MENTAL HEALTH EXAM - CHAPTERS 11, 14,15,17

Ms. S is admitted to your medical unit with a diagnosis of dehydration and a history of depression. She tells you, "I just can't eat. I'm not hungry." Your best therapeutic response would be?

"you aren't hungry?" This is selective reflecting. You have repeated the patient's exact words in a way that encourages her to either explain herself or rephrase her response in some way

The nursing interventions for a patient with major depression would include all of the following EXCEPT:

A active listening skills B Maintaining safe milieu C Encouraging adequate nutrition D Reassuring the patient everything will be "just fine" CORRECT THIS IS FALSE REASSURANCE, WHICH IS NEVER APPROPRIATE IN THERAPEUTIC RELATIONSHIPS. THE OTHER CHOICES ARE ALL APPROPRIATE NURSING INTERVENTIONS FOR A PERSON WHO IS DEPRESSED

The most current thinking on the cause of schizophrenia is?

A brain disorder We now know that schizophrenia is a brain abnormality

ADDICTION

A chronic brain disease characterized by compulsive and maladaptive use of a substance or behavior (e.g., gambling)

SUBSTANCE DEPENDENCE

A cluster of cognitive, behavioral, and physiological symptoms that indicate that the individual continues use of the substance despite significant substance-related problems.

ALCOHOLISM

A complex, progressive disease characterized by significant physical, social, and/or mental impairment directly related to alcohol dependence and addiction

BORDERLINE PERSONALITY

A disorder characterized by a pattern of intense and chaotic relationships with emotional instability and tendency toward self-destructive behavior

SCHIZOAFFECTIVE DISORDER

A disorder manifested by schizophrenic behaviors with a strong element of mood disorders, including depression or mania

NARCISSISTIC PERSONALITY

A disorder that displays exaggerated self-love and self-importance

PSYCHOSIS

A mental state in which there is a severe loss of contact with reality

ILLUSIONS

A misperception of a real external stimulus

SCHIZOID PERSONALITY DISORDER

A pattern of extreme detachment from social relationships and a restricted range of emotional responses

ANTISOCIAL PERSONALITY DISORDER

A pattern of irresponsible, exploitive, and guiltless behavior with tendency to fail to conform to the law and exploit and manipulate others for personal gain. Popularly known as sociopathic personality

SCHIZOTYPAL PERSONALITY DISORDER

A personality disorder characterized by odd and eccentric behaviors but not to the degree of schizophrenia

EXTRAPYRAMIDAL SYMPTOMS (EPS)

A variety of responses associated with drugs that antagonize the dopamine receptors outside the pyramidal tract, causing a variety of effects including tremors and rigidity

Your patient just attended her first AA meeting. Which statement reflects she understands the purpose of AAA?

AAA can help me stay sober Alcoholics Anonymous is a lifelong commitment as one admits powerlessness over alcohol and remains in need of the support

DEPRESSION

An alteration in mood that is expressed by feelings of sadness, despair, and pessimism

MOOD

An individual's sustained emotional tone, which influences behavior, personality, and perception

Your patient admits to using an illegal substance daily, thinking about it we're not actually using it, and spending a lot of time figuring out where to get it. This patient could have?

And addiction These behaviors are the classic ones that indicate an addiction

A patient who is in trouble with the law would probably have which of the following personality disorders?

Antisocial Anti-social/sociopathic personality is usually the type of disorder in which a person would be in trouble with the law

David, 30 years old, comes to your unit for treatment of multiple broken bones following a car accident. He is friendly and flirtatious but very demanding. As you take your data from him, you learn that the police have been looking for him for petty theft. He laughs and says, like they don't have better things to do! He states he has changed jobs three times in the past year and has just broken off his second engagement. His former fiancé is visiting and privately tells you that you need to be careful because he doesn't always tell the truth. You suspect which of the following personality disorders?

Antisocial David is most likely displaying signs of antisocial personality disorder or evidenced by information that he tends to lie, has committed a crime, and his patterns with job and personal relationships. He is not exhibiting signs of suspicious nest or paranoia, nor is he behaving in a dependent manner.

PSYCHOACTIVE DRUGS

Any drug that alters mood, perception, mental functioning , and /or behavior

HISTRIONIC PERSONALITY DISORDER

Associated with extreme dramatic, excessive behaviors in someone who has a pattern of strong emotions

Sally and Susie seek treatment. Susie is treated as an inpatient and Sally is an outpatient. The nurse planning discharge teaching from their programs will encourage them to

Attend weekly AAA and Al - a non-meetings Susie should be encouraged to attend weekly AA meetings and Sally to attend weekly Al - and on meetings. We do not know from the information if they are adult children are alcoholics. There's no need to check into the unit weekly, but they can be told that it is acceptable to call or check in if they choose to do so. The psychologist will tell them the meeting schedule. This would not be a Nursing function for discharge planning

Your patient appears withdrawn and depressed. Which of the following would not be an effective intervention?

Be judgmental Communication in a judgmental manner is always a block to therapeutic, helping realtionships

You are caring for a 25-year-old male who is been admitted for infections that resulted from self inflicted burns. This is not the first admission for this young man, but he is new to you as a new nurse on the unit. You've not read his entire chart, but you suspect he has a history of which one of the following personality disorders?

Borderline Borderline personality, this group tends to engage in self mutilating behaviors

Nurses know that alcoholic functions as a?

CNS depressant Alcohol is a CNS depressant that can lead to impaired judgment, confusion, lethargic, and, in large amounts, the high the people feel is temporary and very misleading

Shawna is a 22-year-old woman who has episodes of extreme muscle rigidity and hyperexcitability. She sometimes repeats a word or phrase over and over. Attempts to move her arm met with even more muscle resistance. What is she exhibiting?

Catatonia Shawna symptoms are consistent with patients who have catatonic schizophrenia.

DEPENDENT PERSONALITY DISORDER

Characterized by a pervasive and excessive nee to be taken care of.

Which of the following medications is most likely to be ordered for a patient experiencing alcohol withdrawal?

Chlordiazepoxide Chlordiazepoxide is often used to safely detoxify a person from heavy alcohol use. It is relatively safe and reduces the risk of complications from alcohol such as seizures.

Sally and Susie are twins. They are 20 years old. Susie has a habit of drinking too much when they go out, and this is been more frequent. They were out celebrating their birthday last night, and this morning Susie is vomiting. Sally calls her sisters teacher. Susie is really ill. I think she has the flu, anyway, she can't come to school today. She said she has a test today and an assignment that she was supposed to pick up. I can come in and get this I'm at for her. When can she make up the test? Sally's behavior might indicate?

Codependency Sally may very well be codependent and her sisters alcohol abuse. Sally is taking responsibility for Susie's behavior instead of having SuzyQ take care of herself.

Your spouse has been an alcoholic for many years. She has been sober for the last two years but has begun drinking again. She drives drunk. You fear for your spouses life, so you begin driving her places. You are displaying what kind of behavior?

Codependent In an effort to be caring, you are in advertently making excuses and encouraging the drinking behavior.

ALCHOHOL ABUSE

Compulsive use of alcohol usually lasting 1 month or longer

PARANOID PERSONALITY DISORDER

Consistent pattern of suspiciousness and mistrust that interferes with functioning in society

The primary goal in working with and actively psychotic/suspicious patient is too

Decrease her anxiety and increase trust Creasing anxiety and promoting trust are both realistic goals. Both of these are a process that can be helped overtime.

SELF-MUTILATING BEHAVIOR

Deliberate, self injurious behavior such as cutting with the intent of causing nonfatal injury to attain the relief of tension

An individual stands on the train tracks with the train coming year. The person explains, I am invincible! The train will not hurt me. This is an example of?

Delusions of grandeur Delusions of grandeur include believing one is not subject to the laws of nature

The defense mechanism most frequently demonstrated by the chemically dependent person is

Denial Denial is the most common defense mechanism used by people who are chemically dependent. Rationalization is also used by some patients

For the patient with a personality disorder, which of the following behaviors would be the most difficult for a patient to comply with?

Developing a friendship Interpersonal relationships are among the most difficult activities for a person with a personality disorder to develop. They can participate in group activities because they can excel and bring attention and gratification to themselves, but developing a close personal relationship is very difficult.

A patient who repeats the word or part of a word over and over might be sad to have which of the following symptoms?

Echolalia Echolalia is the behavior or symptom of catatonic schizophrenia involving the patient repeating a word or part of a word or phrase over and over. Echopraxia is repetitive movement or actions.

BINGE DRINKING

Episodic, excessive drinking. four or more alcoholic drinks (for women) or five or more alcoholic drink (for men) on the same occasion on at least one day.

CO-OCCURRING DISORDER

Existence of both a substance abuse disorder and a serious mental illness. Also called dual diagnosis

The nurse who is assessing a patient with major depression would expect to observe which of the following symptoms

Extreme sadness Major depression usually manifests itself with symptoms of extreme sadness that is the prevalent mood for a period of at least 2 weeks. Euphoria would be more indicative of bipolar depression

HALLUCINATIONS

False sensory perception - can affect any of the five senses

DELUSIONS

Fixed, false belief relating usually to persecution or grandeur

Mrs. J has been diagnosed with dysthymic disorder and has been taking paroxetine for 3 years. On arrival in your mental health clinic, she presents very differently than on her last visit. She is cheerful, energetic, and talkative. Previously she had been fatigued and negative. What should you do?

Get more information from the patient about how she is feeling You want to know more about the patient's changes in behavior before jumping into a plan of action

Mr. G is calling out Nurse! When you arrive in the room, he tells you to be careful of the snake in the corner. You do not see anything in the corner. Mr. G is it experiencing what?

Hallucination This is an example of hallucination. The patient is seeing something that is not there. There is nothing actually visible that could be misinterpreted as a snake. If there was, this would be an illusion

DYSFUNCTIONAL

Having abnormal or ineffective function in mental health pertaining to coping and relationships

One of the major skills a person/family can learn during substance-abuse treatment is?

Honest communication Honest communication is necessary for the person and family to heal

Of the following responses which would be your best response to Mr. D regarding the snake?

I don't see a snake. It is time for your group meeting. I'll walk with you to the meeting room. This is the honest response, and it focuses on returning the patient to reality. The other responses play into the hallucination or border on belittling the patient.

Your best response to Mr. S might be?

I see some cracks in the plaster, but I do not see snakes. Let's go to the day room. Once again, maintaining honesty and reality is the best response.

Mr. S states look at the snakes on the ceiling. You see some cracks in the plaster. Mr. S is experiencing?

Illusion This time you were dealing with an illusion. There is something on the ceiling, and the patient is misinterpreting what is there.

ALCOHOL DEPENDENCE

Improper use of alcohol with impairment of social or occupational functioning, which leads to signs of tolerance or withdrawal

Brian, an 18-year-old with kits schizophrenia, has a negative attitude, is delusional, hears voices, and is withdrawing from others. In nursing intervention that is appropriate for promoting activity for Brian is?

Invite him to join in the party Inviting the patient to the party bring him into the present and allows him to make the choice for himself. This will help increase self-esteem diminish other symptoms.

The following is NOT true about depression

It is more common in men than in women Though men frequently suffer from depression, it is more common in women

In nursing intervention for a person with schizophrenia is to question

Keep the person oriented to reality and to the present It is important always to deal with reality and the present when dealing with people with schizophrenia. Never reinforcing hallucinations and directing people away from situations that are stressful or competitive are also important. ECT is not a Nursing function

Which of the following is not a sign of untreated schizophrenia

Maintaining satisfactory performance on the job Patients with schizophrenia do not function well in society without treatment. Even with treatment, some patients have a difficult time. The reality of schizophrenic people is their own reality and not the reality of the rest of society

Your patient with major depressive disorder isolates herself in her room for the whole day. you find her sitting and staring out the window. What is the best therapeutic response when you walk in the room?

Make frequent short visits to her room and just sit there Rather than pressure the patient to socialize, sitting with the patient shows acceptance and readiness to listen when patient talks.

CO-DEPENDENCY

Maladaptive coping behaviors that reinforce another person's addictive behavior by allowing that person to avoid consequences of his/her actions. Also called enabling

A primary mechanism used by people with personality disorders is?

Manipulation Manipulation is used frequently by patience with personality disorders. This mechanism can be used with other disorders but it is a primary mechanism in personality disorders.

Which is following pairs of symptoms are closely associated with EPS?

Muscle rigidity and protruding tongue Muscle rigidity and protruding tongue classic symptoms of EPS in addition to restlessness and tremors

Your patient has been admitted with a diagnosis of bilateral pneumonia. You have trouble communicating with this patient, who is pouty and is demanding of your constant attention. She talks for long periods about the smallest details of her life. Besides the pneumonia, you asked the position if the patient has a history of which of the following personality disorders?

Narcissistic Characteristics of narcissistic personality include exaggerated sense of self importance and lack of concern for the nurses time

WITHDRAWAL

Negative physiological and psychological reactions that occur when a substance is reduced or no longer taken.

Your new patient is taking an MAOI for sever depression. What would you tell the Dietary Department about her upcoming meals?

No Processed lunch meat Patients taking monoamine oxidase inhibitors (MAOIs) must avoid processed foods to avoid a hypertensive crisis.

PERSONALITY DISORDER

Nonpsychotic, maladaptive behavior that is used to satisfy the self

MAJOR DEPRESSIVE DISORDER

Psychiatric illness characterized by depressed mood or loss of interest or pleasure in usual activities that impacts one's life for at least 2 weeks

ECHOLALIA

Repetition of phrases, words, or part of a word - often part of catatonia

CATATONIA

Rigidity and inflexibility of muscles, resulting in immobility or extreme agitation

You are Sally and Susie's friend. If therapeutic response to them might be?

Sally and Susie, I care for you both, but Susie, you miss use alcohol. You both need help. Sally you are not helping Susie by taking care of her she needs to do it herself This response addresses both sisters and tells them they both need help. It is honest and caring, and puts the responsibility on them to help themselves through this situation.

Patients who display very bizarre behavior most likely have which of the following types of personality disorder?

Schizotypal Schizotypal personality disorder is characterized by bizarre and unusual behaviors - some of which may be also seen in schizophrenia.

Which intervention describes an important component and treatment of personality disorders

Self awareness by the nurse is necessary to ensure a therapeutic relationship The nurse needs to understand how he/she reacts to the challenging behaviors exhibited by people with personality disorders. Medications, long-term therapy, and inpatient hospitalization are rarely effective

SCHIZOPHRENIA

Serious mental health disorder characterized by impaired communication, alteration of reality, and deterioration of personal and vocational functioning

PERSONALITY

Sum of the behaviors and character traits of a person

your patient, Mr. A, had a recent myocardial infarction and open heart surgery with an uncomplicated recovery. His wife tells you that Mr. A has changed and is now uncommunicative, sad, an discouraged about the future. How would you respond to Mrs. A?

Tell me more about the changes in his behavior Though symptoms of depression are quite normal, using an open-ended sentence demonstrates concern about the changes in behavior

SCHIZOPHRENIA SPECTRUM DISORDER

The gradient of psychopathology seen in schizophrenia from least to most severe.

SUBSTANCE ABUSE

The maladaptive and consistent use of a substance accompanied by recurrent and significant negative consequences such as interpersonal, social, occupational, and legal problems

TOLERANCE

The need for increasingly larger or more frequent doses of a substance to obtain the desired effects.

OBSESSIVE-COMPULSIVE PERSONALITY DISORDER

The presence of obsessions and compulsions that the individual feels compelled to think about and perform that interfere with daily functioning

DETOXIFICATION

The process of withdrawal of the substance through supervised medical interventions to prevent complications

Your patient has a diagnosis of major depressive disorder and has been started on sertraline (Zoloft) 50 mg bid. After taking the medications for three days, the patient says, "I don't think this medicine is working. I don't want to take it any longer. "what would be your best response

These medications usually take a few weeks to bring about and improvement to your symptoms. Selective serotonin re-uptake inhibitors like Zoloft typically take anywhere form 2-6 weeks to impact target symptoms like sadness, low energy, loss of appetite, and negative thought

The patient was experiencing delirium tremens is most likely to exhibit which of the following symptoms?

Tremors Auditory-hallucinations Confusion Tremors, confusion, and hallucinations are the classic symptoms of delirium tremens

Nursing care for people with personality disorders include all of the following except

Vague communication - to decrease feelings of inferiority They communication is not acceptable. Honesty and clarity in communication are always necessary. The patient may feel inferior, which may be part of the manipulation. The nurse needs to confront the feelings of inferiority or any others that the patient might state

A patient is suspected of methamphetamine abuse. Which symptom would you most likely see?

Weight loss methamphetamine abuse often includes appetite suppression and weight loss

When setting limits with patents with personality disorders, the consequences to those limits should be set:

When the limit is set Consequences should always be stated at the time the limits are set, to increase consistence.

DYSTHYMIC DISORDER

a chronic form of depression with somewhat milder symptoms than major depressive disorder