MH ATI exam

The emotional numbness associated with PTSD can lead to:

-Depression. -Alcohol abuse. -Substance abuse. -Impairment in establishing and maintaining social relationships.

Adolescents with PTSD may demonstrate the following:

-Disruptive, disrespectful, or destructive behavior -Traumatic reenactment where the traumatic events are injected into their daily lives -Impulsive and aggressive behaviors -Increased risk of suicide, substance abuse, poor social support, poor concentration, academic problems, and poor physical health

Reflectin/Repeating

Sates part of what the patient has said. Allows the patient to hear what they said and consider remark

considerations for admission

- CIWA-Ar >/= 8-15 - history of withdrawal seizures or delirium tremens - decompensated medical condition or major electrolyte disturbances

Risk factors of PTSD

- Exposure to traumatic event (members of emergency services, armed forces, medical professionals, journalists, refugees and asylum seekers - more lkely to be exposed) - Severity of incident - Female sex (depends on type of trauma) - Younger age - Previous experience of trauma - Presence of multiple major life stressors - Low social support, social disadvantage - History of a mental health disorder - Kids - Parental distress, lack of family support

difulfiram

- MOA: inhibits aldehyde dehydrogenase causing increase levels of acetaldehyde - flushing, throbbing, headache, nausea, vomiting, sweating, hypotension, confusion - uses: chronic alcoholism management - dose: 125-500 mg PO QD - drug interactions: phenytoin, warfarin, isoniazid - adverse effects: fatigue, headache, skin rash, hepatic failure

naltrexone

- MOA: u-opioid receptor antagonist - uses: alcohol dependence - dose: 50 mg PO QD, 380 mg IM Q4 WKs - ADEs: headache, syncope, dizziness, vomiting, diarrhea, increased ALT/AST - patient should be opioid free

acamprosate

- MOA: weak NMDA receptor antagonist, increases activity of GABA system - uses: alcohol abstinence - dose: 333-666 mg PO TID - ADEs: NV, diarrhea, rash

signs and symptoms

- anxiety, insomnia, tremor, palpitations, nausea, anorexia -- 1-9+ days after discontinuation - withdrawal seizures -- 1-4 days after discontinuation - alcoholic hallucinations -- 1-4 days after discontinuation - delirium tremens (tachycardia, hypertension, low-grade fever, tremor, diaphoresis, delirium, agitation) -- 2-9 days after discontinuation

learning objectives

- assess signs and symptoms of alcohol withdrawal - understand the clinical institute withdrawal assessment of alcohol (CIWA-Ar) score - given a list of medications, identify the FDA approved medications for alcohol dependence - recommend appropriate treatment options for alcohol withdrawal

pathophysiology

- binds to GABA - chronic drinking causes down-regulation of GABA and upregulation of glutamate, when pts stop drinking will have less GABA and excess of glutamate - causes symptoms like sweating, tachycardia, HTN, seizures

alcohol related complications

- cardiovascular: arrhythmias, CAD - liver: hepatitis, cirrhosis, fibrosis - pancreatitis - peripheral neuropathy - gastrointestinal bleeding

DSM-V alcohol withdrawal

- cessation of or reduction in alcohol intake, which has previously been prolonged/heavy - any 2 of the following symptoms developing within several hours to a few days: autonomic hyperactivity, worsening tremor, insomnia, vomiting and nausea, hallucinations, psychomotor agitation, anxiety, generalized tonic-clonic seizures - the above symptoms cause clinically significant distress or impairment and are not attributable to other causes

other medication

- clonidine - beta blockers - baclofen

CAGE questionnaire

- do you ever feel the need to cut down on your alcohol use - have you ever been annoyed by others telling you that you drink too much - have you ever felt guilty about your drinking or something you did while drinking - did you ever have an eye opener

treatment goals

- early recognition - treat withdrawal symptoms - prevent progression to more severe symptoms - alcohol dependence treatment program after discharge

benzodiazepines

- first line treatment in alcohol withdrawal: improve symptoms, decrease risk of seizure - mechanism: bind to GABAa receptors enhancing inhibitory effects - no benzodiazepine preferred - choose based on dose form, pharmacokinetics, cost, duration of action, metabolism - chlordiazepoxide: PO/IV/IM, 50-100 mg, PO onset 30-120 minutes, half life 10h (long acting), hepatic metabolism by CYP3A4 (active metabolite) - diazepam: PO/IV/IM, 5-10 mg, IV onset 2-5 minutes, half life 43 hours (long acting), hepatic metaboism by CYP3A4 (active metabolite) - lorazepam: PO/IV/IM, 2-4 mg, IV onset 15-20 minutes, half life 14h (intermediate), hepatic metabolism (inactive metabolite) - oxazepam: PO, 15-30 mg, onset 120-180 minutes, half life 8h (short acting), hepatic metabolism (inactive metabolite)

pharmacotherapy overview

- first line: benzodiazepines - alternative: phenobarbital - other: propofol, dexmedetomidine, carbamazepine, anticonvulsants, antipsychotics (haloperidol, olanzapine)

alcohol withdrawal syndrome management

- hydration: diaphoresis and vomiting = hypovolemia - thiamine (B1) 50-100 mg/day x 3-5 days: prevention of Wernicke-Korsakoff syndrome (mental confusion, ataxia, eye movement disorders) - folic acid - multivitamin - electrolyte abnormalities: hypokaleia, hypomagnesemia, hypophosphatemia - monitor blood glucose and treat hypoglycemia

alcohol withdrawal seizures

- up to 10% of patient develop seizures, usually within 48 hours - treatment: -- supportive treatment -- no acute pharmacologic treatment unless status epilepticus -- benzodiazepines: first line to prevent seizures

CIWA alcohol scale

- withdrawal assessment in pts able to communicate evaluating 10 parameters: nausea or vomiting, tremors, paroxysmal sweats, anxiety, tactile disturbances, auditory disturbances, visual disturbances, headache, agitation, orientation - items scored 0-7; max total score 67 - mild alcohol withdrawal: <8 (medications not likely needed) - moderate withdrawal: 8-15 - severe withdrawal: > 15

delirium tremens

- withdrawal delirium - usually occurs 48-72 hours after last drink - diagnosable if patient meets criteria for alcohol withdrawal and delirium - symptoms: tachycardia, HTN, fever, tremor, diaphoresis, delirium, agitation - goals: control agitation, decrease risk of seizure injury, death

summary

- withdrawal symptoms may start early after the last drink - utilize CIWA-Ar score to assess alcohol withdrawal severity - treatment: IV fluids, vitamins, PRN benzodiazepines, other pharmacologic agents, electrolyte replacement as necessary

Children with PTSD often express PTSD in the following ways:

-Changes in mood -Nocturnal enuresis -Forgetting how to talk or not talking at all -Acting out the traumatic event during activities with other children -Being exceptionally needy or clingy

Special considerations for PTSD include the following:

-Exposure to an overwhelming stressor can occur at any age. Childhood trauma, abuse, and molestation can create enduring effects and clinical symptoms that last into adulthood. Additional factors that contribute to the development of PTSD are an individual history of a psychiatric disorder or a lack of emotional support or resources during the trauma. -Refugee trauma is a form of PTSD that is specific to the traumatic events experienced by individuals during war or persecution that may have lifelong effects. Child refugees may exhibit symptoms such as nightmares, anxiety, psychosomatic symptoms, hopelessness, and disrupted sleep patterns. -Children with PTSD may also behave recklessly or aggressively, or they may withdraw from interacting with others. Because of their undeveloped ability to express thoughts or identify emotions, expressions of PTSD in very young children often occur through changes in mood.

Nonpharmacologic therapy options for PTSD include the following:

-Eye-movement desensitization and reprocessing (EMDR) -Cognitive-behavioral training (CBT) -Body-centered therapy -Exposure therapy -Acupuncture

The nurse may be responsible for teaching PTSD patients the following:

-How to monitor the physiological level of arousal -The use of abdominal breathing at first sign of anxiety -The need to express fears that interfere with life -The need to search for, confront, and relieve the source of the original anxiety -The use of positive imagery -The use of calming techniques such as muscle relaxation -The use of positive affirmations such as "I am calm and happy" or "I am very relaxed" -The need to identify safe physical outlets for negative feelings, such as exercise

For children and vulnerable patients who are believed to be victims of abuse, the nurse should follow organizational protocols for reporting these situations. Questions may include:

-How would you describe your mood? -When do you feel most content? When do you feel least content? -What are your favorite activities? -What activities help you relax? -How often do you socialize or participate in activities with others? -Describe your sleep habits. Do you sleep soundly through the night? Do you feel rested when you awaken? -Do you have friends or other individuals with whom you can be open and honest about your thoughts and emotions? -How important is being able to share your thoughts and feelings? -Are you currently working? If so, what type of work are you engaged in?

Stage 3

-Mild decline -family and physician able to detect -cognitive decline -hard time finding the words to say something -remembering names -planning and organizing

Stage 4

-Moderate decline -clear cut symptoms -forget details about life stories -poor short term memory -inability to manage finance and bills

Stage 5

-Moderately severe decline -assist with ADLs (dressing) -significant confusion -can't recall simple details

Stage 1

-No impairment -No symptoms -Memory intact

Examples of patient goals that may be relevant to the care of the patient with PTSD include:

-Patient will remain free from injury or harm. -Patient will report a decreased perception of anxiety. -Patient will report a reduction or cessation of nightmares. -Patient will discuss emotions related to traumatic experiences with at least one trusted mental health specialist or counseling professional. -Patient will verbalize awareness of nonpharmacologic stress-reduction techniques.

Planning includes identification of measurable, realistic patient goals that are relevant to the selected nursing diagnoses. Examples of patient goals that may be relevant to the care of patients with PTSD include:

-Patient will remain free from injury or harm. -Patient will report a decreased perception of anxiety. -Patient will report a reduction or cessation of nightmares. -Patient will discuss emotions related to traumatic experiences with at least one trusted mental health specialist or counseling professional. -Patient will verbalize awareness of nonpharmacologic stress-reduction techniques.

The U.S. Department of Veterans Affairs and Department of Defense identify the following as the front-line standard approach to PTSD:

-Psychopharmacology -Stress inoculation -Exposure -Cognitive-behavioral therapy (CBT) **Complementary integrative health (CIH) approaches, such as yoga and meditation, can also be taught to the patient.

Assessing a patient for PTSD will involve both physical and psychologic approaches. Identify risk and protective factors, and assess immediate and long-term safety concerns. Multiple tools are available for use in screening for PTSD; some have been developed for use with children. Specific interview questions to ascertain the diagnosis of PTSD are aimed at the following clinical manifestations:

-Reexperiencing or flashbacks -Hyperarousal and vigilance -Exaggerated startle response -Sleep disturbance

Depending on the severity and nature of a patient's PTSD manifestations, selective serotonin reuptake inhibitors (SSRIs) are often used in conjunction with psychotherapy as a treatment. The only two SSRIs approved by the U.S. Food and Drug Administration (FDA) for the treatment of PTSD are the following:

-Sertraline (Zoloft) -Paroxetine (Paxil)

Stage 6

-Severe decline -Constant supervision -behavior problems -Assist w/ ADls (toileting) -loss of bowel/bladder control -wandering

Prolonged exposure (PE) therapy is a type of exposure therapy that has four components to assist the patient in working through the feelings associated with the traumatic event:

-Teaching the patient on PTSD, including responses and symptoms -Breathing retraining that teaches the patient how to control breathing while experiencing the stressful feelings -Real-world training that helps by having the patient practice situations that the patient may have been avoiding -Talking through the trauma to assist the patient in not being fearful of memories.

Risk factors for PTSD include the following:

-The severity of the event itself, including whether or not the individual was harmed or watched others be harmed or killed -Little or no social or psychologic support following the trauma -Additional stressors immediately following the event, such as loss of a spouse or family member or loss of employment -Presence of preexisting mental illness

The most effective way to prevent the development of PTSD is for the individual to use a support system after exposure to a traumatic event.

-This may mean reaching out to family and friends or seeking professional help. -Obtaining support will aid the individual in using positive, effective coping skills and prevent the individual from succumbing to ineffective coping skills such as self-medicating with drugs and alcohol.

Stage 2

-Very mild decline -may notice mild memory loss (trouble finding some things) -not detected -Can still do well on memory tests

Stage 7

-Very severe decline -nearing death -inability to respond to environment -utter words -assist w/ all ADLs

Appropriate diagnoses for the patient with PTSD may include the following:

-Violence: Self-Directed, Risk for -Violence: Other-Directed, Risk for -Post-Trauma Syndrome -Anxiety -Fear -Coping, Ineffective -Coping: Family, Compromised -Sleep Pattern, Disturbed

Traumatic events that may trigger PTSD include the following:

-Violent personal assaults -Natural or human-caused disasters -Motor vehicle crashes -Military combat -Being taken hostage or being tortured -Imprisonment -Dismemberment -Incest -Child abuse. **PTSD can also stem from sexual assault or being subjected to sexual experiences during childhood. Even threats of violence or injury may prompt the development of PTSD.

What are the effects of alcohol on the body systems?

0.00 BAC - lowered inhibitions - some loss of muscular coordination - reduced social inhibitions - impaired ability to drive - increased coordination loss - slowed reaction time - clumsiness, exaggerated emotions - unsteadiness - hostile or aggressive behavior - slurred speech - severe intox - inability to walk - confused - incapacitated, loss of feeling - arousal difficulty - coma - death 0.50 BAC

BAC

0.03 - slight euphoria 0.06 - relaxed, lower inhibition, minor reasoning impairment 0.09 - slight balance, speech, vision, reaction time impairment 0.125 - significant motor coordination impairment, loss of judgement, slurred speech 0.15 - lack of physical control, blurry vision, loss of balance 0.20 - dysphoria (anxiety, restlessness) 0.25 - mental confusion, nausea, vomiting 0.30 - loss of consciousness > 0.04 - coma, death

A college student was sexually assaulted when out on a date. After several weeks of crisis intervention therapy, which client statement should indicate to a nurse that the student is handling this situation in a healthy manner? 1. I know that it was not my fault. 2. My boyfriend has trouble controlling his sexual urges. 3. If I don't put myself in a dating situation, I won't be at risk. 4. Next time I will think twice about wearing a sexy dress.

1 ~ The client who realizes that sexual assault was not her fault is handling the situation in a healthy manner. The nurse should provide nonjudgmental listening and communicate statements that instill trust and validate self-worth.

A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the child's face and arms. What other symptom should indicate to the nurse that the child may have been physically abused? 1. The child shrinks at the approach of adults. 2. The child begs or steals food or money. 3. The child is frequently absent from school. 4. The child is delayed in physical and emotional development.

1 ~ The nurse should determine that a child who shrinks at the approach of adults in addition to having bruises and burns may be a victim of abuse. Maltreatment is considered, whether or not the adult intended to harm the child.

Which assessment data should a school nurse recognize as a sign of physical neglect? 1. The child is often absent from school and seems apathetic and tired. 2. The child is very insecure and has poor self-esteem. 3. The child has multiple bruises on various body parts. 4. The child has sophisticated knowledge of sexual behaviors.

1 ~ The nurse should recognize that a child who is often absent from school and seems apathetic and tired may be a victim of neglect. Other indicators of neglect are stealing food or money, lacking medical or dental care, being consistently dirty, lacking sufficient clothing, or stating that there is no one home to provide care.

A nursing instructor is developing a lesson plan to teach about domestic violence. Which information should be included? 1. Power and control are central to the dynamic of domestic violence. 2. Poor communication and social isolation are central to the dynamic of domestic violence. 3. Erratic relationships and vulnerability are central to the dynamic of domestic violence. 4. Emotional injury and learned helplessness are central to the dynamic of domestic violence.

1 ~ The nursing instructor should include the concept that power and control are central to the dynamic of domestic violence. Battering is defined as a pattern of coercive control founded on physical and/or sexual violence or threat of violence. The typical abuser is very possessive and perceives the victim as a possession.

Which of the following nursing diagnoses are typically appropriate for an adult survivor of incest? (SATA) 1. Low self-esteem 2. Powerlessness 3. Disturbed personal identity 4. Knowledge deficit 5. Non-adherence

1, 2 ~ An adult survivor of incest would most likely have low self-esteem and a sense of powerlessness. Adult survivors of incest are at risk for developing post-traumatic stress disorder, sexual dysfunction, somatization disorders, compulsive sexual behavior disorders, depression, anxiety, eating disorders, and substance abuse disorders.

A nursing instructor is teaching about intimate partner violence. Which of the following student statements indicate that learning has occurred? (SATA) 1. Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner. 2. Intimate partner violence is used to gain power and control over the other intimate partner. 3. Fifty-one percent of victims of intimate violence are women. 4. Women ages 25 to 34 experience the highest per capita rates of intimate violence. 5. Victims are typically young married women who are dependent housewives.

1, 2, 4 ~ Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner. It is used to gain power and control over the other intimate partner. Women ages 25 to 34 experience the highest per capita rates of intimate violence. Eighty-five percent of victims of intimate violence are women. Battered women represent all age, racial, religious, cultural, educational, and socioeconomic groups. They may be married or single, housewives or business executives.

In planning care for a woman who presents as a survivor of domestic abuse, a nurse should be aware of which of the following data? (SATA) 1. It often takes several attempts before a woman leaves an abusive situation. 2. Substance abuse is a common factor in abusive relationships. 3. Until children reach school age, they are usually not affected by abuse between their parents. 4. Women in abusive relationships usually feel isolated and unsupported. 5. Economic factors rarely play a role in the decision to stay.

1, 2, 4 ~ When planning care for a woman who is a survivor of domestic abuse, the nurse should be aware that it often takes several attempts before a woman leaves an abusive situation, that substance abuse is a common factor in abusive relationships, and that women in abusive relationships usually feel isolated and unsupported. Children can be affected by domestic violence from infancy, and economic factors often play a role in the victim's decision to stay.

Regarding the choice of benzodiazepine:

1. Chlordiazepoxide (Librium) is the benzodiazepine of choice in uncomplicated alcohol withdrawal due to its long half-life. 2. Lorazepam or diazepam is available as an injection for patients who cannot safely take medications by mouth. 3. Lorazepam and oxazepam are indicated in patients with impaired liver function because they are metabolised outside of the liver.

abstinence syndrome

A characteristic cluster of symptoms that results from sudden decrease in an addictive drugs level of usage Lacrimation, rhinorrhea, yawning, sweating, weakness, gooseflesh, nausea, and vomiting, tremor, muscle jerks, and hyperpnea are signs of this syndrome a characteristic cluster of symptoms that results from sudden decreases in an addictive drug's level of usage

A client is brought to an emergency department after being violently raped. Which nursing action is appropriate? 1. Discourage the client from discussing the rape, because this may lead to further emotional trauma. 2. Remain nonjudgmental while actively listening to the client's description of the violent rape event. 3. Meet the client's self-care needs by assisting with showering and perineal care. 4. Probe for further, detailed description of the rape event.

2 ~ The most appropriate nursing action is to remain nonjudgmental and actively listen to the clients description of the event. It is important to also communicate to the victim that he/she is safe and that it is not his/her fault. Nonjudgmental listening provides an avenue for catharsis, which contributes to the healing process.

A client diagnosed with an eating disorder experiences insomnia, nightmares, and panic attacks that occur before bedtime. She has never married or dated, and she lives alone. She states to a nurse, My father has recently moved back to town. What should the nurse suspect? 1. Possible major depressive disorder 2. Possible history of childhood incest 3. Possible histrionic personality disorder 4. Possible history of childhood physical abuse

2 ~ The nurse should suspect that this client may have a history of childhood incest. Adult survivors of incest are at risk for developing post-traumatic stress disorder, sexual dysfunction, somatization disorders, compulsive sexual behavior disorders, depression, anxiety, eating disorders, and substance abuse disorders.

Order the description of the progressive phases of Walker's model of the cycle of battering? ________ This phase is the most violent and the shortest, usually lasting up to 24 hours. ________ In this phase, the man's tolerance for frustration is declining. ________ In this phase, the batterer becomes extremely loving, kind, and contrite.

2, 1, 3 ~ In her classic studies of battered women and their relationships, Walker identified a cycle of predictable behaviors that are repeated over time. The behaviors can be divided into three distinct phases that vary in time and intensity both within the same relationship and among different couples. 1. Tension building phase. In this phase, the man's tolerance for frustration is declining. 2. Acute battering incident phase. This phase is the most violent and the shortest, usually lasting up to 24 hours. 3. Honeymoon phase. In this phase, the batterer becomes extremely loving, kind, and contrite.

alcoholic hallucinosis

24-72 hours aduitory and visual hallucinations and illusions without autonomic signs

When questioned about bruises, a woman states, "It was an accident. My husband just had a bad day at work. Hes being so gentle now and even brought me flowers. Hes going to get a new job, so it won't happen again." This client is in which phase of the cycle of battering? 1. Phase I: The tension-building phase 2. Phase II: The acute battering incident phase 3. Phase III: The honeymoon phase 4. Phase IV: The resolution and reorganization phase

3 ~ The client is in the honeymoon phase of the cycle of battering. In this phase, the batterer becomes extremely loving, kind, and contrite. Promises are often made that the abuse will not happen again.

A woman comes to an emergency department with a broken nose and multiple bruises after being beaten by her husband. She states, "The beatings have been getting worse, and I'm afraid, next time, he will kill me." Which is the appropriate nursing response? 1. Leopards don't change their spots, and neither will he. 2. There are things you can do to prevent him from losing control. 3. Lets talk about your options so that you don't have to go home. 4. Why don't we call the police so that they can confront your husband with his behavior?

3 ~ The most appropriate response by the nurse is to talk with the client about options so that the client does not have to return to the abusive environment. It is essential that clients make decisions on their own without the nurse being the rescuer. Imposing judgments and giving advice is non-therapeutic.

A client asks, "Why does a rapist use a weapon during the act of rape?" Which is the most appropriate nursing response? 1. To decrease the victimizer's insecurity. 2. To inflict physical harm with the weapon. 3. To terrorize and subdue the victim. 4. To mirror learned family behavior patterns related to weapons.

3 ~ The nurse should explain that a rapist uses weapons to terrorize and subdue the victim. Rape is the expression of power and dominance by means of sexual violence. Rape can occur over a broad spectrum of experience, from violent attack to insistence on sexual intercourse by an acquaintance or spouse.

A survivor of rape presents in an emergency department crying, pacing, and cursing her attacker. A nurse should recognize these client actions as which behavioral defense? 1. Controlled response pattern 2. Compounded rape reaction 3. Expressed response pattern 4. Silent rape reaction

3 ~ The nurse should recognize that this client is exhibiting an expressed response pattern. In the expressed response pattern, feelings of fear, anger, and anxiety are expressed through crying, sobbing, smiling, restlessness, and tension. In the controlled response pattern, the client's feelings are masked or hidden, and a calm, composed, or subdued affect is seen.

A raped client answers a nurses questions in a monotone voice with single words, appears calm, and exhibits a blunt affect. How should the nurse interpret this clients responses? 1. The client may be lying about the incident. 2. The client may be experiencing a silent rape reaction. 3. The client may be demonstrating a controlled response pattern. 4. The client may be having a compounded rape reaction.

3 ~ This client is most likely demonstrating a controlled response pattern. In the controlled response pattern, the client's feelings are masked or hidden, and a calm, composed, or subdued affect is seen. In the expressed response pattern, feelings of fear, anger, and anxiety are expressed through crying sobbing, smiling, restlessness, and tension.

Which information should the nurse in an employee assistance program provide to an employee who exhibits symptoms of domestic physical abuse? 1. Have ready access to a gun and learn how to use it. 2. Research lawyers that can aid in divorce proceedings. 3. File charges of assault and battery. 4. Have ready access to the number of a safe house for battered women.

4 ~ The nurse should provide information about the accessibility of safe houses for battered women when working with a client who has symptoms of domestic physical abuse. Many women feel powerless within the abusive relationship and may be staying in the abusive relationship out of fear.

A woman presents with a history of physical and emotional abuse in her intimate relationships. What should this information lead a nurse to suspect? 1. The woman may be exhibiting a controlled response pattern. 2. The woman may have a history of childhood neglect. 3. The woman may be exhibiting codependent characteristics. 4. The woman may be a victim of incest.

4 ~ The nurse should suspect that this client may be a victim of incest. Many women who are battered have low self-esteem and have feelings of guilt, anger, fear, and shame. Women in abusive relationships often grew up in an abusive home.

A client who is in a severely abusive relationship is admitted to a psychiatric inpatient unit. The client fears for her life. A staff nurse asks, "Why doesn't she just leave him?" Which is the nursing supervisors most appropriate response? 1. These clients don't know life any other way, and change is not an option until they have improved insight. 2. These clients have limited cognitive skills and few vocational abilities to be able to make it on their own. 3. These clients often have a lack of financial independence to support themselves and their children, and most have religious beliefs prohibiting divorce and separation. 4. These clients are paralyzed into inaction by a combination of physical threats and a sense of powerlessness.

4 ~ The nursing supervisor is accurate when stating that clients who are in abuse relationships are paralyzed into inaction by a combination of physical threats and a sense of powerlessness. Women often choose to stay with an abusive partner: for the children, for financial reasons, for fear of retaliation, for lack of a support network, for religious reasons, or because of hopefulness.

Which behavior best demonstrates aggression? a. Stomping away from the nurses station, going to another room, and grabbing a snack from another patient. b. Bursting into tears, leaving the community meeting, and sitting on a bed hugging a pillow and sobbing. c. Telling the primary nurse, I felt angry when you said I could not have a second helping at lunch. d. Telling the medication nurse, I am not going to take that or any other medication you try to give me.

A ~ Aggression is harsh physical or verbal action that reflects rage, hostility, and the potential for physical or verbal destructiveness. Aggressive behavior violates the rights of others. The incorrect options do not feature violation of anothers rights.

A patient tells the nurse, "My husband is abusive most often when he drinks too much. His family was like that when he was growing up. He always apologizes and regrets hurting me."" What risk factor was most predictive for the husband to become abusive? a. History of family violence b. Loss of employment c. Abuse of alcohol d. Poverty

A ~ An abuse-prone individual is an individual who has experienced family violence and was often abused as a child. This phenomenon is part of the cycle of violence. The other options may be present but are not as predictive.

An older adult diagnosed with Alzheimer disease lives with family. During the week, the person attends a day care center while the family is at work. In the evenings, members of the family provide care. Which factor makes this patient most vulnerable to abuse? a. Dementia b. Living in a rural area c. Being part of a busy family d. Being home only in the evening

A ~ Older adults, particularly those with cognitive impairments, are at high risk for abuse. The other characteristics are not identified as placing an individual at high risk for abuse.

An 11-year-old child says, "My parents don't like me. They call me stupid and say I never do anything right, but it doesn't matter. I'm too dumb to learn." Which nursing diagnosis applies to this child? a. Chronic low self-esteem, related to negative feedback from parents b. Deficient knowledge, related to interpersonal skills with parents c. Disturbed personal identity, related to negative self-evaluation d. Complicated grieving, related to poor academic performance

A ~ The child has indicated a belief in being too dumb to learn. The child receives frequent negative and demeaning feedback from the parents. Deficient knowledge is a nursing diagnosis that refers to knowledge of health care measures. Disturbed personal identity refers to an alteration in the ability to distinguish between self and nonself. Grieving may apply, but a specific loss is not evident in this scenario. Low self-esteem is more relevant to the child's statements.

A patient at the emergency department is diagnosed with a concussion. The patient is accompanied by a spouse who insists on staying in the room and answering all questions. The patient avoids eye contact and has a sad affect and slumped shoulders. Assessment of which additional problem has priority? a. Risk of intimate partner violence b. Phobia of crowded places c. Migraine headaches d. Major depression

A ~ The diagnosis of a concussion suggests violence as a cause. The patient is exhibiting indicators of abuse including fearfulness, depressed affect, poor eye contact, and a possessive spouse. The patient may be also experiencing depression, anxiety, and migraine headaches, but the nurses advocacy role necessitates an assessment for intimate partner violence.

An older adult diagnosed with Alzheimer disease lives with family. After observing multiple bruises, the home health nurse talks with the older adult's daughter, who becomes defensive and says, "My mother often wanders at night. Last night she fell down the stairs." Which nursing diagnosis has priority? a. Risk for injury, related to poor judgment, cognitive impairment, and lack of caregiver supervision b. Noncompliance, related to confusion and disorientation as evidenced by lack of cooperation c. Impaired verbal communication, related to brain impairment as evidenced by the confusion d. Insomnia, related to cognitive impairment as evidenced by wandering at night

A ~ The patient is at high risk for injury because of her confusion. The risk increases when caregivers are unable to provide constant supervision. No assessment data support the diagnoses of Impaired verbal communication or Noncompliance. Sleep pattern disturbance certainly applies to this patient; however, the diagnosis Risk for injury is a higher priority.

The nurse is assessing a 5-year-old patient who is diagnosed with posttraumatic stress disorder (PTSD). The child is accompanied by both parents. Which assessment question by the nurse is most appropriate? A. "Do you sleep all the way through the night?" B. "Can you draw me a picture of what happened to you?" C. "Do you feel sad often?" D. "Do you get angry easily?"

A. "Do you sleep all the way through the night?" -When assessing a child who has or may have PTSD, it is helpful to use direct questioning. Assessment of younger children involves questioning the child and/or the parents about significant changes in behavior and sleeping patterns. For example, it may be best to question the child to determine if there has been a change in the individual's sleeping habits. Drawing a picture can often cause children to reexperience the trauma. This should be used with caution in children diagnosed with PTSD. Moreover, children might not recognize when they are angry or sad.

The nurse is teaching a patient with posttraumatic stress disorder (PTSD). Which action should the nurse advise the patient to perform at the first sign of anxiety? A. Abdominal breathing B. Positive imagery C. Distraction techniques D. Muscle relaxation

A. Abdominal breathing -When implementing a plan of care for a patient with PTSD, the patient should be taught to use abdominal breathing at the first sign of anxiety. Positive imagery, muscle relaxation, and distraction techniques are also useful but not at the first sign of anxiety.

The nurse is providing care for a client diagnosed with posttraumatic stress disorder​ (PTSD). The​ client's family has asked about nonpharmacologic therapies that may be appropriate. Which therapy should the nurse mention when responding to this​ family? (Select all that​ apply.) A. Acupuncture therapy B. Atypical antipsychotic therapy C. Eye movement desensitization and reprocessing therapy D. ​Cognitive-behavioral therapy E. Selective serotonin reuptake inhibitor therapy

A. Acupuncture therapy C. Eye movement desensitization and reprocessing therapy D. ​Cognitive-behavioral therapy -Rationale: Acupuncture therapy is a​ complementary, nonpharmacologic therapy that has been useful in the treatment of PTSD.​ Cognitive-behavioral therapy​ (CBT) and eye movement desensitization and reprocessing therapy​ (EMDR) are nonpharmacologic therapies used by interdisciplinary teams to treat posttraumatic stress disorder. Selective serotonin reuptake inhibitor​ (SSRI) and atypical antipsychotic therapy are both pharmacologic therapies that may be used to treat PTSD.

The nurse is providing care to the victim of a kidnapping that occurred over 1 year ago. Which clinical manifestation supports the diagnosis of posttraumatic stress disorder​ (PTSD) in this​ client? (Select all that​ apply.) A. Agitation B. Hypervigilance C. Flashbacks D. Tremors E. Depression

A. Agitation B. Hypervigilance C. Flashbacks E. Depression -Rationale: Agitation,​ flashbacks, depression, and hypervigilance are all clinical manifestations of PTSD that usually emerge within 3 months but may become evident years after the experience. Tremors are not a clinical manifestation of PTSD.

The nurse is assessing a child diagnosed with posttraumatic stress disorder (PTSD). Which finding should be the priority? A. Changes in sleeping patterns B. History of suicide attempts C. History of TBI D. Lack of social support

A. Changes in sleeping patterns -Identification of PTSD in children is improved when they are questioned directly about their experiences. Assessment of younger children involves questioning the child and/or the parents about significant changes in behavior and sleeping patterns. Lack of social support, history of traumatic brain injury, and history of suicide attempts are vital information for other patient populations but are not critical for the pediatric population.

The nurse is teaching about how to recognize those at risk for posttraumatic stress disorder​ (PTSD) to begin early intervention. Which scenario should the nurse include as an example to look for in the general​ population? (Select all that​ apply.) A. Clients who have been taken hostage and tortured B. Clients who have looked at photographs of a war zone C. Clients who watched a documentary about the terror attack of September 11 D. Clients who have engaged in military combat E. Clients who have been to prison

A. Clients who have been taken hostage and tortured D. Clients who have engaged in military combat E. Clients who have been to prison -​Rationale: To be at risk for​ PTSD, the client must have experienced direct exposure to the traumatic stressor and witnessed it in person. The client can also have had indirect exposure​ (for example, by learning that a close friend or relative was exposed to trauma such as a violent or accidental​ death), or have had repeated or extreme exposure to aversive details of the traumatic event​ (usually through professional​ duties, such as being a first​ responder). Nonprofessional exposure through electronic​ media, television,​ movies, or photographs does not qualify for a diagnosis of PTSD.

Which nonpharmacologic therapy has been found to be the most effective for posttraumatic stress disorder (PTSD)? A. Cognitive-behavioral therapy B. Antiadrenergic therapy C. Selective serotonin reuptake inhibitor (SSRI) therapy D. Acupuncture therapy

A. Cognitive-behavioral therapy -The most effective nonpharmacologic therapy for PTSD is cognitive-behavioral therapy. Acupuncture is a complementary therapy that has been found useful for PTSD, but it is not as effective as cognitive-behavioral therapy. Antiadrenergic therapy and SSRI therapy are both pharmacologic options for the treatment of PTSD.

The nurse is planning care for the combat veteran with posttraumatic stress disorder​ (PTSD). Which nursing intervention should the nurse​ include? (Select all that​ apply.) A. Connect clients with resources for​ social, occupational, and interpersonal support. B. Reduce client​ harm, anxiety, and fear. C. Limit contact with the client to reduce the occurrence of compassion fatigue. D. Improve client coping through nonpharmacologic and pharmacologic therapies. E. Remove the family from therapy so the client can focus on health.

A. Connect clients with resources for​ social, occupational, and interpersonal support. B. Reduce client​ harm, anxiety, and fear. D. Improve client coping through nonpharmacologic and pharmacologic therapies. -​Rationale: Appropriate nursing interventions for clients with PTSD aim to reduce and eliminate client​ harm, anxiety, and​ fear, and improve client​ coping, using nonpharmacologic and pharmacologic therapies. Nursing interventions also aim to connect clients and families with organizations and community resources that can provide longer term​ social, occupational, and interpersonal support. The family should be involved and included in resources for support. Compassion fatigue should be recognized but not avoided through decreasing contact with clients.

The nurse is preparing to encounter a client who has experienced multiple violent assaults during the last month. Which priority should the nurse consider when assessing this client with possible posttraumatic stress disorder​ (PTSD)? (Select all that​ apply.) A. Ensure the safety of the client and others. B. Determine alcohol or drug use. C. Assess for indirect nonprofessional exposure. D. Establish trust. E. Lower client anxiety levels.

A. Ensure the safety of the client and others. B. Determine alcohol or drug use. D. Establish trust. E. Lower client anxiety levels. -​Rationale: When assessing a client diagnosed with​ PTSD, the nurse will ensure the safety of the client and​ others, lower the​ client's anxiety​ levels, determine the use of alcohol or​ drugs, and establish trust. Indirect nonprofessional​ exposure, such as observing a terrorist event through electronic​ media, television,​ movies, or​ photographs, is not a factor in the development of PTSD.

A patient with posttraumatic stress disorder (PTSD) wishes to include nonpharmacologic therapy as part of the treatment regimen. Which form of nonpharmacologic therapy allows the patient to develop effective coping skills in a safe, controlled environment? A. Exposure therapy B. Cognitive-behavioral therapy C. Body-centered therapy D. Dual-attention therapy

A. Exposure therapy -Exposure therapy allows the patient to develop effective coping skills in a safe, controlled environment. Cognitive-behavioral therapy, body-centered therapy, and dual-attention stimulus do not provide this for the patient. Exposure therapy assists by gradually exposing the patient to elements of the traumatic event, which enables the patient to face fears. The use of virtual reality also assists the patient in revisiting the site where the traumatic event occurred without having to go back to the real site.

The nurse is teaching the client and the family about eye movement desensitization and reprocessing​ (EMDR) therapy, which has been successful in the treatment of posttraumatic stress disorder. Which teaching should the nurse​ include? (Select all that​ apply.) A. External focus on a different stimulus B. Effective pharmacologic therapy C. Reprocessing the trauma D. Effective nonpharmacologic therapy E. Telehealth strategy

A. External focus on a different stimulus C. Reprocessing the trauma D. Effective nonpharmacologic therapy -​Rationale: The largest number of studies on psychotherapy for PTSD indicates that​ cognitive-behavioral therapy​ (CBT), as well as eye movement desensitization and reprocessing​ (EMDR), are the most effective therapies for PTSD. EMDR includes aspects of CBT and​ body-centered therapy. In this type of​ therapy, the client reprocesses the trauma by focusing internally on the traumatic event while focusing externally on a different stimulus. EMDR is a nonpharmacologic therapy that is used to treat​ PTSD, not a telehealth strategy. Telehealth is the delivery of​ health-related services and information via telecommunication technologies. Effective pharmacologic therapy is not a consideration in eye movement desensitization and reprocessing​ (EMDR) therapy.

Which symptom exhibited by a patient with posttraumatic stress disorder (PTSD) should initiate ensuring the safety of the patient as a nursing priority? A. Hyperarousal B. Depression C. Dissociation D. Depersonalization

A. Hyperarousal -The nursing priority for patients with hyperarousal and vigilance is to ensure the safety of the patient and others while quickly lowering patient anxiety levels. The nursing priorities will be different for patients experiencing depression, dissociation, or depersonalization.

The nurse is using a posttraumatic stress disorder (PTSD) measuring tool during an assessment of a 70-year-old veteran. Older patients are at an increased risk of which occurrence compared with patients of other age groups? A. Suicide B. Depression C. Violence D. Substance abuse

A. Suicide -The older patient who may be experiencing PTSD symptoms should be assessed using a valid PTSD measuring tool and be assessed for suicidal thoughts and behaviors because older adults are at an increased risk of suicide compared with middle-aged adults. Older patients with PTSD are not at an increased risk of depression, violence, or substance abuse.

The nurse is planning care for client families who are refugees from​ war-torn countries. Which client outcome would be the most appropriate for inclusion in a plan of care for a client with posttraumatic stress disorder​ (PTSD)? (Select all that​ apply.) A. The client will articulate decreased feelings of anxiety. B. The client will report no change in the occurrence of nightmares. C. The client will talk about emotions that are associated with traumatic experiences. D. The client will remain free of harm or injury to self or others. E. The client will demonstrate stress reduction techniques.

A. The client will articulate decreased feelings of anxiety. C. The client will talk about emotions that are associated with traumatic experiences. D. The client will remain free of harm or injury to self or others. E. The client will demonstrate stress reduction techniques. -​Rationale: Client goals and outcomes should be measurable. In​ addition, client goals and outcomes should be​ client-specific and tailored to meet the​ client's needs. General examples of client goals and outcomes that may be appropriate for inclusion in the plan of care for the client with PTSD​ include: The client will remain free from harm. The client will be able to talk about emotions associated with the traumatic experiences. The client will demonstrate stress reduction techniques. The client will verbalize a decrease in anxious feelings. The goal for no change in the occurrence of nightmares is inappropriate. An appropriate goal would be for the client to report a decrease in the occurrence of nightmares.

Which therapeutic communication technique is being used in this nurse-client interaction? Client: "My father spanked me often." Nurse: "Your father was a harsh disciplinarian." A. Restatement B. Offering general leads C. Focusing D. Accepting

ANS: A The nurse is using the therapeutic communication technique of restatement. Restatement involves repeating the main idea of what the client has said. The nurse uses this technique to communicate that the client's statement has been heard and understood.

Which example of a therapeutic communication technique would be effective in the planning phase of the nursing process? A. "We've discussed past coping skills. Let's see if these coping skills can be effective now." B. "Please tell me in your own words what brought you to the hospital." C. "This new approach worked for you. Keep it up." D. "I notice that you seem to be responding to voices that I do not hear."

ANS: A This is an example of the therapeutic communication technique of formulating a plan of action. By the use of this technique, the nurse can help the client plan in advance to deal with a stressful situation which may prevent anger and/or anxiety from escalating to an unmanageable level.

The nurse is caring for a client who is diagnosed with posttraumatic stress disorder​ (PTSD). Which outcome should the nurse include in the​ client's plan of​ care? (Select all that​ apply.) A. The client will remain free of harm or injury to self or others. B. The client will report fewer or no nightmares. C. The client will demonstrate avoidance of situations related to the trauma or general social contacts. D. The client will talk about emotions that are associated with traumatic experiences with at least one counseling professional. E. The client will demonstrate comorbidity that may include​ depression, substance​ abuse, or other anxiety disorders.

A. The client will remain free of harm or injury to self or others. B. The client will report fewer or no nightmares. D. The client will talk about emotions that are associated with traumatic experiences with at least one counseling professional. -​Rationale: General examples of client goals and outcomes that may be appropriate for inclusion in the plan of care for the client with PTSD​ include: The client will remain free of harm or injury to self or others. The client will articulate decreased feelings of anxiety. The client will talk about emotions that are associated with traumatic experiences with at least one counseling professional or other mental health care provider. The client will report fewer or no nightmares. The client will articulate awareness of stress reduction techniques that are not pharmacologic. Demonstrating comorbidity or avoidance are clinical manifestations of the​ disorder, and not client goals and outcomes.

The nurse is preparing a presentation on posttraumatic stress disorder​ (PTSD) to a group of people whose spouses have just returned from an active war zone. Which information about PTSD should the nurse include in the​ presentation? (Select all that​ apply.) A. Traumatic events in childhood can create clinical symptoms that last into adulthood. B. History of psychiatric disorders is common. C. Incidence among veterans is low. D. Stressors can occur at any time or age of life. E. Men are more susceptible than women.

A. Traumatic events in childhood can create clinical symptoms that last into adulthood. B. History of psychiatric disorders is common. D. Stressors can occur at any time or age of life. -PTSD is more common among individuals with a history of psychiatric disorders. Exposure to a traumatic stressor can happen at any age or time of life. Traumatic stress in childhood can create effects that persist into adulthood. The incidence of PTSD among veterans is especially high. Women are more susceptible to the development of PTSD than are men.

The nurse is caring for a client in law enforcement diagnosed with posttraumatic stress disorder​ (PTSD). Which finding in the​ client's health history places the client at risk for this​ disorder? (Select all that​ apply.) A. Witnessing the death of a friend B. Preexisting mental illness C. Losing a job after a traumatic event D. ​Adult-onset diabetes mellitus E. Experiencing difficulty sleeping

A. Witnessing the death of a friend B. Preexisting mental illness C. Losing a job after a traumatic event -​Rationale: Risk factors for developing PTSD include preexisting mental​ illness, direct exposure to a traumatic event such as witnessing a​ death, and experiencing loss after a traumatic event. Difficulty sleeping is a clinical manifestation of​ PTSD, not a risk factor. A concurrent diagnosis of diabetes mellitus is not a risk factor for PTSD.

The nurse is assessing an adolescent foster child diagnosed with posttraumatic stress disorder​ (PTSD). Which question is most beneficial for the nurse to ask the adolescent with​ PTSD? A. ​"Have you had thoughts of hurting​ yourself?" B. ​"Are you napping during the​ day?" C. ​"Are you wetting the bed at​ night?" D. ​"Do you know what year it​ is?"

A. ​"Have you had thoughts of hurting​ yourself?" -​Rationale: The adolescent with PTSD is at an increased risk for​ suicide, and reduction of harm is a priority for the client with PTSD. Mental orientation should be performed with the older adult client. A​ follow-up question about napping may be asked to assess​ sleep, but it does not take precedence over suicide and​ self-harm. Bedwetting should be assessed in a child with PTSD.

The client with posttraumatic stress disorder​ (PTSD) states they are experiencing undesirable adverse effects from sertraline​ (Zoloft). Which is the most appropriate response by the​ nurse? A. ​"These effects are​ expected, but they should not stop you from continuing your​ medication." B. ​"You may be overdosing on your​ medication." C. ​"Divide the doses in half to decrease the side​ effects." D. ​"It is OK to stop any medication that does not agree with​ you."

A. ​"These effects are​ expected, but they should not stop you from continuing your​ medication." -​Rationale: Selective serotonin reuptake inhibitors​ (SSRIs) like sertraline have known adverse effects that should be discussed with the client to improve adherence to prescribed pharmacologic treatment. Overdosing is not the cause of adverse effects. Decreasing or stopping medication should not be done without the order from the healthcare provider.​ However, since SSRIs carry a black box warning for increased​ suicidality, the nurse should question the client about experiencing any increase in suicidal ideation and follow up appropriately.

After assertiveness training, a formerly passive client appropriately confronts a peer in group therapy. The group leader states, "I'm so proud of you for being assertive. You are so good!" Which communication technique has the leader employed? A. The nontherapeutic technique of giving approval B. The nontherapeutic technique of interpreting C. The therapeutic technique of presenting reality D. The therapeutic technique of making observations

ANS: A The group leader has employed the nontherapeutic technique of giving approval. Giving approval implies that the nurse has the right to pass judgment on whether the client's ideas or behaviors are "good" or "bad." This creates a conditional acceptance of the client.

A nurse is assessing a client diagnosed with schizophrenia for the presence of hallucinations. Which therapeutic communication technique used by the nurse is an example of making observations? A. "You appear to be talking to someone I do not see." B. "Please describe what you are seeing." C. "Why do you continually look in the corner of this room?" D. "If you hum a tune, the voices may not be so distracting."

ANS: A The nurse is making an observation when stating, "You appear to be talking to someone I do not see." Making observations involves verbalizing what is observed or perceived. This encourages the client to recognize specific behaviors and make comparisons with the nurse's perceptions.

A 68-year-old patient is diagnosed with moderate dementia after multiple strokes. During assessment of the patient, the nurse would expect to find a. excessive nighttime sleepiness. b. difficulty eating and swallowing. c. loss of recent and long-term memory. d. fluctuating ability to perform simple tasks.

ANS: C Loss of both recent and long-term memory is characteristic of moderate dementia

A client is struggling to explore and solve a problem. Which nursing statement would verbalize the implication of the client's actions? A. "You seem to be motivated to change your behavior." B. "How will these changes affect your family relationships?" C. "Why don't you make a list of the behaviors you need to change." D. "The team recommends that you make only one behavioral change at a time."

ANS: A This is an example of the therapeutic communication technique of verbalizing the implied. Verbalizing the implied puts into words what the client has only implied or said indirectly.

During a nurse-client interaction, which nursing statement may belittle the client's feelings and concerns? A. "Don't worry. Everything will be alright." B. "You appear uptight." C. "I notice you have bitten your nails to the quick." D. "You are jumping to conclusions."

ANS: A This nursing statement is an example of the nontherapeutic communication block of belittling feelings. Belittling feelings occur when the nurse misjudges the degree of the client's discomfort, thus a lack of empathy and understanding may be conveyed.

Which nursing response is an example of the nontherapeutic communication block of requesting an explanation? A. "Can you tell me why you said that?" B. "Keep your chin up. I'll explain the procedure to you." C. "There is always an explanation for both good and bad behaviors." D. "Are you not understanding the explanation I provided?"

ANS: A This nursing statement is an example of the nontherapeutic communication block of requesting an explanation. Requesting an explanation is when the client is asked to provide the reason for thoughts, feelings, behaviors, and events. Asking "why" a client did something or feels a certain way can be very intimidating and implies that the client must defend his or her behavior or feelings.

A student nurse is learning about the appropriate use of touch when communicating with clients diagnosed with psychiatric disorders. Which statement by the instructor best provides information about this aspect of therapeutic communication? A. "Touch carries a different meaning for different individuals." B. "Touch is often used when deescalating volatile client situations." C. "Touch is used to convey interest and warmth." D. "Touch is best combined with empathy when dealing with anxious clients."

ANS: A Touch can elicit both negative and positive reactions, depending on the people involved and the circumstances of the interaction.

Which of the following individuals are communicating a message? (Select all that apply.) A. A mother spanking her son for playing with matches B. A teenage boy isolating himself and playing loud music C. A biker sporting an eagle tattoo on his biceps D. A teenage girl writing, "No one understands me" E. A father checking for new e-mail on a regular basis

ANS: A, B, C, D The nurse should determine that spanking, isolating, getting tattoos, and writing are all ways in which people communicate messages to others. It is estimated that about 70% to 90% of communication is nonverbal.

A 68-year-old patient who is hospitalized with pneumonia is disoriented and confused 3 days after admission. Which information indicates that the patient is experiencing delirium rather than dementia? a. The patient was oriented and alert when admitted. b. The patient's speech is fragmented and incoherent. c. The patient is oriented to person but disoriented to place and time. d. The patient has a history of increasing confusion over several years

ANS: A-The patient was oriented and alert when admitted The onset of delirium occurs acutely. The degree of disorientation does not differentiate between delirium and dementia. Increasing confusion for several years is consistent with dementia. Fragmented and incoherent speech may occur with either delirium or dementia.

A student nurse tells the instructor, "I'm concerned that when a client asks me for advice I won't have a good solution." Which should be the nursing instructor's best response? A. "It's scary to feel put on the spot by a client. Nurses don't always have the answer." B. "Remember, clients, not nurses, are responsible for their own choices and decisions." C. "Just keep the client's best interests in mind and do the best that you can." D. "Set a goal to continue to work on this aspect of your practice."

ANS: B Giving advice tells the client what to do or how to behave. It implies that the nurse knows what is best and that the client is incapable of any self-direction. It discourages independent thinking.

Which action will help the nurse determine whether a new patient's confusion is caused by dementia or delirium? a. Administer the Mini-Mental Status Exam. b. Use the Confusion Assessment Method tool. c. Determine whether there is a family history of dementia. d. Obtain a list of the medications that the patient usually takes.

ANS: B The Confusion Assessment Method tool has been extensively tested in assessing delirium

A mother rescues two of her four children from a house fire. In the emergency department, she cries, "I should have gone back in to get them. I should have died, not them." What is the nurse's best response? A. "The smoke was too thick. You couldn't have gone back in." B. "You're feeling guilty because you weren't able to save your children." C. "Focus on the fact that you could have lost all four of your children." D. "It's best if you try not to think about what happened. Try to move on."

ANS: B The best response by the nurse is, "You're experiencing feelings of guilt because you weren't able to save your children." This response utilizes the therapeutic communication technique of reflection which identifies a client's emotional response and reflects these feelings back to the client so that they may be recognized and accepted.

A nurse maintains an uncrossed arm and leg posture. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening? A. S B. O C. L D. E E. R

ANS: B The nurse should identify that maintaining an uncrossed arm and leg posture is nonverbal behavior that reflects the "O" in the active-listening acronym SOLER. The acronym SOLER includes sitting squarely facing the client (S), open posture when interacting with the client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).

A client diagnosed with post-traumatic stress disorder is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique used by the nurse is an example of a broad opening? A. "What occurred prior to the rape, and when did you go to the emergency department?" B. "What would you like to talk about?" C. "I notice you seem uncomfortable discussing this." D. "How can we help you feel safe during your stay here?"

ANS: B The nurse's statement, "What would you like to talk about?" is an example of the therapeutic communication technique of giving broad openings. Using a broad opening allows the client to take the initiative in introducing the topic and emphasizes the importance of the client's role in the interaction.

An older adult diagnosed with dementia lives with family and attends daycare. After observing poor hygiene, the nurse at the center talks with the patient's adult child. This caregiver becomes defensive and says, "It takes all my time and energy to care for my mother. She's awake all night. I never get any sleep." Which nursing intervention has priority? a. Teach the caregiver more about the effects of dementia. b. Secure additional resources for the mother's evening and night care. c. Support the caregiver to grieve the loss of the mother's ability to function. d. Teach the family how to give physical care more effectively and efficiently.

ANS: B The patient's child and family were coping with care until the patient began to stay awake at night. The family needs assistance with evening and night care to resume their precrisis state of functioning. Secondary prevention calls for the nurse to mobilize community resources to relieve overwhelming stress. The other interventions may then be accomplished.

After fasting from 10 p.m. the previous evening, a client finds out that the blood test has been canceled. The client swears at the nurse and states, "You are incompetent!" Which is the nurse's best response? A. "Do you believe that I was the cause of your blood test being canceled?" B. "I see that you are upset, but I feel uncomfortable when you swear at me." C. "Have you ever thought about ways to express anger appropriately?" D. "I'll give you some space. Let me know if you need anything."

ANS: B This is an example of the appropriate use of feedback. Feedback should be directed toward behavior that the client has the capacity to modify.

Which nursing statement is a good example of the therapeutic communication technique of offering self? A. "I think it would be great if you talked about that problem during our next group session." B. "Would you like me to accompany you to your electroconvulsive therapy treatment?" C. "I notice that you are offering help to other peers in the milieu." D. "After discharge, would you like to meet me for lunch to review your outpatient progress?"

ANS: B This is an example of the therapeutic communication technique of offering self. Offering self makes the nurse available on an unconditional basis, increasing client's feelings of self-worth. Professional boundaries must be maintained when using the technique of offering self.

Which therapeutic communication technique should the nurse use when communicating with a client who is experiencing auditory hallucinations? A. "My sister has the same diagnosis as you and she also hears voices." B. "I understand that the voices seem real to you, but I do not hear any voices." C. "Why not turn up the radio so that the voices are muted." D. "I wouldn't worry about these voices. The medication will make them disappear."

ANS: B This is an example of the therapeutic communication technique of presenting reality. Presenting reality is when the client has a misperception of the environment. The nurse defines reality or indicates his or her perception of the situation for the client.

A client slammed a door on the unit several times. The nurse responds, "You seem angry." The client states, "I'm not angry." What therapeutic communication technique has the nurse employed and what defense mechanism is the client unconsciously demonstrating? A. Making observations and the defense mechanism of suppression B. Verbalizing the implied and the defense mechanism of denial C. Reflection and the defense mechanism of projection D. Encouraging descriptions of perceptions and the defense mechanism of displacement

ANS: B This is an example of the therapeutic communication technique of verbalizing the implied. The nurse is putting into words what the client has only implied by words or actions. Denial is the refusal of the client to acknowledge the existence of a real situation, the feelings associated with it, or both.

A patient who has severe Alzheimer's disease (AD) is being admitted to the hospital for surgery. Which intervention will the nurse include in the plan of care? a. Encourage the patient to discuss events from the past. b. Maintain a consistent daily routine for the patient's care. c. Reorient the patient to the date and time every 2 to 3 hours. d. Provide the patient with current newspapers and magazines.

ANS: B Providing a consistent routine will decrease anxiety and confusion for the patient.

The nurse is administering a mental status examination to a 48-year-old patient who has hypertension. The nurse suspects depression when the patient responds to the nurse's questions with a. "Is that right?" b. "I don't know." c. "Wait, let me think about that." d. "Who are those people over there?"

ANS: B-"I don't know." Answers such as "I don't know" are more typical of depression than dementia. The response "Who are those people over there?" is more typical of the distraction seen in a patient with delirium. The remaining two answers are more typical of a patient with mild to moderate dementia.

Which nursing action will be most effective in ensuring daily medication compliance for a patient with mild dementia? a. Setting the medications up monthly in a medication box b. Having the patient's family member administer the medication c. Posting reminders to take the medications in the patient's house d. Calling the patient weekly with a reminder to take the medication

ANS: B-Having the patient's family member administer the medication Because the patient with mild dementia will have difficulty with learning new skills and forgetfulness, the most appropriate nursing action is to have someone else administer the drug.

Which intervention will the nurse include in the plan of care for a patient with moderate dementia who had an appendectomy 2 days ago? a. Provide complete personal hygiene care for the patient. b. Remind the patient frequently about being in the hospital. c. Reposition the patient frequently to avoid skin breakdown. d. Place suction at the bedside to decrease the risk for aspiration.

ANS: B-Remind the patient frequently about being in the hospital. The patient with moderate dementia will have problems with short- and long-term memory and will need reminding about the hospitalization. The other interventions would be used for a patient with severe dementia, who would have difficulty with swallowing, self-care, and immobility.

A 56-year-old patient in the outpatient clinic is diagnosed with mild cognitive impairment (MCI).Which action will the nurse include in the plan of care? a. Suggest a move into an assisted living facility. b. Schedule the patient for more frequent appointments. c. Ask family members to supervise the patient's daily activities. d. Discuss the preventive use of acetylcholinesterase medications.

ANS: B-Schedule the patient for more frequent appointments

A patient is being evaluated for Alzheimer's disease (AD). The nurse explains to the patient's adult children that a. the most important risk factor for AD is a family history of the disorder. b. new drugs have been shown to reverse AD dramatically in some patients. c. a diagnosis of AD is made only after other causes of dementia are ruled out. d. the presence of brain atrophy detected by magnetic resonance imaging (MRI) will confirm the diagnosis of AD.

ANS: C The diagnosis of AD is usually one of exclusion. Age is the most important risk factor for development of AD

An instructor is correcting a nursing student's clinical worksheet. Which instructor statement is the best example of effective feedback? A. "Why did you use the client's name on your clinical worksheet?" B. "You were very careless to refer to your client by name on your clinical worksheet." C. "Surely you didn't do this deliberately, but you breeched confidentiality by using the client's name." D. "It is disappointing that after being told, you're still using client names on your worksheet."

ANS: C The instructor's statement, "Surely you didn't do this deliberately, but you breeched confidentiality by using the client's name." is an example of effective feedback. Feedback is a method of communication to help others consider a modification of behavior. Feedback should be descriptive, specific, and directed toward a behavior that the person has the capacity to modify and should impart information rather than offer advice or criticize the individual.

A client diagnosed with dependant personality disorder states, "Do you think I should move from my parent's house and get a job?" Which nursing response is most appropriate? A. "It would be best to do that in order to increase independence." B. "Why would you want to leave a secure home?" C. "Let's discuss and explore all of your options." D. "I'm afraid you would feel very guilty leaving your parents."

ANS: C The most appropriate response by the nurse is, "Let's discuss and explore all of your options." In this example, the nurse is encouraging the client to formulate ideas and decide independently the appropriate course of action.

Which therapeutic communication technique is being used in this nurse-client interaction? Client: "When I am anxious, the only thing that calms me down is alcohol." Nurse: "Other than drinking, what alternatives have you explored to decrease anxiety?" A. Reflecting B. Making observations C. Formulating a plan of action D. Giving recognition

ANS: C The nurse is using the therapeutic communication technique of formulating a plan of action to help the client explore alternatives to drinking alcohol. The use of this technique, rather than direct confrontation regarding the client's poor coping choice, may serve to prevent anger or anxiety from escalating.

The nurse is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a "general lead"? A. "Do you know why you are here?" B. "Are you feeling depressed or anxious?" C. "Yes, I see. Go on." D. "Can you chronologically order the events that led to your admission?"

ANS: C The nurse's statement, "Yes, I see. Go on." is an example of the therapeutic communication technique of a general lead. Offering a general lead encourages the client to continue sharing information.

A client's younger daughter is ignoring curfew. The client states, "I'm afraid she will get pregnant." The nurse responds, "Hang in there. Don't you think she has a lot to learn about life?" This is an example of which communication block? A. Requesting an explanation B. Belittling the client C. Making stereotyped comments D. Probing

ANS: C This is an example of the nontherapeutic communication block of making stereotyped comments. Clichés and trite expressions are meaningless in a therapeutic nurse-client relationship.

The nurse asks a newly admitted client, "What can we do to help you?" What is the purpose of this therapeutic communication technique? A. To reframe the client's thoughts about mental health treatment B. To put the client at ease C. To explore a subject, idea, experience, or relationship D. To communicate that the nurse is listening to the conversation

ANS: C This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication.

Which nursing statement is a good example of the therapeutic communication technique of giving recognition? A. "You did not attend group today. Can we talk about that?" B. "I'll sit with you until it is time for your family session." C. "I notice you are wearing a new dress and you have washed your hair." D. "I'm happy that you are now taking your medications. They will really help."

ANS: C This is an example of the therapeutic communication technique of giving recognition. Giving recognition acknowledges and indicates awareness. This technique is more appropriate than complimenting the client which reflects the nurse's judgment.

A client on an inpatient psychiatric unit tells the nurse, "I should have died because I am totally worthless." In order to encourage the client to continue talking about feelings, which should be the nurse's initial response? A. "How would your family feel if you died?" B. "You feel worthless now, but that can change with time." C. "You've been feeling sad and alone for some time now?" D. "It is great that you have come in for help."

ANS: C This nursing statement is an example of the therapeutic communication technique of reflection. When reflection is used, questions and feelings are referred back to the client so that they may be recognized and accepted.

When interviewing a client, which nonverbal behavior should a nurse employ? A. Maintaining indirect eye contact with the client B. Providing space by leaning back away from the client C. Sitting squarely, facing the client D. Maintaining open posture with arms and legs crossed

ANS: C When interviewing a client, the nurse should employ the nonverbal behavior of sitting squarely, facing the client. Facilitative skills for active listening can be identified by the acronym SOLER. SOLER includes sitting squarely facing the client (S), open posture when interacting with a client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).

The nurse is concerned about a postoperative patient's risk for injury during an episode of delirium. The most appropriate action by the nurse is to a. secure the patient in bed using a soft chest restraint. b. ask the health care provider to order an antipsychotic drug. c. instruct family members to remain with the patient and prevent injury. d. assign unlicensed assistive personnel (UAP) to stay with the patient and offer reorientation.

ANS: D-assign unlicensed assistive personnel (UAP) to stay with the patient and offer reorientation.

When administering a mental status examination to a patient with delirium, the nurse should a. wait until the patient is well-rested. b. administer an anxiolytic medication. c. choose a place without distracting stimuli. d. reorient the patient during the examination.

ANS: C-choose a place without distracting stimuli. Because overstimulation by environmental factors can distract the patient from the task of answering the nurse's questions, these stimuli should be avoided. The nurse will not wait to give the examination because action to correct the delirium should occur as soon as possible. Reorienting the patient is not appropriate during the examination. Antianxiety medications may increase the patient's delirium.

A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) washes hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation? A. "Everyone diagnosed with OCD needs to control their ritualistic behaviors." B. "It is important for you to discontinue these ritualistic behaviors." C. "Why are you asking for help if you won't participate in unit therapy?" D. "Let's figure out a way for you to attend unit activities and still wash your hands."

ANS: D The most appropriate statement by the nurse is, "Let's figure out a way for you to attend unit activities and still wash your hands." This statement reflects the therapeutic communication technique of formulating a plan of action. The nurse attempts to work with the client to develop a plan without damaging the therapeutic relationship or increasing the client's anxiety.

A client who frequently exhibits angry outbursts is diagnosed with antisocial personality disorder. Which appropriate feedback should a nurse provide when this client experiences an angry outburst? A. "Why do you continue to alienate your peers by your angry outbursts?" B. "You accomplish nothing when you lose your temper like that." C. "Showing your anger in that manner is very childish and insensitive." D. "During group, you raised your voice, yelled at a peer, left, and slammed the door."

ANS: D The nurse is providing appropriate feedback when stating, "During group, you raised your voice, yelled at a peer, left, and slammed the door." Giving appropriate feedback involves helping the client consider a modification of behavior. Feedback should give information to the client about how he or she is perceived by others. Feedback should not be evaluative in nature or be used to give advice.

Which therapeutic communication technique is being used in this nurse-client interaction? Client: "When I get angry, I get into a fistfight with my wife or I take it out on the kids." Nurse: "I notice that you are smiling as you talk about this physical violence." A. Encouraging comparison B. Exploring C. Formulating a plan of action D. Making observations

ANS: D The nurse is using the therapeutic communication technique of making observations when noting that the client smiles when talking about physical violence. The technique of making observations encourages the client to compare personal perceptions with those of the nurse.

A nurse states to a client, "Things will look better tomorrow after a good night's sleep." This is an example of which communication technique? A. The therapeutic technique of "giving advice" B. The therapeutic technique of "defending" C. The nontherapeutic technique of "presenting reality" D. The nontherapeutic technique of "giving false reassurance"

ANS: D The nurse's statement, "Things will look better tomorrow after a good night's sleep." is an example of the nontherapeutic technique of giving false reassurance. Giving false reassurance indicates to the client that there is no cause for anxiety, thereby devaluing the client's feelings.

What is the purpose of a nurse providing appropriate feedback? A. To give the client good advice B. To advise the client on appropriate behaviors C. To evaluate the client's behavior D. To give the client critical information

ANS: D The purpose of providing appropriate feedback is to give the client critical information. Feedback should not be used to give advice or evaluate behaviors.

A client states, "You won't believe what my husband said to me during visiting hours. He has no right treating me that way." Which nursing response would best assess the situation that occurred? A. "Does your husband treat you like this very often?" B. "What do you think is your role in this relationship?" C. "Why do you think he behaved like that?" D. "Describe what happened during your time with your husband."

ANS: D This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication.

Which nursing statement is a good example of the therapeutic communication technique of focusing? A. "Describe one of the best things that happened to you this week." B. "I'm having a difficult time understanding what you mean." C. "Your counseling session is in 30 minutes. I'll stay with you until then." D. "You mentioned your relationship with your father. Let's discuss that further."

ANS: D This is an example of the therapeutic communication technique of focusing. Focusing takes notice of a single idea or even a single word and works especially well with a client who is moving rapidly from one thought to another.

A client tells the nurse, "I feel bad because my mother does not want me to return home after I leave the hospital." Which nursing response is therapeutic? A. "It's quite common for clients to feel that way after a lengthy hospitalization." B. "Why don't you talk to your mother? You may find out she doesn't feel that way." C. "Your mother seems like an understanding person. I'll help you approach her." D. "You feel that your mother does not want you to come back home?"

ANS: D This is an example of the therapeutic communication technique of restatement. Restatement is the repeating of the main idea that the client has verbalized. This lets the client know whether or not an expressed statement has been understood and gives him or her the chance to continue, or clarify if necessary.

A 72-year-old female patient is brought to the clinic by the patient's spouse, who reports that she is unable to solve common problems around the house. To obtain information about the patient's current mental status, which question should the nurse ask the patient? a. "Are you sad?" b. "How is your self-image?" c. "Where were you were born?" d. "What did you eat for breakfast?"

ANS: D-"What did you eat for breakfast?" This question tests the patient's short-term memory, which is decreased in the mild stage of Alzheimer's disease or dementia

Definition of Resilience? Characteristics of resilient people?

Adult capacity to maintain healthy psychological and physical functioning

Alcohol Detoxification

Alcohol detoxification, or detox, for individuals with alcohol dependence, is the abrupt cessation of alcohol intake coupled with substitution of cross-tolerant drugs that have effects similar to the effects of alcohol in order to prevent alcohol withdrawal. As such, the term "detoxification" is somewhat of a misnomer since the process does not in any way involve the removal of toxic substances from the body. Detoxification may or may not be necessary depending upon an individual's age, medical status, and history of alcohol intake. For example, a young man who binge drinks and seeks treatment one week after his last use of alcohol may not require detoxification before beginning treatment for alcoholism. Benzodiazepines are the most common family of drugs used for this, followed by barbiturates.

Other psychological factors causing PTSD/makes a stressor more impactful?

Personal impact of event Extent of perceived control over future threats How one is prepared to deal with a stressor One's beliefs and assumptions about trauma

Characteristics of resilient people (3)

Possess a flexible adaptation to challenges Sense of continuity in their beliefs about themselves/lives Retain ability to regenerate positive experiences(despite ngative traumatic experiences)

Giving Information

Provides specific information which will answer questions or dispel anxiety in hospitalized client is a lack of information

An adult has recently been absent from work for 3-day periods on several occasions. Each time, this person returns to work wearing dark glasses. Facial and body bruises are apparent. What is the occupational health nurse's priority question? a. Do you drink excessively? b. Did your partner beat you? c. How did this happen to you? d. What did you do to deserve this?

C ~ Obtaining the person's explanation is necessary. If the explanation does not match the injuries or if the victim minimizes the injuries, abuse should be suspected.

A client prescribed lithium carbonate (Lithium) 300mg qam and 600mg qhs presents to the ED with impaired consciousness, nystagmus, arrhythmias, and history of recent seizures. which serum lithium would the nurse expect to assess? A. 3.7 mEq/L B. 3.0 mEq/L C. 2.5 mEq/L D. 1.9 mEq/L

Correct Answer: A clients with a serum level greater than 3.5 mEq/L may show signs such as impaired consciousness, Nystagmus, seizures, coma, Oliguria/ anuria, arrhythmias, myocardial infarction, or cardiovascular collapse

Verbalizing Implied thoughts and Feelings

Its a waste of time to do these exercises Nurse: You feel they arent benefiting you?

Selective Reflectng

Most important idea conained in what the client said and directs it back

Silence

Must me attentive gives nurse time to observe clients nonverbal behavior ( depression or withdraw)

Do you offer psychologically-focused debriefing for the prevention or treatment of PTSD?

NO

Sharing Observation Behaviors

Nail biting scratching hard clenching general restlessness

6. A client newly diagnosed with bipolar disorder was prescribed with lithium meds. While giving the health teaching the client keeps asking about why there is a need for frequent blood works. Which of the following statement of the nurse addressing the client's question is true: A. "It will help determine if the medication dosage is still within the therapeutic level" B. "Frequent blood works is unnecessary once medication is taken as ordered" C. "It will help identify if the liver has been working properly" D. "It will monitor if the medication already pass the blood brain barrier"

Answer: A Lithium levels determine whether an effective dose of lithium is being given to maintain a therapeutic level of the drug. Lithium blood work aren't drawn for the reason of figuring out whether the drug pass through the blood brain barrier or if the liver is working properly. Taking the medication as ordered doesn't kill the requirement for blood work.

11. A client's latest lab result shows her plasma lithium level is 0.2 mEq/L. The nurse can expect to implement which of the following nursing interventions? A. Administer an additional oral dose of lithium B. Infuse 1 L of 0.9% sodium chloride over 4 hr C. Prepare to give emergency resuscitation D. Prepare the client immediate for another laboratory draw

Answer: A This plasma level is subtherapeutic and the client should be given an additional dose. Emergency resuscitation may be indicated if the client's laboratory value indicates toxicity. There is no indication that the client need supplemental fluids. There is no reason to question the laboratory results.

4. A client diagnosed with bipolar disorder has been prescribed with lithium (carbonate) by his physician. Which question will help the nurse identify signs of early lithium toxicity? A. Have you been experiencing any nausea, vomiting or diarrhea? B. Do you have frequent headache? C. Have you been urinating excessively/frequently? D. Do you experience leg aches over the past few days?

Answer: A The most common early signs of lithium toxicity is gastrointestinal (GI) disturbance including nausea,vomiting, or diarrhea. B, C, D assessment question is unrelated to lithium toxicity.

25. A client with bipolar disorder was prescribed with lithium (Eskalith). Upon giving teaching, the nurse instructed the client to report severe signs of toxicity? Select all that apply. A. Seizures B. Blurred vision C. Slurred speech D. Ataxia E. Tinnitus

Answer: A, B, D, E Slurred speech can be seen as early signs of toxicity

1. A 9-year-old child has been prescribed with lithium as a mood stabilizer. His lab results shows his lithium level of 1.5 mmol/L. The priority nursing diagnosis for this child should be: A. Activity Intolerance B. Risk for Aspiration C. Ineffective Therapeutic Regimen Management D. Disturbed Thought Process

Answer: B Children who develop lithium toxicity are prone to seizures and coma. Due to the seizures that can occur the child is at risk for aspiration during seizure. This can also occur if the child is comatose. Based on Maslow's hierarchy of needs, maintaining a paten airway is the priority nursing diagnosis.

giving advice

Nurse imposed her own opinions. When clients ask..give factual and pertinent information.

Changing the Subject

Oh by the way That reminds me

18. Which discharge instructions is most important for a client taking lithium (Eskalith)? A. Limit fluid to 1,500 ml daily B. Maintain a high fluid intake C. Take advantage of the warm weather by exercising outside whenever possible D. When feeling a cold coming, it's okay to take over-the-counter (OTC) remedies

Answer: B Client taking lithium need to maintain a high fluid intake. Exercising outside may not be safe; photosensitivity occurs with lithium use, and activity in warm weather could increase sodium loss, predisposing the client to lithium toxicity. The client shouldn't take OTC drugs without the physician's approval.

3. A nurse was giving health teaching to a client newly prescribed with lithium medication. Which of the following statement of the client indicates understanding about the medication? A. "When my mood fluctuates, I can increase the dosage of the medication" B. "I can still eat my favorite salty food" C. "I can crush an extended-release tablet, if ever it will be difficult for me to take it whole by mouth" D. "Drinking too much cranberry juice will help maintain a desirable lithium level"

Answer: B Clients under lithium therapy don't need to limit their sodium intake, instead it is recommended to keep salt intake the same as before prescription of the lithium medication. Increasing the dose of lithium without evaluating the client's lab works can cause lithium toxicity, overdose, and renal failure. Extended-releasetablet should be taken whole, it is uniquely made to release the medication slowly in the body, breaking the pill would cause the drug to be release at one time. Watermelon, cantaloupe, grapefruit juice, and cranberry juice will not therapeutically help in maintaining desirable lithium level because of its diuretic effect.

13. Which of the following is an adverse effect of lithium carbonate taken by a client with bipolar disorder. A. Alopecia B. Tremors C. Urinary retention D. Constipation

Answer: B Fine hand tremors are a common adverse effect in clients who take lithium. Alopecia is not an adverse effect of lithium. Diarrhea and polyuria are side effects of lithium.

22. A female client with manic episodes is taking lithium. Which electrolyte level should the nurse check before administering the medication? A. Calcium B. Sodium C. Chloride D. Potassium

Answer: B Lithium is chemically similar to sodium. If sodium levels are reduced, such as from sweating or diuresis, lithium will be reabsorbed by the kidneys, increasing the risk of toxicity. Clients taking lithium shouldn'trestrict their intake of sodium and should drink adequate amounts of fluid each day. The other electrolytes are important for normal body functions but sodium is most important to the absorption of lithium.

20. A man is prescribed with lithium to manage bipolar disorder. The nurse is most concerned about lithium toxicity when he notices which of these assessment findings? A. Manic episodes a week ago B. Having diarrhea every day C. Client has rashy pruritis on his arms and legs D. The client presents as severely depressed

Answer: B Persistent diarrhea can lead to dehydration, which can increase the risk of lithium toxicity. Rashy pruritis is not a symptoms of lithium toxicity. Having a depressive or manic episodes is not an indication of lithium toxicity—these findings indicates that the lithium is not effective or is not at a therapeutic level.

7. A client under lithium medication reduce his dietary salt intake. Which of the following is expected to show in his blood work? A. Decreased lithium level B. Increased lithium level C. Increased then decrease in the next result of the lithium blood work D. No significant changes

Answer: B There is a direct relationship between the amount of salt and the plasma levels of lithium. Lithium plasma levels increase when there is a decrease in dietary salt. Increase in dietary salt causes the opposite effect of decreasing lithium plasma. That's why it is important that the nurse monitor dietary sodium intake.

8. A female client was prescribed with lithium carbonate 600 mg p.o t.i.d to manage her bipolar disorder. The nurse would be aware that the teaching given to the client with regards to the medication side effects was understood when the client make which of the following statement? "I will call my doctor immediately once I notice any: A. Sensitivity to bright light or sun B. Fine hand tremors or slurred speech C. Sexual dysfunction or breast enlargement D. Inability to urinate or difficulty when urinating

Answer: B These are the common adverse effects of lithium carbonate

24. A physician prescribes lithium for a client diagnosed with bipolar disorder. The nurse needs to provide appropriate education for the client on this drug. Which topic should the nurse cover? Select all that apply. A. The potential for addiction B. Signs and symptoms of drug toxicity C. The potential for tardive dyskinesia D. A low-tyramine diet E. The need for consistently monitor blood levels F. Changes in his mood that may take 7 to 21 days

Answer: B, E, F Client education should cover the signs and symptoms of drug toxicity as well as the need to report them to the physician. The client should be instructed to monitor his lithium levels on regular basis to avoid toxicity. The nurse should explain that 7 to 21 days may pass before the client notes a change in his mood. Lithium does not have addictive properties. Tyramine is a potential concern to clients taking monoamine-oxidase inhibitors.

9. A client receiving lithium carbonate has a lithium level of 2.3 mEq/L. The nurse will immediately assess the client for which of the following symptoms? A. Weakness B. Diarrhea C. Blurred Vision D. Fecal incontinence

Answer: C At lithium levels of 2 -2.5 mEq/L the client will experience blurred vision, muscle twitching, severe hypotension, and persistent nausea and vomiting. With levels between 1.5 and 2 mEq/L the client experiencing vomiting, diarrhea, muscle weakness, ataxia, dizziness, slurred speech, and confusion. At lithium levels of 2.5 to 3 mEq/L or higher, urinary and fecal incontinence occurs, as well as seizures, cardiac dysrhythmias, peripheral vascular collapse, and death.

21. In giving discharge teaching to a client with a home med lithium carbonate. Which of the following should be included: A. Advising the client to watch the diet carefully B. Suggesting that the client take the pills with milk C. Reminding the client that a CBC must be done once a month D. Encouraging the client to have blood levels checked as ordered

Answer: C Blood levels must be checked monthly or bimonthly when the client is on maintenance therapy because there is only a small range between therapeutic and toxic levels.

16. A client with bipolar disorder has been receiving lithium (Eskalith) for 2 weeks. She also has been taking chemotherapeutic drugs that cause her to feel nauseated and anorexic, making it difficult to distinguish early signs of lithium toxicity. Which of the following signs would indicate lithium toxicity at serum drug levels below 1.5 mEq/L? A. Hyperpyrexia B. Marked analgesics and lethargy C. Hypotonic reflexes with muscle weakness D. Oliguria

Answer: C Lithium alters sodium transport in nerve and muscle cells, slowing the speed of impulse transmission, so look for hypotonic reflexes and muscle weakness. Lithium has no known effect on body temperature nor on the transmission of pain impulses. The drug doesn't cause lethargy. Oliguria and other signs of renal failure occur late in sever lithium toxicity.

2. A client receiving lithium therapy for the treatment of his bipolar disorder has a lithium level of 0.85 mEq/L. The appropriate nursing action is: A. Notify the physician immediately B. Observe the client for signs of toxicity C. Record the laboratory result in the client's chart D. Hold the next dose of lithium

Answer: C The client's laboratory result of lithium is within the therapeutic rage 0.4 - 1 mEq/L.

17. A client came to the psychiatric unit 2 days ago. She has a history of bipolar disorder, is in the manic phase, and stopped taking lithium (Eskalith) 2 weeks ago. Which finding would the nurse be least likely to see? A. Flight of ideas B. Delusions of grandeur C. Increased appetite D. Restlessness

Answer: C The manic client is usually unwilling or unable to slow down enough to eat. Flight of ideas, delusions of grandeur and restlessness are associated with the manic phase.

12. A client under your care as a nurse was newly prescribed with lithium carbonate. To prevent lithium toxicity, the nurse should advise the client to do which of the following? A. Avoid the use of acetaminophen for headaches B. Decrease fluid intake to less than 1,500 mL daily C. Restrict intake of foods rich in sodium D. Limit aerobic activity in hot weather

Answer: D Activities that could cause sodium/water depletion should be avoided in order to prevent lithium carbonate toxicity. Acetaminophen, rather than NSAIDs such as ibuprofen, should be used for headaches because NSAIDs interact with lithium and could cause increased blood levels of lithium. The client should make sure to take in enough sodium and increase, rather than decrease fluid intake to prevent toxicity

15. What information is important to include in the nutritional counseling of a family with a member who has bipolar disorder? A. If sufficient roughage isn't eaten while taking lithium, bowel problems will occur. B. If the intake of carbohydrate increases, the lithium level will increase C. If the intake of calories is reduced, the lithium level will increase D. If the intake of sodium increases, the lithium level will decrease.

Answer: D Any time the level of sodium increases, such as with a change in dietary intake, the level of lithium will decrease. The intake of roughage and carbohydrates in the diet isn't related to metabolism of lithium. Reducing the number of calories the client eats don't affect the lithium level in the body.

10. A client under lithium medication suffered from diarrhea and vomiting. Which of the following nursing intervention should the nurse in charge do first? A. Recognize this as a drug interaction B. Give the client Cogentin C. Reassure the client that these are common side effects of lithium therapy D. Hold the next dose and obtain an order for a stat serum lithium level

Answer: D Diarrhea and vomiting are manifestations of Lithium toxicity. The next dose of lithium should be withheld and test is done to validate the observation. A. The manifestations are not due to drug interaction. B. Cogentin is used to manage the extrapyramidal symptom side effects of antipsychotics. C. The common side effects of Lithium are fine hand tremors, nausea, polyuria and polydipsia.

23. A client on lithium has suffered from diarrhea and vomiting. Which of the following is the priority nursing intervention of the nurse in-charge? A. Reassure the client that these are common side effects of lithium therapy B. Recognized this as a drug interaction C. Give the client Cogentin D. Hold the next dose and obtain an order for a stat serum lithium level

Answer: D Diarrhea and vomiting are manifestations of lithium toxicity. The next dose of lithium should be withheld and test is done to validate the observation. These manifestations are not due to drug interaction. Cogentin is used to manage extrapyramidal symptom side effects of antipsychotics. The common side effects of lithium are fine hand tremors, nausea, polyuria and polydipsia.

5. A client who has been taking lithium medication for the past few years, recently got pregnant, and she is so concerned of the effects of the medication to her child. Which of the following statement is true that would address the client's concern? A. Lithium does not cross the placental barrier and poses no risk for the fetus B. Pregnant woman with diagnosed with bipolar disorder should not take lithium meds C. Oral contraceptive and lithium medication may result to a false-positive pregnancy test. D. Lithium should be avoided during the latter part of the first trimester if possible.

Answer: D Lithium crosses placental barrier and poses the risk for developing birth defects to a fetus. To minimize any risk to the fetus, lithium should be avoided in the latter part of the first trimester if possible. Option B is incorrect because it can help control the mother's manic symptoms with little risk to the fetus in the second and third trimester. Option C is also incorrect because it is only true with carbamazepine (Tegretol).

14. A client has been taking lithium carbonate for the management of bipolar disorder. Which of the following adverse reaction does the client need to report? A. Black tongue B. Increased lacrimation C. Periods of disorientation D. Persistent GI upset

Answer: D Persistent GI upset indicates a mild-to-moderate toxic reaction. Black tongue is an adverse reaction of mirtazapine (Remeron), not lithium. Increased lacrimation isn't an adverse effect of lithium. Periods of disorientation don't tend to occur with the use of lithium.

19. The client taking lithium carbonate (Eskalith) is having difficulty time walking, is confused, agitated and is complaining of blurred vision. The nurse checks the lithium level drawn earlier in the day, expecting the level to be within which of the following ranges? A. 0.5 to .8 mEq/L B. 1.2 to 1.5 mEq/L C. 1.5 to 1.8 mEq/L D. 2.0 to 3.0 mEq/L

Answer: D The symptoms listed are those of lithium toxicity, and are seen when the serum level is 2 to 3 mEq/L.

What is PTSD?

Associated with experiencing or witnessing single, repeated or multiple events: - Serious accidents - Assault - Abuse - Trauma (work-related exposure or regarding serious health problems/childbirth issues) - War and conflict - Torture

Recognition of PTSD - symptoms

Associated with functional impairment: Re-experiencing Avoiding (things that relate to the event - feelings/thoughts/places/people) Hyperarousal (physiological reactivity - HR, sleep disturbance, irritability, anger, hyper-vigilance) Negative alterations Emotional numbing Dissociation Emotional dysregulation Interpersonal difficulties or problems in relationships Negative self-perception

What is a nurse's legal responsibility if child abuse or neglect is suspected? a. Discuss the findings with the child's teacher, principal, and school psychologist. b. Report the suspected abuse or neglect according to state regulations. c. Document the observations and speculations in the medical record. d. Continue the assessment.

B ~ Each state has specific regulations for reporting child abuse that must be observed. The nurse is usually a mandated reporter. The reporter does not need to be sure that abuse or neglect has occurred but only that it is suspected. Speculation should not be documented; only the facts are recorded.

A clinic nurse interviews an adult patient who reports fatigue, back pain, headaches, and sleep disturbances. The patient seems tense and then becomes reluctant to provide more information and hurries to leave. How can the nurse best serve the patient? a. Explore the possibility of patient social isolation. b. Have the patient complete an abuse assessment screen. c. Ask whether the patient has ever had psychiatric counseling. d. Ask the patient to disrobe; then assess for signs of physical abuse.

B ~ In this situation, the nurse should consider the possibility that the patient is a victim of intimate partner violence. Although the patient is reluctant to discuss issues, she may be willing to fill out an abuse assessment screen, which would then open the door to discussion.

What feelings are most commonly experienced by nurses working with abusive families? a. Outrage toward the victim and sympathy for the abuser b. Sympathy for the victim and anger toward the abuser c. Unconcern for the victim and dislike for the abuser d. Vulnerability for self and empathy with the abuser

B ~ Intense protective feelings, sympathy for the victim, and anger and outrage toward the abuser are common emotions of a nurse working with an abusive family.

After treatment for a detached retina, a victim of intimate partner violence says, "My partner only abuses me when intoxicated. I've considered leaving, but I was brought up to believe you stay together, no matter what happens. I always get an apology, and I can tell my partner feels bad after hitting me." Which nursing diagnosis applies? a. Social isolation, related to lack of community support system b. Risk for injury, related to partners physical abuse when intoxicated c. Deficient knowledge, related to resources for escape from the abusive relationship d. Disabled family coping, related to uneven distribution of power within a relationship

B ~ Risk for injury is the priority diagnosis because the partner has already inflicted physical injury during violent episodes. The episodes are likely to become increasingly violent. Data are not present that show social isolation or disabled family coping, although both are common among victims of violence. Deficient knowledge does not apply to this patient's use of defense mechanisms.

Which rationale best explains why a nurse should be aware of personal feelings while working with a family experiencing family violence? a. Self-awareness protects one's own mental health. b. Strong negative feelings interfere with assessment and judgment. c. Strong positive feelings lead to underinvolvement with the victim. d. Positive feelings promote the development of sympathy for patients.

B ~ Strong negative feelings cloud the nurse's judgment and interfere with assessment and intervention, no matter how well the nurse tries to cover or deny personal feelings. Strong positive feelings lead to over-involvement with the victim.

A nurse visits the home of an 11-year-old child and finds the child caring for three younger siblings. Both parents are at work. The child says, "I want to go to school, but we cant afford a babysitter. It doesn't matter; I'm too dumb to learn." What preliminary assessment is evident? a. Insufficient data are present to make an assessment. b. Child and siblings are experiencing neglect. c. Children are at high risk for sexual abuse. d. Children are experiencing physical abuse.

B ~ The child is experiencing neglect when the parents take away the opportunity to attend school. The other children may also be experiencing physical neglect, but more data should be gathered before making the actual assessment. The information presented does not indicate a high risk for sexual abuse, and no concrete evidence of physical abuse is present.

A victim of physical abuse by an intimate partner is treated for a broken wrist. The patient has considered leaving but says, "You stay together, no matter what happens." Which outcome should be met before the patient leaves the emergency department? The patient will: a. limit contact with the abuser by obtaining a restraining order. b. name two community resources that can be contacted. c. demonstrate insight into the abusive relationship. d. facilitate counseling for the abuser.

B ~ The only outcome indicator clearly attainable within this time is for a staff member to provide the victim with information about community resources that can be contacted. The development of insight into the abusive relationship requires time. Securing a restraining order can be quickly accomplished but not while the patient is in the emergency department. Facilitating the abuser's counseling may require weeks or months.

A nurse visits the home of an 11-year-old child and finds the child caring for three younger siblings. Both parents are at work. The child says, "I want to go to school, but we cant afford a babysitter. It doesn't matter; I'm too dumb to learn." What preliminary assessment is evident? a. Insufficient data are present to make an assessment. b. Child and siblings are experiencing neglect. c. Children are at high risk for sexual abuse. d. Children are experiencing physical abuse.

B ~ child is experiencing neglect when the parents take away the opportunity to attend school. The other children may also be experiencing physical neglect, but more data should be gathered before making the actual assessment. The information presented does not indicate a high risk for sexual abuse, and no concrete evidence of physical abuse is present.

The nurse is providing care to a client who is diagnosed with posttraumatic stress disorder​ (PTSD). Which factor could interfere with the nurse establishing trust during a therapeutic encounter with this​ client? (Select all that​ apply.) A. Ineffective coping B. Depersonalization C. Hypervigilance D. Nightmares E. Aggressiveness

B. Depersonalization C. Hypervigilance E. Aggressiveness -​Rationale: Clients with PTSD have experienced traumatization and may be physically and emotionally isolated. They may be​ irritable, aggressive, emotionally​ numb, frightened, experiencing​ flashbacks, and on high physical and emotional alert during an appointment with the nurse. They may be reluctant to share their thoughts and feelings and should not be pressured to until they feel ready. These clinical manifestations of PTSD make establishing trust with the client a challenge for the nurse. Nightmares are a clinical manifestation of PTSD that do not take place during therapeutic encounters between the client and nurse. Ineffective coping is a problem that may be included in the nursing plan of care for a client with PTSD.

For patients diagnosed with posttraumatic stress disorder (PTSD), which medical condition may accompany PTSD, as well as other anxiety disorders? A. Eating disorder B. Depression C. Schizophrenia D. Bipolar disorder

B. Depression -As with other anxiety disorders, depression may accompany PTSD. PTSD is generally not associated with the development of eating disorders, schizophrenia, or bipolar disorder.

The nurse is caring for a patient with posttraumatic stress disorder (PTSD) who is blocking emotions related to the traumatic event. Which clinical manifestation is the patient experiencing? A. Dissociative amnesia B. Dissociation C. Hypervigilance D. Depersonalization

B. Dissociation -For patients with PTSD, dissociation may occur, in which the individual blocks emotions related to the traumatic event. This patient is not experiencing signs of depersonalization, hypervigilance, or dissociative amnesia.

A patient with posttraumatic stress disorder (PTSD) reports having repetitive negative thoughts and emotions. Which action should the nurse suggest to alleviate negative thoughts and feelings? A. Muscle relaxation B. Exercise C. Positive imagery D. Distraction techniques

B. Exercise -When implementing a nursing care plan for a patient with PTSD, the nurse should help the patient to identify safe physical outlets for negative feelings, such as exercise. Distraction techniques, muscle relaxation, and positive imagery are useful for other aspects associated with PTSD, but not for negative feelings and emotions.

The most effective nonpharmacologic therapy for posttraumatic stress disorder (PTSD) is cognitive-behavioral therapy (CBT). Which form of nonpharmacologic psychotherapy contains elements of CBT and body-centered therapy? A. Exposure therapy B. Eye-movement desensitization and reprocessing (EMDR) C. Support therapy D. Acupuncture

B. Eye-movement desensitization and reprocessing (EMDR) -EMDR is a form of psychotherapy that contains elements of several types of therapy, including CBT and body-centered therapy. Exposure therapy, support therapy, and acupuncture do not incorporate CBT and body-centered therapy.

The nurse is teaching a group of parents whose children have been diagnosed with posttraumatic stress disorder (PTSD). Which symptoms should the nurse include in the teaching about PTSD in adolescents? A. Social withdrawal B. Impulsive and aggressive behavior C. Somatic symptoms D. Being exeptionally needy or clingy

B. Impulsive and aggressive behavior -Adolescents may engage in traumatic reenactment where the traumatic events are injected into their daily lives. Impulsive and aggressive behaviors are more typical in this age group as well. Children under 6 may socially withdraw or become exceptionally needy or clingy. Older patients may experience somatic symptoms. Older children and adolescents have manifestations similar to those that the adult experiences; however, they may also demonstrate disruptive, disrespectful, or destructive behaviors. Furthermore, there is an increased risk of suicide, substance abuse, poor social support, poor concentration, academic problems, and poor physical health with adolescents diagnosed with PTSD.

A patient recently experienced a traumatic event. Which intervention, if started immediately after the exposure to trauma, prevents the normal stress reactions from developing into acute stress disorder or long-term posttraumatic stress disorder (PTSD)? A. Revisiting the site of the trauma B. Obtaining help and support C. Initiating treatment with selective serotonin reuptake inhibitors (SSRIs) D. Initiating cognitive-behavioral therapy

B. Obtaining help and support -Obtaining help and support as soon as possible after exposure is integral in preventing normal stress reactions from developing into acute stress disorder or longer-term PTSD. Initiating SSRI therapy for depression (if present), initiating cognitive-behavioral therapy, and revisiting the site of the trauma may all be beneficial to patients with PTSD but can be initiated later in the treatment regimen.

The nurse is working with a child suspected of having posttraumatic stress disorder who has been removed from the home because of neglect. Which manifestation may the nurse observe with the young child that conveys a message about the traumatic​ event? (Select all that​ apply.) A. Dreaming B. Playing C. Drawing D. Crying E. Jumping

B. Playing C. Drawing -​Rationale: Young children with posttraumatic stress disorder often recreate a traumatic event by playing and drawing.​ Jumping, dreaming, and crying do not give a coherent message.

The nurse is providing care to a child diagnosed with posttraumatic stress disorder (PTSD) who is experiencing frequent nightmares. Which medication should the nurse anticipate being prescribed for this patient? A. Setraline B. Prazosin C. Paroxetine D. Risperidone

B. Prazosin -Although sertraline, paroxetine, and risperidone are appropriate for a patient diagnosed with PTSD, the only medication that has shown effectiveness in reducing nightmares associated with PTSD is prazosin, an antihypertensive agent.

The nurse is caring for an older patient who is a veteran with posttraumatic stress disorder (PTSD). Which manifestation is reported more often by older veteran patients compared with younger veterans? A. Depression B. Somatic symptoms C. Hostility D. Guilt

B. Somatic symptoms -Older veteran patients report more somatic complaints; fewer typical PTSD general symptoms; and less depression, hostility, and guilt than younger veterans do. A complete mental status exam, including cognitive screening, is recommended when assessing older patients. Assessment of the history of trauma and symptomatology should be performed routinely because these patients may minimize the significance of this history or not report it at all because it likely occurred a long time ago.

A patient wishes to incorporate complementary integrative health (CIH) approaches in the treatment regimen for posttraumatic stress disorder (PTSD). Which type of CIH approach enables the patient to have an effective plan to address the negative obstacles that may be encountered? A. Breathing retraining B. Stress inoculation C. Real-world training D. Prolonged exposure training

B. Stress inoculation -Stress inoculation is a form of psychotherapy in which the therapist teaches the patient on the stress that may be endured, including the negative outcomes. This enables the patient to have an effective plan to address the negative obstacles that may be encountered. Prolonged exposure training, breathing retraining, or real-world training will not enable the patient to have an effective plan to address the potential negative obstacles.

Contraindications

Birth Defect risk for pregnancy Breastfeeding Cardiac, hepatic or renal disease schizophrenia caution use in older clients

BAC

Blood alcohol concentration

An 11-year-old child is absent from school to care for siblings while the parents work. The family cannot afford a babysitter. When asked about the parents, the child reluctantly says, "My parents don't like me. They call me stupid and say I never do anything right." Which type of abuse is likely? a. Sexual b. Physical c. Emotional d. Economic

C ~ Examples of emotional abuse include having an adult demean a child's worth or frequently criticize or belittle a child. No data support physical battering or endangerment, sexual abuse, or economic abuse.

Several children are seen in the emergency department for treatment of illnesses and injuries. Which finding would create a high index of suspicion for child abuse? The child who has: a. repeated middle ear infections. b. severe colic. c. bite marks. d. croup.

C ~ Injuries such as immersion or cigarette burns, facial fractures, whiplash, bite marks, traumatic injuries, bruises, and fractures in various stages of healing suggest the possibility of abuse. In older children, vague complaints such as back pain may also be suspicious. Ear infections, colic, and croup are not problems induced by violence.

An older adult diagnosed with dementia lives with family and attends a day care center. A nurse at the day care center notices the adult has a disheveled appearance, a strong odor of urine, and bruises on the limbs and back. What type of abuse might be occurring? a. Psychological b. Financial c. Physical d. Sexual

C ~ The assessment of physical abuse is supported by the nurse's observation of bruises. Physical abuse includes evidence of improper care, as well as physical endangerment behaviors such as reckless behavior toward a vulnerable person that could lead to serious injury. No data substantiate the other options.

An adult tells the nurse, "My partner abuses me most often when drinking. The drinking has increased lately, but I always get an apology afterward and a box of candy. I've considered leaving but haven't been able to bring myself to actually do it." Which phase in the cycle of violence prevents the patient from leaving? a. Tension building b. Acute battering c. Honeymoon d. Recovery

C ~ The honeymoon stage is characterized by kindly, loving behaviors toward the abused spouse when the perpetrator feels remorseful. The victim believes the promises and drops plans to leave or seek legal help. The tension-building stage is characterized by minor violence in the form of abusive verbalization or pushing. The acute battering stage involves the abuser beating the victim. The violence cycle does not include a recovery stage.

The nurse is providing discharge teaching for a patient diagnosed with posttraumatic stress disorder (PTSD). Which patient statement indicates the need for further teaching? A. "I will use abdominal breathing at the first sign of anxiety." B. "I will use distraction techniques when I feel moderate stress." C. "I will drink a few beers when I am anxious." D. "I will go to the gym for kickboxing class when I have negative feelings."

C. "I will drink a few beers when I am anxious." -Using alcoholic beverages as a means of controlling anxiety indicates the need for further teaching. The other patient statements indicate understanding of the discharge teaching provided by the nurse.

The nurse is using open-ended questions during an assessment of a patient with PTSD. Which is a benefit of this therapeutic technique? A. Pushes the limits of the patient's personal boundaries B. Provokes frustration and anger in the patient C. Allows the patient to express thoughts and feelings comfortably D. Forces the patient to reveal information the individual may not be ready to share

C. Allows the patient to express thoughts and feelings comfortably -Through the inclusion of open-ended questions, the nurse affords the patient the opportunity to express thoughts and feelings to the degree with which the patient is comfortable while demonstrating respect for the patient's personal boundaries. Open-ended questions do not push the limits of the patient's personal boundaries, provoke frustration and anger in the patient, or force the patient to reveal information the patient is not ready to share. Because of the trauma experienced by patients with PTSD, as well as the subsequent potential for emotional and physical isolation, establishment of trust can be especially challenging. **For example, many military personnel and veterans are resistant to openly sharing their thoughts and emotions even with their colleagues and fellow veterans. During the assessment and throughout the care of all patients with PTSD, the nurse should be aware that direct questioning of the patient with regard to traumatic experiences may inhibit establishment of a trusting relationship and can even provoke frustration and anger in the patient.

The nurse is caring for a patient recently diagnosed with posttraumatic stress disorder (PTSD). His mental health provider is providing eye-movement desensitization and reprocessing (EMDR) and cognitive-behavioral therapy (CBT). The patient has demonstrated good progress but presents at the clinic with reports of an inability to sleep due to nightmares and difficulty meeting his daily obligations. Which intervention best addresses this symptom of PTSD? A. Monitor physiological level of arousal. B. Exercise daily. C. Begin pharmacotherapy. D. Use positive affirmation.

C. Begin pharmacotherapy. -This patient is already actively engaged in nonpharmacologic therapies. At this time, the patient may benefit from adding a medication to the treatment regimen. The antihypertensive medication prazosin inhibits the brain's response to norepinephrine, and it may be prescribed for treatment and prevention of nightmares. Teaching patients with PTSD to monitor their physiological level of arousal, encouraging them to exercise, and teaching them how to use positive affirmation techniques are all helpful therapies. However, they do not specifically address the nightmares that are recurring despite this patient's active participation in the plan of care and the progress the patient is making in life. Selective serotonin reuptake inhibitors (SSRIs) may produce undesirable side effects. Therefore, it is important to teach the patient that most side effects will diminish after the first few weeks. If the patient does not understand this, the risk of nonadherence to the medication regimen increases, leaving the patient untreated and susceptible to decompensation of illness.

Which behavior is a characteristic of dissociation experienced by patients with posttraumatic stress disorder (PTSD)? A. Emotional numbing and loss of sense of reality B. Blocking certain elements of the traumatic event C. Blocking emotions related to the traumatic event D. Strong sense of agitation and poor concentration

C. Blocking emotions related to the traumatic event -Dissociation, in which the individual blocks emotions related to the traumatic event, may occur in patients with PTSD. Dissociation is not associated with a strong sense of agitation and poor concentration, emotional numbing and loss of sense of reality, or blocking certain elements of the traumatic event altogether.

Evaluating assessment data for an individual with posttraumatic stress disorder (PTSD) can be challenging. Which condition can compound the manifestations of PTSD for some patients? A. Hyperthyroidism B. Schizophrenia C. Insomnia D. Eating disorders

C. Insomnia -For some patients with PTSD, manifestations of the disorder can be compounded by substance abuse, depression, and insomnia. Hyperthyroidism, schizophrenia, or eating disorders usually will not compound manifestations of PTSD.

Which cause should the nurse associate with a higher incidence of posttraumatic stress disorder (PTSD)? A. Natural disasters B. MVCs C. Intentional infliction of violence D. Imprisonment

C. Intentional infliction of violence -Intentional infliction of harm or violence, such as torture or rape, is associated with a higher incidence of PTSD. PTSD can also be triggered by natural disasters, motor vehicle crashes, and imprisonment, but these triggers are less prevalent than intentional infliction of harm or violence.

The pediatric nurse welcomes the parents of a child adopted from an international agency. The child was orphaned after a border war and still has nightmares. Which diagnosis should the pediatric nurse be prepared to explain to the family? A. Anxiety disorder B. Phobia C. Posttraumatic stress disorder (PTSD) D. Insomnia

C. Posttraumatic stress disorder (PTSD) -The nurse should be prepared to explain a diagnosis of PTSD to the family. That is a more likely diagnosis than anxiety disorder, phobia, or insomnia.

The nurse is planning care for the older veteran with posttraumatic stress disorder​ (PTSD). Which understanding should the nurse apply to the care of this​ client? A. The older veteran with PTSD will report emotional symptoms. B. The older veteran with PTSD is likely to be hostile. C. The older veteran with PTSD is at an increased risk of suicide. D. The older veteran with PTSD will have significant depression.

C. The older veteran with PTSD is at an increased risk of suicide. -​Rationale: The older veteran with PTSD is at increased risk of suicide compared to a​ middle-aged veteran. The older veteran with PTSD is less likely to be​ hostile, has less​ depression, and complains of somatic issues instead of emotional issues when compared to the younger veteran.

The nurse is discussing treatment options with a client with posttraumatic stress disorder​ (PTSD). The client asks the nurse how the PTSD will be cured. How should the nurse​ respond? A. There are medications that can cure PTSD. B. PTSD will reoccur if you skip group counseling. C. Treatment and therapies are done with and without medication. D. We will try the therapies that your insurance company covers.

C. Treatment and therapies are done with and without medication. -​Rationale: The client with PTSD will be treated holistically with pharmacologic and nonpharmacologic therapies to obtain the best results. The​ nurse's response would not focus on medication​ alone, therapy​ alone, or concerns over insurance​ coverage, because it is better to avoid them as therapeutic responses.

The nurse is caring for a combat veteran client with posttraumatic stress disorder​ (PTSD). Which condition can be ideal for acupuncture to be an effective​ treatment? (Select all that​ apply.) A. When solely used as a primary therapy B. When used as a​ short-term therapy for a period of no more than a month C. When used as an adjunct to​ cognitive-behavioral therapy​ (CBT) and other traditional therapies D. When used regularly E. When used for a period of 3 months or more

C. When used as an adjunct to​ cognitive-behavioral therapy​ (CBT) and other traditional therapies D. When used regularly E. When used for a period of 3 months or more -​Rationale: Preliminary research shows that acupuncture may be an effective treatment for PTSD only if the treatment is regular and lasts for at least 3​ months, and is used as an additional treatment with CBT and other more traditional​ therapies, including pharmacologic agents.

Which statement should the nurse expect to hear from a client with posttraumatic stress disorder​ (PTSD)? (Select all that​ apply.) A. ​"I feel very optimistic and positive about the future and what I can​ accomplish." B. ​"I'm a​ high-stress person. I feel content most of the​ time." C. ​"There is no one I can really talk to. I​ don't feel close to​ anyone." D. ​"I have trouble sleeping at night and​ don't feel rested in the​ morning." E. ​"I can't remember the last time I enjoyed​ myself."

C. ​"There is no one I can really talk to. I​ don't feel close to​ anyone." D. ​"I have trouble sleeping at night and​ don't feel rested in the​ morning." E. ​"I can't remember the last time I enjoyed​ myself." -​Rationale: Clients with PTSD experience​ recurrent, involuntary, and intrusive​ memories, traumatic​ nightmares, and flashbacks. They have negative alterations in cognition and mood that began or worsened after the traumatic event. Examples are an inability to experience positive emotions and persistent blame of self or others for causing the trauma or its consequences. Clients may have trouble sleeping and may become emotionally numb or have trouble with​ affection, impairing their relationships. Clients with PTSD typically do not express feelings of optimism and contentment.

Prevention and treatment of PTSD

Cognitive processing therapy Cognitive therapy for PTSD Narrative exposure therapy Prolonged exposure therapy Trauma-focused CBT Trauma-focused Cognitive therapy Eye movement desensitization and reprocessing

An employee has recently been absent from work on several occasions. Each time, this employee returns to work wearing dark glasses. Facial and body bruises are apparent. During the occupational health nurses interview, the employee says, "My partner beat me, but it was because there are problems at work." What should the nurses next action be? a. Call the police. b. Arrange for hospitalization. c. Call the adult protective agency. d. Document injuries with a body map.

D ~ Documentation of the injuries provides a basis for possible legal intervention. The abused adult will need to make the decision to involve the police. Because the worker is not an older adult and is competent, the adult protective agency is unable to assist. Admission to the hospital is not necessary.

An adult has recently been absent from work for 3-day periods on several occasions. Each time, the individual returns to work wearing dark glasses. Facial and body bruises are apparent. What is the occupational health nurse's priority assessment? a. Interpersonal relationships b. Work responsibilities c. Socialization skills d. Physical injuries

D ~ The individual should be assessed for possible battering. Physical injuries are abuse indicators and are the primary focus for assessment. No data support the other options.

The nurse is reviewing a plan of care for a patient diagnosed with posttraumatic stress disorder (PTSD). Which intervention should the nurse question? A. Assist the patient in reducing nightmares. B. Help the patient to discuss emotions related to the traumatic experience. C. Keep the patient free from injury or harm. D. Administer fluoxetine as ordered.

D. Administer fluoxetine as ordered. -Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor (SSRI) not approved by the U.S. Food and Drug Administration (FDA) for use in treating PTSD. The only two SSRIs approved by the FDA for the treatment of PTSD are sertraline (Zoloft) and paroxetine (Paxil). All the other interventions are appropriate for this patient.

Some patients with posttraumatic stress disorder (PTSD) experience hyperarousal and vigilance. Which intervention should be the nursing priority for patients experiencing these symptoms? A. Providing immediate pharmacologic intervention B. Getting the patient to a calm environment C. Teaching the patient new coping mechanisms D. Ensuring the safety of the patient

D. Ensuring the safety of the patient -Nursing priorities for patients with PTSD exhibiting hyperarousal and vigilance are ensuring the safety of the patient and others while quickly lowering patient anxiety levels. Patients experiencing extreme anxiety also require pharmacologic intervention, a quiet and calm environment, and reassurance about personal safety. Once anxiety levels are reduced, the health team can help the patient learn a new process of appraisal and coping mechanisms.

The nurse is caring for a 30-year-old woman 3 months after the woman's assault. Her symptoms include a sense of detachment, altered sense of reality, spontaneous memories of the assault, recurring distressing dreams, psychological distress, and an inability to return to her apartment. Which risk factor should lead the nurse to suspect that the patient is experiencing posttraumatic stress disorder (PTSD)? A. Exhibiting depersonalization B. Avoiding situations related to the trauma C. Experiencing flashbacks D. Experiencing an extremely stressful event

D. Experiencing an extremely stressful event -Risk factors for PTSD include the severity of the stressor event and additional stressors immediately following the event. Depersonalization, avoiding situations related to the trauma, and flashbacks are clinical manifestations of PTSD, not risk factors.

All patients with posttraumatic stress disorder (PTSD) should be assessed using valid PTSD measuring tools. In addition to assessment of psychological and emotional symptoms, which age group also needs cognitive screening? A. Women B. Children C. Adolescents D. Older patients

D. Older patients -The older patient who may be experiencing PTSD symptoms should be assessed using a valid PTSD measuring tool and be assessed for suicidal thoughts and behaviors because older adults are at an increased risk of suicide compared with middle-aged adults. A complete mental status exam, including cognitive screening, is also recommended when assessing the older adult. The other groups are not as likely to require extensive cognitive screening. Older patients may report somatic symptoms as opposed to emotional symptoms and are at an increased risk of suicide.

A patient with posttraumatic stress disorder (PTSD) wishes to add acupuncture to the treatment regimen. Which information on acupuncture should the nurse include while teaching the patient? A. Do not use acupuncture for more than 3 months. B. Do not use acupuncture in conjunction with cognitive-behavioral therapy (CBT). C. Do not use acupuncture in conjunction with traditional therapies. D. Use acupuncture as an adjunctive therapy.

D. Use acupuncture as an adjunctive therapy. -Nurses working with patients who are interested in trying acupuncture as a treatment for PTSD should encourage the patients to add acupuncture as an adjunctive therapy and not to abandon CBT and therapies that are more traditional. Patients may need to participate in acupuncture on a regular basis for a period of 3 months or more.

PTSD and Medical Conditions - why can it occur (3)

Onset of illness can be stressful Diagnosis of a light-threatening disease Prolonged treatment or unpleasant medical procedures

A client is prescribed​ prazosin, an antihypertensive​ medication, for the pharmacologic treatment of posttraumatic stress disorder​ (PTSD). The client asks how a blood pressure medication will help with symptoms. Which response by the nurse is the most​ appropriate? A. ​"The medication reduces your blood​ pressure, which decreases the symptoms of​ PTSD." B. ​"I am not sure why this medication has been​ prescribed, so I will follow up with your healthcare​ provider." C. ​"Your medical record indicates elevated blood pressure during the last two​ visits." D. ​"The medication has been found quite useful to reduce the nightmares associated with​ PTSD."

D. ​"The medication has been found quite useful to reduce the nightmares associated with​ PTSD." -​Rationale: Prazosin is an antiadrenergic agent that has been used to treat hypertension for many years. Recent research has found that this medication is useful in the treatment of the nightmares associated with PTSD through its action of inhibiting the​ brain's response to norepinephrine. While the medication will reduce blood​ pressure, this is not the reason it is used for PTSD. It is inappropriate for the nurse to avoid answering the question and to instead promise to follow up with the healthcare provider.

Defending

Defensive remarks made by the nurse telling the client that their negative remarks are wrong

An emotional numbing and a loss of the sense of reality, feelings, and sense of self in relation to others

Depersonalization

Blocking of emotions related to the traumatic event

Dissociation

Certain elements of the traumatic event blocked altogether

Dissociative amnesia

Interactions

Diuretics - encourage 1.5-3L of fluid a day but caution if pt is losing too much sodium (sweat, frequent diarrhea, polyuria ect) this inhibits lithium excretion. Can lead to toxicity. NSAIDs- concurrent use increases renal abosorption and can lead to toxicity. (Aspirin as a mild analgesic is ok) Anticholinergenics (antihistamines and antidepressants) - combined use can lead sodium imbalances which result in toxicity.

Validating

Do you feel relaxed

Lithium Toxicity Signs/Ranges

Early Indication 1.5 or less slurred speech lethargy,. diarrhea, tremors, weakness or polyuria. Advanced Indications: 1.5 -2 mental confusion, sedation, coarse tremors, ongoing GI Distress/diarrhea Withold the Medication Severe Toxicity 2-2.5 Extreme polyuria, tinnitus, giddy, jerking, blurred vision, ataxia, severe hypotension, stupor, coma, seizures 2.5 or greater leads to rapid progression of symptoms can be fatal. Hemodialysis may be necessary.

Reflecting/Repeating

Everyone here ignores me "Ignores u"

treatment for alcohol dependence

FDA approved for alcohol dependence: - disulfiram (Antabuse) - acamprosate (Campral) - naltrexone (ReVia)

Losing touch with reality and cognitively returning to the traumatic event as if it were happening again

Flashbacks

Which feelings are associated with PTSD?

Guilt Shame Sadness Betrayal Humiliation Anger

Making Stereotypes Comments

How are you feeling Isnt it a beautiful day thats good

Render the affected individual in a near-constant state of "high alert"

Hyperarousal and hypervigilance

Selective Reflecting

I feel so tired. I dont like it here Nurse : You feel tired

Acknowledging the Clients Feelings

I hate this place Nurse: It must be difficult for you to stay in a place you dislike

Belittling the clients feelings

I know how you feel

Clarifying

Im not sure what you mean Are you using this word to mean Avoid MEDICAL JARGON

Lithium Ranges (What they SHOULD be)

Initial Levels at start of treatment - 0.8-1.4 Maintenance Levels : 0.4- 1.0 Levels higher than 1.5 indicate toxicity.

Sharing Observations

Shares with the client they observe reguarding their behavior. Must make the remark so that it is her observation rather than the clients behavior she is questioning. Stay away from words like ANGRY UPSET AFRAID ANXIOUS

General Leads

Shows the client acceptant and understanding conveyed through active listening

Complications Grandma's Famous Pie Was Really Good. Her Baking Has Love.

Some adverse effects resolve after a few weeks GI distress, Fine hand tremors, Polyuria, Weight Gain, Renal Toxicitiy, Goiter, hypothyroidism, bradydysrythmias, hypotension, Lithium toxicity

AW Symptoms

Symptoms: Develop 3-8 hours after they are deprived from alcohol. - Increased NorE (Hyperhidrosis, tachycardia, hypertension, tremor). - Increased dopamine (psychotic symptoms). - Increased glutamate (epileptic seizures). Withdrawal symptoms typically last 5-7 days. 5% develop delirium 2-3 days after they've stopped drinking & in some cases it can be fatal.

Broad Opening Statements

Tell me about your problem Is there something bothering you Is there something you would like to talk about tell me about your pain

Benzodiazepines such as chlordiazepoxide (Librium), diazepam (Valium), lorazepam (Ativan) or oxazepam (Serax) are the most commonly used drugs used to reduce alcohol withdrawal symptoms. There are several treatment patterns in which it is used.

The first option takes into consideration the varying degrees of tolerance. In it, a standard dose of the benzodiazepine is given every half hour until light sedation is reached. Once a baseline dose is determined, the medication is tapered over the ensuing 3-10 days. Another option is to give a standard dose of benzodiazepine based on history and adjust based on withdrawal phenomenon. A third option is to defer treatment until symptoms occur. This method should not be used in patients with prior, alcohol-related seizures. This has been effective in randomized controlled trials. A non-randomized, before and after, observational study found that symptom triggered therapy was advantageous. Dosing of the benzodiazepines can be guided by the CIWA scale.

Stereotype Comments

These statements keep the conversation on a superficial level

Nursing Considerations

This med takes effect in 5-7 days but max benefit will not happen for 2-3 weeks. Short half life of med means it is usually rx at 3x a day Take with food/milk to minimize GI distress. Start of treatment ranges must be monitored every 2-3 days until stable then every 1-3 months.

Re-experiencing

Trauma is re-experienced through intrusive and distressing thoughts, images, flashbacks, or nightmares Flashbacks feel "real". Acting or feeling like the event is recurring

Broad Opening Statements

Using open ended questions helps you obtain info quickly and an be more Specific

Requesting an explanation

Why are you upset (You appear upset) Why did you do that (Can you tell me how you feel about that)

Gender differences of metabolism of alcohol

Women absorb and metabolize alcohol differently from men. They have higher BAC's after consuming the same amount of alcohol as men and are more susceptible to alcoholic liver disease, heart muscle damage, and brain damage. The difference in BAC's between women and men has been attributed to women's smaller amount of body water, likened to dropping the same amount of alcohol into a smaller pail of water. An additional factor contributing to the difference in BAC's may be that women have lower activity of the alcohol metabolizing enzyme ADH in the stomach, causing a larger proportion of the ingested alcohol to reach the blood. The combination of these factors may render women more vulnerable than men to alcohol-induced liver and heart damage.

Gerneral Leads

Yes Oh Go On I see

Sharing Observations

You are trembling You appear upset Stay away from "seems"

Disagreeing with the Client

You are wrong thats not true

Expressing Disapproval

You should stop worrying like this You shouldnt do that

Defending

Your doctor is quite capable The hospital is well equipped She is a very good nurse

seizures

a neurological dysfunction caused by a sudden episode of uncontrolled electrical activity in the brain that may result in the involuntary, uncontrolled muscle contractions. usually characterized by LOC and involuntary spasmodic muscle twitching.

delirium tremens

an acute organic brain syndrome due to alcohol withdrawal that is characterized by sweating, tremor, restlessness, anxiety, mental confusion, and hallucinations , a disorder involving sudden and severe mental changes or seizures caused by abruptly stopping the use of alcohol , a violent delirium with tremors induced by alcoholic liquors

Silence

beneficial to communication allowing the client to collect his thoughts and to reflect upon the topic discussed.

Changing the subject

changes the direction of the conversation rather than allowing the client to discuss what they wish

tremors

continuous quivering or shaking.

Disagreeing with the client

contradicts the client which indicates that what the client said has not been accepted. the client mat refrain from expressing himself further.

A Client prescribed lithium carbonate (Eskalith) is experiencing an excessive output of diluted urine, tremors, and muscular irritability. these symptoms would lead the nurse to expect to assess which serum lithium level? A. 0.6 mEq/L B. 1.5 mEq/L C. 2.6 mEq/L D. 3.5mEq/L

correct answer:C Rational: A client with serum level 2.6 mEq/L may experience excessive diluted urine, tremors, muscular irritability, psychomotor retardation, and mental confusion. the client's symptoms described in the question supports a serial level of 2.6 mEq/L.

time

daily, 30-40 minutes for 4-6 weeks, outpaitent

indications

depression not responding to meds

Reassuring Cliches

everything will be alright You dont need to worry Your doing fine

What are the causes of alcoholism (genetics)?

genetics: If you have a close relative who had alcohol dependency problems the chances that you will have problem also are greatly increased. Alcoholism runs in families. Poverty and physical/sexual abuse are two factors that can contribute to alcoholism addiction. Traits such as impulsiveness, low self-esteem and need for approval all can lead to alcohol dependence. Depression Peer pressure and easy availability of alcohol can aid some users, particularly younger ones, in becoming alcoholics.

validating

have the client demonstrate if teaching took place

Clarifying

if the nurse has not understood the meaning of what the patient said she clarify IMMEDIATELY

BLOOD ALCOHOL LEVELS

legally drunk: .08% 3-5 drinks lethal: .5% 25 drinks

non-invasive therapy

magnetic pulsations stimulate specific areas of the brain

Agreeing with the client

makes it hard for the client to change their mind

Validating

never assume that she has been successful in meeting the clients needs until this has been validated with the client. Asking for feedback

systemic adverse reactions

none

Verbalizing Implied Thoughts and Feelings

nurse says what the client obviously has implied rather than what is actually said

alternative therapies

phenobarbital - moa: binds GABA receptor -> prolongs Cl- channel opening -> enhances GABA inhibitory effects - onset IV: 5 minutes, max effect 30 minutes, duration of action 4-10 hours - limited evidence, may possibly be used in addition to benzodiazepines - dosing 260 mg IV, then 130 mg IV PRN - therapeutic range: 10-40 mcg/mL - adverse effects: bradycardia, hypotension, respiratory depression

electromagnet

plced on scalp. Cleint is alert, may experience tingling/lightheadedness

Lithium Carbonate - Action

produces neurochemical changes in the brain - blocks serotinin Decreases neuronal atrophy used to treat bipolar disorder and control acute mania. Prevents mania/depression and decreases risk of suicide.

adjunctive therapies

propofol - moa: GABA agonist -> hyperpolarization of neurons -> sedation, NMDA glutamate receptor antagonist - uses: severe withdrawal refractory to benzodiazepine therapy, mechanical ventilation - mixed evidence in outcomes: some studies show no difference in length of stay while other studies show increased ICU and hospitalization stays - dose: 5-10 mcg/kg/min continuous infusion - adverse effects: hypertriglyceridemia, hypotension, bradycardia - propofol infusion syndrome: risk factors include sepsis and high doses (>70 mcg/kg/min). onset within 4 days. symptoms- bradycardia or tachycardia, heart failure, hyperkalemia, hyperlipidemia, metabolic acidosis, renal faliure. management- discontinue propofol, manage symptoms. consequences- mortality. dexmedetomidine: - moa: centrally acting alpha2 agoinst -> decrease NE synthesis and sympathetic outflow. causes sedation, anxiolysis, analgesia, sympatholysis, increases parasympathetic tone - uses: sedation, lowers benzodiazepine requirement - dose: 0.2-0.7 mcg/kg/hr continuous infusion - adverse effects: respiratory depression, agitation, nausea, constipation, hypotension, bradycardia, tachycardia, hypertension neuroleptics: - haloperidol 0.5-5mg PO/IM/IV every hour - olanzapine 10 mg IM - uses: agitation, hallucinations, delirium - ADRs: QTc prolongation anticonvulsants: - carbamazepine: used for symptoms treatment, but insufficient evidence. dosed 600-800 mg x 1 day with taper to 200 mg over 5 days. ADRs include NV, agranulocytosis, aplastic anemia

seizures

rare but possible

Reassuring cliches

reduces nurses anxiety but contradicts the clients perception of the situation. Shows the nurse is not interested so the discussion stops

lithium therapeutic levels <0.4-1

side effect signs of toxicity : mild nausea, weight gain, mild thirst, fine hand tremors

sever toxicity >2.0

signs and symptoms: ataxia, serial EEG changes blurred vision, seizures, stupor, large output of diluted urine , coma

moderate lithium toxicity 1.5-2.0

signs and symptoms: coarse hand tremors, persistent GI upset, confusion, muscle hyperirritability, sedation, EEG changes.

mild lithium toxicity 1.0-1.5

signs and symptoms: nausea, vomiting,diarrhea, thirst, polyuria, lethargy, slurred speech, fine hand tremors

symptom triggered versus fixed schedule treatment

symptoms triggered: - medications given in response to symptoms - assess patient hourly using CIWA-Ar - less over sedation - potentially shorter treatment fixed schedule treatment: - consider in severe withdrawal

alcohol withdrawal syndrome

the physical effects that may occur when an alcoholic stops consuming alcohol Anxiety, insomnia, tremor, seizures, visual hallucinations, delirium A person who has developed a physiologic dependence and quits drinking for whatever reason, SxS mild tremor, hallucinations, diaphoresis, N/V, disoriented.....tremors usually happen 6-48 hours after stopping, they may last for 3-5 days, and seizures may happen 12 -24 hours after stopping

Acknowledging the clients Feelings

way for the nurse to convey acceptance of the client by acknowledging the feelings they are expressing without disagreeing

contraindications

• MAOI's • erythromycin • ketoconazole • St. John's Wort • grapefruit juice

side effects

• dizziness • nausea • HA • agitation • constipation • ↑ suicide risk

What meds/substances can ↑ its effects?

• erythromycin • ketoconazole • St. John's Wort • grapefruit juice

indications

• panic disorder • social anxiety • OCD • PTSD • GAD • bruxism (teeth grinding)

client education

• side effects will go away

disadvantage

• takes 2 - 4 weeks to reach full effects • not good for PRN use

benefits

• ↓ dependency • no sedation