NR 326 Exam #2
Contraindications and precautions of MAOIs
-MAOIs are contraindicated in clients taking SSRIs. -MAOIs are contraindicated in clients who have pheochromocytoma, heart failure, cardiovascular and cerebral vascular disease, or severe renal insufficiency. -Use cautiously in clients who have diabetes or seizure disorders, or those taking TCAs.
The nurse is preparing to implement close observation suicide precautions for an acutely suicidal client. Nursing interventions include with regard the following for precautions:
-Maintain line of sight distance with the client at all times. -Ensure that meal trays contain no glass or metal silverware. -Carefully watch the client ingest each dose of medication - talk to the client to assess and have them answer questions -Conduct one-on-one nursing observation and interaction 24 hours a day. -Document client's mood, statements, and behavior per protocol. -The majority of all people who ultimately kill themselves have a history of previous attempt. Rationale: Between 50-80 percent of all people who ultimately kill themselves have at least one previous attempt.
Risk factors for somatic symptom disorder
-First-degree relative who has somatic symptom disorder -Decreased levels of neurotransmitters: serotonin and endorphins -Depressive disorder, personality disorder, or anxiety disorder -Childhood trauma, abuse, or neglect -Learned helplessness
Examples of SSRIs used for depressive disorders
-Fluoxetine -Escitalopram -Paroxetine
Therapeutic uses of paroxetine (an SSRI)
-Generalized anxiety disorder (GAD) -Panic disorder: decreases both the frequency and intensity of panic attacks, and also prevents anticipatory anxiety about attacks -Obsessive compulsive disorder (OCD): reduces manifestations by increasing serotonin -Social anxiety disorder -Post traumatic stress disorder (PTSD) -Depressive disorders -Adjustment disorders -Associated manifestations of dissociative disorders
Nursing actions for TCA toxicity
-Give no more than a 1-week supply of medication to clients who are acutely ill due to the high risk of lethality with a toxic dose. -Obtain baseline ECG. -Monitor vital signs frequently. -Monitor for manifestations of toxicity. -Notify the provider if manifestations of toxicity occur.
What are the goals of group therapies?
-Goals vary depending on type of group, but clients generally: -Discover that members share some common feelings, experiences, and thoughts. -Experience positive behavior changes as a result of group interaction and feedback.
What are the responsibilities of the termination phase of group development?
-Group members discuss termination issues. -The leader summarizes work of the group and individual contributions. -Members of a group can take on any of a number of roles. -Feedback regarding the group therapy is elicited.
Examples of relaxation techniques
-Guided imagery -Breathing exercises -Progressive muscle relaxation -Physical exercise -Meditation
Complications of bupropion (atypical antidepressant used for depressive disorders)
-Headache (treat with mild analgesic), dry mouth (sip water), constipation (increase dietary intake) -Suppression of appetite resulting in weight loss (monitor food intake and weight) -Seizures, especially at higher dose range (avoid administering to clients at risk for seizures/with a head injury)
Complications of SNRIs
-Headache, nausea, agitation, anxiety, dry mouth, and sleep disturbances -Hyponatremia, especially in older adult clients taking diuretics -Anorexia resulting in weight loss (monitor client's weight) -Hypertension -Sexual dysfunction
Risk factors for factitious disorder
-History of emotional or physical distress, child abuse, or frequent/chronic childhood illnesses requiring hospitalizations -Impaired neurologic ability for information processing -Dependent personality -Borderline personality disorder
Posttraumatic stress disorder (PTSD) following a sexual assault expected findings
-Increasing anger and irritability -Avoidance of discussing the event -Detachment and avoidance of relationships -Insomnia
Client education for illness anxiety disorder
-Individual and group therapy -Attend support groups -Utilize prescribed meds -Frequent office visits -Alternative coping mechanisms -Stress management techniques
Client education for conversion disorder
-Individual and group therapy -Support groups -Utilize prescribed meds
How does journal writing help relieve stress?
-Journaling has been shown to allow for a therapeutic release of stress. Journaling can ease anxiety, worry, and obsessional thinking. It also can increase confidence and hope. -This activity can help the client identify stressors and make specific plans to decrease stressors.
What are the goals of family group therapies?
-Learn effective ways for dealing with mental illness within the family. -Improve understanding among family members. -Maximize positive interaction among family members.
Therapeutic uses of fluoxetine (an SSRI used for depressive disorders)
-Major depression -Obsessive compulsive disorder -Bulimia nervosa -Premenstrual dysphoric disorders -Panic disorders -Post traumatic stress disorder (PTSD) -Bipolar disorder -Generalized anxiety disorder -Social anxiety disorder
Indications for electroconvulsive therapy
-Major depressive disorder (MDD) -Schizophrenia spectrum disorders -Acute manic episodes
A nurse working in an acute mental health facility is performing an admission assessment for a client who has major depressive disorder (MDD). NURSING CARE: Describe an appropriate communication technique to relate therapeutically with this client.
-Make time to be with the client even if they don't speak. -Communicate with observations rather than asking direct questions. -Give directions in simple, concrete sentences. -Allow the client sufficient time to verbally respond.
A nurse is leading a peer group discussion about teaching stress‐related strategies. Use the ATI Active Learning Template: Basic Concept to complete this item. NURSING INTERVENTIONS: List 3 behavioral and relaxation techniques the nurse should recommend and how to explain their use to the client.
-Meditation includes formal meditation techniques, as well as prayer for those who believe in a higher power. -Guided imagery: The client is guided through a series of images to promote relaxation. Images vary depending on the individual. For example, one client might imagine walking on a beach, while another client might imagine themselves in a position of success. -Breathing exercises: These are used to decrease rapid breathing and promote relaxation. -Progressive muscle relaxation: A person trained in this method can help a client attain complete relaxation within a few minutes. -Physical exercise (yoga, walking, biking): This causes the release of endorphins that lower anxiety, promote relaxation, and have antidepressant effects.
Complications of ECT
-Memory loss and confusion -Reactions to anesthesia -Cardiovascular changes -Relapse of depression
Manifestations of serotonin syndrome
-Mental confusion, difficulty concentrating -Abdominal pain -Diarrhea -Agitation -Fever -Anxiety -Hallucinations -Hyperreflexia, incoordination -Diaphoresis -Tremors
What are the difference types of behavioral therapy?
-Modeling -Operant conditioning Systematic desensitization -Aversion therapy -Meditation, guided imagery, diaphragmatic breathing, muscle relaxation, and biofeedback
Client education for SSRI administration
-SSRIs may be taken with food. Sleep disturbances are minimized by taking the medication in the morning. -Take the medication on a daily basis to establish therapeutic plasma levels. -It can take up to 4 weeks to achieve therapeutic effects.
Complications of fluoxetine (an SSRI used for depressive disorders)
-Sexual dysfunction -Weight changes -Serotonin syndrome -Hyponatremia -GI bleeding -Bruxism
Therapeutic uses of benzodiazepines
-Short-term treatment for generalized anxiety disorder and panic disorder -OTHER USES: Seizure disorders; Insomnia; Muscle spasm; Alcohol withdrawal (for prevention and treatment of acute manifestations); Induction of anesthesia; Amnesic prior to surgery or procedures
What is an effective coping method for a client with acute mania who has difficulty sleeping?
It is recommended that most adults get 7 to 8 hr. of sleep at night, though some adults may need less. Clients who are in acute mania have great difficulty sleeping at all, so getting 7 hours of sleep by skipping naps is an effective coping method. Naps are not recommended for most adults so that the client can avoid insomnia at night.
What should you do for a lorazepam or diazepam overdose?
Monitor vital signs and ensure patent airway, administer Flumazenil as ordered, gastric lavage followed by activated charcoal, if necessary.
What does monitoring thoughts do?
Monitoring thoughts: Helps clients to be aware of negative thinking.
Nursing care for stress management
Most nursing care involves teaching stress-reduction strategies to clients.
How long does it take to experience therapeutic effects of TCAs?
It can take 10to 14 days or longer before TCAs begin to work, and maximum effects might be not seen until 4 to 8 weeks.
How might patients in a manic state act?
Talking in rapid, continuous speech. Clients experiencing a manic state may laugh, joke, and talk in a continuous stream, with uninhibited familiarity. They often demonstrate boundless enthusiasm, interacting with others in a flirtatious way.
A client talks pass the point he started out with, never reaching the goal of answering the question a nurse has asked him during the admission interview. There is clearly a recognized link between associations. The nurse recognizes this type of thought process to be which of the following?
Tangential
Client education for a patient on SSRIs experiencing bruxism
Use a mouth guard during sleep
Precautions of benzodiazepines
Use benzodiazepines cautiously in clients who have liver disease or a history of a substance use disorder.
Precautions of buspirone
Use buspirone cautiously in clients who have liver or kidney dysfunction, as well as clients who have liver renal dysfunction.
Nursing actions for GI bleeding r/t administration of fluoxetine (an SSRI used for depressive disorders)
Use cautiously in clients who have a history of gastrointestinal bleeding and ulcers, and in those taking other medications that affect
Precautions of MAOIs
Use cautiously in clients who have diabetes or seizure disorders, or those taking TCAs.
Precautions for fluoxetine (an SSRI used for depressive disorder)
Use cautiously in clients who have liver and/or renal dysfunction, cardiac disease, seizure disorders, diabetes, ulcers, and a history of gastrointestinal bleeding.
Nursing considerations for nortriptyline, imipramine, and amoxapine
Use cautiously in clients with coronary artery disease; give no more than one week supply to clients with risk of overdose lethality.
Precautions for amitriptyline
Use cautiously in clients with respiratory disorders; can increase suicide risk; use cautiously in clients who have coronary artery disease
What is vagus nerve stimulation?
VNS provides electrical stimulation through the vagus nerve to the brain through a device that is surgically implanted under the skin on the client's chest similar to a pacemaker device.
What is validation therapy?
Validation therapy: Useful for clients with neurocognitive disorders. It is a process of communication with a disoriented older adult client by respecting and validating their feelings in a time or place that is real to them, even though it does not relate to actual reality.
Which will put a client on Lithium in danger of toxicity? a. Eating foods high in tyramine b. Eating 2-3g of sodium containing foods daily c. Running 4 miles outdoors in the hot sun d. Drinking 2 L of fluids daily
c. Running 4 miles outdoors in the hot sun
Gloria, a recent widow, states, "I'm going to have to learn to pay all the bills. Hank always did this. I don't know if I can handle all of that." This is an example of which of the tasks described by Worden? a. Task I: Accepting the reality of the loss b. Task II: Processing the pain of grief c. Task III: Adjusting to a world without the lost entity d. Task IV: Finding an enduring connection with the lost entity in the midst of embarking on a new life
c. Task III: Adjusting to a world without the lost entity
Which of the following nursing interventions are effective for a client admitted for acute mania with a Bipolar Dx? a. Provide flexible client behavior expectations. b. Avoid thinking of the client as manipulative or risk taking c. Use a firm approach with communication. d. Establish consistent limits and boundaries.
c. Use a firm approach with communication. d. Establish consistent limits and boundaries.
The nurse includes which of the following teaching for Olanzapine? a. Delusions of grandeur b. Oral candidiasis c. Weight gain d. Tachycardia
c. Weight gain
A nurse is providing teaching for a client who is scheduled to receive ECT for the treatment of her depressive disorder. Which of the following client statements indicate understanding of the teaching? a. "It is common to treat depression with ECT before trying medications." b. "I can have my depression cured if I receive a series of ECT treatments." c. "I should receive ECT once a week for 6 weeks." d. "I will receive a muscle relaxant to protect me from injury during ECT."
d. "I will receive a muscle relaxant to protect me from injury during ECT."
Which statement indicates understanding by the nurse about Transcranial magnetic stimulation (TMS)? a. "TMS treatments usually last 5-10 min." b. "I will provide post-anesthesia care following TMS." c. "TMS is indicated for clients who have schizophrenia spectrum disorders." d. "I will schedule the client for daily TMS treatments for 4- 6 weeks."
d. "I will schedule the client for daily TMS treatments for 4- 6 weeks."
What is an example of an atypical anxiolytic/nonbarbiturate?
Buspirone
When should TCAs be administered?
Take medication at bedtime to minimize daytime sleepiness and to promote sleep
When should a patient take fluoxetine hydrochloride?
Take the medication in the AM
What is Bruxism? What med does this adverse effect occur with?
Grinding and clenching of teeth, usually during sleep. Occurs with SSRIs
Manifestations of CNS stimulation r/t administration of phenelzine (MAOI used for depressive disorders)
Hypomania, mania
Nursing actions for hyponatremia in patients taking SSRIs
Obtain baseline blood sodium, and monitor level periodically throughout treatment.
Contraindications of Duloxetine (an SNRI)
Duloxetine should not be used in clients who have hepatic disease or in those who consume large amounts of alcohol.
Contraindications of buspirone
Buspirone is contraindicated for concurrent use with MAOI antidepressants, or for 14 days after MAOIs are discontinued. Hypertensive crisis can result.
What is flooding?
Flooding: Exposing a client, while in the company of a therapist, to a great deal of an undesirable stimulus in an attempt to turn off the anxiety response
Generalized nursing actions for fluoxetine (an SSRI used for depressive disorders)
-Advise clients to take these medications in the morning to minimize sleep disturbances. -Advise clients to take these medications with food to minimize gastrointestinal disturbances. -Obtain baseline sodium levels for older adult clients taking diuretics. Monitor these clients periodically.
Examples of TCAs used for depressive disorders
-Amitriptyline -Doxepin -Imioramine
Medications for somatic symptom disorder
-Analgesics -Antidepressants -Anxiolytics
Teaching for a patient with PTSD on fluoxetine
"You may have decreased desire for sexual intimacy while taking this medication"
Major medications to treat trauma-related and stressor-related disorders
-Antidepressants (SSRIs, SNRIs, TCAs, MAOIs, NaSSA) -Beta blockers (propranolol) -Centrally acting alpha-blockers (prazosin) -Centrally acting alpha 2 agonists (clonidine)
What are some other medications used for bipolar disorder?
-Antipsychotics -Anxiolytics -Antidepressants: Medications (bupropion, venlafaxine, and selective serotonin reuptake inhibitors [SSRIs]) are useful during the depressive phase. These are typically prescribed in combination with a mood stabilizer to prevent rebound mania.
Expected findings for acute stress (fight or flight)
-Apprehension -Unhappiness or sorrow -Decreased appetite -Increased respiratory rate, heart rate, cardiac output, blood pressure -Increased metabolism and glucose use -Depressed immune system
Client education for anticholinergic effects from TCAs
*Methods to minimize anticholinergic effects include: -Chewing sugarless gum -Sipping on water -Wearing sunglasses when outdoors -Eating foods high in fiber -Exercising regularly to promote peristalsis -Increasing fluid intake to at least 2 to 3 L/day from beverage and food sources -Voiding just before taking the medication
A nurse is preparing to assist in providing electroconvulsive therapy (ECT) treatment for a client. Use the ATI Active Learning Template: Therapeutic procedure to complete this item. NURSING INTERVENTIONS (PRE, INTRA, POST)
*Pre-procedure medication management actions: -Administer atropine sulfate or glycopyrrolate 30 min prior to ECT. -Establish IV access prior to ECT. -Inform the client that the anesthesia provider will administer a short‐acting anesthetic (etomidate or propofol) via IV bolus. -Inform the client that a muscle relaxant (succinylcholine) is administered to paralyze the client's muscles during the seizure activity, which decreases the risk for injury. *Intraprocedure actions: -Apply electrodes to the scalp for EEG monitoring. -Apply cardiac electrodes for ECG monitoring. -Assist with the administration of 100% oxygen during and after ECT until the return of spontaneous respirations. -Monitor vital signs.
What are the 15 most commonly reported somatic manifestations?
-Abdominal pain -Back pain -Pain in the extremities/joints -Menstrual problems or cramps -Headaches -Chest pain -Dizziness -Fainting -Heart pounding or racing -Dyspnea -Problems or pain with sexual intercourse -Problems with bowel elimination (constipation/diarrhea) -Nausea, indigestion, or gas -Lethargy -Problems sleeping
Nursing care for somatic symptom disorder
-Accept somatic manifestations as being real to the client -Assess for suicidal ideation and thoughts of self-harm -Identify cultural impact -Identify secondary gains -Limit the amount of time allowed to discuss somatic manifestations -Independence in self-care -Alternative coping mechanisms -Assertiveness techniques -Physical exercise
Nursing actions of a hypertensive crisis from phenelzine administration (MAOI used for depressive disorders)
-Administer phentolamine IV, a rapid-acting alpha-adrenergic blocker, or nifedipine. -Provide continuous cardiac monitoring and respiratory support as indicated.
Interactions with bupropion (atypical antidepressant used for depressive disorders)
-Concurrent use with MAOIs (phenelzine) can increase the risk for toxicity (d/c MAOIs 2 weeks prior to starting bupropion) -Increased risk of seizures with concurrent use of SSRIs
What medications are administered at the time of the ECT procedure?
-At the time of the procedure, an anesthesia provider administers a short-acting anesthetic (etomidate or propofol) via IV bolus. -A muscle relaxant (succinylcholine) is then administered to paralyze the client's muscles during the seizure activity, which decreases the risk for injury. Succinylcholine paralyzes the respiratory muscles so the client requires assistance with breathing and oxygenation.
Client education for administration of SNRIs
-Avoid abrupt cessation of the medication. -SNRIs may be taken with food. -Take the medication on a daily basis to establish therapeutic plasma levels. -Medication can take up to 4 weeks to achieve therapeutic effects.
Contraindications and precautions for bupropion
-Avoid administering to clients who are at risk for seizures -Contraindicated in clients with anorexia nervosa or bulimia nervosa -Bupropion can lower the seizure threshold and should be avoided by clients who have a history of head injury
What should be completed prior to an ECT?
-Baseline ECG allows the provider to identify cardiac changes that can occur during ECT. -Informed consent is required prior to ECT unless the client is receiving involuntary treatment. -Check the client's blood pressure. A baseline blood pressure allows the provider and nurse to identify cardiac stress that can occur during ECT. (ECT does not affect a client's parathyroid hormone level. Therefore, this value is not necessary to obtain prior to treatment. ECT does not directly affect the renal system. Therefore, it is not necessary to obtain a urine specimen prior to treatment)
Behavioral therapy
-Behavioral therapy is based on the theory that behavior is learned and has consequences. Abnormal behavior results from an attempt to avoid painful feelings. Changing abnormal or maladaptive behavior can occur without the need for insight into the underlying cause of the behavior. -Behavioral therapies teach clients ways to decrease anxiety or avoidant behavior and give clients an opportunity to practice techniques. Behavioral therapy teaches activities to help the client reduce anxious and avoidant behavior like relaxation training and modeling.
Major medications to treat anxiety disorders
-Benzodiazepine sedative hypnotic anxiolytic (lorazepam) -Atypical anxiolytic/nonbarbiturate (buspirone) -SSRIs (paroxetine) -SNRIs (venlafaxine) -Other antidepressants (TCAs, MAOIs, antihistamines) -Beta blockers (propranolol) -Centrally acting alpha-blockers (prazosin) -Anticonvulsants (gabapentin)
A nurse is caring for a client who has post traumatic stress disorder (pTSD) following several months in a military combat situation. Use the Active Learning Template: System Disorder to complete this item. ALTERATION IN HEALTH (DIAGNOSIS): Differentiate pTSD from acute stress disorder (ASD).
-Both disorders follow a traumatic incident or multiple experiences that the client perceives as traumatic. -ASD manifestations occur soon after the incident but subside within 1 month of the trauma. -pTSD findings can be delayed for weeks or months after the trauma has subsided and continue for months or years, often causing severe social and occupational implications.
Complications of benzodiazepines
-CNS depression -Anterograde amnesia -Acute toxicity -Paradoxical response -Withdrawal effects
Complications of phenelzine (MAOI used for depressive disorders)
-CNS stimulation -Hypertensive crisis -Orthostatic hypotension
What medical conditions place a patient at high risk for adverse effects with ECT?
-Cardiovascular disorders: Recent myocardial infarction, hypertension, heart failure, cardiac arrhythmias. ECT increases the stress on the heart due to seizure activity that occurs during the treatment. -Cerebrovascular disorders: History of stroke, brain tumor, subdural hematoma. ECT increases intracranial pressure and blood flow through the brain during treatment.
What are the age groups in group therapy?
-Children: In the form of play while talking about a common experience -Adolescent: Especially valuable, as this age group typically has strong peer relationships -Older adult: Helps with socialization and sharing of memories
Expected findings of prolonged stress (maladaptive responses)
-Chronic anxiety or panic attacks -Depression, chronic pain, sleep disturbances -Weight gain or loss -Increased risk for myocardial infarction, stroke -Poor diabetes control, hypertension, fatigue, irritability, decreased ability to concentrate -Increased risk for infection
Risk factors for psychological factors affecting other medical conditions
-Chronic stressors -Depressive disorder or anxiety disorder -Malfunction of neurotransmitters
When is ECT indicated for acute manic episodes?
-Clients who have bipolar disorder with rapid cycling (four or more episodes of acute mania within 1 year) -Clients who are unresponsive to treatment with lithium and antipsychotic medications
Describe a client with illness anxiety disorder
-Clients who have illness anxiety disorder are overly aware of bodily sensations and attribute them to a serious illness. Physical manifestations can be minimal or absent. However, clients still have a preoccupation about having an undiagnosed, serious illness. -Clients research their suspected disease excessively and examine themselves repeatedly, such as examining throat in the mirror -Clients might either seek numerous medical opinions or avoid seeking health care so as not to increase their anxiety. -Clients continue to have anxiety despite negative diagnostic tests and reassurance from the provider.
When is ECT indicated for schizophrenia spectrum disorders?
-Clients who have schizophrenia with catatonic manifestations -Clients who have schizoaffective disorder
When is ECT indicated for MDD?
-Clients whose manifestations are not responsive to pharmacological treatment -Clients for whom the risks of other treatments outweigh the risks of ECT -Clients who are suicidal or homicidal and for whom there is a need for rapid therapeutic response -Clients who are experiencing psychotic manifestations
Examples of cognitive techniques
-Cognitive techniques (cognitive reframing) -Behavioral techniques (relaxation techniques) -Journal writing -Priority restructuring -Biofeedback -Mindfulness -Assertiveness training
Complications of TMS
-Common adverse effects include mild discomfort or a tingling sensation at the site of the electromagnet and headaches. -Monitor for lightheadedness after the procedure. -Seizures are a rare but potential complication.
Interactions with fluoxetine (an SSRI used for depressive disorders)
-Concurrent use with MAOIs, TCAs, or St. John's wort increases the risk of serotonin syndrome. -Concurrent use with warfarin can displace warfarin from bound protein and result in increased warfarin levels (monitor PT and INR levels and assess for indications of bleeding)
Interactions with SNRIs
-Concurrent use with NSAIDs and anticoagulants can further suppress platelet aggregation, thereby increasing the risk of bleeding (monitor for indications of bleeding). -CNS depression with alcohol, opioids, antihistamines, sedative/hypnotics -Concurrent use of MAOIs and St. John's wort can cause serotonin syndrome.
Interactions with SSRIs
-Concurrent use with NSAIDs and anticoagulants can further suppress platelet aggregation, thereby increasing the risk of bleeding. -Concurrent use with TCAs and lithium can result in increased levels of these medications. -Concurrent use with warfarin can displace warfarin from bound protein and result in increased warfarin levels. -Concurrent use of TCAs, MAOIs, or St. John's wort can cause serotonin syndrome.
Interactions with TCAs
-Concurrent use with alcohol, benzodiazepines, opioids, and antihistamines can result in additive CNS depression. -Concurrent use with indirect-acting sympathomimetics can result in decreased effect of these medications -Concurrent use with direct-acting sympathomimetics can result in increased effects of these medications, because uptake is blocked by TCAs. -Concurrent use with MAOIs can cause severe hypertension.
Interactions with MAOIs
-Concurrent use with indirect-acting sympathomimetic medications (ephedrine, amphetamine) can promote the release of norepinephrine and lead to hypertensive crisis (avoid OTC decongestants and cold remedies) -Concurrent use with TCAs can lead to hypertensive crisis (avoid concurrent use of MAOIs and TCAs) -Concurrent use with SSRIs can lead to serotonin syndrome.
Expected findings for psychological factors affecting other medical diagnosis
-Confirmed medical diagnosis -A psychological or behavioral factor that is linked to the medical diagnosis in one of the following ways: Contributes to the development, exacerbation, or delayed recovery of the medical diagnosis; Places the client at increased risk for physical health problems
A nurse working in an acute mental health facility is performing an admission assessment for a client who has major depressive disorder (MDD). EXPECTED FINDINGS: Identify at least four expected findings.
-Depressed mood -Difficulty sleeping or excessive sleeping -Indecisiveness -Decreased ability to concentrate -Suicidal ideation -Increase or decrease in motor activity -Inability to feel pleasure (anhedonia) -Increase or decrease in weight of more than 5% of total body weight over 1 month
Therapeutic uses for Phenelzine (MAOI used for depressive disorders)
-Depression -Bulimia nervosa -First-line treatment for atypical depression -Panic disorder -Social anxiety disorder -Generalized anxiety disorder -Obsessive-compulsive disorder -PTSD
Indications for VNS
-Depression that is resistant to pharmacological treatment and/or ECT. The treatment is approved by the FDA. -Current research studies are determining the effectiveness for VNS in clients who have anxiety disorders, obesity, and pain.
Therapeutic uses of TCAs
-Depressive disorders -Neuropathic pain -Fibromyalgia -Anxiety disorders -Insomnia -Bipolar disorder -Obsessive-compulsive disorder -Attention deficit hyperactivity disorder
Examples of benzodiazepines
-Diazepam -Lorazepam -Clonazepam
Nursing care for psychological factors affecting other medical diagnosis
-Discuss physical exam findings -Assess suicidal ideation or thoughts of self-harm -Explore feelings/fears -Alternative coping mechanisms -Assertiveness techniques -Administer prescribed meds
Manifestations of anticholinergic effects from TCAs
-Dry mouth -Blurred vision -Photophobia -Urinary hesitancy or retention -Constipation -Tachycardia
Equipment needed for an ECT?
-During ECT, the client is monitored with an EEG to track brain wave patterns. -During ECT, the client's blood pressure is monitored to identify changes that can indicate cardiac stress. -During ECT, the client is monitored with continuous telemetry to identify arrhythmias or other changes in the tracing; BP, HR and RR must be monitored (A portable x-ray machine is not necessary for ECT)
Considerations for TMS
-Educate the client about TMS -TMS can be performed as an outpatient procedure. -The TMS procedure lasts 30 to 40 min. -A noninvasive electromagnet is placed on the client's scalp, allowing the magnetic pulsations to pass through. -The client is alert during the procedure. -Clients might feel a tapping or knocking sensation in the head, scalp skin contraction, and tightening of the jaw muscles during the procedure.
Boundaries in dysfunctional families
-Enmeshed boundaries: Thoughts, roles, and feelings blend so much that individual roles are unclear. -Rigid boundaries: Rules and roles are completely inflexible. These families tend to have members that isolate themselves and communication is minimal. Members do not share thoughts or feelings.
Nursing care for clients with conversion disorder
-Ensure safety -Assist client to identify the psychological trigger of the manifestation -Alternative coping mechanisms -Understand the incidence of remissions and recurrence
Expected findings of somatic symptom disorder
-Excessive preoccupation with somatic manifestations -Increased level of anxiety about somatic manifestations -Somatic manifestations are usually present (though actual manifestations can vary) for longer than 6 months -Remissions and exacerbations of somatic manifestations -Probable alcohol or other substance use -Client overmedication with analgesics and antianxiety medications -High utilization of health services and multiple health care providers
Risk factors for conversion disorder
-First-degree relative who has conversion disorder -Childhood physical or sexual abuse -Comorbid psychiatric conditions (Depressive disorder, Anxiety disorder, Posttraumatic stress disorder, Personality disorder, Other somatic disorder) -Comorbid medical or neurologic condition -Recent acute stressful event -Female sex -Adolescent or young adult
Contraindications of SSRIs
-SSRIs are contraindicated in clients taking MAOIs or TCAs. -Clients should avoid alcohol while taking SSRIs.
Nursing actions for Venlafaxine, Duloxetine, Desvenlafaxine, & Levomilnacipran (SNRIs used for deepressive disorders)
-Monitor for hyponatremia, especially in older adult clients. -Monitor for weight loss. -Monitor for increases in blood pressure. -Discuss ways to manage interference with sexual functioning. -Duloxetine should not be used in clients who have hepatic disease or who consume large amounts of alcohol.
Client education for orthostatic hypotension from TCAs
-Monitor for indications of postural hypotension (lightheadedness, dizziness). If these occur, advise the client to sit or lie down. Orthostatic hypotension is minimized by getting up or changing positions slowly. -Avoid dehydration, which increases the risk for hypotension.
Nursing considerations for tricyclic antidepressants
-Monitor for orthostatic hypotension -Give no more than one week supply of medications to clients who are high risk for lethality -Monitor clients who have seizure disorders
A nurse is caring for a client who has post traumatic stress disorder (pTSD) following several months in a military combat situation. Use the Active Learning Template: System Disorder to complete this item. NURSING CARE: List three nursing actions for a client who has pTSD.
-Monitor for suicidal ideation, and take precautions if it occurs. -Provide a safe, routine environment for the client. -Teach strategies to decrease anxiety (breathing techniques or music therapy). -Encourage the client to share feelings. -Use therapeutic communication techniques to assist a client who has cognitive distortions.
Expected findings for a client with conversion disorder
-Motor: Paralysis, movement/gait disorders, seizure-like movements -Sensory: Blindness, inability to speak (aphonia), inability to smell (anosmia), numbness, deafness, tingling/burning sensations Clients who have an extreme desire to become pregnant can manifest a false pregnancy
How do nurses work with families during family therapy?
-Nurses work with families to provide teaching. For example, an RN might instruct a family on medication administration, or ways to help a family member manage their mental health disorder. -Nurses also work to mobilize family resources, to improve communication, and to strengthen the family's ability to cope with the illness of one member.
Client education for a client on MAOIs
-Observe for manifestations and notify the provider if they occur. -Provide the client with written instructions regarding foods and beverages to avoid. Tyramine‑rich foods include aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein, some dietary supplements, some beers, and red wine. -Avoid taking any medications (prescription or OTC) without approval from the provider.
Client education for increased appetite r/t TCA administration
-Observe weight by weighing self weekly. -Good nutrition and exercise will decrease risk of weight gain.
Complications of TCAs
-Orthostatic hypotension -Anticholinergic effects -Sedation -Toxicity -Decreased seizure threshold -Increased appetite -Excessive sweating
Considerations for VNS
-Outpatient surgical procedure. The VNS device delivers around-the-clock programmed pulsations, usually every 5 minutes for a duration of 30 seconds. -Therapeutic antidepressant effects usually take several weeks to achieve. -The client can turn off the VNS device at any time by placing a special external magnet over the site of the implant. -Assist in obtaining informed consent
Examples of SSRIs
-Paroxetine -Sertraline -Escitalopram -Citalopram -Fluvoxamine -Fluoxetine
Client education for somatic symptom disorder
-Participate in group therapy -Utilize prescribed meds -Assist a case manager to develop a follow-up appointment schedule with provider every 4 to 6 weeks.
Client education for factitious disorder
-Participate in individual and group therapy. -Attend community support groups. -Utilize prescribed medications. -Verbalize any feelings.
Client education for psychological factors affecting other medical diagnosis
-Participate in treatment plan -Utilize prescribed meds
Nursing care for factitious disorder
-Perform a self-assessment prior to care -Avoid confrontation. -Build rapport and trust with client. -Ensure safety of client and vulnerable persons affected by the client. -Educate client on alternative coping mechanisms. -Educate client on stress management techniques. -Communicate openly with the health care team any suspicions of factitious disorder or factitious disorder imposed on another.
Examples of MAOIs used for depressive disorders
-Phenelzine -Isocarboxazid -Selegiline (transdermal patch)
What are protective factors increasing a client's resilience, or ability to resist the effects of stress?
-Physical health -Strong sense of self -Religious or spiritual beliefs -Optimism -Hobbies and other outside interests -Satisfying interpersonal relationships -Strong social support systems -Humor
What are other nursing interventions for a suicidal patient?
-Place client on suicide precautions on admission and obtain order in chart; communicate the care plan and safety measures to the clinical team. Suicide precautions: GSP; ASP 1:1; within line of sight. -All belongings inventoried and locked up; no sharps; sharps time supervised at designated times; no shoe laces; no drawstrings on clothes; no bags in the rooms; door in room open at all time; all personal care items, including mouthwash, etc are locked up and personal care is supervised. -Assess for suicide risk: TMAPI- assess for thoughts means, ability, plan, and intent; remove dangerous objects and promote safety. -Limit the amount of time an at‑risk client spends alone. -Involve significant others in the treatment plan.
What are types of cognitive reframing techniques?
-Priority restructuring -Journal keeping -Assertiveness training -Monitoring thoughts
Nursing actions for memory loss and confusion following ECT procedure
-Provide frequent orientation. -Provide a safe environment to prevent injury. -Assist the client with personal hygiene as needed.
Expected findings for factitious disorder
-Report of false physical and psychological manifestations -Possible evidence of self-injury (factitious disorder) or injury to others (factitious disorder imposed on another)
What can put a client at risk for lithium toxicity?
-Strenuous exercise in outdoor heat, which can lead to dehydration, puts the client at risk for lithium toxicity. Mild to moderate exercise will not lead to lithium toxicity, but if the client engages in strenuous exercise during hot weather, she should take care to replace any water and sodium that have been lost through profuse sweating. This also applies to other factors that can cause the client to become dehydrated, such as having diarrhea or taking diuretics. -Diarrhea can lead to dehydration and potentially elevated lithium levels and toxicity. Diarrhea vomiting, and lethargy can also indicate lithium toxicity. The nurse should inform the client to stop taking the medication if the any indications of lithium toxicity occur. The nurse should instruct the client that diarrhea is a manifestation of mild toxicity, not constipation.
A nurse is caring for a client who has post traumatic stress disorder (pTSD) following several months in a military combat situation. Use the Active Learning Template: System Disorder to complete this item. EXPECTED FINDINGS: List three subjective and three objective manifestations of pTSD.
-Subjective manifestations: Client describes dreams and/ or flashbacks of the traumatic event; client reports having insomnia; client verbalizes guilt and self‐blame. -Objective manifestations: Hyperactive startle reflexes; manifestations of anxiety (tachycardia, hyperventilation); inability to focus in order to complete a simple task.
What mental health conditions has ECT not been found useful for?
-Substance use disorders -Personality disorders -Dysphoric disorder
What are the risk factors for suicide?
-Suicidal behavior: history of prior suicide attempts, aborted suicide attempts, or self-injurious behavior -Current/past psychiatric disorders: especially mood disorders, psychotic disorders, alcohol/substance abuse, ADHD, TBI, PTSD, Cluster B personality disorders, conduct disorders (antisocial behavior, aggression, impulsivity) Co-morbidity and recent onset of illness increase risk -Key symptoms: anhedonia, impulsivity, hopelessness, anxiety/panic, global insomnia, command hallucinations -Family history: of suicide, attempts, or Axis 1 psychiatric disorders requiring hospitalization -Precipitants & stressors & Interpersonal: triggering events leading to humiliation, shame, or despair (e.g, loss of relationship, financial or health status—real or anticipated). Ongoing medical illness (esp. CNS disorders, pain). Intoxication. Family turmoil/chaos. History of physical or sexual abuse. Social isolation -Change in treatment: discharge from psychiatric hospital, provider or treatment change -Access to firearms
Client education for benzodiazepines
-Take the medication as prescribed, and to avoid abrupt discontinuation of treatment to prevent withdrawal manifestations. Do not change the dosage or frequency without approval of the prescriber. -Swallow sustained-release tablets and avoid chewing or crushing the tablets. -Keep benzodiazepines in a secure place due to potential for misuse. -Dependency can develop during and after treatment. Notify the provider if indications of withdrawal occur.
What is assertiveness training?
-The client learns to communicate in a more assertive manner in order to decrease psychological stressors. -For example, one technique teaches the client to assert their feelings by describing a situation or behavior that causes stress, discussing feelings about the behavior or situation, and then making a change.
How does priority restructuring help a patient who is experiencing stress?
-The client learns to prioritize differently to reduce the number of stressors affecting them. -For example, a person who is under stress due to feeling overworked might delegate some tasks to others rather than doing them all on their own.
What are the responsibilities of the orientation phase of group development?
-The group leader sets a tone of respect, trust, and confidentiality among members. The group leader is active and provides the purpose of the group. -Members get to know each other and the group leader. -There is a discussion about termination.
What are the responsibilities of the working phase of group development?
-The group leader uses therapeutic communication to encourage group work toward meeting goals. -Members take informal roles within the group, which can interfere with, or favor, group progress toward goals. -Cohesiveness has been established and role of leader is gradually diminishing.
Nursing considerations for ECT procedure
-The nurse monitors vital signs and mental status before and after the ECT procedure. -The nurse assesses the client's and family's understanding and knowledge of the procedure and provides teaching as necessary. -An IV line is inserted and maintained until full recovery. -Electrodes are applied to the scalp for electroencephalogram (EEG) monitoring. -The client receives 100% oxygen during and after ECT until the return of spontaneous respirations. -Ongoing cardiac monitoring is provided, including blood pressure, electrocardiogram (ECG), and oxygen saturation. -Clients are expected to become alert about 15 min following ECT.
A nurse working in an acute mental health unit is caring for a client who has a personality disorder. The client refuses to attend group meetings and will not speak to other clients or attend unit activities. The client enjoys visiting with staff and requests daily to take a walk outside with a staff member. The provider prescribes behavioral therapy with operant conditioning. Use the ATI Active Learning Template: Therapeutic procedure to complete this item. NURSING INTERVENTIONS: Identify an appropriate nursing action to implement operant conditioning with this client.
-The nurse will use tokens, or something similar, to reward the client for a positive change in behavior. The client can use these tokens for larger rewards (a walk outside with a staff member). -The nurse will provide positive feedback and encouragement for a positive change in behavior.
What needs to be obtained prior to ECT treatment?
-The provider obtains informed consent. If ECT is involuntary, the provider can obtain consent from next of kin or a court order. -Pre-ECT work up can include a chest x-ray, blood work, ECG. Benzodiazepines should be discontinued as they will interfere with the seizure process.
Nursing actions for Mirtazapine (SNRI used for depressive disorders)
-Therapeutic effects can occur sooner, and with less sexual dysfunction, than with SSRIs. -This medication is generally well tolerated. Adverse effects include sleepiness that can be exacerbated by other CNS depressants, increased appetite and weight gain, and elevated cholesterol.
Describe a client with conversion disorder
Clients who have conversion disorder have deficits in voluntary motor or sensory functions (blindness, paralysis, seizures, gait disorders, hearing loss)
Nursing actions for Trazodone (SNRI used for depressive disorders)
-This agent is usually used with another antidepressant agent. Sedation can be an issue, so it can be indicated for a client who has insomnia caused by an SSRI. Advise the client to take at bedtime. -This medication should be used with caution in clients who have cardiac disease.
Expected findings for a patient with illness anxiety disorder
-This anxiety is present for more than 6 months though the actual illness the client fears can change. -Preoccupation with performance of behaviors -Some clients have illness anxiety disorder that is the health-seeking type (frequently seeking medical care and diagnostic tests) while others exhibit the care-avoidant type (avoids all contact with providers due to the correlation with increased levels of anxiety)
Therapeutic uses of bupropion (atypical antidepressant used for depressive disorders)
-Treatment of depression -Alternative to SSRIs for clients unable to tolerate the sexual dysfunction adverse effects -Aid to quit smoking -Prevention of seasonal pattern depression
Precautions of SSRIs
-Use cautiously in clients who have liver and renal dysfunction, seizure disorders, or a history of gastrointestinal bleeding. -Use SSRIs cautiously in clients who have bipolar disorder, due to the risk for mania.
What are the components of therapy sessions?
-Use of open and clear communication -Cohesiveness and guidelines for the therapy session -Direction toward a particular goal -Opportunities for development of interpersonal skills; resolution of personal and family issues; and development of appropriate, satisfying relationships. -Encouragement of the client to maximize positive interactions, feel empowered to make decisions, and strengthen feelings of self-worth -Communication regarding respect among all members -Support, as well as education regarding things (available community resources for support)
Precautions for amitriptyline (a TCA)
-Use this medication cautiously in clients who have coronary artery disease; diabetes; liver, kidney, and respiratory disorders; urinary retention and obstruction; angle closure glaucoma; benign prostatic hypertrophy; and hyperthyroidism. -TCAs can increase suicide risk.
Antiepileptic medications for bipolar disorder
-Valproic acid -Carbamazepine -Lamotrigine -Oxcarbazepine -Topiramate
Examples of SNRIs
-Venlafaxine -Duloxetine
Examples of SNRIs used for depressive disorders
-Venlafaxine -Duloxetine -Desvenlafaxine -Levomilnacipran -Mirtazapine -Trazodone
Depending on therapeutic intent, effectiveness of SNRIs is evidenced by the following:
-Verbalized feeling of less anxiety -Description of improved mood -Improved memory retrieval -Maintenance of a normal sleep pattern -Greater ability to participate in social and occupational interactions -Improved ability to cope with manifestations and identified stressors -Ability to perform activities of daily living -Report of increased well-being
Nursing evaluation of medication effectiveness of antidepressant medication
-Verbalizing improvement in mood -Ability to perform ADLs -Improved sleeping and eating habits -Increased interaction with peers
Complications of VNS
-Voice changes due to the proximity of the implanted lead on the vagus nerve to the larynx and pharynx. -Other potential adverse effects include hoarseness, throat or neck pain, coughing. These commonly improve with time. -Dyspnea, especially with physical exertion, is possible. Therefore, the client might want to turn off the VNS during exercise or when periods of prolonged speaking are required.
What does OCD give rise to?
-With OCD, obsessions give rise to anxiety, and the anxiety is then reduced by compulsive behaviors. Compulsive rituals are strengthened and maintained because they decrease the anxiety by terminating the event that gives rise to it. -The compulsive act provides immediate relief from anxiety and is used to cope with stress, conflict, or pain. Although the client is comforted by the feeling of self-control and there is a need to increase self-esteem, the act itself provides immediate relief of anxiety as the client uses this maladaptive response.
Identify the order in which your client, experiencing the death of her spouse, will experience, according to Engel's five stages of grief (write down the order here - use all 5 stages listed): a. Developing awareness b. Restitution c. Shock and disbelief d. Recovery e. Resolution of the loss
1. a 2. c 3. b 4. D 5. e
What is confabulation?
A client's thought process uses falsification that he or she believes to consistently be true, to replace the gaps left by a disorder of the memory with imaginary remembered experiences consistently believed to be true.
What is scapegoating?
A member of the family with little power is blamed for problems within the family. For example, one child who has not completed their chores can be blamed for the entire family not being able to go on an outing.
What type of behavior might a person might a patient who is experiencing a manic episode display?
A client who is experiencing a manic episode displays attention-seeking behavior through means of flashy attire and makeup, or through flirtatious, inappropriate behavior toward others. This interaction is a manifestation of the client's lack of impulse control.
How does therapeutic communication help with cognitive reframing?
A health professional, using therapeutic communication techniques, could help the client reframe that thought into a positive thought ("I've made some bad mistakes as a parent, but I've learned from them and have improved my parenting skills.").
What is a homogenous group?
A homogeneous group is one in which all members share a certain chosen characteristic (diagnosis or gender). Membership of heterogeneous groups is not based on a shared chosen personal characteristic. An example of a heterogeneous group is all clients on a unit, including a mixture of men and women who have a wide range of diagnoses.
How does biofeedback work?
A nurse or other health professional trained in this method uses a sensitive mechanical device to assist the client to gain voluntary control of such autonomic functions as heart rate and blood pressure. Exercise gadgets and smart watches provide the ability to track sleep and heart rates.
What type of patient has a high risk for suicide?
A patient in mania episode
What is PTSD?
A response to an event that is extremely distressing
What is a subgroup?
A subgroup is a small number of people within a larger group who function separately from the group.
What is modeling?
A therapist or others serve as role models for a client, who imitates this modeling to improve behavior.
What is triangulation?
A third party is drawn into the relationship with two members whose relationship is unstable. For example, one parent can develop an alliance with a child, leaving the other parent relatively uninvolved with both.
What is the primary focus of the orientation phase of group deevelopmeent?
Define the purpose and goals of the group.
A nurse is counseling several clients. Which of the following client statements should the nurse identify as expected for factitious disorder imposed on another? A. "I had to pretend I was injured in order to get disability benefits." B. "I know that my abdominal pain is caused by a malignant tumor." C. "I needed to make my child sick so that someone else would take care of them for a while." D. "I became deaf when I heard that my partner was having an affair with my best friend."
A. A client's falsification of an illness or injury for the purpose of personal gain is malingering. B. Although clients who have factitious disorder often use proper medical terminology, a client's fear of a serious illness is expected with illness anxiety disorder. C. CORRECT: A client who has factitious disorder imposed on another often consciously injures another person or causes them to be sick due to a personal need for attention or relief of responsibility. D. Developing a sensory impairment due to an acute stressor is an expected finding of conversion disorder.
A nurse working in an emergency department is caring for a client who has benzodiazepine toxicity. Which of the following actions is the nurse's priority? A. Administer flumazenil. B. Identify the client's level of orientation. C. Infuse IV fluids. D. prepare the client for gastric lavage.
A. Administer flumazenil will reverse the effects benzodiazepines; however, another action is the priority. B. CORRECT: When taking the nursing process approach to client care, the initial step is assessment. Identifying the client's level of orientation is the priority action. C. Infuse IV fluids to maintain blood pressure; however, another action is the priority. D. Gastric lavage will remove excessive medication from the client's GI system; however, another action is the priority.
A nurse is discussing the factors for somatic symptom disorder with a newly licensed nurse. Which of the following risk factors should the nurse include? (Select all that apply.) A. Age older than 65 years B. Anxiety disorder C. Childhood trauma D. Coronary artery disease E. Obesity
A. Age 16 to 25 years is a risk factor for somatic symptom disorder. B. CORRECT: Anxiety disorder is a risk factor for somatic symptom disorder. C. CORRECT: Childhood trauma is a risk factor for somatic symptom disorder. D. Coronary artery disease is not a risk factor for somatic symptom disorder. E. Obesity is not a risk factor for somatic symptom disorder.
A nurse is caring for a client who is taking phenelzine For which of the following manifestations should the nurse monitor as an adverse effectof this medication? (Select all that apply.) A. Elevated blood glucose level B. Orthostatic hypotension C. priapism D. Hypomania E. Bruxism
A. An elevated blood glucose level is not an adverse effect of phenelzine. B. CORRECT: Observe for orthostatic hypotension, which is an adverse effect of phenelzine. C. priapism is an adverse effect of trazodone rather than phenelzine. D. CORRECT: Observe for a headache which is an adverse effect of phenelzine.
A nurse is working with an established group and identifies various member roles. Which of the following should the nurse identify as an individual role? A. A member who praises input from other members B. A member who follows the direction of other members C. A member who brags about accomplishments D. A member who evaluates the group's performance toward a standard
A. An individual who praises the input of others is acting in a maintenance role. B. An individual who is a follower is acting in a maintenance role. C. CORRECT: An individual who brags about accomplishments is acting in an individual role that does not promote the progression of the group toward meeting goals. D. An individual who evaluates the group's performance is acting in a task role.
A nurse is providing discharge teaching for a client who has schizophrenia and a new prescription for iloperidone. Which of the following client statements indicates understanding of the teaching? A. "I will be able to stop taking this medication as soon as I feel better." B. "If I feel drowsy during the day, I will stop taking this medication and call my provider." C. "I will be careful not to gain too much weight while taking this medication." E. "This medication is highly addictive and must be withdrawn slowly."
A. Antipsychotic medications are considered a long‐term treatment for schizophrenia. Discontinuing the medication can result in an exacerbation of manifestations. B. Drowsiness is a common adverse effect of antipsychotic medications. However, it is not appropriate to discontinue the medication. C. CORRECT: Antipsychotic medications (iloperidone) have a high risk for significant weight gain. D. Antipsychotic medications are not considered addictive, and it is not necessary to titrate iloperidone when discontinuing treatment.
A nurse is caring for a client who has bipolar disorder. The client states, "I am very rich, and I feel I must give my money to you." Which of the following responses should the nurse make? A. "Why do you think you feel the need to give money away?" B. "I am here to provide care and cannot accept this from you." C. "I can request that your case manager discuss appropriate charity options with you." D. "You should know that giving away your money is inappropriate."
A. Asking a "why" question is a nontherapeutic form of communication and can promote a defensive client response. B. CORRECT: This statement is matter‐of‐fact and concise and is a therapeutic response to a client who has bipolar disorder. C. This statement does not recognize the possibility of poor judgment, which is associated with bipolar disorder. D. This statement offers disapproval and can be interpreted by the client as aggressive, which can promote a defensive client response.
A nurse is teaching a client who has a new prescription for alprazolam for generalized anxiety disorder. Which of the following information should the nurse provide? A. Three to six weeks of treatment is required to achieve therapeutic benefit. B. Combining alcohol with alprazolam will produce a paradoxical response. C. Alprazolam has a lower risk for dependence than other antianxiety medications. D. Report confusion as a potential indication of toxicity.
A. Buspirone, rather than alprazolam, requires 3 to 6 weeks to achieve therapeutic benefit. B. Combining alcohol with alprazolam can produce CNS and respiratory depression rather than a paradoxical response. C. Alprazolam is preferably used for short‐term treatment because of the increased risk of dependence. D. CORRECT: Confusion is a potential indication of alprazolam toxicity that the client should report to the provider.
A nurse is caring for a client who has generalized anxiety disorder and is experiencing severe anxiety. Which of the following statements actions should the nurse make? A. "Tell me about how you are feeling right now." B. "You should focus on the positive things in your life to decrease your anxiety." C. "Why do you believe you are experiencing this anxiety?" D. "Let's discuss the medications your provider is prescribing to decrease your anxiety."
A. CORRECT: Asking an open‐ended question is therapeutic and assists the client in identifying anxiety. B. Offering advice is nontherapeutic and can hinder further communication. C. Asking the client a "why" question is nontherapeutic and can promote a defensive client response. D. postpone health teaching until after acute anxiety subsides. Clients experiencing severe anxietyare unable to concentrate or learn.
A nurse is caring for a client who has a new prescription for disulfiram for treatment of alcohol use disorder. The nurse informs the client thatthis medication can cause nausea and vomiting when alcohol is consumed. Which of the following types of treatment is this method an example? A. Aversion therapy B. Flooding C. Biofeedback D. Dialectical behavior therapy
A. CORRECT: Aversion therapy pairs a maladaptive behavior with unpleasant stimuli to promote a change in behavior. B. Flooding is planned exposure to an undesirable stimulus in an attempt to turn off the anxiety response. C. Biofeedback is a behavioral therapy to control pain, tension, and anxiety. D. Dialectical behavior therapy is a cognitive‐behavioral therapy for clients who have a personality disorder and exhibit self‐injurious behavior.
A nurse is teaching a client about stress‐reduction techniques. Which of the following client statements indicates understanding of the teaching? A. "Cognitive reframing will help me change my irrational thoughts to something positive." B. "progressive muscle relaxation uses a mechanical device to help me gain control over my pulse rate." C. "Biofeedback causes my body to release endorphins so that I feel less stress and anxiety." D. "Mindfulness allows me to prioritize the stressors that I have in my life so that I have less anxiety."
A. CORRECT: Cognitive reframing helps the client look at irrational cognitions (thoughts) in a more realistic light and to restructure those thoughts in a more positive way. B. Biofeedback, rather than progressive muscle training, uses a mechanical device to promote voluntary control over autonomic functions. C. physical exercise, rather than biofeedback, causes a release of endorphins that lower anxiety and reduce stress. D. priority restructuring, rather than mindfulness, teaches the client to prioritize differently to reduce the number of stressors.
A nurse is preparing to implement cognitive reframing techniques for a client who has an anxiety disorder. Which of the following techniques should the nurse include in the plan of care? (Select all that apply.) A. priority restructuring B. Monitoring thoughts C. Diaphragmatic breathing D. Journal keeping E. Meditation
A. CORRECT: priority restructuring is a cognitive reframing technique. B. CORRECT: Monitoring thoughts is a cognitive reframing technique. C. Diaphragmatic breathing is a form of behavioral therapy rather than a cognitive reframing technique. D. CORRECT: Journal keeping is a cognitive reframing technique. E. Meditation is a form of behavioral therapy rather than a cognitive reframing technique.
A nurse is caring for a client who takes paroxetine to treat post traumatic stress disorder. The client states, "I grind my teeth during the night, which causes pain in my mouth." The nurse should identify which of the following interventions as possible measures to manage the client's bruxism? (Select all that apply.) A. Concurrent administration of buspirone B. Administration of a different SSRI C. Use of a mouth guard D. Changing to a different class of antianxiety medication E. Increasing the dose of paroxetine
A. CORRECT: Concurrent administration of a low‐dose of buspirone is an effective measure to manage the adverse effect of paroxetine. B. Other SSRIs will also have bruxism as an adverse effect therefore this is not an effective measure. C. CORRECT: Using a mouth guard during sleep can decrease the risk for oral damage resulting from bruxism. D. CORRECT: Changing to a different class of antianxiety medication that does not have the adverse effect of bruxism is an effective measure. E. Increasing the dose of paroxetine can cause the adverse effect of bruxism to worsen therefore this is not an effective measure.
A nurse is preparing an educational seminar on stress for other nursing staff. Which of the following information should the nurse include in the discussion? A. Excessive stressors cause the client to experience distress. B. The body's initial adaptive response to stress is denial. C. Absence of stressors results in homeostasis. D. Negative, rather than positive, stressors produce a biological response.
A. CORRECT: Distress is the result of excessive or damaging stressors (anxiety or anger). B. Denial is part of the grief process. The body's initial adaptive response to stress is known as the fight‐or‐flight mechanism. C. Individuals need the presence of some stressors to provide interest and purpose to life. D. Both positive and negative stressors produce a biological response in the body.
A nurse is caring for a client who is experiencing extreme mania due to bipolar disorder. prior to administration of lithium carbonate, the client's lithium blood level is 1.2 mEq/L. Which of the following actions should the nurse take? A. Administer the next dose of lithium carbonate as scheduled. B. Prepare for administration of aminophylline. C. Notify the provider for a possible increase in the dosage of lithium carbonate. D. Request a stat repeat of the client's lithium blood level.
A. CORRECT: During a manic episode, the lithium blood level should be 0.8 to 1.4 mEq/L. It is appropriate to administer the next dose as scheduled. B. Aminophylline can be prescribed for treatment of severe toxicity for levels greater than 1.5 mEq/L. C. A dosage increase would place the client at risk for toxicity and is therefore not an appropriate action. D. A lithium level of 1.2 mEq/L is an expected finding fora client who is experiencing a manic episode. It is not necessary to request a stat repeat of the laboratory test.
A nurse is assessing a client who has generalized anxiety disorder. Which of the following findings should the nurse expect? (Select all that apply.) A. Excessive worry for 6 months B. Impulsive decision making C. Delayed reflexes D. Restlessness E. Sleep disturbance
A. CORRECT: Generalized anxiety disorder is characterized by uncontrollable, excessive worry for more than 6 months. B. Generalized anxiety disorder is characterized by procrastination in decision making. C. Generalized anxiety disorder is characterized by muscle tension. D. CORRECT: Generalized anxiety disorder is characterized by restlessness. E. CORRECT: Generalized anxiety disorder is characterized by the presence of sleep disturbances (the inability to fall asleep).
A nurse working on an acute mental health unit is caring for a client who has posttraumatic stress disorder (pTSD). Which of the following findings should the nurse expect? (Select all that apply.) A. Difficulty concentrating on tasks B. Obsessive need to talk about the traumatic event C. Negative self‐image D. Recurring nightmares E. Diminished reflexes
A. CORRECT: Manifestations of pTSD include the inability to concentrate on or complete tasks. B. A client who has pTSD is reluctant to talk about the traumatic event that triggered the disorder. C. CORRECT: Manifestations of pTSD include feeling guilty and having a negative self‐image. D. CORRECT: Manifestations of pTSD include recurring nightmares or flashbacks. E. A client who has pTSD has an increased startle reflex and hypervigilance.
A charge nurse is discussing mirtazapine with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates understanding? A. "This medication increases the release of serotonin and norepinephrine." B. "I should tell the client about the likelihood of insomnia while taking this medication." C. "This medication is contraindicated for clients who have an eating disorder." D. "Sexual dysfunction is a common adverse effect of this medication."
A. CORRECT: Mirtazapine provides relief from depression by increasing the release of serotonin and norepinephrine. B. Tell the client about the likelihood of drowsiness rather than insomnia when taking this medication. C. Bupropion, rather than mirtazapine, is contraindicated in clients who have an eating disorder. D. Sexual dysfunction is an adverse effect of SSRIs rather than mirtazapine.
A nurse is assessing a client who has illness anxiety disorder. Which of the following are expectedfor this disorder? (Select all that apply.) A. Obsessive thoughts about disease B. History of childhood abuse C. Avoidance of health care providers D. Depressive disorder E. Narcissistic personality
A. CORRECT: Obsessive thoughts about disease is an expected finding in a client who has illness anxiety disorder. B. CORRECT: A history of childhood abuse is an expected finding in a client who has illness anxiety disorder. C. CORRECT: Avoidance of health care providers is an expected finding in clients who have illness anxiety disorder of the care‐avoidant type. D. CORRECT: A depressive disorder is an expected finding in a client who has illness anxiety disorder. E. Low self‐esteem is an expected finding in a client who has illness anxiety disorder.
A charge nurse is discussing manifestations of schizophrenia with a newly licensed nurse. Which of the following manifestations should the charge nurse identify as being effectively treated by first‐generation antipsychotics? (Select all that apply.) A. Auditory hallucinations B. Withdrawal from social situations C. Delusions of grandeur D. Severe agitation E. Anhedonia
A. CORRECT: positive symptoms of schizophrenia (auditory hallucinations) are effectively treated with first‐generation antipsychotics. B. First‐generation antipsychotics have minimal effectiveness with negative symptoms of schizophrenia (social withdrawal). C. CORRECT: positive symptoms of schizophrenia (delusions of grandeur) are effectively treated with first‐generation antipsychotics. D. CORRECT: positive symptoms of schizophrenia (severe agitation) are effectively treated with first‐generation antipsychotics. E. First‐generation antipsychotics have minimal effectiveness with negative symptoms of schizophrenia (anhedonia).
A nurse is caring for a client who takes ziprasidone. The client reports difficulty swallowing the oral medication and becomes extremely agitated with injectable administration. The nurse should contact the provider to discuss a change to which of the following medications? (Select all that apply.) A. Olanzapine B. Quetiapine C. Aripiprazole D. Clozapine E. Asenapine
A. CORRECT: Olanzapine is available in an orally disintegrating tablet, which is appropriate for clients who have difficulty swallowing oral tablets. This route also decreases the risk for agitation associated with an injection. B. Quetiapine is available only in tablets or extended‐release tablets and will therefore not address the current concerns with medication administration. C. CORRECT: Aripiprazole is available in an orally disintegrating tablet, which is appropriate for clients who have difficulty swallowing oral tablets. This route also decreases the risk for agitation associated with an injection. D. CORRECT: Clozapine is available in an orally disintegrating tablet, which is appropriate for clients who have difficulty swallowing oral tablets. This route also decreases the risk for agitation associated with an injection. E. CORRECT: Asenapine is available in a sublingual tablet, which is appropriate for clients who have difficulty swallowing oral tablets. This route also decreases the risk for agitation associated with an injection.
A nurse is discussing routine follow‐up needs with a client who has a new prescription for valproate. The nurse should inform the client of the need for routine monitoring of which of the following? A. AST/ALT and LDH B. Creatinine and BUN C. WBC and granulocyte counts D. Blood sodium and potassium
A. CORRECT: Routine monitoring of liver function tests is necessary due to the risk for hepatotoxicity. B. Baseline levels can be drawn. However, routine monitoring of creatinine and BUN is not necessary. C. Baseline levels can be drawn. However, routine monitoring of WBC and granulocyte counts is not necessary. D. Baseline levels can be drawn. However, routine monitoring of blood sodium and potassium is not necessary.
A nurse is reviewing the medical record of a client who has conversion disorder. Which of the following findings should the nurse identify as placing the client at risk for conversion disorder? A. Death of a child 2 months ago B. Recent weight loss of 30 lb C. Retirement 1 year ago D. History of migraine headaches
A. CORRECT: The death of a child 2 months ago is an acute stressor that places the client at risk for conversion disorder. B. A recent weight loss of 30 lb does not place the client at risk for conversion disorder. Recent acute stress can be a risk factor. C. Retiring 1 year ago does not place the client at risk for conversion disorder. pTSD can be a risk factor. D. A history of migraine headaches does not place the client at risk for conversion disorder. History of depression can be a risk factor.
A nurse working on an acute mental health unit is admitting a client who has major depressive disorder and comorbid anxiety disorder. Which of the following actions is the nurse's priority? A. Placing the client on one‐to‐one observation B.Assisting the client to perform ADLs C. Encouraging the client to participate in counseling D. Teaching the client about medication adverse effects
A. CORRECT: The greatest risk for a client who has MDD and comorbid anxiety is injury due to self‐harm. The highest priority intervention is placing the client on one‐to‐one observation. B. The client who has MDD can require assistance with ADLs. However, this does not address the greatest risk to the client and is therefore not the priority intervention. C. Encourage the client who has MDD to participate in counseling. However, this does not address the greatest risk to the client and is therefore not the priority intervention. D. Teach the client who has MDD about medication adverse effects. However, this does not address the greatest risk to the client and is therefore not the priority intervention.
A nurse is planning care for a client who has body dysmorphic disorder. Which of the following actions should the nurse plan to take first? A. Assess the client's risk for self‐harm B. Instill hope for positive outcomes C. Encourage the client to participate in group therapy sessions D. Assist the client to participate in treatment decisions
A. CORRECT: The greatest risk to a client who has an anxiety or obsessive‐compulsive disorder is self‐harm or suicide. Therefore, the first action to take is to assess the client's risk for self‐harm to ensure that the client is provided with a safe environment. B. Instill hope for positive outcomes, without providing false reassurance, as part of milieu therapy; however, there is another action to take first. C. Encourage the client to participate in group therapy to assist the client in order to address social impairments that result from the disorder; however, there is another action to take first. D. Encourage the client to participate in treatment decisions as part of milieu therapy; however, there is another action to take first.
A nurse is planning care for a client following surgical implantation of a VNS device. The nurse should plan to monitor for which of the following adverse effects? (Select all that apply.) A. Voice changes B. Seizure activity C. Disorientation D. Cough E. Neck pain
A. CORRECT: Voice changes are a common adverse effect of VNS due to the proximity of the implanted lead on the vagus nerve to the larynx and pharynx. B. Seizure activity is associated with ECT rather than VNS. C. Disorientation is associated with ECT rather than VNS. D. CORRECT: Coughing is a potential adverse effect of VNS. E. CORRECT: Neck pain is a potential adverse effect of VNS. However, this usually subsides with time.
A nurse is teaching a client who has a new prescription for imipramine how to minimize anticholinergic effects. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A. Void just before taking the medication. B. Increase the dietary intake of potassium. C. Wear sunglasses when outside. D. Change positions slowly when getting up. E. Chew sugarless gum.
A. CORRECT: Voiding just before taking the medication will help minimize the anticholinergic effectsof urinary hesitancy or retention. B. The anticholinergic effects of imipramine do not affect the client's potassium level. C. CORRECT: Wearing sunglasses when outside will help minimize the anticholinergic effect of photophobia. D. The client should change positions slowly to avoid orthostatic hypotension. However, this is not an anticholinergic effect. E. CORRECT: Chewing sugarless gum will help minimize the anticholinergic effect of dry mouth.
A nurse is discussing acute vs. prolonged stress with a client. Which of the following effects should the nurse identify as an acute stress response? (Select all that apply.) A. Chronic pain B. Depressed immune system C. Increased blood pressure D. panic attacks E. Unhappiness
A. Chronic pain indicates a prolonged or maladaptive stress response. B. CORRECT: A depressed immune system is an indicator of acute stress. C. CORRECT: Increased blood pressure is an indicator of acute stress. D. panic attacks indicate a prolonged or maladaptive stress response. E. CORRECT: Unhappiness is an indicator of acute stress.
A nurse is teaching a client who has an anxiety disorder and is scheduled to begin classical psychoanalysis. Which of the following client statements indicatesan understanding of this form of therapy? A. "Even if my anxiety improves, I will need to continue this therapy for 6 weeks." B. "The therapist will focus on my past relationships during our sessions." C. "psychoanalysis will help me reduce my anxiety by changing my behaviors." D. "This therapy will address my conscious feelings about stressful experiences."
A. Classical psychoanalysis is a therapeutic process that requires many sessions over months to years. B. CORRECT: Classical psychoanalysis places a common focus on past relationships to identify the cause of the anxiety disorder. C. Classical psychoanalysis focuses on identifying and resolving the cause of the anxiety rather than changing behavior. D. Classical psychoanalysis assesses unconscious, rather than conscious, thoughts and feelings.
A nurse is teaching a client who has a new diagnosis of premenstrual dysphoric disorder (pMDD). Which of the following statements by the client indicates understanding of the teaching? A. "I can expect my problems with pMDD to be worst when I'm menstruating." B. "I should avoid exercising when I am feeling depressed." C. "I am aware that my pMDD causes me to have rapid mood swings." D. "I should increase my caloric intake with a nutritional supplement when my pMDD is active."
A. Clinical findings of pMDD are present during the luteal phase of the menstrual cycle just prior to menses. B. Aerobic and other exercise are effective treatments for depressive disorders, including pMDD. C. CORRECT: A clinical finding of pMDD is emotional lability. The client can experience rapid changes in mood. D. pMDD increases the client's risk for weight gain due to overeating. It is not appropriate to increase caloric intake.
A nurse is providing teaching to a client who has a new prescription for amitriptyline. Which of the following statements by the client indicates an understanding of the teaching? A. "I can expect to experience diarrhea while taking this medication." B. "I may feel drowsy for a few weeks after starting this medication." C. "I cannot eat my favorite pizza with pepperoni while taking this medication." D. "This medication will help me lose the weight that I have gained over the last year."
A. Constipation rather than diarrhea can occur with TCAs, due to anticholinergic effects. B. CORRECT: Sedation is an adverse effect of amitriptyline during the first few weeks of therapy. C. Foods (pepperoni) should be avoided if the client is prescribed an MAOI rather than a TCA like amitriptyline. D. Observe for manifestations of hypomania or mania caused by CNS stimulation with phenelzine.
A nurse is assessing a client who is currently taking perphenazine. Which of the following findings should the nurse identify as an extrapyramidal symptom (EpS)? (Select all that apply.) A. Decreased level of consciousness B. Drooling C. Involuntary arm movements D. Urinary retention E. Continual pacing
A. Decreased level of consciousness is an indication of neuroleptic malignant syndrome rather than an EpS. B. CORRECT: Drooling is an indication of pseudoparkinsonism, which is an EpS. C. CORRECT: Involuntary arm movements are an indication of tardive dyskinesia, which is an EpS. D. Urinary retention is an anticholinergic effect rather than an EpS. E. CORRECT: Continual pacing is an indication of akathisia, which is an EpS.
A nurse is assisting with systematic desensitization for a client who has an extreme fear of elevators. Which of the following actions should thenurse implement with this form of therapy? A. Demonstrate riding in an elevator, and then ask the client to imitate the behavior. B. Advise the client to say "stop" out loud every time they begin to feel an anxiety response related to an elevator. C. Gradually expose the client to an elevator while practicing relaxation techniques. D. Stay with the client in an elevator until the anxiety response diminishes.
A. Demonstration followed by client imitation of the behavior is an example of modeling. B. Teaching a client to say "stop" when anxiety occurs is an example of thought stopping. C. CORRECT: Systematic desensitization is the planned, progressive exposure to anxiety‐provoking stimuli. During this exposure, relaxationtechniques suppress the anxiety response. D. Exposing the client to a great deal of an undesirable stimulus in an attempt to turn off the anxiety response is an example of flooding.
A nurse is discussing early indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. The nurse should include which of the following manifestations in the teaching? (Select all that apply.) A. Constipation B. polyuria C. Rash D. Muscle weakness E. Tinnitus
A. Diarrhea, rather than constipation, is an early indication of lithium toxicity. B. CORRECT: polyuria is an early indication of lithium toxicity. C. A rash is not indication of lithium toxicity. D. CORRECT: Muscle weakness is an early indication of lithium toxicity. E. Tinnitus is an indication of severe, rather than early, toxicity.
A nurse is discussing free association as a therapeutic tool with a client who has major depressivedisorder. Which of the following client statements indicates understanding of this technique? A. "I will write down my dreams as soon as I wake up." B. "I might begin to associate my therapist with important people in my life." C. "I can learn to express myself in a nonaggressive manner." D. "I should say the first thing that comes to my mind."
A. Dream analysis and interpretation are therapeutic tools. However, they are not an example of free association. B. Associating the therapist with significant persons in the client's life is an example of transference rather than free association. C. Learning to express feelings and solve problems in a nonaggressive manner is an example of assertiveness training, rather than free association. D. CORRECT: Free association is the spontaneous, uncensored verbalization of whatever comes to a client's mind.
A nurse is caring for a client who is experiencing a panic attack. Which of the following actions should the nurse take? A. Discuss new relaxation techniques. B. Show the client how to change the behavior. C. Distract the client with a television show. D. Stay with the client and remain quiet.
A. During a panic attack, the client is unable to concentrate on learning new information. B. During a panic attack, the client is unable to concentrate on learning new information. C. During a panic attack, avoid further stimuli that can increase the client's level of anxiety. D. CORRECT: During a panic attack, quietly remain with the client. This promotes safety and reassurance without additional stimuli.
A nurse will consider which of the following factors that increases the client's relapse episode for mania in Bipolar Disorder? A.Use of substances, sleep disturbances, psychological stressors B.Use of substances, a co-occurring borderline personality disorder, psychological stressors C.Use of substances, sharing medications with other people, lack of stable housing D.Use of substances, financial instability, lack of family support
A.Use of substances, sleep disturbances, psychological stressors
A nurse is planning group therapy for clients dealing with bereavement. Which of the following activities should the nurse include in the initial phase? (Select all that apply.) A. Encourage the group to work toward goals. B. Define the purpose of the group. C. Discuss termination of the group. D. Identify informal roles of members within the group. E. Establish an expectation of confidentiality within the group.
A. During the working phase, the group works toward goals. B. CORRECT: During the initial phase, identify the purpose of the group. C. CORRECT: During the initial phase, discuss termination of the group. D. During the working phase, identify informal roles that other members in the group often assume. E. CORRECT: During the initial phase, set the tone of the group, including an expectation of confidentiality.
A nurse is leading a peer group discussion about the indications for ECT. Which of the following indications should the nurse include in the discussion? A. Borderline personality disorder B. Acute withdrawal related to a substance use disorder C. Bipolar disorder with rapid cycling D. Dysphoric disorder
A. ECT has not been found to be effective for the treatment of personality disorders. B. ECT has not been found to be effective for the treatment of substance use disorders. C. CORRECT: ECT is indicated for the treatment of bipolar disorder with rapid cycling. D. ECT has not been found effective for the treatment of dysphoric disorder.
A nurse is providing teaching for a client who is scheduled to receive ECT for the treatment of major depressive disorder. Which of the following client statements indicates understanding of the teaching? A. "It is common to treat depression with ECT before trying medications." B. "I can have my depression cured if I receive a series of ECT treatments." C. "I should receive ECT once a week for 6 weeks." D. "I will receive a muscle relaxant to protect me from injury during ECT."
A. ECT is indicated for clients who have major depressive disorder and who are not responsive to pharmacological treatment. B. ECT does not cure depression. However, it can reduce the incidence and severity of relapse. C. The typical course of ECT treatment is two to three times a week for a total of six to 12 treatments. D. CORRECT: A muscle relaxant (succinylcholine) is administered to reduce the risk for injury during induced seizure activity.
A nurse is developing a plan of care for a client who has conversion disorder. Which of the following actions should the nurse include? A. Encourage the client to spend time alone in their room. B. Monitor the client for self‐harm once per day. C. Allow the client unlimited time to discuss physical manifestations. D. Discuss alternative coping strategies with the client.
A. Encourage the client to communicate with others and participate in group therapy and support groups. B. Continuously monitor the client for risk of self‐harm. C. Establish a time limit for discussion of physical manifestations. D. CORRECT: Discuss alternative coping strategies with the client.
A nurse is planning care for a client who has bipolar disorder and is experiencing a manic episode. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A. Provide flexible client behavior expectations. B. Offer concise explanations. C. Establish consistent limits. D. Disregard client concerns. E. Use a firm approach with communication.
A. Establish consistent client behavior expectations to decrease the risk for client manipulation. B. CORRECT: Offering concise explanations improves the client's ability to focus and comprehend the information. C. CORRECT: Establishing consistent limits decreases the risk for client manipulation. D. Respond to valid client concerns to foster a trusting nurse‐client relationship. E. CORRECT: Using a firm approach with client communication promotes structure and minimizes inappropriate client behaviors.
A nurse is caring for a client who has derealization disorder. Which of the following findings should the nurse identify as an indication of derealization? A. The client describes a feeling of floating above the ground. B. The client has suspicions of being targeted in order to be killed and robbed. C. The client states that the furniture in the room seems to be small and far away. D. The client cannot recall anything that happened during the past 2 weeks.
A. Feeling that one's body is floating above the ground is an example of depersonalization, in which the person seems to observe their own body from a distance. B. Having the idea of being targeted in order to be killed and robbed is an example of a paranoid delusion. C. CORRECT: Stating that one's surroundings are far away or unreal in some way is an example of derealization. D. Being unable to recall any events from the past 2 weeks is an example of amnesia.
A nurse is caring for a client who has major depressive disorder. Which of the following should the nurse identify as a risk factor for depression? (Select all that apply.) A. Male sex B. History of chronic bronchitis C. Recent death in client's family D. Family history of depression E. personal history of panic disorder
A. Females are twice as likely as males to experience a depressive disorder. B. CORRECT: Depressive disorders are more common in a client who has a chronic medical condition. C. CORRECT: Depressive disorders are more likely to occur in a client who is experiencing a high amount of stress (when grieving the death of a family member). D. CORRECT: Depressive disorders are more likely to occur in a client whose has a family history of depression. E. CORRECT: A history of an anxiety or personality disorder increases a client's risk for depressive disorder.
A nurse is assessing a client 4 hr after receiving an initial dose of fluoxetine Which of the following findings should the nurse report to the provider as indications of serotonin syndrome? (Select all that apply.) A. Hypothermia B. Hallucinations C. Muscular flaccidity D. Diaphoresis E. Agitation
A. Fever, rather than hypothermia, is an indication of serotonin syndrome. B. CORRECT: Hallucinations are an indication of serotonin syndrome. C. Muscle tremors, rather than flaccidity, are an indication of serotonin syndrome. D. CORRECT: Diaphoresis is an indication of serotonin syndrome. E. CORRECT: Agitation is an indication of serotonin syndrome.
A nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and a flat affect. The nurse should expect a prescription for which of the following medications? A. Chlorpromazine B. Thiothixene C. Risperidone D. Haloperidol
A. First‐generation antipsychotics (chlorpromazine) are used mainly to control positive, rather than negative, symptoms of schizophrenia. B. First‐generation antipsychotics (thiothixene) are used mainly to control positive symptoms of schizophrenia. C. CORRECT: Second‐generation antipsychotics (risperidone) are effective in treating negative symptoms of schizophrenia (lack of grooming and flat affect). D. First‐generation antipsychotics (haloperidol) are used mainly to control positive symptoms of schizophrenia.
A nurse is caring for a client who is prescribed lithium therapy. The client tells of the plan to take ibuprofen for osteoarthritis pain relief. Which of the following statements should the nurse make? A. "That is a good choice. Ibuprofen does not interact with lithium." B. "Regular aspirin would be a better choice than ibuprofen." C. "Lithium decreases the effectiveness of ibuprofen." D. "The ibuprofen will make your lithium level fall too low."
A. Ibuprofen is not recommended for clients taking lithium. B. CORRECT: Aspirin is recommended as a mild analgesic rather than ibuprofen due to the risk for lithium toxicity. C. Lithium does not decrease the effectiveness of ibuprofen. However, concurrent use is not recommended due to the risk of toxicity. D. Ibuprofen increases the risk for a toxic, rather than low, lithium level.
A nurse is assessing a client immediately following an ECT procedure. Which of the following findings should the nurse expect? (Select all that apply.) A. Hypotension B. paralytic ileus C. Memory loss D. polyuria E. Confusion
A. Immediately following ECT, the client's blood pressure is expected to be elevated. B. paralytic ileus is not an expected finding of ECT. C. CORRECT: Transient short‐term memory loss is an expected finding immediately following ECT. D. polyuria is not an expect finding of ECT. E. CORRECT: Confusion is an expected finding immediately following ECT.
A nurse is admitting a client who has a new diagnosis of bipolar disorder and is scheduled to beginlithium therapy. When collecting a medical history from the client's caregiver, which of the following statements is the priority to report to the provider? A. "Current medical conditions include diabetes that is controlled by diet." B. "Recent medications include a course of prednisone for acute bronchitis." C. "Current vaccinations include a flu vaccine last month." D. "Current medications include furosemide for congestive heart failure."
A. It is important to notify the provider of the client's medical history. However, this information does not pose the greatest risk to the client and is therefore not the priority. B. It is important to notify the provider of the client's medical history. However, this information does not pose the greatest risk to the client and is therefore not the priority. C. It is important to notify the provider of the client's medical history. However, this information does not pose the greatest risk to the client and is therefore not the priority. D. CORRECT: Diuretics (furosemide) are contraindicated for use with lithium due to the risk for toxicity. Thisis the greatest risk for the client and is therefore the highest priority to report to the provider.
A nurse wants to use democratic leadership witha group whose purpose is to learn appropriate conflict resolution techniques. The nurse is correct in implementing this form of group leadership when demonstrating which of the following actions? A. Observes group techniques without interfering with the group process B. Discusses a technique and then directs members to practice the technique C. Asks for group suggestions of techniques and then supports discussion D. Suggests techniques and asks group members to reflect on their use
A. Laissez‐faire leadership allows the group process to progress without any attempt by the leaderto control the direction of the group. B. Autocratic leadership controls the direction of the group. C. CORRECT: Democratic leadership supports group interaction and decision making to solve problems. D. Autocratic leadership controls the direction of the group.
A nurse is talking with a client who reports experiencing increased stress because a new partner is "pressuring me and my kids to go live with him.I love him, but I'm not ready to do that." Which of the following recommendations should the nurse make to promote a change in the client's situation? A. Learn to practice mindfulness. B. Use assertiveness techniques. C. Exercise regularly. D. Rely on the support of a close friend.
A. Mindfulness is appropriate to decrease the client's stress. However, it does not promote a change in the client's situation. B. CORRECT: Assertive communication allows the client to assert their feelings and then make a change in the situation. C. Regular exercise is appropriate to decrease the client's stress. However, it does not promotea change in the client's situation. D. Social support is appropriate to decrease the client's stress. However, it does not promote a change in the client's situation.
A nurse observes a client who has OCD repeatedly applying, removing, and then reapplyingmakeup. The nurse identifies that repetitive behavior in a client who has OCD is due to which of the following underlying reasons? A. Narcissistic behavior B. Fear of rejection from staff C. Attempt to reduce anxiety D. Adverse effect of antidepressant medication
A. Narcissism causes clients to seek admiration from others. B. Fear of rejection might cause a client to avoid social situations and might be associated with social phobia anxiety disorder. C. CORRECT: Clients who have OCD demonstrate repetitive behavior in an attempt to suppress persistent thoughts or urges that cause anxiety. D. Clients who have OCD might take an antidepressant to help control repetitive behavior.
A nurse is reviewing the medical record of a client who has a new prescription for bupropion for depression. Which of the following findings is the priority for the nurse to report to the provider? A. The client has a family history of seasonal pattern depression. B. The client currently smokes 1.5 packs of cigarettes per day. C. The client had a motor vehicle crash last year and sustained a head injury. D. The client has a BMI of 25 and has gained 10 lb over the last year.
A. Report family history information. However, this does not address the greatest risk to the client and is not the priority. B. Report the client's current smoking status. However, this does not address the greatest risk to the client and is not the priority. C. CORRECT: The greatest risk to the client is development of seizures. Bupropion can lower the seizure threshold and should be avoided by clients who have a history of a head injury. This information is the highest priority to report to the provider. D. Report the client's BMI and change in weight. However, this does not address the greatest
A nurse is caring for a client who has bipolar disorder. Which of the following is the priority nursing action? A. Set consistent limits for expected client behavior. B. Administer prescribed medications as scheduled. C. provide the client with step‐by‐step instructions during hygiene activities. D. Monitor the client for escalating behavior.
A. Set consistent limits for expected client behavior. However, this does not address the client's priority need for safety and is therefore not the priority action. B. Administer prescribed medications as scheduled. However, this does not address the client's priority need for safety and is therefore not the priority action. C. provide the client with step‐by‐step instructions during hygiene activities. However, this does not address the client's priority need for safety and is therefore not the priority action. D. CORRECT: Monitoring for escalating behavior addresses the client's priority need for safety and is therefore the priority nursing action.
A charge nurse is discussing TMS with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. "TMS is indicated for clients who have schizophrenia spectrum disorders." B. "I will provide postanesthesia care following TMS." C. "TMS treatments usually last 5 to 10 minutes." D. "I will schedule the client for TMS treatments 3 to 5 times a week for the first several weeks."
A. TMS is indicated for the treatment of major depressive disorder that is not responsive to pharmacological treatment. ECT is indicated for the treatment of schizophrenia spectrum disorders. B. postanesthesia care is not necessary after TMS because the client does not receive anesthesia and is alert during the procedure. C. The TMS procedure lasts 30 to 40 min. D. CORRECT: TMS is commonly prescribed 3 to 5 times a week for the first four to six weeks.
A nurse is caring for a client who is to begin taking fluoxetine for treatment of panic disorder. Which of the following statements indicates the client understands the use of this medication? A. "I will take the medication at bedtime." B. "I will follow a low‐sodium diet while taking this medication." C. "I will need to discontinue this medication slowly." D. "I will be at risk for weight loss with long‐term use of this medication."
A. The client should take fluoxetine in the morning to minimize sleep disturbances. B. The client is at risk for hyponatremia while taking fluoxetine. C. CORRECT: When discontinuing fluoxetine, the client should taper the medication slowly according to a prescribed tapered dosing schedule to reduce the risk of withdrawal syndrome. D. The client is at risk for weight gain, rather than loss, with long‐term use of fluoxetine.
A nurse is collecting an admission history for a client who has acute stress disorder (ASD). Which of the following client behaviors should the nurse expect? A. The client remembers many details about the traumatic incident. B. The client expresses heightened elation about what is happening. C. The client remembers first noticing manifestations of the disorder 6 weeks after the traumatic incident occurred. D. The client expresses a sense of unreality about the traumatic incident.
A. The client who has ASD tends to be unable to remember details about the incident and can block the entire incident from memory. B. The client who has ASD reacts to what is happening with negative emotions (anger, guilt, depression, and anxiety). Elation is an emotion that can occur in clients who have mania. C. Manifestations of ASD occur immediately to a few days following the event. D. CORRECT: The client who has ASD often expresses dissociative manifestations regarding the event, which includes a sense of unreality.
A nurse is discussing relapse prevention with a client who has bipolar disorder. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. Use caffeine in moderation to prevent relapse. B. Difficulty sleeping can indicate a relapse. C. Begin taking your medications as soon as a relapse begins. D. participating in psychotherapy can help prevent a relapse. E. Anhedonia is a clinical manifestation of a depressive relapse.
A. The client who has bipolar disorder should avoid the use of caffeine because it can precipitate a relapse. B. CORRECT: The client should be alert for sleep disturbances, which can indicate a relapse. C. The client who has bipolar disorder should take prescribed medications to prevent and minimize a relapse. D. CORRECT: The client who has bipolar disorder can participate in psychotherapy to help prevent a relapse. E. CORRECT: The onset of anhedonia, the inability to feel pleasure, is a manifestation of depression which can indicate a relapse of bipolar disorder.
A nurse in an acute mental health facility is planning care for a client who has dissociative fugue. Which of the following interventions should the nurse add to the plan of care? A. Teach the client to recognize how stress brings on a personality change in the client. B. Repeatedly present the client with information about past events. C. Make decisions for the client regarding routine daily activities. D. Work with the client on grounding techniques.
A. The client who has dissociative identity disorder displays multiple personalities, while the client who has dissociative fugue has amnesia regarding their identity and past. B. Avoid flooding the client with information about past events, which can increase the client's level of anxiety. C. Encourage the client to make decisions regarding routine daily activities in order to promote improved self‐esteem and decrease the client's feelings of powerlessness. D. CORRECT: Grounding techniques (stomping the feet, clapping the hands, or touching physical objects) are useful for clients who have a dissociative disorder and are experiencing manifestations of derealization.
A charge nurse is discussing the care of a client who has major depressive disorder (MDD) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. "Care during the continuation phase focuses on treating continued manifestations of MDD." B. "The treatment of MDD during the maintenance phase lasts for 6 to 12 weeks." C. "The client is at greatest risk for suicide during the first weeks of an MDD episode." D. "Medication and psychotherapy are most effective during the acute phase of MDD."
A. The focus of the continuation phase is relapse prevention. Treatment of manifestations occurs during the acute phase of MDD. B. The maintenance phase of treatment for MDD can last for 1 year or more. C. CORRECT: The client is at greatest risk for suicide during the acute phase of MDD. D. Medication therapy and psychotherapy are used during the continuation phase to prevent relapse of MDD.
A nurse is involved in a serious and prolonged mass casualty incident in the emergency department. Which of the following strategies should the nurse use to help prevent developing a trauma‐related disorder? (Select all that apply) A. Avoid thinking about the incident when it is over. B. Take breaks during the incident for food and water. C. Debrief with others following the incident. D. Avoid displays of emotion in the days following the incident. E. Take advantage of offered counseling.
A. Thinking and talking about a traumatic incident can help prevent development of a trauma‐related disorder. B. CORRECT: Taking breaks and remembering to drink water and eat nutritious foods while working during a traumatic incident can help prevent development of a trauma‐related disorder. C. CORRECT: Debriefing with others following a traumatic incident can help prevent development of a trauma‐related disorder. D. Displaying emotions following a traumatic incident can help prevent development of a trauma‐related disorder. E. CORRECT: Taking advantage of counseling offered by an employer or others can help prevent development of a trauma‐related disorder.
A nurse is caring for a client who states, "I'm so stressed at work because of my coworker. I am expected to finish others' work because of their laziness!" When discussing effective communication, which of the following statements by the client to the coworker indicates client understanding? A. "You really should complete your own work. I don't think it's right to expect me to complete your responsibilities." B. "Why do you expect me to finish your work? You must realize that I have my own responsibilities." C. "It is not fair to expect me to complete your work. If you continue, then I will report your behavior to our supervisor." D. "When I have to pick up extra work, I feel very overwhelmed. I need to focus on my own responsibilities."
A. This statement is an example of disapproving/ disagreeing, which can prompt a defensive reaction and is therefore nontherapeutic. B. This statement uses a "why" question, which implies criticism and can prompt a defensive reaction and is therefore nontherapeutic. C. This statement is aggressive and threatening, which can prompt a defensive reaction and is therefore nontherapeutic. D. CORRECT: This response demonstrates assertive communication, which allows the client to state his feelings about the behavior and then promote a change.
A nurse on an acute mental health unit forms a group to focus on self‐management of medications. At each of the meetings, two of the members conspire together to exclude the rest of the group. This is an example of which of the following concepts? A. Triangulation B. Group process C. Subgroup D. Hidden agenda
A. Triangulation is when a third party is drawn into a relationship with two members whose relationship is unstable. B. Group process is the verbal and nonverbal communication that occurs within the group during group sessions. C. CORRECT: A subgroup is a small number of people within a larger group who function separately from that group. D. A hidden agenda is when some group members have a different goal than the stated group goals. The hidden agenda is often disruptive to the effective functioning of the group.
A nurse is interviewing a client who has a new diagnosis of persistent depressive disorder. Which of the following findings should the nurse expect? A. Wide fluctuations in mood B. Report of a minimum of five clinical findings of depression C. Presence of manifestations for at least 2 years D. Inflated sense of self‐esteem
A. Wide fluctuations in mood are associated with bipolar disorder. B. MDD contains a minimum of five clinical findings of depression. C. CORRECT: Manifestations of persistent depressive disorder last for at least 2 years in adults. D. A decreased, rather than inflated, sense of self‐esteem is associated with persistent depressive disorder.
A nurse is teaching a newly licensed nurse about the use of electroconvulsive therapy (ECT) for the treatment of bipolar disorder. Which of the following statements by the newly licensed nurse indicates understanding? A. "ECT is the recommended initial treatment for bipolar disorder." B. "ECT is contraindicated for clients who have suicidal ideation." C. "ECT is effective for clients who are experiencing severe mania." D. "ECT is prescribed to prevent relapse of bipolar disorder."
A. pharmacological intervention is the recommended initial treatment for bipolar disorder. B. ECT is effective for clients who have bipolar disorder and suicidal ideation. C. CORRECT: ECT is appropriate for the treatment of severe mania associated with bipolar disorder. D. ECT is prescribed for clients experiencing an acute episode of bipolar disorder rather than for the prevention of relapse.
A nurse is conducting a family therapy session. The younger child tells the nurse about plans to make the older sibling look bad, believing this will earn more freedom and privileges. The nurse should identify this dysfunctional behavior as which of the following? A. placation B. Manipulation C. Blaming D. Distraction
A. placation is the dysfunctional behavior of taking responsibility for problems to keep peace among family members. B. CORRECT: Manipulation is the dysfunctional behavior of using dishonesty to support an individual agenda. C. Blaming is the dysfunctional behavior of blaming others to shift focus away from the individual's own inadequacies. D. Distraction is the dysfunctional behavior of inserting irrelevant information during attempts at problem solving.
The nurse is assessing the severity of depression symptoms of a client by asking questions from the PH-Q 9 screening tool. Which of the following questions will the nurse ask the client? (Select all that apply) A."Are you feeling bad about yourself or that you are a failure and you've let your family down?" B."Are you feeling down, depressed, or hopeless?" C."Are you having thoughts that you would be better off dead or of hurting yourself in some way?" D."What are your favorite hobbies or activities you enjoy doing?" E."Do you have poor appetite or are you overeating?"
A."Are you feeling bad about yourself or that you are a failure and you've let your family down?" B."Are you feeling down, depressed, or hopeless?" C."Are you having thoughts that you would be better off dead or of hurting yourself in some way?" E."Do you have poor appetite or are you overeating?"
The nurse is administering Bupropion to a client with Major Depressive Disorder. Contraindications includes which of the following? A.Avoid administering to clients who are at risk for seizures; contraindicated in clients with anorexia nervosa or bulimia nervosa B.There is a risk for serotonin syndrome, neuroleptic malignant syndrome, and hyponatremia C.Avoid concurrent use of anticoagulants, antibiotics, and benzodiazepines D.There is a risk for sexual dysfunction adverse effects, bruxism, orthostatic hypotension E.Avoid sun exposure, caffeine, tyramine foods.
A.Avoid administering to clients who are at risk for seizures; contraindicated in clients with anorexia nervosa or bulimia nervosa
A client diagnosed with obsessive-compulsive disorder spends many hours during the day and night washing hands. The nurse should initially allow the client to continue this behavior because it has what therapeutic effect for the client? A.Relieves the client's anxiety B.Decreases the chance of infection C.Gives the client the feeling of self-control D.Increases the client's sense of self-esteem
A.Relieves the client's anxiety Critical reason: The compulsive act provides immediate relief from anxiety and is used to cope with stress, conflict, or pain. Although the client is comforted by the feeling of self-control and there is a need to increase self-esteem, the act itself provides immediate relief of anxiety as the client uses this maladaptive response. Extra: Ensure basic needs are met/food/fluids, rest, hygiene/grooming. Nurse will identify situations that precipitate compulsive behavior and encourage the client to verbalize thoughts and feelings; explore fav music, activities, movement therapy to replace repetitive behavior towards more adaptive coping; model adaptive behavior
Management in healthy families
Adults of a family agree on important issues (rule making, finances, plans for the future).
Later adverse effects of SSRIs
After 5 to 6 weeks of therapy: sexual dysfunction (impotence, delayed or absent orgasm, delayed or absent ejaculation, decreased sexual interest), weight gain, headache -Weight changes -Hyponatremia -Serotonin syndrome -Bruxism -Withdrawal syndrome
What are support groups for addiction r/t family members/teens?
Al-ATeen support group for teens who have been affected by addiction in the family
Socialization in healthy families
All members interact, plan, and adopt healthy ways of coping. Children learn to function as family members, as well as members of society. Members are able to change as the family grows and matures.
What is VNS believed to result in?
An increased level of neurotransmitters and enhances the actions of antidepressant medications.
How long does it take to achieve therapeutic effects of SSRIs?
As SSRIs have a long effective half-life, up to 4 weeks are necessary to produce therapeutic medication levels.
What are comorbidities of somatic symptom disorder?
Anxiety and depression
How long does it take to achieve therapeutic effects of buspirone?
Antianxiety effects develop slowly. Initial responses take 1 week, and full effects take up to 4 weeks. As a result of this pharmacological action, buspirone needs to be taken on a scheduled basis, and is not suitable for PRN usage.
Medications for conversion disorder
Antidepressant Anxiolytic
What are the 5 main groups of antidepressant medications?
Antidepressant medications are classified into five main groups: tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), atypical antidepressants.
Medications for illness anxiety disorder
Antidepressants Anxiolytics
What does assertiveness training do?
Assertiveness training: Teaches clients to express feelings, and solve problems in a nonaggressive manner.
What should you assess in older adults who are prescribed benzodiazepines?
Assess fall risk
Nursing actions for a client on MAOIs
Assess the client for ability to follow strict adherence to dietary restrictions
What is reattribution treatment?
Assists clients to identify the link between physical manifestations and psychological factors while promoting a sense of caring and understanding.
What are symptoms of lithium toxicity?
Ataxia, confusion, large output of dilute urine, blurred vision, clonic movements, seizures, stupor, severe hypotension, and coma. Pulmonary complications may lead to death. The nurse should withhold the medication, because the client is displaying manifestations of toxicity.
What is administered prior to ETC?
Atropine is commonly administered prior to ECT to reduce secretions and protect against vagal stimulation (bradycardia) during the procedure
What should patients on MAOIs avoid?
Avoid Tyramine rich foods - may cause a hypertensive crisis
Client education for Venlafaxine, Duloxetine, Desvenlafaxine, & Levomilnacipran (SNRIs used for deepressive disorders)
Avoid abrupt cessation. Discontinue gradually.
Client education for withdrawal syndrome associated with SSRIs
Avoid abrupt discontinuation and taper medication slowly.
Nursing care for a client diagnosed with Major Depressive Disorder includes which of the following? A. Discontinue all medications suddenly to see the effects on level of depression and maintain a safe environment B. Assess the client's risk for suicide and implement appropriate safety precautions C. Assist the client with removing the feelings of guilt and improve problem solving skills D. Expect the therapeutic effects of medications to be immediate and monitor the client's ability to perform activities of daily living
B. Assess the client's risk for suicide and implement appropriate safety precautions
The nurse is caring for a client diagnosed with Bipolar Disorder and is in a manic state. The nurse determines which group of foods would be best for the client? A.Beef stew, fruit salad, tea B.Cheeseburger, banana, milk C.Macaroni and cheese, apple, milk D.Scrambled eggs, orange juice, coffee
B. Cheeseburger, banana, milk Critical Reason: B is the most portable; client in manic state has inadequate food and fluid intake as a result of physical agitation. The nurse will promote avoidance of caffeine intake during the manic state.
A nurse caring for a client with Major Depressive Disorder is giving the client his ordered dose of a Tricyclic Antidepressant. Which of the following are important nursing considerations? (Select all that apply) A.Sedation increases over time so teach the client to take the medication in the middle of the day B. Monitor for orthostatic hypotension C.Decrease fluid intake as urinary retention occurs in all clients D.Give no more than one week supply of medications to clients who are high risk for lethality E.Monitor clients who have seizure disorders
B. Monitor for orthostatic hypotension D.Give no more than one week supply of medications to clients who are high risk for lethality E.Monitor clients who have seizure disorders
A nurse is assessing lethality and suicide risk during an admission assessment. Which of the following situations demonstrates the most risk for suicide? A.A Client who is sad and verbalizing they need more sleep B.A Client who is responding internally with hallucinations, in a manic state C.A Client who just received recent news that their cancer has progressed and metastasized D.A Client who verbalizes not being able to concentrate, tearful, verbalizing that their boyfriend abandoned them and broke of their relationship
B.A Client who is responding internally with hallucinations, in a manic state
The nurse is conducting medication teaching for a client with Major Depressive Disorder. Which of the following will the nurse include in the medication teaching? A.Due to the risk for hypotensive crisis, avoid foods with tyramine if prescribed monoamine oxidase inhibitors B.Change positions slowly to minimize dizziness from orthostatic hypotension when prescribed a tricyclic antidepressant C.Taking St John's wort with SSRIs increases therapeutic efficacy of medications D.Limit fluids as many of the medications have a side effect of urinary retention
B.Change positions slowly to minimize dizziness from orthostatic hypotension when prescribed a tricyclic antidepressant
The nurse knows that a diagnosis of Major Depressive Disorder recognized by the DSM-5 includes which of the following criteria occurring almost every day for at least 2 weeks, and last most of the day. (Select all that apply) A.Depressed mood with mania or hypomania B.Depressed mood, insomnia or hypersomnia C.Anhedonia and anergia D.Suicidal ideation, decreased ability to concentrate E.Increase or decreased weight, more than 5% of total body weight over one month
B.Depressed mood, insomnia or hypersomnia C.Anhedonia and anergia D.Suicidal ideation, decreased ability to concentrate E.Increase or decreased weight, more than 5% of total body weight over one month
A nurse is taking care of a client that presents with serotonin syndrome. Nursing priority of action includes which of the following? A.Discontinue serotonergic agents, start preparations for electroconvulsive therapy and give Dantrolene B.Discontinue serotonergic agents; give Benzodiazepines and if necessary, Cyproheptadine C.Discontinue serotonergic agents; provide warming blankets and monitor for hypotension and bradycardia D.Discontinue serotonergic agents and antipsychotics, start intravenous fluids, move client to intensive care unit
B.Discontinue serotonergic agents; give Benzodiazepines and if necessary, Cyproheptadine
A client is admitted in an acute manic episode, proclaiming to be a champion poker player and has not taken prescribed medications for one month. Nursing care will include which of the following? A.Provide the client with increased activities to avoid social isolation while assessing for suicidal thoughts B.Provide the client with frequent rest periods while assessing for suicidal thoughts C.Provide client with 1:1 monitoring, seclusion, and medications D.Provide the client with options for partnering with other peers in the milieu to teach them how to play poker
B.Provide the client with frequent rest periods while assessing for suicidal thoughts
A nurse is interviewing a client who is demonstrating speech that takes a circuitous route before reaching its goal. Extra unnecessary and sometimes tedious details are added. The client often needs to be interrupted and redirected. Nursing actions includes which of the following? A.Recognize that the client's speech is tangential so the nurse will need to repeat assessment questions slower. B.Recognize that the client's speech is circumstantial so the nurse will need to focus questions to redirect client responses. C.Recognize that the client's speech demonstrates loose associations so the nurse will need to stop the interview and give the client their scheduled medications. D.Recognize that the client's speech demonstrates psychosis so the nurse will need to offer the client a prn (as needed) medication.
B.Recognize that the client's speech is circumstantial so the nurse will need to focus questions to redirect client responses.
A nurse is preparing the first dose of Amitriptyline to give to a client. Which of the following are contraindications and precautions? (Select all that apply) A.This medication is a safe treatment for clients with seizure disorders B.This medication is used cautiously in clients with respiratory disorders C.This medication can increase suicide risk D.This medication is used with MAOIs for increased efficacy E.This medication is used cautiously in clients who have coronary artery disease.
B.This medication is used cautiously in clients with respiratory disorders C.This medication can increase suicide risk E.This medication is used cautiously in clients who have coronary artery disease.
What medications is bipolar disorder managed with?
Bipolar disorder is primarily managed with mood‐stabilizing medications (lithium carbonate). Bipolar disorder also can be treated with certain antiepileptic medications.
Contraindications of benzodiazepines
Benzodiazepines are contraindicated in clients who have sleep apnea, respiratory depression, and/or glaucoma.
Boundaries in healthy families
Boundaries are distinguishable between family roles. Clear boundaries define roles of each member and are understood by all. Each family member is able to function appropriately.
Types of brain stimulation therapies
Brain stimulation therapies include electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and vagus nerve stimulation (VNS).
Why are breathing exercises used?
Breathing exercises are used to decrease rapid breathing and promote relaxation
What is stage 2 of reattribution treatment?
Broadening the agenda: Provide acknowledgment of the client's concerns and provide feedback about assessment findings.
Examples of atypical antidepressants used for depressive disorders
Bupropion
A client had a motor vehicle crash last year and sustained a head injury, what medication will the HCP likely prescribe?
Bupropion Rationale: The greatest risk for the client is development of seizures. Bupropion can lower the seizure threshold and should be avoided by clients who have a history of head injury. This information is the highest priority to report to the Provider.
Fluoxetine hydrochloride is prescribed for a client with MDD. The nurse provides instructions for the client regarding administration of the medication. Which statement by the client indicates an understanding about administration of the medication? A."I should take the medication with my evening meal." B."I should take the medication at noon with an antacid." C."I should take the medication in the morning when I first wake up." D."I should take the medication right before bedtime with a snack."
C."I should take the medication in the morning when I first wake up." Critical Reason: This med can cause CNS Stimulation. To decrease effects of insomnia- teach client to take med in the AM; avoid excessive caffeine use; teach relaxation techniques
A client with a diagnosis of Major Depressive Disorder states to the nurse, "I should have died. I've always been a failure." Which of the following is a therapeutic response by the nurse? A."You don't see anything positive?" B."You still have a great deal to live for." C."You have feelings of failure for quite some time now." D."Feeling like a failure is part of your illness"
C."You have feelings of failure for quite some time now." Critical Reason: The correct option is an example of the use of restating. The nurse will restate what is expressed by the client with an effective therapeutic response- it also validates their feeling. The nurse can then proceed to explore coping methods that have worked in the past, and teach new coping strategies. The nurse will focus on the client's strengths. The other options block communication, minimize the client's experience, and does not facilitate exploration of the client's expressed thoughts and feelings.
Interactions with benzodiazepines
CNS depressants (alcohol, barbiturates, opioids) can cause respiratory depression.
When can serotonin syndrome begin after the administration of fluoxetine (an SSRI used for depressive disorders)?
Can begin 2 to 72 hr after the start of treatment, and it can be lethal.
A client is hospitalized and placed on suicide precautions at a psychiatric unit. The client verbalizes the thoughts and feelings of self-harm is still present. Nursing interventions for appropriate priority of action include:
Check on the client every 15 minutes, or if necessary, assign a staff person to stay with the client on a one-to-one basis. Rationale: This is the appropriate nursing intervention to maintain safety and observations of a patient with ruminating thoughts and a possible plan. Safety rounds in the inpatient milieu is every 15 min the rounder accounts for each patient's behavior and location, mood
Socialization in dysfunctional families
Children do not learn healthy socialization skills within the family and have difficulty adapting to socialization roles of society.
What is grandiosity?
Grandiosity refers to the client's belief that he has special abilities or great powers
A nurse is caring for a client who has psychological factors affecting other medical conditions. RISK FACTORS: Identify the risk factors of psychological factors affecting other medical conditions.
Chronic stressors, depressive disorder or anxiety disorder, and imbalance of neurotransmitters.
What is the focus of individual group therapies?
Client needs and problems The therapeutic relationship
Where are clients with somatic symptom disorder usually seen first?
Clients are usually seen initially in a primary or medical care setting rather than a mental health setting.
Describe clients who have somatic symptom disorder
Clients who have somatic symptom disorder spenda significant amount of time worrying about their physical manifestations to the point where it assumes a central role in the client's life and relationships. Clients often reject a psychological diagnosis as the cause for their physical manifestations. They seek care from several providers, increasing medical costs.
How to PTSD patients sometimes cope? What can you do to help them?
Clients with PTSD sometimes cope by an adaptive use of dissociation by temporarily blocking memories and perceptions from conscious thought. Dissociation involves a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment. A physical response of hand trembling when hearing a loud noise, and choosing to dissociate from the loud noise by reading a book is an adaptive response. Holding a book helps purposeful movement and focusing on reading helps with distraction.
What type of clients have high risk taking behavior, including risk for SUD?
Clients with PTSD, trauma, and high ACE (adverse childhood experiences) scores
What is cognitive reframing?
Cognitive reframing assists clients to identify negative thoughts that produce anxiety, examine the cause, and develop supportive ideas that replace negative self-talk.
What is cognitive reframing?
Cognitive reframing is correlated with a greater positive affect and higher self-esteem. The goal is to have a negative perception changed to a positive one.
Cognitive therapy
Cognitive therapy is based on the cognitive model, which focuses on individual thoughts and behaviors to solve current problems. The belief is that thoughts come before feelings and actions. It treats depression, anxiety, eating disorders, and other issues that can improve by changing a client's attitude toward life experiences.
Cognitive-behavioral therapy
Cognitive-behavioral therapy uses both cognitive and behavioral approaches to assist a client with anxiety management. This therapy takes into account what clients think influences their feelings and behaviors.
Contraindications of bupropion (atypical antidepressant used for depressive disorders)
Contraindicated in clients with seizure disorders, anorexia nervosa, or bulimia nervosa
What is conversion disorder?
Conversion disorder results when a client exhibits neurologic manifestations in the absence of a neurologic diagnosis. Clients who have conversion disorder transmit emotional or psychological stressors into physical manifestations.
What is DIGFAST?
DIGFAST is a way to recall and apply manifestations of manic episodes: delusions, impulsivity, grandiose thoughts, flight of ideas, accelerated speech, sleeplessness, and talkativeness.
What is fluoxetine (an SSRI) the first line of treatment for?
Depression
Dialectical behavior therapy
Dialectical behavior therapy is a cognitive-behavioral therapy for clients who have a personality disorder and exhibit self-injurious behavior. This therapy focuses on gradual behavior changes and provides acceptance and validation for these clients.
Family behavior that can be healthy or dysfunctional is the action of...?
Disciplining
Nursing actions for acute toxicity
Flumazenil is administered to counteract sedation and reverse the adverse effects.
Complications of buspirone
Dizziness, nausea, headache, lightheadedness, agitation
What must you do when discontinuing benzodiazepines?
Do not abruptly discontinue; gradually taper the dosage over several weeks
Why are benzodiazepines generally used for short-term use?
Due to the high risk of dependence
Why is tonic-clonic seizure activity no longer an effect of the the ECT treatment?
Due to the use of anesthesia and muscle relaxants, the tonic-clonic seizure activity associated with the procedure in the past is no longer an effect of the treatment.
A nurse is preparing to assist in providing electroconvulsive therapy (ECT) treatment for a client. Use the ATI Active Learning Template: Therapeutic procedure to complete this item. DESCRIPTION OF PROCEDURE
ECT is a nonpharmacologic brain stimulation therapy for the treatment of mentalhealth disorders, especially major depressive disorder.ECT induces seizure activity, which is thought to enhance the effects of neurotransmitters in the brain.
Client education for relapse of depression following an ECT procedure
ECT is not a permanent cure. Weekly or monthly maintenance ECT can decrease the incidence of relapse.
What is ECT?
ECT uses electrical current to induce brief seizure activity while the client is anesthetized. The exact mechanism of ECT is still unknown. One theory suggests that the seizure activity produced by ECT can enhance the effects of neurotransmitters (serotonin, dopamine, and norepinephrine) in the brain.
Nursing care for illness anxiety disorder
Encourage independence in self-care
Interactions with buspirone
Erythromycin, ketoconazole, St. John's wort, and grapefruit juice can increase the effects of buspirone.
What are other individual stress-reduction techniques?
Examples include individual hobbies (fishing, scrapbooking), music therapy, pet therapy, sleep, massage, and aerobic exercise.
What is factitious disorder?
Factitious disorder (previously known as Munchausen syndrome) is the conscious decision by the client to report physical or psychological manifestations. The falsification of manifestations is done in the absence of personal gain by the client other than possible fulfillment of an emotional need for attention. In some cases, clients inflict self-injury.
What is factitious disorder imposed on another?
Factitious disorder imposed on another (previously known as Munchausen syndrome by proxy) is present when the client deliberately causes injury or illness to a vulnerable person. The emotional need for attention or relief of responsibility remains a possible motivating factor.
What assessments are included in family therapy?
Family assessments include focused interviews and use of various family assessment tools.
What is the focus of family group therapies?
Family needs and problems within family dynamics Improving family functioning
What is stage 1 of reattribution treatment?
Feeling understood: Use therapeutic communication, active listening, and empathy to obtain a thorough history of manifestations while focusing on the client's perception of the manifestations and their cause. This stage also includes a brief physical assessment.
Early adverse effects of SSRIs
First few days/weeks: nausea, diaphoresis, tremor, fatigue, drowsiness
Therapeutic tools for psychoanalysis
Free association Dream analysis and interpretation Use of defense mechanisms
Therapeutic uses of buspirone
Generalized anxiety disorder
What is group norm?
Group norm is the way the group behaves during sessions, and, over time, it provides structure for the group. For example, a group norm could be that members raise their hand to be recognized by the leader before they speak. Another norm could be that all members sit in the same places for each session.
What is group process?
Group process is the verbal and nonverbal communication that occurs during group sessions, including how thework progresses and how members interact with one another.
What is guided imagery?
Guided imagery is a relaxation technique which includes thinking about a peaceful scene, and is an effective coping technique.
What is the focus of group therapies?
Helping individuals develop more functional and satisfying relations within a group setting
What is a hidden agenda?
Hidden agenda: Some group members (or the leader) might have goals different from the stated group goals that can disrupt group processes. For example, three membersmight try to embarrass another member whom they dislike.
A client frequently seeks medical care and constantly asks the nurse to have her provider order excessive lab test that are not necessary. The client has been preoccupied for more than 6 months with excessive anxiety that a serious illness is present, or will be acquired. The nurse understands that this is consistent with what disorder?
Illness anxiety disorder
What can illness anxiety disorder lead to?
Illness anxiety disorder, previously known as hypochondriasis, can lead to obsessive thoughts and fears about illness.
Focus of family therapy
In family therapy, the focus is on the family as a system, rather than on each person as an individual.
What can be an indication of mania or hypomania?
In order to relieve stress, it is recommended that adults exercise 30 minutes, 3 to 4 times weekly; however, this client is exercising aerobically over 600 minutes weekly. Excessive exercising may be an indication of mania or hypomania and is not effective.
What is transference?
Includes feelings that the client has developed toward the therapist in relation to similar feelings toward significant persons in the client's early childhood
What other findings are associated with PTSD?
Increasing anger and irritability
Therapeutic uses of escitalopram (an SSRI)
Indicated for GAD, OCD, panic disorder, PTSD, and social anxiety disorder.
Therapeutic uses of sertraline (an SSRI)
Indicated for panic disorder, OCD, social anxiety disorder, and PTSD.
Pharmacological action of bupropion (atypical antidepressant used for depressive disorders)
Inhibits dopamine uptake
Manifestations of a paradoxical response
Insomnia, excitation, euphoria, anxiety, rage
What does journal keeping do?
Journal keeping: Helps clients write down stressful thoughts and has a positive effect on well-being.
Lab tests and diagnostics for conversion disorder
Laboratory and diagnostic tests (CT scans, MRIs), can be performed to rule out underlying pathology.
Lab tests and diagnostics for illness anxiety disorder
Laboratory and diagnostic tests (CT scans, MRIs), can be performed to rule out underlying pathology.
Labs and diagnostics for factitious disorder
Laboratory and diagnostic tests (CT scans, MRIs), can be performed to rule out underlying pathology.
Lab and diagnostic tests for somatic symptom disorder
Laboratory and diagnostic tests, (CT scans, MRIs), can be performed to rule out underlying pathology.
Mood stabilizer used to treat bipolar disorder
Lithium Carbonate
What must be monitored in a patient taking valproate?
Liver function tests must be monitored. Rationale: Pancreatitis, hepatic dysfunction, and thrombocytopenia are serious adverse effects occasionally associated with valproate. Liver function tests should be monitored periodically to check for hepatic failure.
What is bruxism treated with?
Low-dose buspirone
Contraindications of MAOIs
MAOIs are contraindicated in clients who have pheochromocytoma, heart failure, cardiovascular and cerebral vascular disease, or severe renal insufficiency.
A nurse working in an acute mental health facility is performing an admission assessment for a client who has major depressive disorder (MDD). ALTERATION IN HEALTH (DIAGNOSIS)
MDD is a single episode or recurrent episodes of unipolar depression resulting in a significant change in a client's normal functioning (social, occupational, self‐care) accompanied by at least five clinical findings of MDD, which must occur almost every day for a minimum of 2 weeks, and last most of the day.
What is MDD?
Major depressive disorder (MDD), recognized by DSM 5, includes a single episode or recurrent episodes of unipolar depression, not associated with mood swings, resulting in significant change in a patient's normal functioning, accompanied by the following, occurring almost every day, for a minimum of 2 weeks: Anhedonia, depressed mood, insomnia or hypersomnia, decreased ability to concentrate, increase or decrease weight over 5% more than one month.
What are the goals of individual group therapies?
Make more positive individual decisions. Make productive life decisions.Develop a strong sense of self.
What is stage 3 of reattribution treatment?
Making the link: Use therapeutic communication to acknowledge the lack of a physical cause for the manifestations while allowing the client to maintain self-esteem.
Management in dysfunctional families
Management can be chaotic, with a child making management decisions at times.
Side effects of olanzapine
May cause weight gain of 3 lb in 2 weeks
Nursing actions for weight changes in patients taking SSRIs
Monitor client's weight
Nursing actions for decreased seizure activity r/t TCA administration
Monitor clients who have seizure disorders
Manifestations of withdrawal syndrome associated with SSRIs
Nausea, sensory disturbances, anxiety, tremor, malaise, unease
What is stage 4 of reattribution treatment?
Negotiating further treatment: Work with the provider and client to develop a treatment plan that allows for regular follow-up visits.
What lithium level indicates advanced lithium toxicity?
Nurse is administering lithium to a client with Bipolar Disorder knows that this medication has a narrow therapeutic range and before severe toxicity, the following indicates advanced lithium toxicity: A lithium level of greater than 2.0
A nurse working in an acute mental health unit is caring for a client who has a personality disorder. The client refuses to attend group meetings and will not speak to other clients or attend unit activities. The client enjoys visiting with staff and requests daily to take a walk outside with a staff member. The provider prescribes behavioral therapy with operant conditioning. Use the ATI Active Learning Template: Therapeutic procedure to complete this item. OUTCOMES/EVALUATION: Identify an appropriate client outcome.
OUTCOMES/EVALUATION -The client will attend group meetings. -The client will attend unit activities. -The client will appropriately socialize with other clients on the unit
What patients are more likely to get hyponatremia while taking SSRIs?
Older adults taking diuretics
Communication in dysfunctional families
One or more members use unhealthy patterns, including -Blaming: Members blame others to shift focus away from their own inadequacies. -Manipulating: Members use dishonesty to support their own agendas. -Placating: One member takes responsibility for problems to keep peace at all costs. -Distracting: A member inserts irrelevant information during attempts at problem solving. -Generalizing: Members use overall descriptions ("always" and "never") in describing family encounters.
What is aversion therapy?
Pairing of a maladaptive behavior with a punishment or unpleasant stimuli to promote a change in the behavior.
Nursing interventions for a post-ECT patient
Patients are expected to have short term memory loss, IV line is maintained until full recovery, monitor for possible hypertension and bradycardia after ECT procedure.
How does physical exercise help with stress?
Physical exercise (yoga, walking, biking) causes release of endorphins that lower anxiety, promote relaxation, and have antidepressant effects.
What is carbamazepine used for? What should a nurse report with this medication?
Prescribed for a patient to treat and prevent relapse of manic and depressive episodes of Bipolar Disorder. Nursing education for this medication includes: Report nystagmus, staggering gait, excess bruising, and lethargy
Client education for trazodone (SNRI used for depressive disorders)
Priapism can be a serious adverse effect. Seek medical attention immediately if this occurs.
What are cognitive reframing techniques for a patient who has an anxiety disorder?
Priority restructuring and journaling
What does priority restructuring do?
Priority restructuring: Assists clients to identify what requires priority (devoting energy to pleasurable activities).
What is progressive muscle relaxation?
Progressive muscle relaxation is an adaptive coping method which releases stress and includes tightening and relaxing muscles starting with the feet and moving upward or starting at the head and moving downward.
What is the primary focus of the working phase of group development?
Promote problem-solving skills to facilitate behavioral changes. Power and control issues can dominate in this phase.
What should you do while assessing a patient for suicidal thoughts?
Provide the patient with frequent rest periods
What is psychoanalysis, psychotherapy, and behavioral therapies?
Psychoanalysis, psychotherapy, and behavioral therapies are approaches to addressing mental health issues using various methods and theoretical bases.
Intervention for a client with a diagnosis of mania, acting out, making sexual remarks and lewd gestures toward staff and peers, comes out of the room without clothes on- which should the nurse implement, first:
Quietly approach the patient and escort her to her room to get dressed.
What is the relapse rate of conversion disorder?
Relapse rate is approximately 20% usually within 1 year of initial diagnosis.
What should you do upon admission for a mental health patient?
Remember to assess lethality risk, and obtain assessment of TMAPI on admission: Thoughts, Means, Ability, Plan and Intent
What percentage of clients with conversion disorder does remission occur?
Remission occurs without intervention in approximately 95% of clients, especially if the onset of manifestations is due to an acute stressful event.
What does OCD involve?
Repetitive thoughts or behaviors to decrease the severe anxiety
Client education for later adverse effects of SSRIs
Report problems with sexual function (managed with dose reduction, medication holiday, changing medications).
What is response prevention?
Response prevention: Preventing a client from performing a compulsive behavior with the intent that anxietywill diminish
How can a hypertensive crisis occur from phenelzine administration (MAOI used for depressive disorders)
Resulting from intake of dietary tyramine: severe hypertension as a result of intensive vasoconstriction and stimulation of the heart.
What is used to assess suicide risk factors?
SAFE-T handout
Pharmacological action of SSRIs used for depressive disorders
SSRIs selectively block reuptake of the monoamine neurotransmitter serotonin in the synaptic space, thereby intensifying the effects of serotonin.
What do atypical antidepressants have an increased risk for?
Serotonin syndrome and neuroleptic malignant syndrome
Why is disciplining important?
Setting limits on children's behavior protects their safety and provides them with security. Disciplining should be consistent, timely, and age appropriate. Parents should administer discipline in private, when they are calm. Caregivers should be in unison on when and how to discipline.
What needs to be controlled following an ECT procedure?
Severe hypertension should be controlled because a short period of hypertension occurs immediately after the ECT procedure.
Compare and contrast bipolar disorder and MDD in terms of sleeping and dressing
Sleeping for long periods of time is not typical in Bipolar, yet typical in MDD. Constant activity and a reduced need for sleep is typical in mania, preventing proper rest. Although short periods of sleep are possible, some clients may not sleep for several days. This nonstop physical activity and lack of sleep and food can lead to physical exhaustion and even death if not treated. Dressing in black or grey clothing is not typical of bipolar, but typical of MDD> Modes of dress often reflect the person's grandiose grasp of reality. Dress may be described as outlandish, bizarre, colorful, and noticeably inappropriate. Makeup may be flamboyant, flashy, and overdone.
What do somatic manifestations cause?
Somatic manifestations cause distress for clients and often lead to long-term use of health care services. Manifestations can be vague or exaggerated. The course of the disease can be acute, but is often chronic, with periods of remission and exacerbation
What do somatic symptom and related disorders include?
Somatic symptom and related disorders include somatic symptom disorder, illness anxiety disorder, conversion disorder, factitious disorder, and psychological factors affecting other medical conditions.
What is somatization?
Somatization is the expression of psychological stress through physical manifestations. The physical manifestations of somatic symptom disorder cannot be explained by underlying pathology.
What are panic disorders and social phobias?
Specific fears about an object or situation
What are other behaviors a patient in mania episode might display?
Spending large sums of money may be another behavior in mania episode. In the manic state, a person often gives away money, prized possessions, and expensive gifts. They may throw lavish parties, attend expensive night clubs and restaurants, and spend money freely on friends and strangers. This excessive spending, use of credit cards and high living continue even in the face of bankruptcy. Intervention often is needed to prevent financial collapse.
Contraindications for TMS
TMS is contraindicated for clients who have cochlear implants, brain stimulators, or medication pumps because the metal in the devices can interfere with the treatment.
Nursing actions for serotonin syndrome r/t administration of fluoxetine (an SSRI used for depressive disorders)
Start symptomatic treatment (medications to create serotonin receptor blockade and muscle rigidity, cooling blankets, anticonvulsants, artificial ventilation).
What is stress and what are stressors?
Stress is the body's nonspecific response to any demand made upon it. Stress is the brain's natural response to any demand. Stressors are physical or psychological factors that produce stress. Any stressor, whether it is perceived as "good" or "bad," produces a biological response in the body.
What is stress management?
Stress management is a client's ability to experience appropriate emotions and cope with stress. The client who manages stress in a healthy manner is flexible and uses a variety of coping techniques or mechanisms.
Examples of group therapy
Stress management, substance use disorders, medication education, understanding mental illness, and dual diagnosis groups
How is suicide prevention facilitated when administering antidepressants?
Suicide prevention is facilitated by prescribing only 1 week of medication for an acutely ill client, and following that, only prescribing 1 month of medication at a time, especially with TCAs, which have a high risk for lethality with a toxic dose. Assess clients for suicide risk. Antidepressant medications can increase the client's risk for suicide particularly during initial treatment. Antidepressant‐induced suicide is mainly associated with clients under the age of 25.
What are symptom characteristics of PTSD?
Sustained level of anxiety, difficulty sleeping, difficulty concentrating, irritability, and outbursts of anger.
Systematic desensitization use in mental health nursing
Systematic desensitization begins with the client mastering relaxation techniques. Then, the client is exposed to increasing levels of the anxiety-producing stimulus (either imagined or real) and uses relaxation to overcome anxiety. The client is then able to tolerate a greater and greater level of the stimulus until anxiety no longer interferes with functioning. Used to assist clients who have phobias that are anxiety producing.
What is transcranial magnetic stimulation (TMS)?
TMS is a noninvasive therapy that uses magnetic pulsations (MRI strength) to stimulate the cerebral cortex of the brain.
What are the indications for TMS?
TMS is approved by the United States Food and Drug Administration (FDA) for the treatment of major depressive disorder for clients who are not responsive to pharmacological treatment. TMS is similar to ECT but does not induce seizure activity.
Pharmacological action of MAOIs used for depressive disorders
These medications block MAO in the brain, thereby increasing the amount of norepinephrine, dopamine, and serotonin available for transmission of impulses. An increased amount of those neurotransmitters at nerve endings intensifies responses and relieves depression.
What is guided imagery?
The client is guided through a series of images to promote relaxation. Images vary depending on the individual. For example, one client might imagine walking on a beach, while another client might imagine themselves in a position of success.
What does cognitive reframing do?
The client is helped to look at irrational cognitions (thoughts) in a more realistic light and to restructure those thoughts in a more positive way.
What is mindfulness?
The client learns to restructure negative thoughts and interpretations into positive ones. For example, instead of saying, "It's so frustrating that the elevator isn't working," the client restructures the thought into, "Using the stairs is a great opportunity to burn off some extra calories."
What is operant conditioning?
The client receives positive rewards for positive behavior (positive reinforcement).
Pharmacological action of TCAs
These medications block reuptake of norepinephrine and serotonin in the synaptic space, thereby intensifying the effects of these neurotransmitters.
What affects the dynamics of a group in group therapy?
The dynamics of a group are affected by the group either being open (new members join as old members leave) or closed (no new members join after the formation of a group)
Working phase of group development
The group leader sets the tone, respect, and goals; Working phase: Problem-solving skills are facilitated; Termination phase: Leader summarizes group work and contributions
What is thought stopping?
Thought stopping: Teaching a client, when negative thoughts or compulsive behaviors arise, to say or shout, "stop," and substitute a positive thought. The goal over time is for the client to use the command silently.
What are protective factors for a patient with suicide risk?
The patient's feelings of support from a partner, children, family, or spiritual belief; feeling a sense of purpose; knowing that someone important to them is counting on them for care and support; ability to problems solve, etc
What is the typical course of ECT treatment?
The typical course of ECT treatment is two to three times a week for a total of 6 to 12 treatments for depression.
What is countertransference?
The unconscious feelings that the healthcare worker has toward the client. The client can remind them of a person from their past in a positive or negative manner.
When should a patient expect to experience therapeutic effects of bupropion (atypical antidepressant used for depressive disorders)
Therapeutic effects might not be experienced for 1 to 3 weeks. Full therapeutic effects can take 2 to 3 months.
A nurse is caring for a client who has post traumatic stress disorder (pTSD) following several months in a military combat situation. Use the Active Learning Template: System Disorder to complete this item. THERAPEUTIC PROCEDURES: Describe two therapeutic techniques used to treat a client who has pTSD.
Therapeutic techniques for a client who has pTSD include eye movement desensitization and reprocessing (EMDR), group and family therapy, and cognitive behavioral therapy.
Communication in healthy families
There are clear, understandable messages between family members, and each member is encouraged to express individual feelings and thoughts.
Contraindications of ECT
There are no absolute contraindications. However, the nurse should assess for medical conditions that place clients at higher risk of adverse effects.
How is buspirone different than other anxiolytics?
There is less potential for dependency than with other anxiolytics. Use of buspirone does not result in sedation or potentiate the effects of other CNS depressants. It carries no risk of misuse.
What are multigenerational issues?
These are emotional issues or themes within a family that continue for at least three generations (a pattern of substance use or addictive behavior, dysfunctional grief patterns, triangulation patterns, divorce).
Contraindications of fluoxetine (an SSRI used for depressive disorders)
These medications are contraindicated in clients taking MAOIs or TCAs.
What medication is administered prior to ECT treatment?
Thirty minutes prior to the beginning of the procedure, an IM injection of atropine sulfate or glycopyrrolate is administered to decrease secretions that could cause aspiration and to counteract any vagal stimulation effects (bradycardia)
What is the primary focus of the termination phase of group development?
This marks the end of group sessions.
Contraindications for amitriptyline (a TCA)
This medication is contraindicated for clients who have seizure disorders.
What is systematic desensitization?
This therapy is the planned, progressive, or graduated exposure to anxiety-provoking stimuli in real-life situations, or by imagining events that cause anxiety. During exposure, the client uses relaxation techniques to suppress anxiety response.
What does meditation, guided imagery, diaphragmatic breathing, muscle relaxation, and biofeedback do?
This therapy uses various techniques to control pain, tension, and anxiety.
Why is thyroid testing important for a client with long-term lithium use?
Thyroid testing is important because long-term use of lithium may lead to thyroid dysfunction.
T/F: Amitriptyline is a Pregnancy Risk Category C medication.
True
T/F: Benzodiazepines can be administered with meals or snacks if GI upset occurs
True
T/F: Families can have healthy or dysfunctional characteristics in one or more areas of functioning.
True
T/F: Healthy family relationships support the well being of each member of the family unit.
True
T/F: The development of certain medical conditions (heart disease, cancer), has been linked to clients who have depressive and anxiety disorders.
True
T/F: The mind-body connection has been the subject of research, proving a link between a client's psychological state and their physical condition.
True
T/F: The roles the family members fulfill change throughout the stages. For instance, when adults become parents they care for and model behavior for their children. As children mature, they rely on their parents less. Later on, the parents can have to depend on their children to meet their needs.
True
T/F: This medication does not interfere with activities because it does not cause sedation
True
T/F: Tolerance, dependence, or withdrawal manifestations are not an issue with this medication
True
T/F: bupropion is a pregnancy risk category B med
True
T/F: family is the first system to which a person is attached and is the most influential system to which an individual will belong.
True
T/F: if a patient is experiencing sexual dysfunction from fluoxetine (an SSRI used for depressive disorders), the provider can prescribe an atypical antidepressant with fewer sexual dysfunction adverse effects (bupropion)
True
What types of techniques are used for a patient with dissociative identity disorder?
Use grounding techniques such as clapping hands or touching objects; the goal is to integrate the alters (multiple identities).
How do you determine the appropriateness of relaxation techniques for a patient?
Use nursing judgment to determine the appropriateness of relaxation techniques for clients who are experiencing acute manifestations of a psychotic disorder
What are signs of a relapse of bipolar disorder?
Use of impulsivity, presence of anhedonia, and difficulty sleeping can indicate a relapse.
Therapeutic uses of fluoxetine (an SSRI)
Used for panic disorder, social anxiety disorder, OCD, and PTSD
What is the Patient Health Questionnaire 15 (PHQ-15) used for?
Used to identify the presence of the 15 most commonly reported somatic manifestations
How should clients discontinue using benzodiazepines?
When discontinuing benzodiazepines that have been taken regularly for long periods and in higher doses, taper the dose over several weeks using a prescribed dosing schedule.
Which statement by the client indicates understanding about Fluoxetine? a. "I should take the medication in the morning when I first wake up." b. "I should take the medication with my evening meal." c. "I should take the medication at noon with an antacid." d. "I should take the medication right before bedtime with a snack."
a. "I should take the medication in the morning when I first wake up."
Nurse admits a client dx'd w/MDD & anxiety disorder. Which of the following actions is the nurse's priority? a. Placing the client on one‑to‑one observation b. Encouraging the client to participate in counseling c. Teaching the client aboutmedication adverse effects d. Assisting the client to perform ADLs
a. Placing the client on one‑to‑one observation
Which of the following statements by a client dx w/Bipolar Disorder indicate adaptive coping?(SATA) a. "I think about being on my favorite beach vacation when I get anxious." b. "I tense and release my muscles, starting with my feet." c. "I exercise aerobically three times a day for 30 minutes at a time." d. "I get about 2-3 hours of sleep because I don't need sleep."
a. "I think about being on my favorite beach vacation when I get anxious." b. "I tense and release my muscles, starting with my feet."
A nurse is caring for a client who lost his mother to cancer to cancer a month ago. The client states, "I would still have my daughter if the doctor would have diagnosed her sooner." Which response is the best one for the nurse to choose? a. "You sound angry. Anger is a normal feeling associated with loss." b. "I think you would feel better If you talked about your feelings with a support group." c. "I understand just how you feel. I felt the same when my mother died." d. "Do other members of your family feel this way?
a. "You sound angry. Anger is a normal feeling associated with loss."
The nurse reviews the following during an assessment for suicide risk (SATA): a. Assess the patient's thoughts b. Assess the patient's ability c. Assess the patient's plan d. Assess the patient's patterns of speech
a. Assess the patient's thoughts b. Assess the patient's ability c. Assess the patient's plan
A nurse is caring for a client who is prescribed disulfiram (Antabuse) for the treatment of alcohol use disorder. The nurse informs the client that this medication can cause nausea and vomiting if he drinks alcohol. Which of the following types of treatment is this method an example? a. Aversion therapy b. Flooding c. Biofeedback d. Dialectical behavior therapy
a. Aversion therapy
The nurse caring for a Bipolar patient in mania realizes which of the following medications reduces symptoms of mania? a. Carbamazepine b. Bupropion c. Propanalol d. Lorazepam
a. Carbamazepine
Nursing considerations for a client prescribed Amitriptyline (SATA): a. Contraindicated for clients who have seizure disorders b. Use cautiously for clients with a respiratory disorder c. Use cautiously as it can cause insomnia d. Contraindicated for clients with hypertension
a. Contraindicated for clients who have seizure disorders b. Use cautiously for clients with a respiratory disorder
A nurse is reviewing the medical record of a client who has conversion disorder. Which of the following findings should the nurse identify as placing the client at risk for conversion disorder? a. Death of a child 2 months ago b. Recent weight loss of 30 lb c. Retirement 1 year ago d. History of migraine headaches
a. Death of a child 2 months ago
When Frank's wife of 34 years dies, he is very stoic, handles all of the funeral arrangements, doesn't cry or appear sad, and comforts all of the other family members in their grief. Two years later, when Frank's best friend dies, Frank has sleep disturbances, difficulty concentrating, loss of weight, and difficulty performing on his job. This is an example of which of the following maladaptive responses to loss? a. Delayed grieving b. Distorted grieving c. Prolonged grieving d. Exaggerated grieving
a. Delayed grieving
Which of the following are important nursing considerations for a client prescribed a TCA medication (SATA)? a. Give no more than one week supply of medications b. Monitor for fever c. Monitor for tachycardia d. Monitor for orthostatic hypotension
a. Give no more than one week supply of medications d. Monitor for orthostatic hypotension
The nurse gets ready to assess a client after an ECT procedure. Which of the following includes care and monitoring? a. IV line, potential memory loss, monitor possible HTN and bradycardia b. LOC, offer fluids immediately, monitor possible hypotension and tachycardia c. Indwelling bladder cath, permanent memory loss, monitor seizure activity d. Monitor EKG changes, depressed moods, fever
a. IV line, potential memory loss, monitor possible HTN and bradycardia
Preoccupation > 6 months w/excessive anxiety thinking a serious illness is present or will be acquired. a. Illness anxiety disorder b. Somatic symptom disorder c. Conversion disorder d. Factitious disorder
a. Illness anxiety disorder
Which of the following is a correct statement when attempting to distinguish normal grief from clinical depression? (Mark All That Apply) a. In clinical depression, anhedonia is prevalent b. In normal grieving, the person has generalized feelings of guilt c. The person who is clinically depressed relates feelings of depression to a specific loss d. In normal grieving, there is a persistent state of dysphoria
a. In clinical depression, anhedonia is prevalent b. In normal grieving, the person has generalized feelings of guilt
Client w/bipolar disorder shows the nurse fresh self-inflicted cuts along her right arm. Nursing priority: a. Inspect the cuts for debris b. Document the size and location of the cuts c. Implement the client's behavioral modification plan. d. Administer a tetanus antitoxin
a. Inspect the cuts for debris
A nurse is assessing a client who has illness anxiety disorder. Which of the following findings should the nurse expect? (Mark All That Apply) a. Obsessive thoughts about disease b. History of childhood abuse c. Avoidance of health care providers d. Depressive disorder e. Narcissistic personality
a. Obsessive thoughts about disease c. Avoidance of health care providers
Client on Valproate should receive which of the following discharge teaching education? a. Obtain lab draws for liver function test every 2 months b. Obtain lab draw for thyroid function test every 6 months c. Obtain EEG test every 3 months d. Obtain sodium levels every 6 months
a. Obtain lab draws for liver function test every 2 months
After witnessing a friend get killed client states, "I'm keyed up all the time, can't sleep, and having nightmares." a. PTSD b. OCD c. Panic Disorder d. Social Phobia
a. PTSD
A nurse is facilitating a family therapy session. The adolescent son tells the nurse he plans on ways to make his sister look bad to his parents. He thinks this will make himself look like he is the better sibling which he believes will get him more privileges. The nurse knows that this type of dysfunctional behavior as: a. Placation b. Manipulation c. Blaming d. Distraction
a. Placation
Scotty experienced loss of his son in a motorcycle accident. Which of the following stages of grief will he experience, according to Kubler-Ross? (Mark all that apply) a. Disequilibrium b. Denial c. Anger d. Bargaining e. Depression
b. Denial c. Anger d. Bargaining
A nurse is going to implement cognitive reframing techniques for a client who has an anxiety disorder. Which of the following techniques should the nurse prepare to include in the plan of care? (Mark all that apply): a. Priority restructuring b. Monitoring thoughts c. Diaphragmatic breathing d. Journal keeping e. Meditation
a. Priority Restructuring b. Monitoring thoughts d. Journal keeping
A client demonstrates speech w/a circuitous route before reaching its goal; often needs redirection. Nursing action: a. Speech is circumstantial, the nurse will redirect client responses. b. Speech has loose associations, the nurse will give scheduled medications. c. Speech is pressured, the nurse will offer the client a prn med. d. Speech is tangential, the nurse will speak slower
a. Speech is circumstantial, the nurse will redirect client responses.
Which of the following client education should be included for lithium therapy? a. Stop the medication if experiencing vomiting or diarrhea. b. Consume a low salt diet. c. Lab draws will be needed daily. d. Take the medication on an empty stomach.
a. Stop the medication if experiencing vomiting or diarrhea.
Client with Bipolar Disorder is on long term treatment with Lithium. Which lab will be monitored? a. TSH Assay b. Liver function test c. Erythrocyte sedimentation rate d. BNP
a. TSH Assay
Which of the following client actions will the nurse interpret as displaying manic behavior? (SATA): a. Talking in rapid, continuous speech b. Spending large sums of money c. Dressing in black, grey clothing d. Interacting with others in a flirtatious way
a. Talking in rapid, continuous speech b. Spending large sums of money d. Interacting with others in a flirtatious way
The major difference between normal and maladaptive grieving has been identified as which of the following? a. There is no loss of self-esteem in normal grieving. b. There are no feelings of depression in normal grieving. c. In normal grief the person does not show anger toward the loss. d. Normal grieving lasts no longer than 1 year.
a. There is no loss of self-esteem in normal grieving.
A nurse is planning care following surgical implantation of a VNS device. The nurse should plan to monitor for which of the following adverse effects? (Mark all that apply) a. Voice changes b. Seizure activity c. Disorientation d. Dysphagia e. Neck pain
a. Voice changes d. Dysphagia e. Neck pain
The client on Lithium reports blurred vision, polyuria, ataxia. Which of the following actions should the nurse take? a. Withhold the medication and obtain lithium and sodium levels as ordered b. Prepare to administer propranolol and obtain lithium level as ordered. c. Administer the next dose as prescribed and obtain lithium level as ordered. d. Plan to administer levothyroxine and obtain lithium level as ordered
a. Withhold the medication and obtain lithium and sodium levels as ordered
Which of the following actions should the nurse take prior to the scheduled ECT? a. Witness the informed consent b. Request an ECG c. Obtain a serum parathyroid hormone level d. Check the client's blood pressure
a. Witness the informed consent b. Request and ECG d. Check the client's BP
Nursing education to a client taking monoamine oxidase inhibitors (MAOI) includes which of the following? a. Due to risk for seizures, avoid the medication if there is seizure history. b. Due to the risk for hypertensive crisis, avoid foods with tyramine. c. Due to risk for cognitive impairment, avoid working with heavy machinery. d. Due to risk for respiratory depression, avoid giving with benzodiazepine
b. Due to the risk for hypertensive crisis, avoid foods with tyramine.
Which of the following is true about suicide risk? a. Using the term suicide increases the client's risk for a suicide attempt. b. A no-suicide contract with the client may reduce risk. c. A client's verbal threat of suicide is attention-seeking behavior. d. Interventions are ineffective for clients really wanting to commit suicide.
b. A no-suicide contract with the client may reduce risk.
MDD dx criteria include which of the following affecting social, occupational, self‑care? a. Mania b. Anhedonia c. Low or irritable mood d. Grief loss
b. Anhedonia c. Low or irritable mood
A nurse is discussing risk factors for somatic disorder to a new RN grad. Which of the following risk factors should the nurse include? (Mark All That Apply) a. Age older than 65 years b. Anxiety disorder c. Female gender d. Coronary artery disease e. Obesity
b. Anxiety disorder c. Female gender
Which of the following findings should the nurse expect w/PTSD? a. Client avoids talking about the traumatic event has diminished reflexes b. Client has recurring nightmares and negative self-image. c. Client presents with obsessive compulsive disorders and diminished reflexes d. Client presents with a positive self-image and has recurring nightmares
b. Client has recurring nightmares and negative self-image.
Which of the following risk factors will the nurse include in the nursing assmt of a recently admitted client? (SATA) a. Client presents with family support, lacks resources to obtain medications b. Client presents with impulsivity and hallucinations c. Client presents with history of suicide attempts, history of depression d. Client presents with unemployment, moving back home with parents
b. Client presents with impulsivity and hallucinations c. Client presents with history of suicide attempts, history of depression
During an admission, an assessment of the client's protective factors includes: a. Client's plans for self-harm and ability to carry it out b. Client's support from family, spiritual beliefs, problem-solving skills c. Client's thoughts for harm to others and means to carry it out d. Client's amount of desired medications and therapeutic benefits
b. Client's support from family, spiritual beliefs, problem-solving skills
A nurse is planning a group therapy session for clients dealing with bereavement. The following activities should be included in the initial phase (Mark all that apply): a. Encourage group members to work toward goals b. Define the purpose of the group c. Discuss termination of the group d. Identify informal roles of members within the group e. Establish an expectation of confidentiality with the group
b. Define the purpose of the group c. Discuss termination of the group d. Identify informal roles of members within the group e. Establish an expectation of confidentiality with the group
Which of the following instructions should the nurse give about Valproate during discharge teaching? a. Obtain lab draw for Thyroid function tests every 6 months b. Obtain lab draw for Liver Function Tests every 2 months c. Obtain lab draw for Sodium levels every 4 months d. Obtain an Electroencephalogram (EEG) every 2 months
b. Obtain lab draw for Liver Function Tests every 2 months
Which of the following manifestations is an early indication of toxicity in a client taking Lithium? a. Seizures b. Ongoing GI distress c. Polyuria d. Muscle weakness
b. Ongoing GI distress
A client in mania says he is superman and has not taken prescribed medications for one month. Nursing care includes: a. Provide activities to avoid social isolation, assess for suicidal thoughts b. Provide frequent rest periods while assessing for suicidal thoughts. c. Provide the client with more activities, prn medications d. Provide 1:1 monitoring, seclusion, and medications.
b. Provide frequent rest periods while assessing for suicidal thoughts.
Client in mania runs out of her room, topless, making sexual remarks and lewd gestures. Nursing intervention include: a. Ask other patients to ignore her behavior, place her in a time out b. Quietly approach and escort her to back to the room to get dressed. c. Confront her about inappropriate behavior, place in seclusion d. Insist that she go to her own room, immediately
b. Quietly approach and escort her to back to the room to get dressed.
Which of the following is a nursing priority of action to report for a client on Bupropion? a. The client smokes 1.5 packs of cigarettes per day. b. The client had a motor vehicle crash and sustained a head injury. c. The client's BMI Is 25, with weight gain of 10 pounds. d. The client has history of seasonal patterns of depression
b. The client had a motor vehicle crash and sustained a head injury.
Which is an appropriate intervention for a client in mania, running around the unit organizing competitive games? a. The nurse will direct the client to play table tennis with a peer. b. The nurse will direct the client to take a walk with them. c. The nurse will praise the client'sefforts to engage in social interactions. d. The nurse will suggest the client to exercise on a stationary bike
b. The nurse will direct the client to take a walk with them.
A major difference between normal and maladaptive grieving has been identified to which of the following? a. There are no feeling of depression in normal grieving b. There is no loss of self-esteem in normal grieving c. Normal grieving lasts no longer than 1 year d. In normal grief the person does not show anger toward the loss
b. There is no loss of self-esteem in normal grieving
Nursing interventions for Dissociative Identify Disorder (DID) include which of the following? a. The goal is to get alters to continue to talk to each other b. Use grounding techniques like clapping hands, touching an object c. Use antipsychotics and antidepressants d. The goal is to integrate alters
b. Use grounding techniques like clapping hands, touching an object d. The goal is to integrate alters
Which question is most important for the nurse to assess suicide risk in a client? a. "Has anyone in your family committed suicide?" b. "Why do you want to hurt yourself?" c. "Do you have a plan to hurt yourself?" d. "Can you describe how you are feeling right now?"
c. "Do you have a plan to hurt yourself?"
Which client statement should the nurse expect about a client who has factitious disorder imposed on another a. "I became deaf when I heard my daughter's husband abandoned her." b. "I know that my abdominal pain is caused by a malignant tumor." c. "I needed to make my son sick so someone else would take care of him." d. "I had to pretend I was injured in order to get disability benefits"
c. "I needed to make my son sick so someone else would take care of him."
A nurse is counseling a client who has factitious disorder imposed on another. Which of the following client statements should the nurse expect? a. "I had to pretend I was injured in order to get disability benefits" b. "I know that my abdominal pain is caused by a malignant tumor." c. "I needed to make my son sick so that someone else would take care of him for a while." d. "I became deaf when I heard that my husband was having an affair with my best friend."
c. "I needed to make my son sick so that someone else would take care of him for a while."
Client demanding to see the Psychiatrist pounds fist on table at 0300 am. Best nursing response: a. "I can't call a doctor this early unless it is an emergency." b. "Go back to your room, I'll call the doctor later in the morning." c. "You're feeling upset. We can sit and talk or walk and talk." d. "You're being unreasonable. Go back toyour room, please."
c. "You're feeling upset. We can sit and talk or walk and talk."
Lithium has a narrow therapeutic range. Which of the following indicates advanced lithium toxicity? a. Greater than 2.5 mEq/L b. 1.5 -2.0 mEq/L c. 2.0 -2.5 mEq/L d. 1.0-1.5 mEq/L
c. 2.0 -2.5 mEq/L
Which grief reaction can the nurse anticipate in a 10 year old child? a. Statements that the deceased person will soon return b. Regressive behaviors, such as loss of bladder control c. A preoccupation with the loss d. Thinking that they may have done something to cause the death
c. A preoccupation with the loss
A nurse is leading a peer group discussion about the indications for ECT. Which of the following indications should the nurse include in the discussion? a. Borderline personality disorder b. Acute withdrawal related to a substance use disorder c. Bipolar disorder with rapid cycling d. Dysphoric disorder
c. Bipolar disorder with rapid cycling
The nurse is including which of the following as suicide risk factors? a. Client's recent residential move, support, lack of access to medications b. Clients w/ recent unemployment, new relationship, loss of transportation c. Client is impulsive, has hallucinations, w/past history of suicide attempts d. Client is homeless, seeks employment, decides to stop using street drugs
c. Client is impulsive, has hallucinations, w/past history of suicide attempts
The nurse conducts a family therapy group and identifies attributes of healthy families as having the following: a. Placating boundaries b. Enmeshed boundaries c. Distinguishable boundaries d. Rigid boundaries
c. Distinguishable boundaries
A nurse is assisting with systematic desensitization for a client who has an extreme fear of elevators. Which of the following actions should the nurse implement with this form of therapy? a. Demonstrate riding in an elevator, then ask the client to imitate the behavior b. Advise the client to say, "stop," out loud every time he begins to feel an anxiety response related to an elevator c. Gradually expose the client to an elevator while practicing relaxation techniques d. Stay with the client in an elevator until his anxiety response diminishes
c. Gradually expose the client to an elevator while practicing relaxation techniques
Which of the following is thought to facilitate the grief process? a. The ability to grieve in anticipation of the loss b. The ability to grieve alone without interference from others c. Having recently grieved for another loss d. Talking personal responsibility for the loss
c. Having recently grieved for another loss
A nurse is assessing a client immediately following an ECT procedure. Which of the following findings should the nurse expect? (Mark all that apply): a. Hypotension b. Paralytic ileus c. Memory loss d. Nausea e. Confusion
c. Memory loss d. Nausea e. Confusion
A charge nurse is discussing TMS with a new RN graduate. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? a. "TMS is indicated for clients who have schizophrenia spectrum disorders." b. "I will provide post anesthesia care following TMS." c. "TMS treatments usually last 5-10 min." d. "I will schedule the client for daily TMS treatments for the first several weeks."
d. "I will schedule the client for daily TMS treatments for the first several weeks."
Which of the following is not true regarding grieving by an adolescent? a. Adolescents may not show their true feelings about the death b. Adolescents tend to have an immoral attitude c. Adolescents do not perceive death as inevitable d. Adolescents may not exhibit acting out behavior as part of their grief
d. Adolescents may not exhibit acting out behavior as part of their grief
Which medication should be used cautiously in clients who have CAD, respiratory disorders, & angle-closure glaucoma? a. Escitalopram b. Paroxetine c. Sertraline d. Amitriptyline
d. Amitriptyline
A charge nurse reviews one of the 5 stages of grief according to Kubler-Ross: a. Disequilibrium b. Developing awareness c. Restitution d. Anger
d. Anger
Which of the following medications should the nurse anticipate administering prior to ECT procedure? a. Diphenhydramine b. Epinephrine c. Fluoxetine d. Atropine
d. Atropine
Which of the following findings should the nurse identify as an indication of Derealization? a. Client describes a feeling of floating above the ground b. Client has suspicions of being targeted in order to be killed and robbed c. Client cannot recall anything that happened during the past 2 weeks d. Client states the furniture in the room seems small and far away.
d. Client states the furniture in the room seems small and far away.
Client teaching for a patient who is prescribed Fluoxetine: a. Take medication at bedtime b. Wear sunglasses outside c. Empty bladder before taking medication d. Decreased desire for sexual intimacy
d. Decreased desire for sexual intimacy
A nurse is developing a plan of care for a client who has conversion disorder. Which of the following actions should the nurse include? a. Encourage the client to spend time alone in his room b. Monitor the client for self-harm once per day c. Allow the client unlimited time to discuss physical manifestations d. Discuss alternative coping strategies with the client
d. Discuss alternative coping strategies with the client
A nurse working in an adult mental health unit at a hospital forms a group to focus on self-management of medications. There are two members of the group that disrupt the group process at each of the meetings as they talk together about their interest in gambling and sports. This is an example of which following concept? a. Triangulation b. Group process c. Subgroup d. Hidden agenda
d. Hidden agenda
Which of the following statements by the client indicates an understanding of the medication, amitriptyline? a. This medication will help me to lose the weight I gained from the last year b. I cannot eat my favorite pizza with pepperoni while on this medication. c. I can expect to have diarrhea while on this medication. d. I may be drowsy for a few weeks after starting this medication.
d. I may be drowsy for a few weeks after starting this medication.
Nursing evaluation of medication effectiveness of mood stabilizers include which of the following? a. Improved weight gain and mood b. Improved mood and sodium retention c. Improved mood and plasma concentration of liver enzymes d. Improved sleep and reduction of mania
d. Improved sleep and reduction of mania
Nurse uses cognitive reframing techniques for a patient w/anxiety disorder. Which will the nurse choose? a. Yoga and diaphragmatic breathing b. Pet therapy and music therapy c. Gym activities and power walking d. Priority restructuring and journaling
d. Priority restructuring and journaling
A client is admitted for rapid-cycling Bipolar Disorder, on Carbamazepine. Nursing education includes: a. Report skin rashes, severe GI effects, thirst, Wt gain of 5 lbs X 3 months b. Report polyuria, tinnitus, constipation, and fever c. Report increased mania, restless legs, racing heartbeat, fever d. Report nystagmus, staggering gait, excess bruising, and lethargy
d. Report nystagmus, staggering gait, excess bruising, and lethargy
Which of the following is thought to facilitate the grief process? a. The ability to grieve alone without interference from others b. Having recently grieved for another loss c. Taking personal responsibility for the loss d. The ability to grieve in anticipation of the loss
d. The ability to grieve in anticipation of the loss
Engel identifies which of the following as successful resolution of the grief process? a. When the bereaved person can talk about the loss without crying b. When the bereaved person no longer talks about the lost entity c. When the bereaved person puts all remembrances of the loss out of sight d. When the bereaved person can discuss both positive and negative aspects about the lost entity
d. When the bereaved person can discuss both positive and negative aspects about the lost entity
