Psych 162 Exam 3

The nurse is caring for a client that states, "Everyone would be better off if I just drove off the bridge into the ocean!" Which question will the nurse ask to determine the intent to die?

"Can you tell me how serious you are about dying?"

When conducting a focused assessment on a newly admitted client who attempted suicide, which question should the nurse include to ensure the client's safety?

"Do you still have a plan to harm yourself?" "Have you ever tried to hurt yourself before?" "Are you willing to tell us if you plan to harm yourself again?"

A nursing instructor is teaching about different depressive disorders and identifies a need for further instruction when a student states what?

"Dysthymic disorder is less chronic than major depression."

A 43-year-old female client is observed walking and dancing around the unit dressed in red high heels and a provocative style of dress. The client is seen sitting on the lap of a male client on the unit, and they are laughing. Which is the most therapeutic nursing intervention?

"I need for you to get off his lap, this behavior is not appropriate."

The spouse of a client diagnosed recently with a mood disorder calls the nurse therapist to report a change in the client's mood. The spouse states, "The client is clearly in a better mood than usual. I would say the client seems mildly elated. The client is functioning fine at work and home. The client is energetic, up and doing things at 5:00 a.m. and really confident again. It seems fantastic, but unusual. Is this something to worry about?" Which potential response by the nurse accurately assesses the situation?

"The client sounds hypomanic. Let's schedule an appointment for this week for an evaluation. The client may need additional or different medication."

A client comes to the emergency department reporting a severe pounding headache in the temples and a stiff neck. The client is flushed and diaphoretic, and the client's pulse is racing. The client states that the client is being treated for depression with an MAOI. Which question by a nurse would be most important to ask at this time?

"What have you had to eat or drink today?"

hypomania

-A mild manic state in which the individual seems infectiously merry, extremely talkative, charming, and tireless. -No psychotic features (delusions/hallucinations) -May be more productive

A client has just been diagnosed with a major depressive disorder following recent problems with the client's mood, work performance, and sleep quality. When planning this client's care, the nurse should anticipate what interventions?

-Administration of a selective serotonin reuptake inhibitor (SSRI) -Cognitive therapy

A nurse is developing a plan of care for a client diagnosed with an antisocial personality disorder who has been admitted to the inpatient psychiatric unit. Which item(s) would the nurse most likely include?

-Developing a therapeutic relationship -Holding the client responsible for behavior

The nurse provides care to a client who is experiencing side effects due to prescribed antidepressant medication. Which nonpharmacologic intervention does the nurse include in the plan of care for the client who is experiencing dry mouth?

-Drink 6 to 8 cup of water per day. -Use sugarless gum and/or lozenges.

A client with borderline personality disorder is prescribed pharmacotherapy. The nurse understands that this treatment aims to control which of the following?

-Emotional dysregulation -Impulsive aggression -Cognitive disturbances -Anxiety

Interventions for MANIC phase of BIPOLAR DISORDER

-Limit interaction time -Monitor lithium blood level -Reduce stimuli before bedtime -Provide meals with finger foods -Use a calm, nonthreatening approach

A client is brought to the emergency department by a friend with reports of confusion and vomiting after using cocaine. The heart rate is 146 beats per minute, BP 200/140 mm Hg, and pupils are dilated. Which is the necessary action(s) by the nurse?

-Maintain a safe environment for the client. -Monitor heart rate and blood pressure frequently.

A nurse is assessing a client with borderline personality disorder. Which response pattern would the nurse most likely assess?

-Mood lability -Anger issues -Impulsive behavior -Fear of abandonment

ECT Preperation

-NPO after midnight -Remove nail polish -Void before procedure -IV placed -Short Acting anesthetic -Paralytic/muscle relaxer (such as succinylcholine) -EEG to monitor seizure activity -Oxygen and breathing assist w/ Ambu-bag

A client with bipolar disorder is experiencing a major depressive episode. Which would the nurse expect to assess?

-Obsessive rumination -Hypersomnia -Difficulty concentrating

After ECT

-Patient awakens after a few minutes -VS monitored -Monitor for return of gag reflex -May be mildly confused/briefly disoriented -Monitor memory loss (short term is common) -May eat when as soon as hungry -Monitor and medicate as needed for headaches

When assessing a client with borderline personality disorder (BPD), which behaviors would the nurse expect to find?

-Repeated, frequent crisis episodes -Self-directed anger -Learned helplessness -Deceptive competence

signs of alcohol overdose

-Respiratory depression -Seizures -Cardiac arrest

signs of cocaine overdose

-Respiratory depression -Seizures -Cardiac arrest -Chest pain -Psychosis

signs of PCP overdose

-Seizures -Respiratory Depression -Psychosis -Vomiting -Confusion

When developing the plan of care for a client with borderline personality disorder (BPD), which areas would the nurse identify as likely problematic?

-Sleep -Nutrition -Self-harm

A nurse is preparing an educational session for family members affected by substance abuse. Which point should the nurse include in the session?

-Substance abuse is an illness like any other. -An individual with substance abuse issues typically cannot use drugs socially.

A client taking lithium for bipolar disorder comes to the clinic and reports symptoms which the nurse interprets as consistent with moderate lithium toxicity. Which action should the nurse perform?

-Withhold additional doses of lithium. -Obtain a blood sample for lithium level. -Push fluids. -Contact the physician.

Mania

-a distinct period during which mood is abnormally and persistently elevated, expansive or irritable -typically lasts about 1 week

A client with a history of alcohol use disorder seeks medical attention for withdrawal symptoms. Which medication(s) would the nurse expect to be prescribed to help reduce the symptoms?

-diazepam -lorazepam -chlordiazepoxide

The nurse is caring for a client with a history of a substance use disorder. Which problem(s) will the nurse add to the plan of care when the client reports difficulty adjusting without the substance?

-ineffective coping -inability to fulfill role expectations

Mood Disorders (AKA Affective Disorders)

-pervasive alterations in emotions that are manifested by depression, mania or both -Interfere with the person's ability to live life (long-term sadness, agitation or elation) -Most common psych dx associated with suicide

A client recovering from a substance use disorder reports feelings of anxiety. Which activity(ies) would the nurse recommend to help relieve the client's stress?

-relaxing -exercise -listen to music -learn a new activity

An older client who has attempted suicide has an underlying diagnosis of depression. Which would a nurse anticipate as being ordered for the client?

-selective serotonin reuptake inhibitor -electroconvulsive therapy

A client is admitted for acute pancreatitis due to chronic alcohol use disorder and has not had a drink in 2 days. The client states, "bugs are crawling on the bed!" The client is anxious, agitated, diaphoretic. Which is the priority action by the nurse to treat the withdrawal symptoms?

Administer chlordiazepoxide.

The nurse is caring for a psychiatric-mental health client who has just been diagnosed with bipolar disorder. The physician has ordered medication for for the client. Which class of medications, if prescribed, would the nurse question?

Antidepressants

Which diagnosis is associated with a pervasive disregard for and violation of the rights of others?

Antisocial personality

A mental health nurse is planning a psychotherapy group for clients with personality disorders. The nurse knows the group will be comprised of a significant number of clients from Arab and Asian ethnicity. Which should the nurse consider when planning this group?

Be aware of the how each client's personality has been affected by his or her cultures values and beliefs.

After several visits to the primary care provider, a client has been diagnosed with depression. Within the context of the behavioral theorists' beliefs about this disorder, which factors may underlie the client's diagnosis?

Exaggerated response to stressful life event

Gambling, binge eating, and engaging in unsafe sex are examples of what?

Impulsivity

An older adult client with liver disease is experiencing alcohol withdrawal. Based on the nurse's understanding of drug therapy, which of the following would the nurse expect to be prescribed?

Lorazepam

In the past year, a client's parent reports the client has experienced six manic episodes, each lasting for 3 weeks. This is best described as what?

Rapid cycling

A client in the emergency department has self-inflicted wounds on both arms. Assessment reveals that the client was diagnosed with borderline personality disorder 6 months ago, for which the client has been receiving outpatient treatment. The client tells the nurse that the client recently found out the client's therapist is moving and will no longer be able to work with the client. What is the priority nursing diagnosis for this client?

Self-mutilation

The nurse is involved in the care of a client with antisocial personality disorder. Which purpose does the nurse identify as a priority when participating in a periodic team meeting when caring for this client?

Team consistency is important to prevent manipulation by the client.

A client is hospitalized on a psychiatric unit secondary to a suicide attempt. The client has been diagnosed with depression and is consistently depressed. When assessing the client, which finding would alert the nurse that the client's suicidal risk has increased?

The client says the client feels better, with more energy to interact with others

The nurse is performing an assessment of a client with depression. It took more than four sessions to complete. What is the likely reason for needing multiple sessions?

The client was too tired to answer all of the nurse's questions in one session.

The nurse is providing care for a client who has been diagnosed with antisocial personality disorder. Which outcome should the nurse prioritize when planning this client's care?

The client will to express anger in an adaptive, nonviolent manner

During a home visit, a 47-year-old female client with depression who is taking time off from work because of being recently widowed admits not taking medication after learning that two other close family members died in an automobile accident.

The nurse is concerned that the client is at risk for suicide because of lack of support systems and not taking medication.

Which statement about clients with a dual diagnosis is accurate?

Traditional methods of treatment have not been very successful for these clients.

electroconvulsive therapy (ECT)

a therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient. generally, 6-15 treatments.

s/s of Mania

inflated self-esteem or grandiosity; decreased sleep; excessive and pressured speech (unrelenting, rapid, often loud talking without pauses); flight of ideas (racing, often unconnected, thoughts); distractibility; increased activity or psychomotor agitation; and excessive involvement in pleasure-seeking or risk-taking activities with a high potential for painful consequences.

Anergia

lack of energy

For clients with borderline personality disorder, there is a tendency to see the world as either good or bad. As a result, these clients use the primitive defense of what?

splitting

A client who routinely uses methamphetamine is withdrawing from the substance. Which finding indicates to the nurse that the client is crashing?

suicide ideation