Nurn 113 Exam 1 mental health

During assessment of a client with schizophrenia, the nurse notes the client has ideas of reference. Which statement of the client would have led the nurse to conclude this?

"The news of the terrorist attack is directed to me. The terrorists are trying to warn me."

Individual (personal) i.e. , biological make-up

(some issues run in families), self esteem, capacity for growth, ability to find meaning in life, emotional resilience

Olanzapine (Zyprexa)

*class*: Antipsychotic, mood stabilizers *Indication*: schizophrenia, mania, depression, anorexia nervosa, nausea/vomiting related to chemotherapy *Action*: antagonizes dopamine and serotonin *Nursing Considerations*: - do not use while breastfeeding - can cause neurolyptic malignant syndrome, seizures, suicidal thoughts, insomnia, tardive dyskinesia, agranulocytosis, constipation, tremors - assess mental status - monitor hemodynamics - assess blood sugars - assess intake and output - monitor liver function tests

What medication can you administer to treat the symptoms of a patient experiencing Acute Dystonia?

Benztropine IM or Benadryl IM

A client has bipolar disorder and has just begun a regimen of lithium, 600 mg tid. Which is the most critical management issue for the client during the first 2 weeks of treatment?

Ensuring the client's blood levels reach a therapeutic and safe dose

psychoanalytic therapy focus

Focus on discovering causes of patient's unconscious, repressed thoughts, feelings, conflicts related to anxiety Focuses on resolving early conflicts Free association, dream analysis, behavior interpretation used to gain insight into and resolve these conflicts, anxieties

What is the purpose of psychoanalytic therapy?

Focuses on resolving early conflicts and discovering causes of patient's unconscious, repressed thoughts, feelings, conflicts related to anxiety

Psychoanalytic Theories: Sigmund Freud

ID, EGO, SUPER EGO

Dissociation

Involves dealing with emotional conflict by a temporary alteration in consciousness or identity

What was the purpose of the Community Mental Health Act of 1963

It focused on mobbing patients to their homes community for treatment

Patients taking this class of medication should avoid certain foods that contain the amino acid tyramine

MAOIs

When assessing a client who has been referred to the outpatient mental health clinic with symptoms of depression, the psychiatric nurse should closely observe the client's affect and which assessment component?

Physical appearance

The psychiatric nurse correctly identifies the client's form of communication as circumstantiality when the client does what?

Provides long, irrelevant explanations when asked why the client abuses alcohol.

Explain how SSRIs work in the body

SSRIs work by blocking the reuptake of serotonin and norepinephrine

What is the most serious risk for a client taking a tricyclic antidepressant?

Suicide by overdose

Ego (Freud)

The balancing or mediating force between the id and superego. Represents mature and adaptive behavior that allows a person to function successfully in the world.

Intellectualization

The client is aware of the facts of the situation but does not show emotions associated with the situation

Which action is most effective in assisting the nurse to provide culturally competent care?

The client's perception of the stressor

ideas of reference

The false impression that outside events have special meaning for oneself.

Crisis Intervention

The nurse must focus on the patients previous coping strategies in other situations and provide support to deal with the current situation

Id (Freud)

The part of one's nature that reflects basic or innate desires such as pleasure-seeking behavior, aggression, and sexual impulses. It seeks instant gratification, causing impulsive unthinking behavior, and has no regard for rules or social convention.

A client is receiving clozapine. For which life-threatening disorder should the nurse be alert when assessing this client?

agranulocytosis

Social/cultural (environmental)

assess to adequate resources, a positive, yet realistic view of one's world, intolerance of violence

Hospitals established by Dorothea Dix were designed to provide

asylum

Revolving-door effect

people with severe and persistent mental illness have shorter hospital stays, they are admitted to hospitals more frequently

Sigmund Freud (1856-1939)

scientific study, diagnosis and treatment of mental illness He studied the mind, its disorders, and their treatment as no one had done before. Freud challenged society to view human beings objectively

Which side effect is associated with selective serotonin reuptake inhibitors (SSRIs)?

sexual dysfunction

Blunt affect

showing little or a slow-to-respond facial expression

Flat affect

showing no facial expression

flight of ideas

symptom of mania that involves an abruptly switching in conversation from one topic to another

A client is being seen in the mental health clinic. The client has been on haloperidol for 8 months and is now exhibiting tongue protrusion, lip smacking, and rapid eye blinking. A nurse would document this chronic syndrome as:

tardive dyskinesia

Hildegard Peplau is best known for her writing about

therapeutic nurse-client relationship

Define tangential thinking

wandering off the topic and never providing the information requested

tangenital thinking

wandering off the topic and never providing the information requested

loose associations

Disorganized thinking, jumping from one idea to another with no clear relationship between thoughts

Mental Illness and the 21st Century

Economic burden ( both health care costs and lost productivity) exceeds that of all types of cancer.

A nurse has been asked to complete a mental status examination of a psychiatric-mental health client. Which is a necessary component of this assessment?

Evaluation of insight and judgment

Personal space and distance is a cultural perspective that can impact nurse-client interactions. What is the best way for the nurse to interact physically with a client who has a different cultural perspective on space and distance than the client?

Explain that physical contact is necessary and ask about the client's cultural personal space preferences.

Erik Erikson

Extended Freuds work on personality development in life stages and published the Eight stages of psychosocial development In each stage, the person must complete a life task that is essential to his or her well-being and mental health. Completing these tasks allow the person to achieve life's virtues: hope, purpose, fidelity, love, caring, and wisdom. Psychosocial growth occurs in sequential phases if u don't complete one stage - you aren't going to move onto the next stage and each stage is dependent on completion of the previous stage and life task.

True or False: Neuroleptic Malignant Syndrome is a type of EPS

FALSE

The nurse is caring for a client in an inpatient psychiatric-mental health facility for substance use. The family asks the nurse how they can support the client. Which statement made by the nurse would be most appropriate teaching?

Family support is important in the recovery process. It is encouraged that you continue to provide a positive resource for the client

Linda Richards (1841-1930)

First American psychiatric nurse She organized educational programs in state mental hospitals Believed that "the mentally sick should be at least as well cared for as the physically sick"

Psychiatric Nursing Practice

First psychiatric nursing textbook (Nursing Mental Diseases) published in 1920 by Harriet Bailey Johns Hopkins: first school of nursing to include psychiatric nursing course (1913) National League for Nursing (accredits nursing programs) (1950) requiring schools to include psychiatric nursing experience

How do nurses use the DSM-5?

Nurses use the DSM-5 to get a better understanding of the client's psychiatric mental health medical diagnosis

Transference

Occurs when the client displaces onto the therapist attitudes and feelings that the client originally experience in other relationships

Hildegard Peplau

Orientation - directed by the nurse and involves engaging the client in treatment, providing explanations and information, and answering questions Identification - begins when the client works interdependently with the nurse, expresses feelings, and begins to feel stronger. Exploitation - the client makes full use of the services offered Resolution - the client no longer needs professional services and gives up dependent behavior. The relationship ends

The nurse is scheduled to begin a clinical rotation at an outpatient mental health clinic that is in a neighborhood with a large number of Asian residents. Since the nurse does not share this cultural background with the potential clients, which is the best way for the nurse to ensure cultural sensitivity in this setting?

Reflect on, analyze, and foster awareness of the nurse's own culture

If a client states, "I carry this lucky rabbit's foot for luck, my parent did too, and it really works," which statement by the nurse reflects respect for the client's belief?

I can accept that you feel it is lucky, so let's get to our activities for the day

The nurses on the psychiatric-mental health unit care for many diverse clients and receive an in-service education on cultural humility. Which statement by the nurse would indicate teaching was effective?

I will remain open and honest about self-reflection, because I know that even with training, I could have stereotypes and biases

orientation and working phase

Identification of client's problems

hierarchy of needs theory

Maslow's theory that human needs - physiological, safety, social, esteem, and self-actualization - form a sort of hierarchy

Name some food that a patient taking MAOIs should avoid

Mature or aged cheeses Aged meats such as pepperoni, salami, mortadella, summer sausage, beef logs Chocolate

orientation phase

Meeting nurse, client - Beginning of trust building

Period of enlightenment (1790s)

Creation of asylums as a safe refuge or haven offering protection at institutions where people had been whipped, beaten, and starved because they were mentally ill.

What risk factors increase a person risk of developing NMS

Dehydration Poor nutrition Concurrent medical illnesses

Managed care movement (early 1970s)

Designed to control the balance between the quality of care provided and the cost of care People receive care based on need rather than on request

What is the DSM-5?

A classification system used by mental health practitioners that identified significant symptoms associated with each psychiatric diagnosis

Systematic desensitization

A type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. Commonly used to treat phobias.

Name the conditions that may develop in a patient experiencing EPS (Extrapyramidal Syndrome)

Acute dystonia Pseudo parkinsonism Akathisia

A client describes the recent breakup of a dating relationship when being interviewed by the nurse. Which finding will the nurse determine is the client's affect?

An emotionless tone and flat facial expression

Which medication classification blocks serotonin reuptake?

Antidipressants

Which drug classification is the primary medication treatment for Schizophrenia?

Antipsychotics

Define broad openings

Broad openings allow the client to take the initiative in introducing the topic

super ego (freud)

Direct opposite to the id. The part of the person's nature that reflects moral and ethical concepts, values, and parental and social expectations

A client taking lithium comes to the hospital for a 2-week follow-up. The client complains of a hand tremor that keeps from holding a coffee cup and states that the client feels confused, has stomach aches, and trips occasionally. Which would be the most therapeutic intervention of the psychiatric nurse?

Call the client's psychiatrist because her symptoms are indicative of moderate toxicity

labile

Changing rapidly and often

Countertransference

Circumstances in which a psychoanalyst develops personal feelings about a client because of perceived similarity of the client to significant people in the therapist's life. Occurs when the therapist displaces onto the client attitudes or feelings from his or her past

working phase of interview

Clients feeling are examined

Asking the client to complete serial sevens assesses what?

Concentration

During a conversation, the client states, "It's raining outside and raining in my heart. Did you know that St. Valentine used to visit jails? I've never been to jail." The nurse can correctly identify this thought process as what?

Flight of ideas

Word Salad

Flow of unconnected words that convey no meaning to the listener

Abraham Maslow

Humanistic psychologist known for his "Hierarchy of Needs" and the concept of "self-actualization"

What is the most significant benefit of using Beck's Depression Inventory in evidence-based nursing practice?

It is a standardized, reliable depression tool.

Explain the mechanism behind how Olanzapine (Zyprexa) works

It works by blocking dopamine receptors in the brain

What behavior can be described as a patient laughing, then angry and then crying for no apparent reason?

Labile

A client with psychosis who was recently admitted to a psychiatric unit says to the nurse, "The car is red. Are you ready for lunch? My head is hurting. Dogs bark loud." The client is exhibiting which type of speech?

Loose associations

How do MAOIs work in the body?

MAOIs work by preventing the breakdown of MAO, an enzyme that breaks down neurotransmitters

Suppression

Replacing the desired gratification with one that is more readily available

A novice nurse is beginning work on a behavioral health unit and states to the preceptor, "What if I encounter a client that is sexually aggressive?" Which is the appropriate response by the preceptor?

Set firm limits and boundaries for the client.

What are the signs and symptoms of Acute Dystonic Reaction?

Severe spasm of the tongue, neck, face and back. Head can be twisted to one side, back arched and eyes may roll back in their head

Clozapine side effects

Side effects: NEUROLEPTIC MALIGNANT SYNDROME, sedation, salivation, dizzy, H/A, tremors, sleep problems, akinesia, fever, seizures, confusion, insomnia, slurred speech, dystonia, tachycardia, hypo/hypertension, blurred vision, drooling, constipation, abd pain, N/V/D weight gain, dry mouth, urinary abnormalities, leukopenia, agranulocytosis, rigidity, diaphoresis, death (demented geriatrics)

Displacement

The ventilation of intense feelings toward a person less threatening than one who aroused those feelings

How do TCSs work in the body?

TCSs work by blocking the reuptake of serotonin and norepinephrine

A patient is exhibiting uncontrolled repetitive movements of the mouth and tongue, facial grimacing and rocking back and forth. What side effect from an antipsychotic medication is this patient experiencing?

Tardive Dyskinesia

DSM-5

Taxonomy published by the American Psychiatric Association Describes all mental disorders, outlining specific diagnosis and diagnostic criteria to guide assessment; to identify nursing diagnoses; and to plan, implement, and evaluate care. vIt is based on clinical experience and research. vAll mental health clinicians who diagnose psychiatric disorders use this diagnostic taxonomy

When we are assessing our patients, why is it so important that we ask our patients to describe his/her problems?

We need to have an understanding of the client's perspective or view of his/her problems

When the client asks the nurse how long it will take before the selective serotonin reuptake inhibitor (SSRI) antidepressant medication will be effective, which reply is most accurate and therapeutic?

You will have gradual improvement in symptoms over the next 4 to 6 weeks.

Which medication is LEAST likely to cause extrapyramidal side effects?

Ziprasidone (Geodon)

Neuroleptic Malignant Syndrome

a potentially fatal hyperpyrexia with temp of over 104, looks like EPS except for temp

A nurse is assessing a client and asks the client to repeat the days of the week backward. The nurse is assessing which component of the client's mental status?

attention and concentration

Which type of hallucination is the most common?

auditory

Dorothea Dix (1802-1887)

began a crusade to reform the treatment of mental illness Opened 32 state hospitals that offered asylum to the suffering She advocated for adequate shelter, nutritious food, and warm clothing

Five Stages of Psychosexual stages of development (freud)

childhood development on the belief that sexual energy, termed libido, was the driving force of human behavior Oral- birth to 18 months Anal -18-36 months Phallic/oedipal - 3-5 years Latency - 5-11 years or 13 years Genital - 11-13 years

Gary Kielhofner

developed The Model of Human Occupation therapeutic use of self

Broad affect

displaying a full range of emotional expressions

Restricted affect

displaying one type of expression, usually serious or somber

Which client behavior would the nurse document as being an automatism?

drumming one's fingers on the table top

Interpersonal (relationship)

effective communication, ability to help others, intimacy, no sense of belonging, coping abilities

A nurse counsels a pediatric client and family in psychosocial stages of development. The client is beginning to develop a conscience and learning to manage conflict and anxiety. Which Erikson stage of development is the child currently attempting to overcome?

initiative versus guilt

An important part of cultural competence includes the capacity to communicate effectively and convey information that is easily understood. When providing care the nurse should know that cultural competence includes which example?

linguistic competence