no way I believe that." d. "That must be frightening to you. Tell me about how you feel about that."

a. "There are no people living on MARS."

A client diagnosed with a thought disorder is experiencing clang associations. Which nursing diagnosis reflects this client's problem? a. Impaired verbal communication b. Risk for violence c. Ineffective health maintenance d. Disturbed sensory perception

a. Impaired verbal communication

Which outcome should the nurse expect from a client diagnosed with schizophrenia who is hearing and seeing things others do not hear and see? a. The client will recognize distortions of reality by discharge b. The client will demonstrate the ability to trust by day 2 c. The client will recognize delusional thinking by day 3 d. The client will experience no auditory hallucinations by discharge

a. The client will recognize distortions of reality by discharge

Which client is most likely to benefit from group therapy? a. a client diagnosed with schizophrenia being followed up in an out-patient clinic b. a client diagnosed with schizophrenia newly admitted to an in-patient unit for stabilization c. a client experiencing an exacerbation of the signs and symptoms of schizophrenia d. a client diagnosed with schizophrenia who is not compliant with antipsychotic medications

a. a client diagnosed with schizophrenia being followed up in an out-patient clinic

A homeless client, diagnosed with schizophrenia, is seen in the mental health clinic complaining of insects infesting arms and legs. Which intervention should the nurse implement first? a. check the client for body lice b. present reality regarding somatic delusions c. explain the origin of persecutory delusions d. Refer in-patient hospitalizations because of substance-induced psychosis

a. check the client for body lice

A client has been prescribed ziprasidone (Geodon) 40 mg bid. Which of the following interventions are important related to this medication? Select all that apply. a. obtain a baseline EKG initially and periodically throughout treatment b. teach the client to take the medication with meals c. monitor the client's pulse because of the possibility of palpitations d. institute seizure precautions, and monitor closely e. watch for s/s of a manic episode

a. obtain a baseline EKG initially and periodically throughout treatment b. teach the client to take the medication with meals c. monitor the client's pulse because of the possibility of palpitations

Bulimia nervosa

an eating disorder characterized by episodes of overeating, usually of high-calorie foods, followed by vomiting, laxative use, fasting, or excessive exercise

A client admitted to an in-patient setting has not been adherent with antipsychotic medications prescribed for schizophrenia. Which outcome related to this problem should the nurse expect the client to achieve? a. The client will maintain anxiety at a reasonable level by day 2 b. The client will take antipsychotic medications by discharge c. The client will communicate to staff any paranoid thoughts by day 3 d. The client will take responsibility for self-care by day 4

b. The client will take antipsychotic medications by discharge

From a biochemical influence perspective, which accurately describes the etiology of schizophrenia? a. adopted children with nonschizophrenic parents, raised by parents diagnosed with schizophrenia have a higher incidence of this disease b. an excess of dopamine-dependent neuronal activity in the brain c. a higher incidence of schizophrenia occurs after there is prenatal exposure of the mother to influenza d. poor parent-child interaction and dysfunctional family systems

b. an excess of dopamine-dependent neuronal activity in the brain

When using a behavioral modification approach for the treatment of eating disorders, which nursing intervention would be most likely to produce positive results? a. take a matter-of-fact, directive approach with the input of the entire treatment team b. clients should perceive that they are in control of clearly communicated treatment choices c. appropriate treatment choices are presented to the client's family for consideration d. the treatment team develops a system of rewards and privileges that can be earned by the client

b. clients should perceive that they are in control of clearly communicated treatment choices

A client recently prescribed fluphenazine (Prolixin) complains to the nurse of severe muscle spasms. On examination, heart rate is 110, blood pressure is 160/92 mm Hg, and temperature is 101.5 F. Which nursing intervention takes priority? a. check the chart for a prn order of benztropine mesylate (Cogentin) because of increased extrapyramidal symptoms b. hold the next dose of Prolixin and call the physician immediately to report the findings c. schedule an examination with the client's physician to evaluate cardiovascular function d. ask the client about any recreational drug use, and ask the physician to order a drug scren

b. hold the next dose of Prolixin and call the physician immediately to report the findings

Which nursing intervention would directly assist a hospitalized client diagnosed with bulimia nervosa in avoiding the urge to purge after discharge? a. locking the door to the client's bathroom b. holding a mandatory group after mealtime to assist in exploration of feelings c. discussing preplanned meals to decrease anxiety around eating d. educating the family to recognize purging side effects

b. holding a mandatory group after mealtime to assist in exploration of feelings

A client with cachexia states, "I don't care what you say, I am horribly fat and will continue to diet." The client is experiencing arrhythmias and bradycardia. Based on this client's symptoms, which nursing diagnosis takes priority? a. ineffective denial b. imbalanced nutrition: less than body requirements c. disturbed body image d. ineffective coping

b. imbalanced nutrition: less than body requirements

A client's family is having a difficult time accepting the client's diagnosis of schizophrenia, and this has led to family conflict. Which nursing diagnosis reflects this problem? a. impaired home maintenance b. interrupted family processes c. social isolation d. disturbed thought processes

b. interrupted family processes

A client was admitted recently with a diagnosis of schizophrenia. Since admission the client has had several verbal outbursts of anger but has not been violent. A staff member tells the nurse the client is pacing up and down the hallway very rapidly and muttering in an angry manner. What would the nurse do first? a. prepare a PRN intramuscular injection of haloperidol (Haldol) to give the client b. observe the client's behavior and approach the client in a nonthreatening manner c. contact the client's psychiatrist and request an order to place the client in seclusion d. gather several staff members to approach the client together

b. observe the client's behavior and approach the client in a nonthreatening manner

A client prescribed quetiapine (Seroquel) 50 mg bid has a nursing diagnosis of risk for injury R/T sedation. Which nursing intervention appropriately addresses this client's problem? a. assess for homicidal and suicidal ideation b. remove clutter from the environment to prevent injury c. monitor orthostatic changes in pulse or blood pressure d. evaluate for auditory and visual hallucinations

b. remove clutter from the environment to prevent injury

A client is newly prescribed hydroxyzine (Atarax) 50 mg qhs and clozapine (Clozaril) 25 mg bid. Which is an appropriate nursing diagnosis for this client? a. risk for injury R/T serotonin syndrome b. risk for injury R/T possible seizure c. risk for injury R/T clozapine toxicity d. risk for injury R/T depressed mood

b. risk for injury R/T possible seizure

A client diagnosed with paranoid schizophrenia tells the nurse about the three previous suicide attempts. Which nursing diagnosis would take priority and reflect this client's problem? a. disturbed thought processes b. risk for suicide c. violence: directed toward others d. risk for altered sensory perception

b. risk for suicide

delusion of being controlled

belief that one's thoughts, feelings, or behaviors are being imposed or controlled by an external force

persecution delusion

belief that others are out to get them

grandeur delusion

belief that they have great power, knowledge, or talent

somatic delusions

believes that his body is changing in an unusual way, such as growing a third arm

Anorexia Nervosa Medical Complications

bradycardia, orthostatic hypothension, arrhythmias, QTc prolongation, ST-T wave changes, anemia, leukopenia, enlarged brain ventricles, dec. brain white/gray matter, peripheral neuropathy, lanugo, muscle wasting, amenorrhea parotid enlargement inc. amylase leveles, hypokalemia

A woman is prescribed risperidone (Risperidal) 1 mg bid. At her 3-month follow-up, the client states, "I knew it was a possible side effect, but I can't believe I am not getting my period anymore." Which is a priority teaching need? a. "Sometimes amenorrhea is a temporary side effect of medications and should resolve itself." b. "I am sure this was very scary for you. How long has it been since your last menstrual cycle?" c. "Although your menstrual cycles have stopped, there is still a potential for you to become pregnant." d. "Maybe the amenorrhea is not due to your medication. Have your menstrual cycles been regular in the past?"

c. "Although your menstrual cycles have stopped, there is still a potential for you to become pregnant."

A client diagnosed with schizophrenia takes clozapine (Clozaril) 25 mg qd. Lab results reveal: RBC 4.7 million/mcL, WBC 2000/mcL, and TSH 1.3 mc-IU. Which would the nurse expect the physician to order? a. "Levothyroxine sodium (Synthroid) 150 mcg qd." b. "Ferrous sulfate (Feosol) 100 mg tid. c. "Discontinue clozapine." d. "Discontinue clozapine and start levothyroxine sodium (Synthroid) 150 mcg qd."

c. "Discontinue clozapine."

A nurse sitting with a client diagnosed with anorexia nervosa notices that the client has eaten 80% of lunch. The client asks the nurse, "What do you like better, hamburgers or spaghetti?" Which is the best response by the nurse? a. "I'm Italian, so I really enjoy a large plate of spaghetti." b. "I'll weigh you after your meal." c. "Let's focus on your continued improvement. You ate 80% of your lunch." d. "Why do you always talk about food? Let's talk about swimming."

c. "Let's focus on your continued improvement. You ate 80% of your lunch."

Shortly after hospitalization, an adolescent diagnosed with anorexia nervosa says to the nurse, "Being fat is the worst thing in the world. I hope it never happens to me." Which response by the nurse is appropriate? a. "You need to gain weight to become healthier." b. "Your world would not change if you gained a few pounds." c. "Tell me how your world would be different if you were fat." d. "Your attractiveness is not defined by a number on the scales."

c. "Tell me how your world would be different if you were fat."

A client is being admitted to the in-patient psychiatric unit with a diagnosis of bulimia nervosa. The nurse would expect this client to fall within which age group? a. 5 to 10 years old b. 10 to 14 years old c. 18 to 22 years old d. 40 to 45 years old

c. 18 to 22 years old

A client on an in-patient psychiatric unit refuses to take medications because "The pill has a special code written on it that will make it poisonous." What kind of delusion is this client experiencing? a. An erotomanic delusion b. A grandiose delusion c. A persecutory delusion d. A somatic delusion

c. A persecutory delusion

The children's saying "Step on a crack and you break your mothers back" is an example of which type of thinking? a. Concrete thinking b. Thinking using neologisms c. Magical thinking d. Thinking using clang associations

c. Magical thinking

A client diagnosed with schizophrenia is experiencing anhedonia. Which nursing diagnosis addresses the client's problem that this symptom may generate? a. Disturbed thought processes b. Disturbed sensory perception c. Risk for suicide d. Impaired verbal communication

c. Risk for suicide

A client has the nursing diagnosis of impaired home maintenance R/T regression. Which behavior confirms this diagnosis? a. The client fails to take antipsychotic medications b. The client states, "I haven't bathed in a week." c. The client lives in an unsafe and unclean environment d. The client states, "You cant draw my blood without crayons."

c. The client lives in an unsafe and unclean environment

Which outcome should the nurse expect from a client with a nursing diagnosis of social isolation? a. The client will recognize distortions of reality by day 4 b. The client will use appropriate verbal communication when interacting by day 3 c. The client will actively participate in unit activities by discharge d. The client will rate anxiety as 5/10 by discharge

c. The client will actively participate in unit activities by discharge

A client taking olanzapine (Zyprexa) has a nursing diagnosis of altered sensory perception R/T command hallucinations. Which outcome would be appropriate for this client's problem? a. The client will verbalize feelings related to depression and suicidal ideations b. The client will limit caloric intake because of the side effect of weight gain c. The client will notify staff members of bothersome hallucinations d. The client will tell staff members if experiencing thoughts of self-harm

c. The client will notify staff members of bothersome hallucinations

As a result of neuroleptic malignant syndrome your patient has hyperthermia. Which of the following nursing interventions would be most appropriate? a. bromocriptine (Parlodel) b. dantroline (Dantrium) c. acetaminophen (Tylenol) d. clozapine (Clozaril)

c. acetaminophen (Tylenol)

The nurse is assessing a client with a body mass index of 35. The nurse would suspect this client to be at risk for which of the following conditions? Select all that apply. a. hypoglycemia b. rheumatoid arthritis c. angina d. respiratory insufficiency e. hyperlipidemia

c. angina d. respiratory insufficiency e. hyperlipidemia

The nurse is discussing the side effects experienced by a female client taking antipsychotic medications. The client states, "I haven't had a period in 4 months." Which client teaching should the nurse include in the plan of care? a. antipsychotic medications can cause a decreased libido b. antipsychotic medications can interfere with the effectiveness of birth control c. antipsychotic medications can cause amenorrhea, but ovulation still occurs. d. antipsychotic medications can decrease RBC, leading to amenorrhea

c. antipsychotic medications can cause amenorrhea, but ovulation still occurs.

A client is leaving the inpatient psychiatric facility after 1 month of treatment for anorexia nervosa. Which outcome is appropriate during discharge planning for this client? a. client will accept refeeding as part of a daily routine b. client will perform nasogastric tube feeding independently c. client will verbalize recognition of "fat" body misperception d. client will discuss importance of monitoring weight daily

c. client will verbalize recognition of "fat" body misperception

After a routine dental examination on an adolescent, the dentist reports to the parents that bulimia nervosa is suspected. On which of the following assessment data would the dentist base this determination? Select all that apply. a. extreme weight loss b. amenorrhea c. discoloration of dental enamel d. bruises of the palate and posterior pharynx e. dental enamel dysplasia

c. discoloration of dental enamel d. bruises of the palate and posterior pharynx e. dental enamel dysplasia

Which medication is used most often in the treatment of clients diagnosed with anorexia nervosa? a. fluphenazine (Prolixin) b. clozapine (Clozaril) c. fluoxetine (Prozac) d. methylphenidate (Ritalin)

c. fluoxetine (Prozac)

A client exhibiting sedation, auditory hallucinations, dystonia, and grandiosity. The client is prescribed haloperidol (Haldol) 5 mg tid and trihexyphenidyl (Artane) 4 mg bid. Which statement about these medications is accurate? a. artane would assist the client with sedation b. artane would assist the client with auditory hallucinations c. haldol would assist the client in decreasing grandiosity d. haldol would assist the client with dystonia

c. haldol would assist the client in decreasing grandiosity

Which structure in the brain contains the appetite regulation center? a. thalamus b. amygdala c. hypothalamus d. medulla

c. hypothalamus

Lithium carbonate (lithium) is to mania as clozapine (Clozaril) is to: a. anxiety b. depression c. psychosis d. akathisia

c. psychosis

A client is prescribed aripiprazole (Abilify) 10 mg qam. The client complains of sedation and dizziness. Vital signs reveal B/P 100/60 mm Hg, pulse 80, respiration rate 20, and temperature 97.4 F. Which nursing diagnosis takes priority? a. risk for noncompliance R/T irritating side effects b. knowledge deficit R/T new medication prescribed c. risk for injury R/T orthostatic hypotension d. activity intolerance R/T dizziness and drowsiness

c. risk for injury R/T orthostatic hypotension

The nurse documents that a client diagnosed with schizophrenia is expressing a flat affect. What is an example of this symptom? a. the client laughs when told of the death of his or her mother. b. The client sits alone and does not interact with others c. the client exhibits no emotional expression d. the client experiences no emotional feelings

c. the client exhibits no emotional expression

Refeeding syndrome

catastrophic treatment complication in which the demands of a replenished circulatory system overwhelm the capacity of a nutritionally depleted cardiac muscle which results in cardiovascular collapse

Metabolic syndrome

caused by meds prescribed; Typical associated; such as insulin resistance, increased LDL, HTN, etc.

psychogenic polydipsia

compulsive water drinking

A client who is hearing and seeing things others do not is brought to the emergency department. Lab values indicate a sodium level of 160 mEq/L. Which nursing diagnosis would take priority? a. Altered thought processes R/T low blood sodium levels b. Altered communication processes R/T altered thought processes c. Risk for impaired tissue integrity R/T dry oral mucous membranes d Imbalanced fluid volume R/T increased serum sodium levels

d Imbalanced fluid volume R/T increased serum sodium levels

A client has an order for "ziprasidone (Geodon) 20 mg IM q4H for agitation with a maximum daily dose of 40 mg/d." Administration times are documented in the medication record. Which times indicate safe medication administration? a. "0800 and 1100" b. "1200, 1700 and 2100" c. "0900, 1200 and 2100" d. "1300 and 1700"

d. "1300 and 1700"

A client taking fluphenazine (Prolixin) complains of dry mouth and blurred vision. What would the nurse assess as the specific cause of these symptoms? a. Increased dopamine at receptor sites b. Blockade of beta receptors c. Dopamine agonist symptom d. Anticholinergic effect

d. Anticholinergic effect

A client has a history of schizophrenia, controlled by haloperidol (Haldol). During an assessment, the nurse notes continuous restlessness. Which medication would the nurse expect the physician to prescribe for this client? a. Haloperidol (Haldol) b. Fluphenazine decanoate (Prolixin Decanoate) c. Clozapine (Clozaril) d. Benztropin mesylate (Cogentin)

d. Benztropin mesylate (Cogentin)

Which atypical antipsychotic medication has the highest potential for a client experience serious side effects? a. Haloperidol (Haldol) b. Chlorpromazine (Thorazine) c. Risperidone (Risperadol) d. Clozapine (Clozaril)

d. Clozapine (Clozaril)

The nurse documents that a client diagnosed with a thought disorder is experiencing anticholinergic side effects from long-term use of thioridazine (Mellaril). Which symptoms has the nurse noted? a. Akinesia, dystonia, and pseudoparkinsonism b. Muscle rigidity, hyperpyrexia, and tachycardia c. Hyperglycemia and diabetes d. Dry mouth, constipation, and urinary retention

d. Dry mouth, constipation, and urinary retention

Using the DSM-IV-TR, which statement is true as it relates to the diagnosis of obesity? a. Obesity is a diagnosis classified on Axis I and is similar to other eating disorders b. Obesity is not classified as an eating disorder because medical diagnoses are not classified under DSM-IV-TR c. Obesity is currently evaluated for all clients as a "psychological factor affecting medical conditions" d. Obesity is not classified as an eating disorder but can be placed on Axis III as a medical condition

d. Obesity is not classified as an eating disorder but can be placed on Axis III as a medical condition

Clients diagnosed with schizophrenia may have difficulty knowing where their ego boundaries end and others begin. Which client behavior reflects this deficit? a. The client eats only prepackaged food. b. The client believes that family members are adding poison to food. c. The client looks for actual animals when others state, "It's raining cats and dogs." d. The client imitates other people's physical movements.

d. The client imitates other people's physical movements. When clients imitate other people's physical movements, they are experiencing echopraxia. The behavior of echopraxia is an indication of alterations in the clients sense of self. These clients have difficulty knowing where their ego boundaries end and others begin. Weak ego boundaries cause these clients to lack feelings of uniqueness. Echopraxia is an attempt to identify with others.

A client diagnosed with anorexia nervosa is newly admitted to an in-patient psychiatric unit. Which intervention takes priority? a. assessment of family issues and health concerns b. assessment of early disturbances in mother-infant interactions c. assessment of the client's knowledge of selective serotonin reuptake inhibitors used in treatment d. assessment and monitoring of vital signs and lab values to recognize and anticipate medical problems

d. assessment and monitoring of vital signs and lab values to recognize and anticipate medical problems

In the United States, which diagnosis has the lowest percentage of occurrence? a. major depressive disorder b. generalized anxiety disorder c. obsessive-compulsive disorder d. schizophrenia

d. schizophrenia

A disheveled client diagnosed with a thought has body odor and halitosis. Which nursing diagnosis reflects this client's current problem? a. social isolation b. impaired home maintenance c. interrupted family processes d. self-care deficit

d. self-care deficit

Atypical Antipsychotic Drugs

drugs that target both dopamine and serotonin Tx: Positive and Negative symptoms May cause metabolic syndrome Aripirprazole (Abilify)-no significant risk of metabolic syndrome Clozapine (clozaril)-agranulocytosis Olanzapine (Zyprexa) Paliperidone (Invega) Quetiapine (Seroquel) Risperidone (Risperidal) Ziprasidone (Geodon)-seizures

Lanugo

growth of fine, downy hair on the face and back

Neuroleptic Malignant Syndrome Treatment

immediate withdrawal of antipsychotics, hydration, hypothermic blankets, antipyretics, benzodiazepines, and muscle relaxants

Orthorexia

obsession with healthy eating

Rumination Disorder

repeated regurgitation of food

Bulimia Nervosa S/S

-binge eating behaviors -often self-induced vomiting (or laxative or diuretic use) after bingeing -history of anorexia nervosa in one fourth to one third of individuals -depressive signs and symptoms -Problems with: interpersonal relationships, self-concept, impulsive behaviors -increased levels of anxiety and compulsive -possible chemical dependency -possible impulsive stealing -controls/undoes weight after bingeing, which is motivated by feelings of emptiness

A nurse assess four adolescents diagnosed with various eating disorders. Which comment would the nurse expect from the adolescent diagnosed with anorexia nervosa? a. "I look good because whenever I overeat, I purge myself." b. "I love sweets, I make myself throw up so I can eat more." c. "I've lost 60 lbs but I'm still a size 2. I want to be a size 0." d. "I've hidden my eating disorder from everyone, even my parents."

c. "I've lost 60 lbs but I'm still a size 2. I want to be a size 0."

Anorexia Nervosa S/S

-terror of gaining weight -preoccupation with thoughts of food -view of self as fat even when emaciated -peculiar handling of food: cutting food into small bits, pushing pieces of food around on plate -possible development of rigorous exercise regimen -possible self-induced vomiting; use of laxatives and diuretics -cognition is so disturbed that the individual judges self-worth by his or her weight -controls what he or she eats to feel powerful to overcome feelings of helplessness

Although symptoms of schizophrenia occur at various times in the life span, what client would be at higher risk for the diagnosis? a. 10-year old girl b. 20-year old man c. 50-year old woman d. 64 year old man

b. 20-year old man

The school nurse assesses four adolescents, all of whom outwardly appear healthy. Which adolescent meets one criterion for anorexia nervosa with mild severity? a. 5'2" tall; weight 104 lbs b. 5'7" tall; weight 110 lbs c. 5'5" tall; weight 114 lbs d. 5'8" tall; weight 127 lbs

b. 5'7" tall; weight 110 lbs

Phases of Schizophrenia

-Phase I Premorbid Phase- social maladjustment, social withdrawal, irritability, and antagonistic thoughts and behavior -Phase II Prodromal Phase- certain signs and symptoms that precede the characteristic manifestations of the acute, fully developed illness. -Phase III Schizophrenia- active phase of the disorder. Two or more of the following present for a significant amount of time during one month: delusions, hallucinations, social/occupational dysfunction, duration, schizoaffective and mood disorder exclusion, substance/general medical condition exclusion, relationship to a pervasive developmental disorder Phase IV Residual Phase- characterized by periods of remission and exacerbation. A residual phase usually follows an active phase of the illness.

Bulimia Nervosa medical Complications

- Swollen or infected parotid glands, dehydration, electrolyte imbalances - Cardiac arrhythmias and ECG changes - Esophageal tearing and bleeding, dental problem - Reverse peristalsis, muscle fatigue, weakness, numbness, renal problems, hypoglycemia, menstrual irregularities

(Positive Symptoms) Alterations in Speech

-Associative Looseness -Word salad -Neologisms -Echolalia -Clang Associations

Schizophrenia Intervention: Milieu Therapy

-Safety -Solitary (1:1 interaction) -Structure -Same staff -Trust -Distraction

DSM Criteria-Schizophrenia Spectrum

2 or more of the following (At least 1 must be either 1, 2 or 3) 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized behavior 5. Negative symptoms Interferes with work, relationships, self-care Symptoms persist x6 months Schizophreniform: preschizophrenia not meeting time criteria, has s/s for a month but not 6 months

Anosognosia

A condition in which a person with an illness seems unaware of the existence of his or her illness.

thought broadcasting delusion

A delusion that one's thoughts are being broadcast out loud so that they can be perceived by others.

associative looseness

A disturbance of thinking in which ideas shift from one subject to another in an oblique or unrelated manner. "We wanted to take the bus, but the airport has a lot of people at the terminal"

Overgeneralization

A single event affects unrelated situations. "He didn't ask me out. It must be because I'm fat." "I was happy wen I wore a size 6. I must get back to that weight."

Schizophrenia Overview

Brain Disorder -Behavior -Emotion -Reasoning -Though process Prevalence: 1% worldwide Age of onset: mid-late teens Co-morbidity -Schizoaffective -Psychogenic polydipsia -Metabolic syndrome

Pica

Eat, lick or chew nonnutritive substances for a period of at least 1 month

Personalization

Events are overinterpreted as having personal significance. "I know everybody is watching me eat." "People won't like me unless I'm thin."

personalization delusion

Ex: People on tv are talking to them.

Theories of causation schizophrenia

Genetic factors Biological -Neuroanatomical (something wrong with the brain) -Neurotransmitters (Excess dopamine, serotonin and glutamate) Non-genetic Risk Factors -prenatal exposure to influenza -hypoxia at birth -prenatal exposures to toxins -starvation

(Positive Symptoms) Alterations in Thinking Delusions (False fixed belief) Common types:

Ideas of Reference/personalization (paranoid) Persecution Grandeur Somatic Delusions Thought broadcasting/insertion/withdrawal Delusion of being controlled Concrete thinking Erotomanic

(Positive Symptoms) Alterations in Behavior

Motor agitation -Stereotyped behaviors (repetitive meaningless movement) ex: sweeping floors motions but not doing -Automatic obedience (Robotic movements) -Negativism (Opposite) -Agitated Behaviors: Ex: start changing channels on someone. Motor retardation -Waxy flexibility/stupor/bizarre posturing (immobile posture/not moving)

Criteria for Hospital Admission of Individuals with Eating Disorders

Physical Criteria -weight loss more than 30% over 6 months -rapid decline in weight -inability to gain weight with outpatient treatment -severe hypothermia caused by loss of subcutaneous tissue or dehydration (body temp lower than 36 C or 96.8 F) -HR less than 40 beats per minute -Systolic BP less than 70 mm Hg -Hypokalemia (Less than 3 mEq/L) or other electrolyte disturbances not corrected by oral supplementation -ECG changes (esp dysrhythmias) Psychiatric Criteria -suicidal or severely irrepressible, self-mutilating behaviors -uncontrollable use of laxatives, emetics, diuretics, or street drugs -failure to comply with treatment contract -severe depression -psychosis -family crisis or dysfunction

schizoaffective disorder

Psychotic disorder featuring symptoms of both schizophrenia and major mood disorder.

Echolalia

The uncontrollable and immediate repetition of words spoken by another person

The instructor is teaching nursing students about the psychodynamic influences of eating disorders. Which statement indicates that more teaching is necessary? a. "Eating disorders result from very early and profound disturbances in father-infant interactions." b. "Disturbances in mother-infant interactions may result in retarded ego development." c. "When a mother meets the physical and emotional needs of a child by providing food, this behavior contributes to the child's ego development." d. "Poor self-image leads to a perceived lack of control. The client compensates for this perceived lack of control by controlling behaviors related to eating."

a. "Eating disorders result from very early and profound disturbances in father-infant interactions."

A client, diagnosed with schizophrenia, is experiencing social withdrawal, flat affect, and impaired role functioning. To distinguish whether this client is in the prodromal or residual phase of schizophrenia, what question would the nurse ask the family? a. "Have these symptoms followed an active period of schizophrenic behaviors?" b. "How long have these symptoms been occurring?" c. "Has the client had a change in mood?" d. "Has the client been diagnosed with any developmental disorders?"

a. "Have these symptoms followed an active period of schizophrenic behaviors?"

On an in-patient unit, the nurse is caring for a client who is assuming bizarre positions for long periods of time. To which diagnostic category of schizophrenia would this client most likely be assigned? a. Disorganized schizophrenia b. Catatonic schizophrenia c. Paranoid schizophrenia d. Undifferentiated schizophrenia

b. Catatonic schizophrenia

The nurse is assessing a client diagnosed with schizophrenia. The client states, "We wanted to take the bus, but the airport took all the traffic." Which charting entry accurately documents this symptom? a. "The client is experiencing associative looseness." b. The client is attempting to communicate by the use of word salad." c. "The client is experiencing delusional thinking." d. "The client is experiencing an illusion involving planes."

a. "The client is experiencing associative looseness."

The nurse is assessing a client diagnosed with disorganized schizophrenia. Which symptoms should the nurse expect he client to exhibit? a. Markedly regressive, primitive behavior, and extremely poor contact with reality. Affect is flat or grossly inappropriate. Personal appearance is neglected, and social impairment is extreme. b. Marked abnormalities in motor behavior manifested in extreme psychomotor retardation with pronounced decreases in spontaneous movements and activity. Waxy flexibility is exhibited. c. The client is exhibiting delusions of persecution or grandeur. Auditory hallucinations related to a persecutory theme are present. The client is tense, suspicious, and guarded and may be argumentative, hostile, and aggressive. d. The client has a history of active psychotic symptoms, such as delusions or auditory and visual hallucinations, but these prominent psychotic symptoms are not exhibited currently.

a. Markedly regressive, primitive behavior, and extremely poor contact with reality. Affect is flat or grossly inappropriate. Personal appearance is neglected, and social impairment is extreme.

A nurse is assessing a client with a long history of being a loner and having few social relationships. This client's father has been diagnosed with schizophrenia. The nurse would suspect that this client is in what phase of the development of schizophrenia? a. Phase I-schizoid personality b. Phase II-prodromal phase c. Phase III-schizophrenia d. Phase IV-residual phase

a. Phase I-schizoid personality It is important for the nurse to know if this client has recently experienced an active phase of schizophrenia to distinguish the symptoms presented as indications of the prodromal or residual phase of schizophrenia. Schizophrenia is characterized by periods of remission and exacerbation. A residual phase usually follows an active phase of the illness. Symptoms during the residual phase are similar to those of the prodromal phase, with flat affect and impairment in role function being prominent.

Which anorexia nervosa symptom is physical in nature? a. dry, yellow skin b. perfectionism c. frequent weighing d. preoccupation with food

a. dry, yellow skin

A client diagnosed with an eating disorder has a nursing diagnosis of low self-esteem. Which nursing intervention would address this client's problem? a. offer independent decision-making opportunities b. review previously successful coping strategies c. provide a quiet environment with decreased stimulation d. allow the client to remain in a dependent role throughout treatment

a. offer independent decision-making opportunities

Which of the following nursing evaluations of a client diagnosed with anorexia nervosa would lead the treatment team to consider discharge? Select all that apply. a. the client participates in individual therapy b. the client has a body max index of 16 c. the client consumes adequate calories as determined by the dietitian d. the client is dependent on mother for most basic needs e. the client states, "I realize that I can't be perfect."

a. the client participates in individual therapy c. the client consumes adequate calories as determined by the dietitian e. the client states, "I realize that I can't be perfect."

The nurse reports that a client diagnosed with a thought disorder is experiencing religiosity. Which client statement would confirm this finding? a. "I see Jesus in my bathroom." b. "I read the Bible every hour so that I will know what to do next." c. "I have no heart. I'm dead and in heaven today." d. "I cant read my Bible because the CIA has poisoned the pages."

b. "I read the Bible every hour so that I will know what to do next." Religiosity is an excessive demonstration of or obsession with religious ideas and behavior. The client may use religious ideas in an attempt to provide rational meaning and structure to behavior.

A client on an in-patient psychiatric unit has been diagnosed with bulimia nervosa. The client states, "I'm going to the bathroom and will be back in a few minutes." Which nursing response is most appropriate? a. "Thanks for checking in." b. "I will accompany you to the bathroom." c. "Let me know when you get back to the dayroom." d. "I'll stand outside your door to give you privacy."

b. "I will accompany you to the bathroom."

The nurse states, "It's time for lunch." A client diagnosed with schizophrenia responds, "It's time for lunch, lunch, lunch." Which type of communication process is the client using, and what is the underlying reason for its use? a. Echopraxia, which is an attempt to identify with the person speaking. b. Echolalia, which is an attempt to acquire a sense of self and identity. c. Unconscious identification to reinforce weak ego boundaries. d. Depersonalization to stabilize self-identity.

b. Echolalia, which is an attempt to acquire a sense of self and identity. When clients diagnosed with schizophrenia repeat works that they hear, they are exhibiting echolalia. this is an indication of alterations in the client's sense of self. Weak ego boundaries cause these clients to lack feelings of uniqueness. Echolalia is an attempt to identify with the person speaking.

An 18 year-old female client weighs 95 pounds and is 70 inches tall. She has not had a period in 4 months and states, "I am so fat!" Which statement is reflective of this client's symptoms? a. The client meets the cirteria for an Axis I diagnosis of bulimia nervosa b. The client meets the criteria for an Axis I diagnosis of anorexia nervosa c. The client needs further assessment to be diagnosed using the DSM-IV_TR d. The client is exhibiting normal developmental tasks according to Erikson

b. The client meets the criteria for an Axis I diagnosis of anorexia nervosa

A client diagnosed with anorexia nervosa has a short-term outcome that states, "The client will gain 2 pounds in 1 week." Which nursing diagnosis reflects the problem that this outcome addresses? a. ineffective coping r/t lack of control b. altered nutrition: less than body requirements r/t decreased intake c. self-care deficit: feeding r/t fatigue d. anxiety r/t feelings of hopelessness

b. altered nutrition: less than body requirements r/t decreased intake

A nurse is working with a client diagnosed with schizoid personality disorder. What symptom of this diagnosis should the nurse expect to assess, and at what risk is this client for acquiring schizophrenia? a. delusions and hallucinations-high risk b. limited range of emotional experience and expression-high risk c. indifferent to social relationships-low risk d. loner who appears cold and aloof-low risk

b. limited range of emotional experience and expression-high risk

What is required for effective treatment of schizophrenia? a. concentration on pharmacotherapy alone to alter imbalances in affected neurotransmitters b. multidisciplinary, comprehensive efforts, which include pharmacotherapy and psychosocial care c. emphasis on social and living skills training to help the client fit into society d. group and family therapy to increase socialization skills

b. multidisciplinary, comprehensive efforts, which include pharmacotherapy and psychosocial care

Erotomatic Delusions

believing that they have a secret love relationship with someone (movie star, singer, or head cheerleader in high school) IE: I am secretly married to Jennifer Lopez

While weighing patients on an eating disorders unit, the nurse overhears a psychiatric technician say, " I wish i had an eating disorder, maybe i'd lose a little weight." What is the nurse's best action? a. report the clinical observation to the nursing supervisor b. ask the psychiatric technician, "What did you mean by that comment?" c. privately discuss the importance of sensitivity with the psychiatric technician d. immediately interrupt the interaction between the patient and psychiatric technician

c. privately discuss the importance of sensitivity with the psychiatric technician

A client diagnosed with bulimia nervosa has responded well to citalopram (Celexa). Which is the possible cause for this response? a. there is an association between bulimia nervosa and dilated blood vessels and inactive alpha-adrenergic and serotoninergic receptors b. there is an association between bulimia nervosa and the neurotransmitter dopamine c. there is an association between bulimia nervosa and the neurotransmitters serotonin and norepinephrine d. there is an association between bulimia nervosa and a malfunction of the thalamus

c. there is an association between bulimia nervosa and the neurotransmitters serotonin and norepinephrine

A client with a long history of bulimia nervosa is seen in the emergency department. The client is seeing things that others do not, is restless, and has dry mucous membranes. Which is most likely the cause of this client's symptoms? a. mood disorders, which often accompany the diagnosis of bulimia nervosa b. nutritional deficits, which are characteristic of bulimia nervosa c. vomiting, which may lead to dehydration and electrolyte imbalance d. binging, which causes abdominal discomfort

c. vomiting, which may lead to dehydration and electrolyte imbalance

The nurse is interviewing a client who states, "The dentist put a filling in my tooth; I now receive transmissions that control what I think and do." The nurse accurately documents this symptom with which charting entry? a. "Client is experiencing a delusion of persecution." b. "Client is experiencing a delusion of grandeur." c. "Client is experiencing a somatic delusion." d. "Client is experiencing a delusion of influence."

d. "Client is experiencing a delusion of influence."

A nursing instructor is teaching about the etiology of schizophrenia. What statement by the nursing student indicates an understanding of the content presented? a. "Schizophrenia is a disorder of the brain that can be cured with the correct treatment." b. "A person inherits schizophrenia from a parent." c. "Problems in the structure of the brain cause schizophrenia." d. "There are many potential causes for this disease, and it's etiology is controversial."

d. "There are many potential causes for this disease, and it's etiology is controversial."

A patient is hospitalized with a diagnosis of anorexia nervosa. The nurse reviews the patient's laboratory results below. Sodium 143 mEq/L Potassium 3.1 mEq/L Chloride 102 mEq/L Magnesium 2.2 mEq/L Calcium 8.4 mg/dL Phosphate 3.0 mg/dL The nurse should take which action? a. Measure the patient's body temperature. b. Inspect the patient's skin and sclera for jaundice. c. Assess the patient's mucous membranes for erosion. d. Auscultate the patient's heart rate, rhythm, and sounds.

d. Auscultate the patient's heart rate, rhythm, and sounds.

Imbalanced nutrition: less than body requirements r/t altered body perception AEB client's being 5 feet 4 inches tall, weighing 75 pounds, is assigned to a client diagnosed with anorexia nervosa. Which nursing intervention would address this client's problem? a. encourage the client to keep a diary of food intake b. plan exercise tailored to individual choice c. help the client to identify triggers to self-induced purging d. monitor physician-ordered nasogastric tube feedings.

d. monitor physician-ordered nasogastric tube feedings.

Word Salad

flow of unconnected words that convey no meaning to the listener "Hip hooray, the flip is cast and wide sprinting in the forest"

Two subtypes of anorexia nervosa

restricting type and binge-eating/purging type

Clang associations

rhythmic patterns associated with psychotic speech "It's very cold. The gold was sold. I am old."

Cachectic

severely underweight with muscle wasting

Binge eating disorder

significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory purging, fasting, or excessive exercise that marks bulimia nervosa

Emotional reasoning

subjective emotions determine reality. "I know I'm fat because I feel fat." "When I'm thin, I feel powerful."

negative symptoms of schizophrenia

the absence of appropriate behaviors Apathy: no feeling of emotion Affect: flat or blunted, inappropriate, bizarre Anergia: no energy Anhedonia: no pleasure Avolition: no motivation Alogia: (very little speech) poverty of content, poverty of speech, thought blocking