NUR220 - Mental Health Questions

What are the s/s of EPS?

- dystonia (involuntary muscle contractions that cause repetitive twitching movements) - Pseudo parkinsonism (Parkinson-like symptoms, weakness, tremors, slurred speech, TD) - bradykinesia (slowness of movement) - akathisia (movement disorder, difficult to stay still) - spasms of neck, jaw, back, extremities, eyes, throat and tongue

What are s/s of depakote toxicity?

- facial swelling, GI upset, N/V, fever, ataxia, sore throat, petechiae, check liver function*

What are positive signs aka excess or distortion of normal functions of Schizophrenia?

- grossly disorganized or catotonic behavior - inappropriate affect - hallucinations - delusions - disordered or pressured speech

What are s/s of mania?

- inflated self esteem - decrease need for sleep - more talkative - increased distractibility - increased sociability --> witty, intrusive, interruptive

What are side effects of ADHD?

- insomnia and restlessness - weight loss - reduce appetite

An individual is diagnosed with depression when they have 5 or more of these for at least 5 weeks:

- irritable, anger or rage - hopelessness (major factor of increase suicide) or worthlessness - difficulty concentrating/focus, difficult making decisions - guilt, psychomotor, retardation or agitation, change in eating/sleeping, decrease energy/fatigue, withdraw from friends/fam, preoccupation with death, suicidal ideation/plan/attempt

Which patients are contraindicated from using tricyclic antidepressants?

- not good for older adults as they can cause confusion - not used with pregnancy - glaucoma - CV

What are the nursing considerations for pt's with depression?

- suicide risk - assess for suicide risk - self-care, communication (make observations, don't ask 'direct' questions, make time for the client), maintenance of a safe environment, counseling

A stimulant should NOT be prescribed IF?

- the pt displays TICs - family hx or tourettes - glaucoma - seizures - MAIOs

What are the side effects of non-stimulant ADHD meds?

- weight gain - decreased libido - NMS

What are some disadvantages of antidepressant?

- weight gain, decreased libido, GI upset, may cause NMS or serotonin syndrome when used with MAOIs

restriction of intake leading to significantly low body weight *vomiting/diuretics/laxative use is UNCOMMON

Anorexia nervosa

A nurse is counseling a client for management of anxiety. The client is consistently late for appointments and ignores household chores. The client states, "I'm just too stressed. I need to be taken care of." The nurse identifies this behavior as an example of which of the following defense mechanisms. A. Dissociation B. Introjection C. Regression D. Repression

C. Regression

attributing YOUR OWN unacceptable thoughts or feelings to someone or something else - misattribution of undesired thoughts onto another person who does not have those thoughts ex.) your mad at your friend so you yell they are mad at you

Projection

you might hate someone, but your superego tells you that such hatred is unacceptable, so you believe that they hate you

Projection

What are nursing considerations for bipolar disorder I?

Pt safety and maintaining physical health

What should be done with anxiolytics?

Pt should taper off not completely stop

What are some nursing interventions when it comes to a pt with PTSD?

RN should stay with the pt when flashbacks occur, use guided imagery to help reduce anxiety

I failed my math exam, but I'm not that bothered it wasn't my fault, it was Mr. Wright who can't teach

Rationalization

Justifying one's behaviors by sustaining "good" acceptable reasons for the real motivations - supplying a logical reason as opposed to the real reason

Rationalization

The sex obsessed individual becomes the prude

Reaction formation

There is this girl at work who I hate. She intimidating and disrespectful. Strangely, she's now one of my best friends

Reaction formation

adopting beliefs, attitudes and feelings contrary to what you really believe - converting of unwanted or dangerous thoughts, feelings or impulses into their opposite, true belief causes anxiety

Reaction formation

It's so unfair! My mom doesn't care how much I cry and scream, she won't get me a car, she doesn't even care about me!

Regression

reverting to an older, less mature way of handling stress/feelings ex.) Kali is mad Alyssa wore her sweater so she cried in Ed's lap)

Regression

What does ECT do?

Produces an electrical current to induce a seizure while the pt is anesthetized, may enhance neurotransmitters in the brain (serotonin, nor epi and dopamine)

You get really mad at your husband but scream that he's the one mad at you

Projection

What should the nurse know when it comes to COMMAND hallucinations?

The nurse should ask/know what the 'voices' are saying to the client, for safety reasons ex.) they are telling me to harm you and my roommate

What needs to be monitored during an ECT?

The nurse should monitor the pt's cardiac rhythm via electrocardiogram - seizure induced during ECT can stress the heart

pattern of disregard and violation of others occurring since age 15, evidence of conduct disorder before age 15 (troubled kid) - 3 or more - failure to conform to social norms, unlawful behavior, deceitful/lying, fail to plan ahead, anger, irritable, aggression, must be 18, impulsive, lack of empathy, irresponsible

antisocial personality disorder (cluster b)

inability to speak

aphasia

this phase of anger deals with act of violence, restrains, PRN medications

assaultive

What is the treatment for schizophrenia?

atypical antipsychotics *first choice with the exception of clozapine and olanzapine (not given) because of their metabolic effects*

pattern or social inhibitions, feelings of inadequacy, hypersensitive to negative (shy/quiet person) - 4 or more - avoid occupational activity that involves interpersonal relationships, restricted social life, expects to be criticized by others, inhibit new interpersonal relationships, shows restraint in personal relationships, reluctant to take risks

avoidant personality disorder (cluster c)

What are s/s of cannabis withdrawal?

irritable, fever, HTN

What are nursing interventions when it comes to a pt with Alzheimers?

keep daily routine, orienting pt, use calm assuring soft approach, supervision, keep mobile and independent as much as possible, respectfully use pt's name/title, provide simple choices

How long does the phase of mania last?

lasts at least 1 week, every day, most of the day

What are the s/s of TD?

lip smacking, sucking, tongue protrusion (tongue sticking out and pushing on cheek), worm like movement of the tongue, grimacing, eye blinking, roaring, movements of the fingers and toes, toe and finger tapping, involuntary movements, squinting, puckers, jaw clenching, biting hands and twisting

What are the 'warning signs' for suicide?

long ambivalent process, deep depression, hopelessness, withdrawal and isolation, sudden elevated mood and pre-suicidal comments

What are s/s of feeding/eating disorders?

- altered body image, amenorrhea, anxiety, cognitive distortions, bradycardia, OCD, anxiety, depression

What are some non-stimulants used for ADHD?

- atomoxetine (strattera), SSRIS's, guanfacine/tenex

What are negative signs aka reduction or loss of normal functions of Schizophrenia?

- blunted or flattened affect - lack of emotion (APATHY) - lack of motivation/interest (AMOTIVATION) - lack of speech (ALOGIA) (in a group but mumbles to self instead of contributing to the conversation) - lack of pleasure or joy (ANHEDONIA) - unkempt appearance, poor eye contact, poor hygiene - impaired social skills - increased serotonin

What are s/s of anxiety?

- changes in eating - sleeping problems - GI upset - somatic pain - sweaty palms

Describe the assessment for an individual with mental health issues.

- chief complaint, hx, social hx, developmental hx, education *stress and meds*, what's going on right now? any legal issues? Hx of trauma?

What are the side effects of ECT?

- confusion - slight headache - short term memory problems

newly coined words - made up works/phrases that only have meaning to you

Neologisms (schizophrenia)

This is a life-threatening reaction - HOT/STIFF/OUT OF IT

Neuroleptic malignant syndrome (NMS)

The duty to avoid harm

Nonmalficence

What does PTSD stand for? What can these pt's be?

Post-traumatic stress disorder - these patients can be very angry/irritable

How is borderline personality disorder treated?

SSRIs for anxiety and depression symptoms. Behavioral therapy helps reconstruct their thoughts

uninterrupted period or illness meeting symptoms of positive signs for schizophrenia concurrently with either a major depressive episode, manic episode or mixed episode - must be present with at least 2 weeks of only psychotic symptoms; delusions, hallucinations

Schizoaffective disorder

pervasive pattern of detachment from social relationships and restricted range of emotions in interpersonal settings-loner 4 or more - do not enjoy or desire close relationships (including family), likely to choose solitary activities, little interest in sex, emotional coldness, flat affect, detachment

Schizoid personality disorder (Cluster A)

disturbances of perception, cognition, emotions, behavior, social relationships

Schizophrenia

With this disorder, symptoms and characteristics are similar to schizophrenia - duration is at least 1 month but less than 6 - may be the first diagnosis which can change to schizophrenia after 6 months of s/s - 1/3 recover, 2/3 develop schizoprenia - social or occupational dysfunction may or may not occur

Schizophreniform disorder

pervasive pattern of social and interpersonal deficits in close relations as well as cognitive or perceptual disturbances and eccentric behaviors - 5 or more - ideas of reference, odd beliefs, magical thinking, unusual perceptions and experiences, paranoid ideations, lack of close friends, odd behavior/appearance

Schizotypal personality disorder (Cluster A)

this level of anxiety includes attention severely limited, inability to learn, inappropriate responses, intellectual, cognitive, social and occupational function diminish

Severe

What are the s/s of depression?

- depressed mood, sadness OR Anhedonia (lack of pleasure), one of these 3 must be present - hopelessness, worthlessness, guilt, irritability, anger, rage, difficulty in focus/making decisions

What is the therapeutic range for lithium?

0.6-1.2 mEq/L

What are the physical s/s of anorexia nervosa?

growth of lungo, cardiac arrhythmias, early osteoporosis, hair loss, temp control, amenorrhea

What is ALWAYS needed when it comes to brain stimulation therapy aka electroconvulsive therapy (ECT)?

**informed consent**

What are the treatment options for ADHD?

*avoid caffeine Psychopharmacological interventions CNS STIMULANTS have 80% response rate - Methylphenidate (ritalin) - most commonly used due to the least side effects associated - Dextroamphetamine (dexedrine), dextroamphetamine and amphetamine (adderall), lisdexamfetamine (vyvanse)

What are examples of tricyclic antidepressants? (Second line treatment)

- Imipramine (tofranil) - Amitriptyline (elavil) - Mirtazapine (anafranil) - Remeron

What are s/s of HTN crisis related to MAIO's?

- Increase BP, stiff neck, N/V, sweating, fever, chills, clammy, dilated pupils, tachycardia, chest pain

What is ECT used for?

- MDD - schizophrenia - acute mania *the seizure that ECT causes, helps relive the symptoms of these conditions, cause on how is still unknown

What are examples of antidepressants that are used?

- SSRIs (selective serotonin reuptake inhibitors) - fluoxetine (prozac) - fluvoxamine (luvox) - paroxetine (paxil) - seratine (zoloft) - citalopram (celexa) - escitalopram (lexapro)

What are MAIOs?

- a type of antidepressant - Monoamine oxidase inhibitors and are the second line of defense when treating depression and anxiety

What are the 4 types of hallucinations?

1. Auditory - most common -- command = most dangerous, can have a RISK involved -- running auditory -- multiple voices 2. Visual - when pt's are on other substances, this is very common (lewy body dementia/drug abuse) 3. Olfactory - smelling (seizure disorder) 4. Tactile - feeling things (drug abuse/alcohol withdrawal)

What are 5 relaxation techniques helpful with coping?

1. Breathing exercises 2. Meditations 3. Guided imagery 4. Journaling - outlet technique to relieve stress and anxiety 5. Mindfulness - being aware of surroundings

What are the 3 personality disorder clusters?

1. Cluster A - odd, eccentric-type paranoid, schizoid, schizotypal - anxiety, ineffective coping, social isolation, disturbances of thought process 2. Cluster B - dramatic, emotional, erratic, antisocial, borderline, historian, narcissistic - ineffective coping, disturbed personal identity, chronic low self-esteem, risk for self-injury 3. Cluster C - anxious, fearful, avoidant, depressant - anxiety, ineffective coping, low self-esteem, impaired social interaction

What are 3 examples of Tort?

1. False imprisonment - placing a pt in restraints without probable cause, ex.) understaffing and needing to prevent them from leaving their room 2. Assault - threat 3. Battery - unlawful act; physical contact

What are 3 types of crisis?

1. Maturational 2. Situational 3. Adventitious

What are the 4 levels of anxiety?

1. Mild 2. Moderate 3. Severe 4. Panic

What are the 5 subtypes of schizophrenia?

1. Paranoid 2. Disorganized 3. Catatonic 4. Undifferentiated 5. Residual

What are 3 examples of MAIOs?

1. Phenelzine (nardil) 2. Tranylcypromine (pavnate) 3. Isocarboxazid (maspion)

What are the 3 phases of anger?

1. Pre-assaultive 2. Assaultive 3. Post assaultive

What are the 4 types of admission?

1. Voluntary - the client or client's guardian chooses admission into a mental health facility in order to obtain treatment; has the right to apply for release at any time, has the right to refuse treatment - considered competent 2. Temporary emergency admission - the client is admitted due to inability to make decisions regarding care; usually 72 hours but the length may not exceed 15 days; could be admitted by a family member ex.) a client who has borderline personality disorder and assaulted a homeless man with a metal rod 3. Involuntary admission - the client enters the mental health facility against her will for an indefinite period of time ex.) risk to harm self or others, inability to provide self-care - the pt has the right to refuse treatment and medication, ONLY if considered competent 4. Long-term involuntary admission - must be imposed by courts; usually 60-180 days, could be no release date - court ordered and required by the judge's decision

What are 4 behaviors that may indicate a pt may have conduct disorder?

1. aggression to others/animals 2. Destruction of property 3. Deceitfulness 4. Theft

What are 4 anger management comorbidities?

1. depression 2. PTSD 3. psychosis 4. some personality disorders

What is the first line of defense when treating anxiety/depression? What is the second line of defense?

1st = SSRI's --> 1st line of treatment also for conduct disorder and bulimia nervosa 2nd = MAIO's, tricyclic antidepressant

A nurse is assessing a client who has obsessive-compulsive disorder (OCD) and find that the client demonstrates constant repetitive cleaning. The nurse knows that this behavior is an attempt to: A. Decrease anxiety B. Focus on non-threatening tasks C. Manipulate others D. Decrease time available for interaction with people

A. Decrease anxiety

Which of the following would you recognize as manic behavior? Select all that apply. A. Talking in rapid, continuous speech B. Interacting with others in a flirtatious way C. Spending large sums of money D. Sleeping for long periods of time E. Dressing in black or grey clothing

A, B and C

A nurse is assessing for the presence of extrapyramidal side effects (EPSs) in a client taking chlorpromazine (Thorazine). Which of the following findings should the nurse recognize as EPSs? Select all that apply. A. Muscle contractions of the neck B. Fidgeting behavior C. Fluctuating vital signs D. Impaired gait E. Sexual dysfunction

A, B and D

A nurse is discussing comorbidities associated with eating disorders with a newly licensed nurse. Which of the following should the nurse include in the discussion? A. Anxiety B. Obsessive-compulsive disorder C. Schizophrenia D. Breathing-related sleep disorder E. Depression

A, B and E

Which of the following are expected findings in the client with obsessive compulsive disorder (OCD)? Select all that apply. A. Difficulty relaxing B. Irrational fear of certain objects C. Rule-conscious behavior D. Unaware of compulsions E. Perfectionist behavior

A, C and E

A nurse is caring for an adolescent client with an eating disorder. The client is 64 inches tall and weighs 85lb. Upon assessment, which of the following manifestations should the nurse recognize are consistent with the admitting diagnosis? Select all that apply. A. Amenorrhea B. Verbalized desire to gain weight C. Altered body image D. Over-exercizing E. Bradycardia

A, C, D and E

A nurse is documenting admission assessment findings for a client who has major depressive disorder. The nurse should identify which of the following findings as clinical manifestations? (Select all that apply.) A. Feelings of hopelessness B. Pressured speech C. Grandiosity D. Anhedonia E. Flat facial expression

A, D and E

A nurse is caring for a client three days after admission for treatment of depression. The client leaves her current activity, approaches the nurse and states, "There's no reason to go on living. I just want to end it all." Which of the following nursing interventions is appropriate? A. Ask her if she has a plan to commit suicide B. Recognize the attempt at manipulation and escort her back to her activity C. Assist her to her room and allow her to rest before resuming activity D. Notify her family and request a visitor stay with her until thoughts of suicide are gone

A. Ask her if she has a plan to commit suicide

A nurse is caring for a client in an urgent care center with traumatic injuries following an assault. She sits quietly and calmly in the exam room. The nurse should recognize this behavior as which of the following? A. Denial B. Deplacement C. Introjection D. Undoing

A. Denial

The client with depressive disorder, is in alcohol withdrawal and reports a recent job loss. Which of the following should be the priority nursing intervention? A. Determine the presence and degree of suicidal risk B. Assis the client to identify negative effects of chemical dependency C. Identify support groups in the community for long term treatment D. Refer client to a mental health care provider for evaluation and treatment

A. Determine the presence and degree of suicidal risk Maslow's hierarchy is the priority for this client so ensuring safety is the first nursing action

The depressed client refuses to participate in group therapy or perform ADL's. Which statement by the nurse is appropriate? A. I will assist you in getting out of bed and getting dressed B. You can remain in bed until you feel well enough to join the milieu C. The unit rules state you may not remain in bed D. If you don't participate in your care, you will not get better

A. I will assist you in getting out of bed and getting dressed

The client begins to make sexual advances toward the nurse. Which of the following is an appropriate statement by the nurse? A. I'm going to leave now and I'll return in one hour to spend time with you then B. I'm sure you don't intend to behave this way so I'm going to ignore this behavior C. I'm very flattered but I am married and cannot engage in this behavior D. I'm curious as to why you are behaving this way. Can you please explain it to me?

A. I'm going to leave now and I'll return in one hour to spend time with you then

Which of the following is the highest priority nursing intervention for the client who has depression? A. Monitor for risk of self-harm B. Administer prescribed antidepressants C. Encourage adequate fluid intake D. Assist with activities of daily living

A. Monitor for risk of self-harm

A nurse is caring for a client with serum lithium level of 2.0 mEq/L. Which of the following is the priority action? A. Notify the provider of this toxic blood level B. Continue to monitor this expected maintenance level C. Anticipate increasing the dose as this value is subtherapeutic D. Anticipate decreasing the dose because this is slightly above therapeutic level

A. Notify the provider of this toxic blood level

A nurse is planning care for a client who has schizophrenia and reports auditory hallucinations. Which of the following interventions should the nurse include in the plan? A. Promote the use of music to compete with the client's auditory hallucinations B. Inform the client that the auditory hallucinations are not real C. Avoid asking the client if they are experiencing auditory hallucinations D. Instruct the client on the use of voice recognition regarding the auditory hallucinations

A. Promote the use of music to compete with the client's auditory hallucinations

A nurse is caring for a client who requires a crisis intervention of acute anxiety. Which of the following is the highest priority? A. Protecting the client from injury B. Determining the cause of the client's anxiety C. Ensuring that the client feels safe D. Identifying the client's coping skills

A. Protecting the client from injury

A nurse is discussing the home care of a client who has advanced Alzheimer's disease with the client's partner, who is planning to go out of town for several days. Which of the following resources should the nurse recommend to the caregiver? A. Respite care B. Partial hospitalization C. Adult Day care program D. Geropsychiatric unit

A. Respite care

Which of the following is an unexpected finding for a client with major depressive disorder (MDD)? A. Significant change in weight B. Hyperexcitability C. Exaggerated response of pleasure to stimuli D. Attention seeking behavior

A. Significant change in weight

A nurse is caring for a client diagnosed with depression. His spouse asks the nurse about possible side effects of electroconvulsive therapy (ECT). After explaining that ECT will not cause brain damage, what additional information should the nurse offer? A. The main side effects are temporary and may include mild confusion, slight headache, and short-term memory problems B. Most have no adverse effects from this treatment, although muscle cramping may result from the induced seizure C. Some have been known to have a myocardial infarction, but we will monitor him closely to be certain this doesn't happen D. The common side effects are related to the use of anesthesia

A. The main side effects are temporary and may include mild confusion, slight headache, and short-term memory problems

A nurse is reviewing the medical record of a client who has anorexia nervosa. Which of the following findings should the nurse identify as an indication the client requires hospitlization? A. Total body fat 8.7% B. Potassium 3.6 mEg/L C. Temperature 36.1 C (96.9 F) D. Heart rate 54/min

A. Total body fat 8.7%

The nurse at a provider's office is interviewing an older adult client. Which of the following actions should the nurse plan to take? The client reports history of anxiety; diagnosed with Alzheimer's disease 2 months ago. A. Use a screening tool to evaluate the client for depression B. Ask the provider to decrease the dosage of the client's blood pressure medication C. Instruct the client to decrease intake of vitamin B12 D. Suggest the client go for a brisk walk 20 min just before bedtime

A. Use a screening tool to evaluate the client for depression

A nurse is caring for a client who receiving chlorpromazine (Thorazine) and is given a pass to attend a family outing on a sunny day. Which of the following is most important for the nurse to include in the client's teaching about the side effects of chlorpromazine? A. Wear a hat and a long-sleeved shirt B. Suck on hard candies C. Drink plenty of fluids D. Limit alcoholic beverages to one beer only

A. Wear a hat and a long-sleeved shirt

A nurse in a hospital is caring for a client who has agoraphobia. The nurse should evaluate that the client is making progress when the client is able to attend: A. a picnic in a local park B. daily group therapy sessions C. recreational therapy in the day room D. lunch in the hospital cafeteria with family

A. a picnic in a local park

The client who is bipolar is being discharged on lithium. The nurse understand that lithium toxicity can occur if the client: A. engages in strenuous exercise B. discontinues the drug abruptly C. increases sodium intake D. eats food high in tyramine

A. engages in strenuous exercise

A nurse in a psychiatric unit is caring for a client who is being admitted involuntarily after attacking a neighbor. The nurse knows that the client can be kept in the hospital after the 72-hour hold is over if the client: A. is a danger to herself or others B. is unwilling to accept that treatment is needed C. does not have anyone that she could stay with D. is financially incapable of paying for prescription medications

A. is a danger to herself or others

What should be done every 6 mnths with antipsychotic meds?

AIMs test - pt can feel 'ok' in the head but their body is moving involuntarily

What are the advantages of antidepressants? Disadavantages?

Advantages - effective for many disorders Disadvantages - weight gain, decrease libido, may cause NMS (hot/stiff/out of it) when taken with MAOIs

What are the advantages of anxiolytics? Disadvantages?

Advantages - fast acting/useful as PRN Disadvantages - sedation, cognitive impairment can lead to addiction, avoid alcohol

The demeanor and mental appearance of the individual (how do they appear at that specific moment)

Affect

fear of places and situations that may cause pain, helplessness or embarrassment ex.) standing in line/closed or open spaces/public transportation

Agoraphobia

How can a nurse help a pt with OCD to decrease/reduce anxiety?

Allow time for rituals - helps to reduce anxiety

healing your own pain by helping others ex.) wife dies so you keep yourself busy by volunteering at church to help the homeless

Altruism

What does conduct disorder as a child lead to in adulthood?

Antisocial disorder

What does OCD result in?

Anxiety

What does OCD develop as a mean to control?

Anxiety comorbidity - anxiety

What is used to help treat anxiety?

Anxiolytics (addictive)

What are the PIPS used for schizophrenia?

Aripiprazole Brexpiprazole *adjunctive therapy, can be used with another medication when used for MDD

If pt is suicidal what should the nurse ask and get?

Ask the pt if they have a 'plan' - get a safety contract with the patient

This is the persistent pattern of inattention, hyperactivity, impulsiveness that is more severe than typical individuals for their age and level of development

Attention Deficit Disorder/ Hyperactivity Disorder (ADHD)

recognize pt had a voice/respect rights

Autonomy

A nurse is caring for a client who is experiencing a crisis related to anxiety. Which of the following interventions are appropriate? Select all that apply. A. Avoid eye contact to prevent escalation of anxiety B. Establish rapport with the client C. Identify the cause of the anxiety D. Validate the client's feelings E. Develop a flexible crisis intervention plan

B, C and D

A nurse is caring for a client admitted with acute psychosis, being treated with haloperidol (Haldol). The nurse should suspect tardive dyskinesis as an adverse reaction when the client exhibits which of the following? Select all that apply. A. Urinary retention and constipation B. Tongue twisting and lip smacking C. Fine hand tremors and pill rolling D. Facial grimacing and eye blinking E. Extreme sedation and lethargy F. Repetitive involuntary movements

B, D and F

A nurse is caring for a group of clients. Which of the following findings should the nurse report? A. A client who is taking clozapine and has a WBC count of 7,500/mm3 B. A client who is taking lamotrigine and has developed a rash C. A client who is taking valproate and has a platelet count of 150,000/mm3 D. A client who is taking lithium and has a lithium level of 1.2 mEq/L

B. A client who is taking lamotrigine and has developed a rash

A nurse is planning care for a client who is experiencing acute mania. Which of the following interventions should the nurse include in the plan to promote sleep? A. Have the client participate in a morning aerobics group B. Encourage frequent rest periods throughout the day C. Provide a distraction such as television at night D. Offer the client hot chocolate at bedtime

B. Encourage frequent rest periods throughout the day

A nurse is caring for a client who has anorexia nervosa and over-exercises to avoid gaining weight. Which of the following nursing interventions is appropriate? A. Praise the client for looking at herself in the mirror B. Establish a contract with the client requiring her to talk to the nurse when she feels the urge to exercise C. Confront the client about damage over-exercising can do to her body D. Restrict the client from being weighed

B. Establish a contract with the client requiring her to talk to the nurse when she feels the urge to exercise

A nurse is caring for a client who has bipolar disorder and is hospitalized for a severe depressive episode. The client has been taking citalopram (Celexa) for 2 weeks and reports sleeping better and having improved appetite, but still feels hopeless. Which of the following is an appropriate nursing action? A. Speak to the provider about increasing the dose of citalopram B. Explain that antidepressants often take several weeks to be fully effective C. Notify the provider so the client can be prescribed a different medication D. Recommend a sleep study be done on the client

B. Explain that antidepressants often take several weeks to be fully effective

A nurse in a community health center is working with a group of clients who have post-traumatic stress disorder. Which of the following interventions should the nurse include to reduce anxiety among the group members? A. Response prevention B. Guided imagery C. Aversion therapy D. Light therapy

B. Guided imagery

A nurse is observing a newly licensed nurse as he provides family therapy for a client regarding relationship concerns with his spouse. Which of the following statements by the new nurse requires intervention? A. Tell me about the concerns that you have regarding your relationship B. I think you should try to see your wife's point of view as well as your own C. We should invite your wife to be a part of our discussion D. Relationship difficulties are stressful and require effort to resolve

B. I think you should try to see your wife's point of view as well as your own This is a 'false-option' question, option B is a non-therapeutic statement

The client with chronic anxiety is being discharged. Which of the following should the nurse include in the discharge plan? A. Contact crisis counselor once a week B. Identify anxiety-producing situations C. Try to repress feelings of anxiety D. Eliminate stress and anxiety from daily life

B. Identify anxiety-producing situations

A nurse is reviewing the electronic medical record of a client who has schizophrenia and is taking clozapine. Which of the following findings is the priority for the nurse to notify the provider? A. The client's chart indicates a 1.36kg (3-lb) weight gain in 1 month B. The client reports an inability to breathe easily C. The client's laboratory results indicate a fasting blood glucose level of 130 mg/dL D. The client reports having recently started smoking cigarettes

B. The client reports an inability to breathe easily

Can a pt take back informed consent?

Yes, they have the right to refuse at any time

A nurse in the ED is caring for a client taking haldol for the past 3 months. The client's temperature is 102F, BP 150/110 and has tachycardia. The nurse should know that these indicate a diagnosis of: A. agranulocytosis B. neuroleptic malignant syndrome (NMS) C. hypertensive crisis D. tardive dyskinesia

B. neuroleptic malignant syndrome (NMS)

prevent harm/promote good

Beneficence

Which meds are Anxiolytics?

Benzodiazepines (can cause addiction) Diazepam (vallum) Chlordiazepoxide (librium) Clonazepam (klonopin) Lorazepam (ativan) Alprazolam (xolax)

Recurrent binge eating WITHOUT compensatory purging (gets fat)

Binge eating disorder

characterized by or 1 major depressive episodes with at least 1 hypomanic episode - more depressive symptoms

Bipolar II disorder

This is characterized by occurrence of 1 or more manic episodes, depressive symptoms and mood swings

Bipolar disorder I *depressive phase lasts longer than bipolar II

This is a preoccupation with an imagined defect in appearance *ideas of reference - people are talking about them/thinks everything said is about them ex.) someone says their nose itches and person thinks they are picking on their nose

Body dysmorphic disorder

normal range of appropriate emotions

Broad

These are recurrent episodes of binge eating, vomiting, diuretic/laxative abuse is common *tooth decay is a result from stomach acid from vomit

Bulimia nervosa

A nurse is caring for a group of clients. For which of the following situations should the nurse complete an incident report? A. A client refuses electroconvulsive therapy after signing the consent form B. A client who was voluntarily admitted left the unit against medical advice C. A client was administered one-half of the prescribed dose of medication D. A client was placed in restraints after attempts to de-escalate aggressive behaviors failed

C. A client was administered one-half of the prescribed dose of medication

A charge nurse on a mental health unit is discussing client rights with a newly licensed nurse. Which of the following statements should the charge nurse make? A. "Clients can't refuse to take medications if they are admitted involuntarily" B. "You can notify a client's family if they are admitted involuntarily" C. "Clients who are admitted involuntarily maintain the right to give informed consent for procedures" D. "You can remove a client's privileges if they are admitted involuntarily and refuse to attend therapy sessions"

C. "Clients who are admitted involuntarily maintain the right to give informed consent for procedures"

A nurse is caring for a group of clients. Which of the following findings is the nurse required to report? A. A client who has bipolar disorder and tested positive for genital herpes simplex virus reports having multiple sexual partners B. A client who has depression reports having a lack of interest in assisting their partner in the care of their children C. A client who has borderline personality disorder threatened to harm their roommate D. An adolescent client who has anorexia nervosa has a BMI of 17

C. A client who has borderline personality disorder threatened to harm their roommate

A nurse is teaching a group of newly licensed nurses about the use of mechanical restraints. Which of the following information should the nurse include in the teaching? A. Complete documentation about the client's status every hour while they are in restraints B. Maintain the client in restraints for a minimum of 4hr C. Apply restraints when other means of managing the client's behavior have failed D. Request that the provider assess the client within 8hr of the application of restraints

C. Apply restraints when other means of managing the client's behavior have failed

A client with schizophrenia is experiencing a variety of hallucinations. Which of the following hallucinations is the priority concern? A. Visual hallucination B. Gustatory hallucination C. Command hallucination D. Tactile hallucination

C. Command hallucination

A nurse in an emergency department is admitting a client who reports experiencing a headache and heart palpitations after having a glass of wine 1hr ago. The client has a history of depression and a blood pressure of 210/105mm Hg and a temperature of 103.8. Which of the following actions should the nurse take first? A. Administer phentolamine 5mg IV to the client B. Apply a hypothermic blanket to the client C. Determine the client's prescribed medication regimen D. Initiate IV access for the client

C. Determine the client's prescribed medication regimen

A nurse is caring for a client with depression. The client refuses to get out of bed, go to activities or participate in any unit programs. Which of the following statements is appropriate? A. You really need to follow the rules of the unit and get out of bed B. If you do not get out of bed, you will not receive your meal C. I will help you get ready and then you can rest after activities D. You should rest until you feel able to join the group

C. I will help you get ready and then you can rest after activities

Which of the following statements by a client with a mood disorder indicates readiness for discharge? A. Right now, I can't bathe myself or dress myself, but I feel good about that B. Going home will be fun, but if it isn't fun, I can always have my mother to help me C. I will take my medications as I should, and know to call the number you gave me if I have bad thoughts D. Taking care of myself is important, but it's okay if I don't want to do anything

C. I will take my medications as I should, and know to call the number you gave me if I have bad thoughts

The nurse is assessing an adolescent client with anorexia. Which of the following client statements is a sign of cognitive distortion? A. I like to cut my food into small portions B. I really need to get in shape C. If I eat one piece of candy, I may as well eat ten D. I can't afford to gain weight

C. If I eat one piece of candy, I may as well eat ten "If I eat one piece" displays all or nothing thinking, a form of cognitive distortion

A nurse is teaching a newly licensed nurse about electroconvulsive therapy (ECT). Which of the following statements by the new nurse indicates understanding? A. ECT is an effective treatment for personality disorders B. I should monitor the client closely for hypotension following the ECT C. Informed consent should be obtained prior to ECT D. It is a myth that client's experience seizures during ECT

C. Informed consent should be obtained prior to ECT

The client with bipolar disorder approaches the nurse and reveals fresh, self-inflicted superficial cuts going up and down his right arm. Which of the following actions should the nurse perform first? A. Implement the client's behavioral modification plan B. Document the size and location of the cuts C. Inspect the cuts for debris D. Administer a tetanus antitoxin

C. Inspect the cuts for debris

A nurse drives up to the house of her client, who has schizophrenia with manic episodes. This is the nurse's fifth visit. On this occasion, the client is sitting on his front porch with a shotgun in his arms. Which of the following is an appropriate action by the nurse? A. Honk the car horn to get the client's attention B. Calmly speak the client's name out of the car window C. Keep driving in a path going away from the client's house D. Stop the car in the client's driveway and call the authorities

C. Keep driving in a path going away from the client's house

A nurse is caring for a client hospitalized with bipolar disorder. The client's provider prescribes valproate (Depakote). Which of the following instructions should the nurse give about this medication? A. Thyroid function tests must be done every 6 months B. A pretreatment electroencephalogram (EEG) will be done C. Liver function and complete blood counts must be monitored D. White blood count must be monitored weekly

C. Liver function and complete blood counts must be monitored

A nurse is caring for a patient with paranoid schizophrenia. Which of the following interventions should be included in the plan of care? A. Rotate staff assignments for this client B. Use touch to calm the client during periods of anxiety C. Remove medication from sealed packages at the client's bedside D. Assign assistive personnel to feed the client

C. Remove medication from sealed packages at the client's bedside Opening meds reduces the pt's fear that the medication is poisoned

A nurse in a mental health clinic is caring for a client who has post-traumatic stress disorder (PTSD) after returning from military deployment. Which of the following is the priority action for the nurse to take? A. Assist the client to identify personal area of strength B. Encourage the client to talk about experiences during the deployment C. Stay with the client when flashbacks occur D. Teach the client stress-management techniques

C. Stay with the client when flashbacks occur

The nurse is caring for a client who is in the manic phase of bipolar disorder. The client is running around the unit trying to organize competitive games with the clients. Which of the following is an appropriate intervention? A. Recommend a game of table tennis with another client B. Suggest the client exercise on a stationary bike C. Take the client outside for a walk D. Do nothing, as the client's behavior is considered therapeutic

C. Take the client outside for a walk

Which of the following statements by the newly licensed nurse indicates an understanding of the underlying reason clients with OCD perform ritualistic behaviors? A. The ritualistic behavior provides sexual satisfaction B. The client performs ritualistic behavior to boost self-esteem C. The ritualistic behavior temporarily relives anxiety D. The client performs ritualistic behavior to decrease feelings of shame

C. The ritualistic behavior temporarily relives anxiety

What should be avoided when it comes to stimulants?

Caffeine

What can conduct disorder lead to?

Can lead to antisocial personality disorder as an adult

patient is just "there" - at least 2 or more of the following: - motor immobility evidenced by catalepsy or spur - excessive motor activity apparently purposeless and not influenced by external stimuli - extreme negativism (being extremely negative) - mutism (inability to speak) - maintenance or rigid posture - resistance to all instructions - voluntary assumption of inappropriate or bizarre posture, stereotyped movement or grimacing - echolalia (spoken word repetition) or echopraxia (meaningless repetition or limitation of the movements)

Catatonic

What is neuroleptic malignant syndrome (NMS) caused from?

Caused if use SSRIs with MAIOs; antiphsychotics

talks in circles

Circumstantially (schizophrenia)

A nurse is assessing a client receiving treatment for schizophrenia with the typical antipsychotic fluphenazine (Prolixin) for 12 months. The nurse observes fine, fasciculating tongue movements and associates this finding with which of the following? A. A drug-food reaction to grapefruit juice B. The client has missed several doses of medication C. Early symptoms of neuroleptic malignant syndrome (NMS) D. Early symptoms of tardive dyskinesis (TD)

D. Early symptoms of tardive dyskinesis (TD)

This examines and restructures your stressful thoughts to alleviate stress or anxiety

Cognitive reframing (coping skill)

These are auditory hallucinations that instruct a pt to act in specific ways - can be life threatening acts, VERY serious!

Command halluncations

Many great artists and musicians have unhappy lives and have used the medium of art and music to express themselves

Compensation

emphasizing strengths to make up for weakness

Compensative

Persistent pattern or behaviors in which the basic rights of others and rules of society are violated (serious violation of rules)

Conduct disorder

the client can make up stories when questioned about events or activities that she/he does not remember. This can seem like lying, but it is actually an unconscious attempt to save self-esteem and prevent admitting that she/he does not remember the occasion - creating false memories, production or fabricated, distorted or misinterpreted about oneself or the world

Confabulation

uttering socially unacceptable words

Coprolalia (tic disorder)

these are inappropriate gestures

Copropraxia (tourett'es disorder)

This is inappropriate writing

Corpographia (tourette's disorder)

Nurse transfers their feelings onto the patient

Countertransference (defense mechanism)

When an individual encounters a precipitating event that cannot be dealt with through utilization of usual methods of problem solving (aka coping mechanisms)

Crisis

A charge nurse is preparing an educational session for a group of newly licensed nurses to review client rights under the law. Which of the following statements should the nurse take? A. "Information regarding clients should remain confidential after their death." B. "Failure to report suspected maltreatment or neglect of a disabled adult is a felony in all states." C. "As long as client identity is disguised, their health information can be shared between professionals on the internet." D. "In the event a client threatens harm to others, medications can be administered without consent."

D. "In the event a client threatens harm to others, medications can be administered without consent."

A nurse is receiving change-of-shift report for four clients. Which of the following clients should the nurse plan to see first? A. A client who has avoidant personality disorder and refuses to attend group therapy B. A client who has bipolar disorder and reports being kidnapped by aliens overnight C. A client who is taking bupropion and reports having insomnia the past 2 nights D. A client who is taking clozapine and reports a sore throat and chills

D. A client who is taking clozapine and reports a sore throat and chills

A nurse is caring for a client who is cognitively impaired. Which of the following is a therapeutic environment for this client? A. A bright colorful room close to the nursing station B. A room with little furniture and many safety devices C. A clean room with monitors and a TV D. A quiet room with personal belongings

D. A quiet room with personal belongings

A community health nurse is assigned to administer an IM medication for control of hallucinations to a client with schizophrenia. The prior nurse reports the client will let the nurse in her house only if the nurse carries a public health-issued blue bag and wears black pants. Which of the following is an appropriate action by the nurse? A. Telephone the client and tell her the new nurse will be wearing white pants B. Arrive as scheduled carrying only a stethoscope, vial, alcohol wipe and medication syringe C. Arrive as scheduled with a police officer D. Arrive carrying a blue bag and wearing black pants

D. Arrive carrying a blue bag and wearing black pants

A nurse is providing teaching to a client who is to begin undergoing light therapy at home. Which of the following information should the nurse include in the teaching? A. Ensure a family member can be present during treatment B. Increase fluid intake for 24hr before the treatment starts C. Change position slowly when the treatment is complete D. Avoid looking directly at the light during treatment

D. Avoid looking directly at the light during treatment

A nurse is delegating client care tasks to a licensed practical nurse (LPN) and an assistive personnel. Which of the following tasks should the nurse assign to the LPN? A. Obtain the weight of a client who has bipolar disorder and is experiencing mania B. Assess the nutritional intake of a client who has anorexia nervosa and has refused to eat for the past 2 days C. Monitor the cardiovascular status of a client who is experiencing serotonin syndrome D. Change the dressings of a client who has borderline personality disorder and superficial self-inflicted wounds

D. Change the dressings of a client who has borderline personality disorder and superficial self-inflicted wounds

Which findings support the diagnosis of hypochondriasis? A. Prior physical health followed by the need for two surgeries within the last three months B. Obsession over a fictitious defect in physical appearance C. Sudden unexplained loss of peripheral sensation D. Constant worry about the undiagnosed presence of a terminal illness

D. Constant worry about the undiagnosed presence of a terminal illness

A nurse is completing an admission assessment for a client who has depression. Findings include an inability to concentrate, an inability to complete everyday tasks and a preference to sleep all day. Which of the following is an appropriate intervention to include in the plan of care? A. Discourage rest only at bedtime B. Instruct family to avoid visiting during mealtimes C. Offer frequent low-calorie snacks D. Develop a structured routine for the client to follow

D. Develop a structured routine for the client to follow

A nurse in a psychiatric unit is caring for a client with moderate anxiety disorder. Which measures should the nurse include in the immediate plan of care? A. Circumvent a discussion about concerns B. Remain near the client C. Encourage the client to sit for a while D. Foresee anxiety-provoking circumstances

D. Foresee anxiety-provoking circumstances

A nurse in a mental health clinic is planning care for four clients. Which of the following tasks should the nurse delegate to an assistive personnel (AP)? A. Discuss outpatient resources with a client who has post-traumatic stress disorder B. Create a plan of care for a client who is experiencing alcohol withdrawal C. Explain sleep hygiene to a client who has insomnia D. Stay with a client who has anorexia nervosa for 1hr after mealtimes

D. Stay with a client who has anorexia nervosa for 1hr after mealtimes

A nurse is admitting a client who has multiple trauma after a motor vehicle accident. Shortly after admission her husband arrives. He is distraught and blames himself for the accident. Which of the following is an appropriate nursing response? A. Don't worry about that. Your wife will be fine. B. I think you should calm down a little before you see your wife C. Why do you think the accident was your fault? D. Tell me more about your feelings about what happened to your wife

D. Tell me more about your feelings about what happened to your wife "tell me more" encourages him to express feelings and uses the technique of exploring

disorganized speech, disorganized behavior, flattened or inappropriate affect **clang associations - rhyming words but not making sense, meaningless** - rhyming - grimacing - poor grooming *early onset, poor prognosis

Disorganized (schizophrenia subtype)

I missed my bus, forgot my homework and then I was late to work, when I got home, I punched a wall and screamed at my mom

Displacement

shifting feelings or thoughts from its actual source to something or someone else ex.) taking aggression on someone else, redirecting of thoughts upon another person/object

Displacement

A charge nurse overhears another nurse talking with a client who has schizophrenia. Suddenly the client yells, "I am the devil. I am God. Open the gate for me!" Which of the following replies by the nurse requires intervention by the charge nurse? A. Tell me who you are B. I don't understand. Can you tell me what that means? C. Are you saying that you are both good and bad? D. There is no gate

D. There is no gate

Why are clozapine/olanzapine (PINES) the last resort when it comes to antipsychotic meds?

Due to metabolic effects Clozapine s/s = sore throat, fever, weakness, jaundice - weekly WBC; risk of agranu locytosis Olanzapine - rapidly dissolving form from acute agitation

more severe than limited ex.) no emotions

Deflected

this is an acute mental condition that is reversible, if cause if identified - pt is at risk for falls

Delirium

"I am solely responsible for my aunt's health"

Delusion of guilt

non-bizarre delusions lasting at least 1-month, positive signs of schizophrenia have never been met

Delusional disorder

"I am convinced that she loves me"

Delusions of erotomania

big, powerful, "I am the smartest person alive, I should be president or king of the world."

Delusions of grandeur

someone is after you - a person, group or organization is mistreating them

Delusions of persecution

are you talking about me?

Delusions of reference

Alzheimer's causes?

Dementia

When a pt tried to answer questions and will be concerned with mistakes

Dementia

not accepting reality because its too painful - refused to accept something that is in fact true ex.) arrested for drunk driving several times but cannot admit that there is an issue with alcohol consumption

Denial

when an individual has a depressed mood/sadness

Depression

repeated last word or phrase heard

Echolalia (tic disorder)

What does therapeutic communication allow the pt to do?

Express empathy, elicit and attend to all clients thoughts, feelings and concerns, obtain information, evaluate progress, promote functional behavior, speech/body language is observed, active listening

A feeling of internal motor restlessness that can present as tension, nervousness or anxiety

Extrapyramidal symptoms (EPS)

True or False: It is important for the nurse to hasten the pt with OCD?

False

Faithful

Fidelity

What are example of antidepressants?

Fluoxetine (prozac) Sertraline (zoloft) Escitalopram (lexapro) Citalopram (celexa)

pattern or excessive emotionality and attention seeking - 5 or more - attention seeking, uncomfortable when not the center of attention, shallow expression, rapidly shifting emotions, uses self-appearance to draw attention, easily influenced by others, speech is impressionistic but lacks details

Historian personality disorder (cluster b)

How is HTN crisis related to MAIO's treated?

IV phentolamine

conscious or unconscious assumptions of the characteristics or another individual or group

Identification

What is considered a therapeutic relationship failure?

If trust is not built in the relationship and client-provider interactions

Separation of emotions and social facts when analyzing or coping with a situation or event ex.) avoiding unacceptable emotions by focusing on the intellectual aspects

Intellectualization

attempting to avoid a painful thought or feeling by objectifying and emotionally detaching oneself from feeling

Isolation of affect

the duty to be fair

Justice

inappropriate emotions ex.) laughing about death instead of being upset

Labile

What are some important factors when it comes to eating disorders with children/adolescents?

Level of development, communication, use of play, family dynamics, family stressors, family commitment to treatment

decreased range of emotions

Limited

What med is used to help treat phases of mania?

Lithium (Eskalith) - also: Lamotrigine (lamictal) - off med for 5 days, must restart at risk for life threatening rash mood stabilizer Divalproex (depakote) - anticonvulsant - blood levels checked every few weeks until reach 50mg/ml

Schizophrenic related - rapidly shifting from topic to topic, with no connect of thoughts

Loose associations

If a pt is suicidal what MUST be done?

Make a safety contract** - can contact emergency services

A distinct period of abnormally and persistently elevated, expansive or irritable mood - elevated mood, expansive or irritable

Mania

What is used to treat Opiod use disorder?

Methadone

What helps with withdrawal from opioids?

Methadone/suboxone *Buprenorphine (ATI)

At what level of anxiety are relaxation techniques taught?

Mild

this level of anxiety includes tension of day-to-day life, adaptive response, sharpened senses, learning is increased, motivation is increased

Mild

this level of anxiety includes selective attention, restlessness, increase in use to defense mechanisms, muscle tension, difficulty concentrating

Moderate

How are personality disorders treated?

Most people with personality disorders do not seek treatment - there are no specific medications or treatments for most EXCEPT for borderline personality disorder

What are early s/s of lithium toxicity?

N/V/D, slurred speech, muscle weakness

What can cause lithium toxicity/ increase in lithium levels?

NSAIDs, certain BP meds and meds to treat epilepsy

pattern of grandiosity and need for admiration, lack of empathy (cocky) - 5 or more - grand sense of self-importance, fantasies of power, wealth and success, believes they are special/unique, devalues others, require admiration, high self-esteem, lack of empathy

Narcissistic personality disorder (cluster b)

intrusive, recurrent, persistent thoughts (obsessions), uncontrolled repetitive behaviors that cause marked distress (compulsions) - feel driven to perform certain behaviors

OCD

What does a pt need to be in order for a therapeutic relationship to work?

Objective and open to supervision (needs to be goal oriented and theory based on their specific situation)

The behaviors or mental acts are aimed at preventing or reducing anxiety but are not connected in a realistic way with what they are designed to neutralize or prevent ex.) hand washing, checking, counting, ordering of objects

Obsessive compulsive disorder (OCD)

This condition provides positive reinforcement in return for a desired behavior ex.) restraints from manipulative behavior is a desired response

Operant conditioning

pattern of angry/irritable mood, argumentative/defiant behavior or vindictiveness lasting at least 6 months

Oppositional defiant disorder

What is the level for lithium toxicity? S/s?

Over 1.5 s/s - ^ thirst, ^ urine, lethargy, seizures, coma - also possible tremors (hand temors), ataxia, acne, weight gain, alopecia, edema, alters Na, K- careful with salad, black/green tea, coffee, parsley, monitor blood levels regularly

This consists of probing questions that allow a more defined view of the patient's feelings and emotions

PHQ9 - depression screening

these symptoms develop after personal experience involving actual or threatened death or serious injury to self or others

PTSD

repeated own sounds or words

Palilalia (tic disorder)

this level of anxiety includes inability to understand simple directions, suicidal ideation, increase psychosomatic pain, inability to distinguish between internal and external environment along with one s/s of severe anxiety

Panic

preoccupation with delusions or hallucinations - no disorganized speech (not prominent) - no catatonic behavior - no flattened effect *patients will present with a broad affect and little disorganization; will have delusions and hallucinations *best prognosis but also most aggressive

Paranoid (schizophrenia subtype)

pervasive mistrust and suspiciousness of others - 4 or more - suspect others of exploding, harming or deceiving them s/s - **unforgiving, consistently holds grudges** hold negative stereotypes of others, reluctant to confide in others, quick to react/counteract

Paranoid personality disorder (Cluster A)

How is schizophrenia diagnosed, what is the diagnostic criteria?

Patient will need to have 2 or more of the following for a significant portion of a 1-month period for a 6-month time span: - delusions - grossly disorganized or catotonic behavior - hallucinations - negative signs - disorganized speech

Who is contraindicated from getting an ECT?

Patients with cardiovascular disorders and cerebrovascular disorders

When does alcohol withdrawal occur? What are the s/s?

Peak 24-48hrs s/s = delirium, muscle cramps, vomiting, restlessness, insomnia, hallucinations, increased HR, BP, RR and temp, seizures (give diazepam)

Bad things happen to me in my past, but I've unconsciously buried them deep in my mind

Repression

burying painful feelings or thoughts from your awareness, though it may resurface in symbolic form/ not aware if happened (can't remember father's funeral) - unconscious blocking of unacceptable thoughts UNCONSCIOUS ACTION

Repression

phase of schizophrenia - absence of prominent positive signs such as: - delusions - hallucinations - disorganized speech - grossly disorganized of catatonic behavior after first episode *continuing evidence of the disturbance indicted by the presence of negative signs and 2 or more positive signs but in attenuated form

Residual

What does SLAP stand for?

S - social support L - lethality A - assess P - pain

This method is to assess suicidality by assessing social support, lethality, assess plan, family hx, any previous attempts, or if they have a plan

SLAP

What is the first line of therapy for depression?

SSRIs (antidepressants)

"My scalp itches and therefore I must have incurable head lice"

Somatic delusions

everything in the world is seen as all good or all bad; nothing in between (one or the other) ex.) friend cancels lunch so they are the worst friend ever

Splitting

What are the 3 stages of Alzheimers?

Stage 1 - mild Stage 2 - moderate Stage 3 - severe

slight changes in personality, cognitive losses (calculating, recognition), recent memory loss, mild behavior problems, sensory motor function will remain intact - sleep will be normal, be aware of changes = can lead to depression (use of defense mechanisms), confabulation, self-grief

Stage 1 mild Alzhemiers

Cognitive decline, paranoid ideations, increase in amnesia, develop language problems: aphasia, perseveration (repetitive), pacing and wandering, SUNDOWNING, labile emotions, aggression, sleeplessness, refusing food/hydration, deficit in self-care, poor judgement, begin to not recognize close family members

Stage II moderate Alzheimer's

decrease in self-care, become total care, communication will be limited, secondary illnesses (due to symptoms - choking, emaciated, pneumonia) grief

Stage III - severe Alzheimer's

My mother-in-law has come to stay for the day and is driving me crazy, I'm just staying out of the way by doing homework

Sublimation

redirecting unacceptable instinctual drives into personality and socially acceptable changes - acting out unacceptable impulses in a socially acceptable way ex.) intense rage substitute and redirected into passion of boxing

Sublimation

This includes a genetic factor, has gene lines, biological factor - an imbalance of neurotransmitters, serotonin and norepinephrine. Hormone imbalances, physiological factors - sense of hopelessness, nothing to live for, recent loss, isolation from social groups, fear of abandonment, cultural factors

Suicide (ideology)

The effort to hide and control unacceptable thoughts or feelings CONSCIOUS ACT

Suppression

These are brief, non-purposeful movements or vocalizations ex.) movements of face, neck, shoulders, muscles/limbs

TIC disorders

loss of focus

Tangentiality (schizophrenia)

involuntary muscle movements in the lower face and distal extremities

Tardive dyskinesia (TD)

(following precipitating event) - manifested by: anxiety, depression, disorganized function, fluctuating attempts at using old and new coping skills

Temporary disequilibrium

This is the purposeful and essential use of communication to build and maintain helping relationships with clients, families and significant others

Therapeutic communication

If trust is not built, this equals?

Therapeutic failure

The primary purpose of this is to identify the client's problems or needs and then focus on assisting the client in meeting and resolving those issues

Therapeutic relationship

Civil wrongdoing, wrongful act against a person or belongings

Tort

This disorder consists of motor and vocal tics

Tourette's disorder

Patient transfers their feelings onto the nurse

Transference (defense mechanism)

True or False: Behavioral and affective disorders are usually associated with eating disorders

True

True or False: It is important to build a trusting relationship/listen/don't get too personal/don't share personal issues/give good advice/have patient describe what depression feels like

True

True or False: Mental health patients have the same rights as anyone else unless there is a safety issue

True

True or False: When it comes to anorexia nervosa, the death rate is higher than all other mental illness due to starvation and suicide

True

True or False: You MUST taper dosage of withdrawal symptoms when it comes to MAIO's or it can lead to HTN crisis

True

What are dietary restrictions when it comes to MAIOs?

Tryamine, avoid deli meat, aged cheese, ripe avocado, liver, anchovies

These act effectively on positive symptoms and agitation

Typicals

positive signs are present but criteria is not met for paranoid or others - poor prognosis with long prodromal signs and symptoms

Undifferentiated

Performing an action to make up for a prior behavior ex.) Christain buys Kali Goodwin home fries after he tells Ed she farted

Undoing

What is the saying when it comes to substance abuse?

Use leads to abuse which leads to dependence

What does therapeutic communucation use?

Uses interactive, purposeful, communication skills

greatest good for greatest number

Utilitarianism

Truthful

Veracity

throat clearing, sniffing, grunting

Vocalizations (tic disorder)

When can you no longer keep information confidential?

When pt is in the way of harm

physical and psychological changes takes more of a substance to relieve these symptoms

Withdrawal

random words that make no sense

Word salad (schizophrenia)

fear of pain

algophobia

What are the s/s of delirium?

altered state of consciousness/cognition, rapid onset, fluctuating level of consciousness, confused esp. at night, memory impairment, confused to time/place, unable to answer questions, frightened, angry

What are the disadvantages of tricyclic antidepressants?

anticholinergic effects (urinary retention), severe headaches, blurred vision, agitation

What are the key factors of a need for intervention and rehab?

consequences in mental and physical health, behavioral evidence and diagnostic criteria, social impairment, impaired control, risky use, binge drinking

What are withdrawal symptoms from anxiolytics?

cramps, convulsions, depressed, can't sleep, N/V, sweating, tremors (taper off)

fear of heights

acrophobia

natural disaster ex.) fire, rape, crimes of violence

adventitious crisis

fear of cats

ailurophobia

inconsistent interpersonal relationships, self-image, moods and impulsivity - 5 or more - frantic efforts to avoid/fear abandonment, **recurrent suicidal behavior, self-mutilation, gestures, threats** chronic feelings of emptiness, impulsive potentially self-harming/damaging behaviors, inappropriate intense anger, sarcastic

borderline personality disorder (cluster b)

have psychotic break and never happens again - lasts at least 1 day but less than 1 month

brief psychotic disorder

What are disadvantages to stimulants?

insomnia, restlessness, weight loss, reduce appetite

What can substance abuse stem from?

caffeine, alcohol, nicotine

Which meds are typicals?

chlorpromazine (thorazine) perphenazine (trilafon) fluphenazine (prolivin) thioridazine (mellaril)

fear of confined spaces

claustrophobia

What are s/s of neuroleptic malignant syndrome (NMS)?

decrease level of consciousness, increase muscle tone and rigidity, fever, HTN, tachycardic, extreme diaphoresis, leukocytosis, increased creatine

continuing maladaptive behavior/pattern of abuse with a significant impact

dependence

need to be taken care of, submissive and clingy behavior, fear of separation - inability to make decisions - 5 or more - difficulty making decisions without consulting others, needs others to assume responsibility to most areas of life, difficulty expressing disagreement with others, uncomfortable and hopeless when alone, can't start projects alone, fear of being left to care for self

dependent personality disorder (cluster c)

thinking away from reality

dereisms (schizophrenia)

What are accompanying psychological factors of anorexia nervosa?

disturbed body image, lack of control, fear of fat

difficulty remembering names/words

dysnomia

What factors can cause delirium?

hospitalization-post op, elderly (meds), dehydrated, physical pathology affecting brain, comorbid dementia, immobile

focusing on funny aspects of a painful situation

humor

What are the risk/protective factors when it comes to crisis?

hx of loss, stressors, health, age, support system, religion

What does borderline personality disorder go with?

eating disorders, suicide ideation, self-harm

What are the benefits of atypical antipsychotics?

effective for positive and negative symptoms, lower risk of EPS

What does ECT stand for?

electroconvulsive therapy

fear of blushing

erythrophobia

What are side effects of typicals?

extrapyramidal syndrome (EPS) and tardive dyskinesia (TD)

What are the risk factors for suicide?

family hx, mental health issues, previous attempts, belonging to high-risk groups, plan is lethal, drug and alcohol abuse

What is the most common first sign of Alzheimer's?

first sign is often misplacing items

What are s/s of PTSD?

flashbacks, hallucinations, avoiding, anger, fits of rage, difficulty sleeping, flat effect, depressed mood/sadness, lack of interest - children with PTSD can show delays in potty training

What are comorbidities of eating disorders?

major depressive disorder (MDD), borderline personality disorder, anxiety, alcoholism, substance abuse

can occur throughout life when older coping mechanisms don't work anymore

maturational crisis

What are s/s of dementia?

memory impairment, slow to develop, progressive, irreversible

fear of germs

mysophobia

pattern of preoccupied with orderliness, perfection - 4 or more - preoccupied with details, lists, organization and rules to the extent that the major point is lost, perfection interferes with task completion, excessively devoted to work exclusion of leisure activity, not flexible with morals or values, reluctant to delegate tasks

obsessive compulsive disorder (cluster c)

fear of everything

panophobia

What are additional s/s of PTSD?

persistent negative/guilty feelings, flashbacks, nightmares, avoiding situations, decreased sex drive, experiences feelings of isolation

this phase of anger deals with reason through word to avoid recurrence ex.) staff reviews the incident with the patient

post assaultive

What does quetiapine (seroquel) cause? What is it used for?

potential for eye changes/cataracts - used for bipolar depression

this phase of anger deals with anxiety, verbal, abuse, hyperactivity

pre assaultive

a stressor acting upon one individual that threatens his/her self-concept, self-esteem or interpersonal relationships

precipitating event

repeating same concept

preservation (schizophrenia)

What are nursing considerations when it comes to a pt with mania?

pt safety, decrease simulation with a quiet room, don't ask 'why' questions, know defense mechanisms - encourage frequent rest periods - provide frequent high-calorie snacks - decrease simulation w/out isolating patient

What are s/s of a pt with anger issues?

restless pacing, use of defense mechanisms, negative facial expressions, eye contact, anxiety awareness or an impending anger

What is included in an assessment with a pt with anger issues?

risk factors for anger, hx of violence, impulse control issues, coping skills, support system, gather subjective and objective data

What are the DONES meds used for schizophrenia?

risperidone ziprasidone lurasidone liopendone

hearing and seeing what other person says they heard and saw

shared psychotic disorder

What are s/s of hypomania?

similar to manic symptoms but never reaching the same severity or duration - decreased need for sleep - increased grandiosity - increased goal directed behavior - easily distracted - increase in risky behavior

arises from external events or unexpected events ex.) financial or loss of family member

situational crisis

What are s/s of alcohol abuse?

slurred speech, memory impairment, altered judgement, decreased motor skills - nystagmus stupor, coma, resp. arrest, peripheral collapse, death

What interfers with the treatment of schizophrenia?

smoking interferes with how the drug works - increase dose if smoker because it metabolizes faster

What are adverse effects of atypical antipsychotics?

suicide, TD, drooling, sedation, weight gain, orthostatic hypotension, QT prolongation

the need to increase for the amount to have effect

tolerance

What are advantages to antidepressants?

usually effective to treat mental disorders (FIRST line of defense)

fear of people from other countries/people who are different (strangers)

xenophobia

fear of animals in everyday life

zoophobia