psych

The parents of a child diagnosed with impulsive-type attention deficit/hyperactivity disorder (ADHD) ask the health care provider if their child's diagnosis has any physical basis. Which explanation by the health care provider is correct regarding the neurobiological etiology of this condition? -"Altered dopamine levels are present in the impulsive subtype of ADHD." -"Altered thyroid hormone levels cause many of the symptoms of ADHD." -"Alterations in brain chemicals called neurotransmitters are the same for all subtypes of ADHD." -"Alterations in glucose and cortisol in the bloodstream are thought to influence the hyperactive behavior in ADHD."

"Altered dopamine levels are present in the impulsive subtype of ADHD." Alterations in neurotransmitters contribute to the symptoms in ADHD. The neurotransmitter that is affected relates to the subtype of the disorder. Clients with impulsive-type ADHD have a variation in the dopamine transporter, while clients with inattention-type ADHD have norepinephrine transporter gene variations. These variations explain why a client's response to medication is individualized.

grandiose

(adj.) grand in an impressive or stately way; marked by pompous affectation or grandeur, absurdly exaggerated

The spouse of a client who was admitted to an alcohol detox center is attending an AL-ANON meeting. The spouse asks the group leader if their children could inherit the tendency for alcohol addiction. Which is a correct response by the group leader? -"Children of alcoholics are three times more likely to inherit the disease than children of non-alcoholic parents." -"Current studies are being conducted to investigate heredity as a factor, but unfortunately, there has been no progress." -"There are no genetics involved; alcohol abuse and addictions are learned behaviors." -"Genetics have a minor effect, but if you educate your children about the dangers of drinking, they should be OK."

-"Children of alcoholics are three times more likely to inherit the disease than children of non-alcoholic parents." Children of alcoholics have an increased risk for developing alcoholism. They are three times more likely to inherit the disease than children of nonalcoholic parents.

The nurse is providing discharge education for a client prescribed a tricyclic antidepressant. Which statement by the client indicates the need for additional teaching? -"It is best for me to take the full dose of the medication when I get up each morning." -"My mood should improve within 7-28 days after starting my medicine." -"It may take up to 6-8 weeks for me to experience the full effect of the medication." -"The side effects of drowsiness and dizziness usually go away after the first few weeks."

-"It is best for me to take the full dose of the medication when I get up each morning." If possible, the client should take the full dose of tricyclic antidepressants at bedtime to reduce the experience of side effects during the day.

A 5-year-old cries and screams continuously from the time their mother drops them off at kindergarten until she picks him up 4 hours later. He is calm and relaxed when he is with his mother. The mother seeks advice from a friend who is a nurse. Which response by the nurse is best? -"Talk with your healthcare provider about referring him to a mental health clinic." -"Talk with the school principal about withdrawing him until he is more mature." -"Arrange with the teacher to let him call home during playtime." -"Send a picture of yourself to school to keep with him."

-"Talk with your healthcare provider about referring him to a mental health clinic. Separation anxiety disorder becomes apparent when the child is separated from the attachment figure. The first evidence of this disorder often occurs when the child begins going to school, and it may be based of the child's fear that something will happen to the attachment figure. Professional help is needed to learn how to cope with anxiety effectively. Separation anxiety is common childhood condition that usually becomes evident around seven months of age, but should subside around three years of age.

The nurse is educating a new staff member about the causes of personality disorders. The nurse is correct to identify which causes? -Abnormal brain structure and disturbances involving serotonin and GABA. -Abnormal brain structure and disturbances involving dopamine and GABA. -Nutrition al deficiencies and damage to the brain stem. -Nutritional deficiencies and damage to the limbic system.

-Abnormal brain structure and disturbances involving serotonin and GABA A combination of genetic, biological, and environmental factors is responsible for the various signs and symptoms of personality disorders. An imbalance of the neurotransmitter serotonin has been attributed to irritability, impulsivity, and hypersensitivity. GABA is neurotransmitter linked to rapid and brief shifts in mood. Abnormalities of the structure and function of the brain have been detected in the areas that regulate and integrate emotions with thoughts.

Which meds would the nurse identify as being used as pre-anesthetic agents? -Barbiturates -Benzodiazepines -Antieplietpics Agents -Atypical antipsychotics -Mood stabilizing agents

-Barbiturates -Benzodiazepines both are sedative-hypnotics that may be used to decrease effects of anxiety in presurgical clients.

A client who has been taking chlorpromazine (Thorazine) for several months presents in the ER with EPS of restlessness, drooling, and tremors. What medications will the nurse expect the DR to order? -Paroxetine (Paxil) -Carbamazepine (Tegretrol) -Benztropine (Cogentin) -Lorazepam (Ativan)

-Benztropine (Cogentin)

An interdisciplinary treatment team meets to discuss a client diagnosed with paranoid schizophrenia and cannabis abuse who is experiencing increased hallucinations and delusions. How should the team plan an effective treatment? -Consider each diagnosis primary and provide simultaneous treatment. -Treat the schizophrenia before establishing goals for substance abuse treatment. -Withdraw the client from cannabis before treating the symptoms of schizophrenia. -Hospitalize the client for the longest possible stay that insurance will allow.

-Consider each diagnosis primary and provide simultaneous treatment. Clients with dual or co-occurring diagnoses, such as a substance use disorder with a psychiatric disorder, should be treated for both conditions simultaneously. They are both considered a primary diagnosis and need to be addressed for treatment to be effective.

Which intervention would the nurse follow while dealing with family members after the death of the client who was critically injured in an earthquake? -Expressing intense grief -Avoiding concrete language -Coordinating with crisis staff -Avoiding words such as death and dying -offering the option of speaking to a clergy

-Coordinating with crisis staff -Offering the option of speaking to a clergy

A client with stage 3 Alzheimer's disease is admitted to a behavioral health hospital. Due to the progression of the disease, the client is experiencing an increase in amnesia and agnosia, and has declined to the point of not recognizing familiar objects and people. Which action should the nurse take to help reduce the client's fear and anxiety and adjust to the new setting? -Cover mirrors and pictures if they are upsetting the client. -Keep the TV on in the room throughout the day. -Provide the client with a stuffed animal. -Serve the client's meals in a private room.

-Cover mirrors and pictures if they are upsetting the client. Agnosia is the inability to recognize familiar objects. Clients that experience this cognitive impairment do not recognize themselves in a mirror; this may result in the client thinking that there is a stranger in the room. Covering the mirror provides the client with an increased sense of safety.

According to psychodynamic theory, which purpose do delusions severe? -Delusions are a defense against anxiety caused by real or imagined threats -Magical thinks is a delusion that ensures desirable outcomes -delusions are a method of dealing with and interpreting external stimuli -subconsciously delusions are a way to safely express anger and hostility

-Delusions are a defense against anxiety caused by real or imagined threats

The school nurse is providing an in-service program to high school girls about date rape drugs. A student expresses interest about particular drugs and asks the nurse what these drugs look like and how they affect the body. Which response by the nurse it correct? -Flunitrazepam (Rohypnol) is a pill that dissolves in liquids and causes muscle relaxation and amnesia. -Diphenhydramine (Compose) is a pill or capsule that is used to induce sleep. -Acetaminophen plus ephedrine (NyQuil) comes in pill and liquid form and causes drowsiness. -Cyclobenzaprine (Flexeril) comes in a pill form and causes drowsiness and relaxation.

-Flunitrazepam (Rohypnol) is a pill that dissolves in liquids and causes muscle relaxation and amnesia. Flunitrazepam (Rohypnol) is a date rape pill that is also called "forget-me-not." It dissolves in water, becomes more potent when combined with alcohol, and causes relaxation and amnesia.

An addiction counselor is teaching a client and family about cross tolerance, cross addiction and alcohol, benzodiazepines, and barbiturates. The counselor is also teaching about the dangers of concurrent use. The nurse is correct to state that alcohol and CNS depressants act on which receptors? -GABA. -Serotonin. -Dopamine. -Opioid.

-GABA. Alcohol and other CNS depressants act specifically on GABA receptors. The fact that these substances produce the same effect in the neurobiological system explains how cross tolerance and cross addiction readily occur. When taken together, they have a synergistic effect that causes an increase in the level and duration of central nervous system (CNS) depression; the combined effect can result in respiratory arrest.

For a client with the diagnosis of schizophrenia, undifferentiated type, which client statement reflects the most commonly used defense mechanism? _The nurses are mentally ill, so they are trying to kill me -I don't want to take bath. The water is cold and it hurts -Something bad happened, but I can't remember anything -I didn't have any money, so I couldn't buy my medications

-I don't want to take bath. The water is cold and it hurts Regression is the defense commonly used by client used with schizophrenia undifferentiated types.

The treatment team is reviewing the plan of care for a client diagnosed with borderline personality disorder. The client has been acting out during group meetings and creating conflict between staff members. Which interventions by the staff will be most effective to decrease the behavior of "splitting" the staff? -Increase frequency of staff meetings to discuss concerns and plan strategies. -Designate one staff member to work with the client. -Plan a meeting with the client's family to discuss the client's disruptive behavior. -Exclude the client from attending groups until the behavior improves.

-Increase frequency of staff meetings to discuss concerns and plan strategies. Clients with personality disorders challenge the ability of therapeutic staff to work as a team. One of the manipulative behaviors used by the client is known as "splitting," which causes the staff to disagree about the client's abilities and needs resulting in inconsistent treatment. Frequent and ongoing communication is needed to maintain firm and consistent expectations of the client's behavior.

The treatment team discusses plans regarding two clients who both exhibit self-mutilating behavior. The nurse expresses concerns about the decision to use restraints on one client, while assigning one-to-one supervision for the other. Which ethical principal is the nurse concerned about violating? -Justice. -Autonomy. -Beneficence. -Fidelity.

-Justice. Implementing different plans of care for clients with the same condition brings into question the issue of fairness. The nurse is concerned about justice, which refers to the fair treatment of both clients with the least restrictive method.

The family and friends of a client with a heroin addiction are planning an intervention meeting to convince the client to seek help. Which strategy should the group employ to help ensure a successful intervention? -Make notes on what to say to the client and rehearse before the meeting. -Attempt the intervention at a time when the client is under the influence. -Stage the intervention in a public place that is familiar to the client. -Set boundaries and be prepared to act in case the client behaves defensively.

-Make notes on what to say to the client and rehearse before the meeting. An intervention is a useful tool to help an addict who is resistant to treatment. Members of the intervention team should prepare ahead of time, and each member should write down and rehearse what is to be said to the client.

Which intervention should the nurse encourage the client to do to improve their mood? -Participate in daily cardio aerobic exercises. -Develop a strong support system in the workplace. -Add more caffeinated beverages to the diet. -Increase intake of fruits and vegetables. -Create an environment that promotes restful sleep.

-Participate in daily cardio aerobic exercises. -Increase intake of fruits and vegetables. -Create an environment that promotes restful sleep.

A client is undergoing treatment for schizophrenia. Which outcome provides evidence that the client's negative symptoms are improving? -Refrains from yelling and trying to touch the health care provider for the last 48 hours. -Participates in music therapy and states that he enjoys playing the drums. -Eats meals in his room instead of causing disturbances during mealtime. -Reports having no hallucinations for the last week.

-Participates in music therapy and states that he enjoys playing the drums. An inability to experience pleasure and a desire to remain isolated are examples of negative symptoms exhibited by clients with schizophrenia. By participating in therapy and expressing enjoyment, the client shows a decrease in negative symptoms and evidence that the treatment is being effective.

The nurse is caring for a victim of severe emotional violence inflicted by her husband. The client states that the abuse occurs most often when her husband is intoxicated, and that he is always remorseful afterwards. She also tells the nurse that her husband's father was an alcoholic who beat him and his mother. What evidence exists that the husband is at risk of becoming a perpetrator of physical abuse? -Past childhood abuse. -Feelings of remorse. -Temporary behavioral changes. -Excessive alcohol consumption.

-Past childhood abuse. An abuse-prone individual is one who has experienced family violence and has likely been abused as a child. The client's husband is at risk for becoming a perpetrator of physical abuse because he witnessed and experienced similar abuse as a child.

A client diagnosed with borderline personality disorder has been hospitalized several times for self-mutilation and suicide attempts. Dialectical behavioral therapy has been initiated in an outpatient setting. The client describes feelings of mild depression and anger over a breakup with a significant other and agrees to be treated with medication to help manage the symptoms. The nurse should prepare a teaching plan for which medication? -Monoamine oxidase inhibitors (MAOIs). -Benzodiazepines. -Selective serotonin reuptake inhibitors (SSRIs). -Antipsychotics.

-Selective serotonin reuptake inhibitors (SSRIs). SSRIs are less toxic in the event of an overdose and are therefore considered the drug of choice for clients who are suicidal.

A 4-year-old child is referred to a mental health clinic for evaluation of hyperactivity and impulsive behaviors. At the first visit, nursing staff begin observing and assessing the child's behavior. Which developmental task should the child have achieved by this age? -A sense of autonomy. -Satisfactory relationships with peers. -The ability to establish goals. -Separation from parents and the ability to socialize.

-Separation from parents and the ability to socialize. A 4-year-old child should have attained the developmental task of autonomy. According to Erikson's eight stages of development theory, the second stage is autonomy versus shame and doubt, which should occur between the ages of 1 and 1/2 to 3 years old. Unsuccessful resolution of the developmental task at this stage could lead to severe feelings of self-doubt and an internal independence/fear conflict.

For a client with the diagnosis of schizophrenia, which clinical findings are positive signs/symptoms? -anergy -flat affect -social withdrawal -disorganized thoughts -auditory hallucinations

-disorganized thoughts -auditory hallucinations

to deal with a client's hallucinations therapeutically, which nursing intervention should be implemented? -reinforce the perceptual distortions until the client develops new defenses -provide an instructed environment -avoid making connections between anxiety-producing situations and hallucinations -distract the client's attention

-distract the client's attention the nurse should first emphasize with the client by focusing on feelings generated by the hallucinations, present objective reality , and then distract or redirect the client to reality- based activities.

Effective therapeutic communication would directly affect which outcomes for a client who has schizophrenia? -becomes capable of part-time employment -effectively expressive emotional and physical needs -demonstrates wellness reflective of physical potential -demonstrates an understanding of the mental health disorder -recognizes the issues most important to managing this disorder

-effectively expressive emotional and physical needs -demonstrates an understanding of the mental health disorder -recognizes the issues most important to managing this disorder

which clinical manifestations would the nurse observe in a client with opioid withdrawal? -muscle twitching -runny nose -tachycardia -flulike symptoms -pinpoint pupils

-muscle twitching -runny nose -tachycardia -flulike symptoms

which meds are used as the first-line treatment for PTSD? -sertraline -paroxetine -phenelzine -venlafaxine -amitriptyline

-sertraline -paroxetine

which intervention would the nurse use to prevent injury to others when caring for a client with intermittent explosive disorder? -admin antipsychotics -set limits and expectations -use seclusion and time outs -provide structure and boundaries -ignore attention-seeking behaviors

-set limits and expectations -provide structure and boundaries -ignore attention-seeking behaviors

Types of therapy Crisis Intervention

1. A crisis may develop when previously learned coping mechanisms are ineffective in dealing with the current problem. 2. This form of therapy is directed at the resolution of an immediate crisis, when the induvial in unable to handle unable. 3. The individual is usually in a state of disequilibrium 4 If the client is in a panic state as a result of the disorganization, be very directive 5. Focus on the problem , not the cause 6. Identify support systems 7 Id past-coping patterns used in other stressful situations 8. The goal is to return the individual to precrisis level of functioning 9 Crisis intervention is limited to 6 weeks

blood dyscrasia

1. Agranulcytosis: occurs in first weeks of treatment Signs: sore throat, fever, chills 2. thrombocytopenia: decreased platelets Signs: sore throat, fever, chills sign: brusies easily, pechia Nursing intervention: protect from infection. Provide comfort measures: gargle for sore throat etc. teach safety measures

major signs of an impending suicide attempt

1. Client begins giving away possessions 2. a previously depressed client becomes happy, frequently he or she may have made the decision to commit suicide and no longer debating the possibility. The client ma have regained the energy to act on suicidal feelings and has figured out how to accomplish the suicide.

moderate dep

1. Feeling of helplessness and powerlessness 2. decreased energy 3. sleep pattern disturbances 4. appetite and weight changes 5. slowed speech, thought, movement (may also be agitated and hyperactive) 6. Rumination on negative feelings.

Serve depression

1. Feelings of hopelessness, worthlessness, guilt, shame 2. despair 3. flat affect 4. indecisiveness 5. lack of motivation, anergia, and decreased concentration 6. change in physical appearance (slumped posture, unkempt) 7. suicidal thoughts 8. possible delusions and hallucinations 9. sleep and appetite disturbances 10. loss in interest in sexual activity 11. constipation

Mild depression

1. Feelings of sadness. 2. Difficultly concentrating and performing usual activities. 3. Difficulty maintaining usual activity level

Types of therapy Family

1. Form of group 2. based on the concept of the family as a system of interrelated parts forming a whole 3. the focus is on the patterns of interaction within the family, not on any individual member 4. the therapist assists the family's in id'ing the roles assigned to each member based on family rules 5. congruent and incongruent communication patterns and behaviors are identified 6. life scripts (living out parents' dream) and self-fulfilling prophecies (unconsciously following what one thinks should happen, therefore setting it ups to happen) are identified 7. The goal is to decrease family conflict and anxiety and to develop appropriate role relationships.

Moderate mania (bipolar)

1. Grandiosity 2. Talkativeness 3. Pressurized speech 4. impulsiveness 5. excessive spending 6. Bizarre dress and grooming

Type of therapy Electroconvulsive ECT

1. Involves use of electrically induced seizures for psychiatric purposes. It used with severely depressed clients who fail to respond to antidepressant meds and therapy. It may be used with extremely suicidal clients bc 2 weeks are needed for antidepressants to take effect.

intimate partner violence

1. It is a criminal act of physical, emotional, economic, or sexual abuse between an assailant and a victim who most commonly are or were intimate relationship (maybe married or dating) 2. abuse is usually a tension-releasing action, as well as a lack of impulse control 3. Assailants may come from families in which battering and physical violence were present. 4. person act more violently when drinking alcohol or using psychoactive substances 5. the relationship is usually characterized by issues of power and control. 6. individuals in a battering relationship may lack self-confidence and feel trapped. They may be embarrassed about their situation, which results in isolation and dependency on the abuser. 7. abuse often begins during pregnancy or occurs more frequently during pregnancy.

Types of therapy Cognitive therapy

1. It is directed at replacing a client's irrational beliefts and distorted attitudes 2. It is focused, problem-solving therapy 3. The therapist and client work together to id and solve problems and overcome difficulties 4. it is short term of 2-3 months duration 5. it involves cognitive restucturing

psychological determinants of eating disorders

1. Low self-esteem and harsh self-judgement focused primarily on the subject of weight 2. results of anorexic clients living in families that are controlling and emphasize perfection 3. results of bulimic clients living among chaotic and emotionally expressive families

Nursing care after ECT

1. Maintain patent airway. the pt is unconscious after it. 2. Check vitals every 15 min until client is alert. 3. Reorient client after ECT. (mild confusion is likely upon awakening, and short-term memory impairemtn may occur.) 4.common Issues Headache, Muscle soreness, Nausea, Retrograde amnesia

Possible causes of anorexia nervosa

1. Neurobiological and neuroendocrine abnormalities are associated with both anorexia and bulimia; however, there is no consensus on where the abnormalities caused the eating disorder or the eating disorder caused the abnormality 2. genetic factor contributing to the risk of developing an eating disorder A. 70% concordance rate for identical twins B. For fraternal twins, there is a 20% rate.

Client is hallucinating

1. Protect client from injury that might result from responding to commands of the voices; pay attention to the content 2. avoid denying or arguing with client about the hallucination 3. discuss your observations with your client (you appear to be listening to something) 4. make frequent but brief remarks to interrupt the hallucinations 5. admin antipsychotic drugs 6. monitor and treat side effects of psychotropic drugs 7. admin anticholinergic drugs

Catatonia

1. Stupor (decrease in reaction to the environment) or mutism 2. Rigidity (maintenance of a posture against efforts to be moved) 3. Posturing (waxy flexibility) 4. Negativism (resistance to instructions) 5. Excitement (severely agitated, out of control) 6. Potential for violence to self or others during stupor or excitement

Type of therapy: Milieu

1. The planned use of people, resources, and activities in the environment to assist in improving interpersonal skills, social functioning, and activities in the environment to assist in improving interpersonal skills, social functioning, and ADLs as well as safety and protection for all clients 2. occurs inpatient and outpatient by providing the patient an opportunity to actively participate in treatment, decrease social isolation, encourage appropriate social behaviors, and educate the client in basic living skills. 3.patients are provided a safe place to learn and adopt mature and responsible behaviors through staff limit-setting and responsible behavior through staff limit-setting and client responses to maladaptive social responses 4. Limit setting is a component that requires the consistent setting of appropriate limits by all staff, nurses, physicians, and health care workers to work with one via shared communications to maint and reestablish limit setting. 5.Uses activities that support group sharing, cooperation, and compromise 6. Nursing Interventions support client privacy and autonomy and provide clear expectation

Types of therapy Behavior Modication

1. This process attempts to change ineffective or maladaptive behavioral patterns: it focuses on the consequences of the client's actions rather than on peer pressure 2. Positive reinforcement is used to strength desired behavior 3 negative reinforcement is used to decrease or eliminate inappropriate behavior 4 role modeling and teaching a new behavior are important interventions.

psychosis (with schizophrenia)

1. a severe mental condition in which there is deterioration of the personality, deterioration in social function and lost of contact with or distortion of reality. 2. my be evidence of hallucinations and delusional thinking 3 can occur with or without organic impairment

Bulimia Nervosa

1. an eating disorder characterized by eating excessive amounts of food followed by self-induced purging by vomiting, misuse of laxatives, diuretics', or other meds, fasting, and/or excessive exercise. 2. clients usually report a loss of control over eating during bingeing.

Client is delusional

1. encourage recognition of distorted reality 2. divert focus from delusional thought to reality: do not permit rumination on false ideas 3. do not agree with or support delusions 4. avoid arguing about delusion. Be very matter of fact. 5. avoid physically touching client, especially if delusions are persecutional 6. Admin antipsychotic drugs 7. monitor and treat side effects of psychotropic drugs 8. admin anticholinergic drugs.

server mania (bipolar)

1. extreme hyperactivity 2. flight of ideas 3. nonstop activity (running, pacing) 4. sexual acting out; explicit language 5. talkativeness 6. over responsiveness to external stimuli 7. easily distracted 8. agitation and possibly explosiveness 9. severe sleep disturbance 10. delusions of grandeur or persecutions

Mild Mania (bipolar)

1. feeling of being on a high 2. feelings of well-being 3. minor alterations in habits 4 usually does not seek treatment because of pleasurable effect

Suicide precautions

1. obtain history A. a previous attempt is most significant risk factor. Other risk groups include those with biologic and organic causes of depression, such as substance abuse, organic brand disorders, or other medical problems B. Clients with a history of a family member's suicide are at higher risk for suicide. 2. Know warning signs for impending suicide attempt.

Key symptoms of schizophrenia

1. positive symptoms A. Delusions B. Hallucinations 2. Disorganized speech 3. disorganized behavior 4. negative symptoms A. movement disorders, flat affect, anhedonia, inability to begin or sustain planned activities, poverty of speech. 5. Cognitive symptoms A. Difficulty understanding information, trouble paying attention, inability to use information after learning it.

Nursing care before ECT

1. prepare client by teaching what the treatment involves 2. Avoid use the word "shock" when discussing the treatment 3. An anticholinergic is usually given 30 mins before to dry oral secretion's (typically atropine sulfate) 4. A quick acting muscle relaxant (succinylcholine ) or a general anesthetic agent is given to the client before the ECT. This helps to relax the client, thus preventing bone or muscle damage. 5. Provide and emergency cart, suction equipment, and oxygen in room.

A cleint is prescribed MAOIs for depression. The nurse includes teaching on foods and meds known to cause serious adverse effects when used to combo with MAOI's. Which adverse effect would the nurse include in the teaching plan? -a serious drop in BP -A serious increase in BP -A significant increase in liver enzymes -A significant increase in cholesterol levels

A serious increase in blood pressure when taken with foods high in tyramine (pickled foods, beer, wine, aged cheeses) meds such's as antidepressants, certain pain meds, and decongestant can causes life threatening increase in BP.

anorexia nervosa

A. 2 types 1. client who restricts own intake of food and consequently does not maintain min. weight for height and age. 2. client who employs binge eating and/or purging as a mechanism to control body weight B. A distorted body image and intense fear of becoming obese drive excessive dieting and exercise C. a reported 15-20% die D. more common in females E. occurs in adolescence and may con. throughout life F. Athletes exhibit a greater incidence of eating disorders. G. Frequently paired with other mental illnesses H. Eating disorders occur globally; these disorders also occur among ethnic minorities in the US as well as in non western countries.

What are some of the family risk factors the nurse should look for when interviewing a client who is suspected of being in an abusive relationship? A. Mental health problems in the nuclear family B. Substance abuse by household members C. Family relationships that appear dysfunctional D. The ethnic and cultural background of the family D. Educational background of client and family members

A. Mental health problems in the nuclear family B. Substance abuse by household members C. Family relationships that appear dysfunctional

Bipolar or manic depressive illness

A. it is an affective disorder that is manifested by mood swings involving euphoria, grandisoty and an inflated sense of self-worth. This disorder may or may not include sudden swings to depression. B. In order to be diagnosed, according to the DSM-5 classification, a client must have a least one episode of major depression. A client may cycle, going from elevation to depression, with periods of normal activity in between.

Which characteristics will the client with chronic schizophrenia most likely exhibit? -Apathy -Hostility -Flatness -Elation -Sadness -Depression

Apathy Flatness

Coping styles Idenificaiton

Attempt to be like someone or emulate the personality, traits, or behaviors of another person EX: A teenage boy dresses and behaves like his favorite singer

Coping Style Projection

Attributing one's own thoughts or impulses to another person EX: A student who has sexual feelings toward a teacher tells friends the teacher is "coming on to the student"

The sibling of a young client with borderline personality disorder asks the nurse why the client has frequent mood changes. Which is the best response by the nurse to explain the neurobiological basis of this behavior? -Brief shifts in mood are caused by an imbalance of nervous system chemicals that help regulate emotions. -Shifts in mood are the result of an intolerance to certain chemicals found in food substances. -Mood changes are due to the client's emotional immaturity and lack of insight into this behavior. -Mood changes are common in clients during this phase of life due to hormonal changes.

Brief shifts in mood are caused by an imbalance of nervous system chemicals that help regulate emotions.

delusional disorder

Characterized by suspicious, strange behavior, which may be precipitated by a stressful event and can manifest as an intense hypochondriasis

Coping Style Undoing

Communication or behavior has done to negate a previously unacceptable act EX: A young person who used to hunt wild animals now chairs a committee for the protection of animals.

Which essential, initial interventions would be included in the plan of care for a client admitted to the psychiatric unit during the first episode of an acute psychotic disorder? A. Assessing the symptoms and teaching the client about the disorder B. Encouraging the participation in cognitive enhancement and providing social skills and enhancement C. Maintaining a daily routine and institution family and group therapies D. instituting psychopharmacological prescriptions and offering supportive communication

D. instituting psychopharmacological prescriptions and offering supportive communication

Traumatic and Stressor Disorder

DSM-5 no longer considers PTSD as a component of anxiety disorders. New name is "traumatic and stressor related disorders" . These disorders include severe anxiety, which result from experiencing or witnessing a traumatic event directly or indirectly nd can include a persistent re-experience of the trauma. Symptoms include intrusion, negative mood, dissociation, and arousal.

Coping Style Reaction formation

Development of conscious attitudes and behaviors that are the opposite of what is really felt. EX: A person who dislikes animals does volunteer work for the Humane Society

A client experienced a second spontaneous abortion and expresses anger toward the health care provider, the hospital and the rotton nursing care. Which coping mechanisim is the client displaying? -Denial -Projection -Displacement -Reaction formation

Displacement

A client has prescribed imipramine 75 mg 3 times per day. Which nursing action is appropriate when administering this med? -Tell the client steroids will not be prescribed -Warning the client not to eat cheese -Monitoring the client for increased tolerance -Having the client checked for increased intraocular pressure

Having the client checked for increased intracular pressure

Failure to keep medical appointments, arriving late, and being non-compliant with prescribed medications are common behaviors exhibited by clients with personality disorders. Which intervention should be incorporated into the plan of care when a client demonstrates any of these behaviors? -Designate a staff member to be responsible for imposing compliance with treatments and appointments. -Include the client in the decision-making process regarding treatments and appointments. -Designate a family member to help the client remain compliant with treatments and appointments. -Restrict privileges until the client demonstrates compliance with treatments and appointments.

Include the client in the decision-making process regarding treatments and appointments. Due to lack of trust, clients diagnosed with personality disorders are frequently non-compliant when others, including health care providers, make decisions for them. Giving them choices whenever possible will assist them in regaining a sense of control.

Coping Style Introjection

Incorporation of values or qualities of an admired person or group into one's own ego structure. A young man deals with a business client in the same fashion his father deals with business clients.

Anticholinergic Drugs 1. Trihexyphenidyl HCL (Artane) 2. Benztropine mesylate (cogentin) 3. amantadine (Symmetrel)

Indications: 1. Acts on the extrapyramidal system to reduce disturbing symptoms 2. Relaxes muscle tissues: used to treat stiffness: tremors and spasms caused by certain drugs A. difficult urinating, shuffling, slowed movements, rigid posture, stuffing triggered by Trilafon or Thorazine. Reactions: 1. Anticholinergic effects 2. drowsiness 3. headaches 4. urinary hesitancy 5. memory impairment Nursing: 1. usually given in conjunction with antipsychotic drugs.

Coping Style Passive -aggression

Indirectly expressing aggression toward others; a façade of overt compliance masks covert resentment. EX: An employee arrives late to a meeting and disrupts others after being reminded of the meeting earlier that day and promising to be on time.

Coping Style Rationalization

Offering an acceptable, logical explanation to make unacceptable feelings and behaviors acceptable. EX: A student who did not do well in a course says it was poorly taught and the course content was not important anyway

The health care provider is evaluating a client with bulimia who is being treated with fluoxetine (Prozac), a selective serotonin reuptake inhibitor. It is determined that medication has been ineffective because the client's mood and obsessive compulsive behaviors have not improved. Which unconventional antipsychotic agent should the health care provider recommend for the client? -Olanzapine (Zyprexa). -Sertraline (Zoloft). -Lorazepam (Ativan). -Zolpidem (Ambien).

Olanzapine (Zyprexa). Olanzapine (Zyprexa) is an unconventional antipsychotic agent used to treat some mental disorders. It has proven successful in some clients by decreasing compulsions and improving mood.

A 7-year-old client with attention-deficit/hyperactivity disorder (ADHD) is being evaluated at a mental health clinic. A nursing diagnosis of delayed growth and development related to neurological status has been established, as evidenced by hyperactivity that prevents participation in play. The plan for care includes the administration of methylphenidate (Ritalin). Which outcome indicator should the nurse monitor? -Expressive communication. -Participation in group play activities. -Child socialization skills. -Decreased fear and anxiety.

Participation in group play activities.

A client diagnosed with schizophrenia was prescribed antipsychotic meds and developed extrapyramidal symptoms. The nurse understands which meds might be responsible for these symptoms? -Clozpine -Olanzpine -Perpnenzine -Fluphenzine -Trifluoperzine

Perpnenzine -Fluphenzine -Trifluoperzine These are 1st gen antipsychotic meds with a high risk of extrapyramidal symptoms. Second gen such as clozapine and olanzapine have a lower risk.

Coping Style Regression

Reverting to an earlier level of development when anxious or highly stressed. EX: After moving to a new home, a 6 year old starts wetting the bed.

a client with the diagnosis of borderline personality disorder has a history of suicidal behavior and self-mutilation. Which rationale best explains the self mutilation? -The client uses self mutilation to control others -Self mutilations is an experssion of anger or frustration -The client is trying to convey feelings of autonomy -The behavior is used to manipulate family and friends

Self mutilation is an expression of anger or frustrations

Coping Style Isolation

Separation of an unacceptable feeling, idea, or impulse from one's thought process. A nurse working in an emergency room is able to care for the seriously injured by isolating or separating the nurse's feelings and emotions related to the clients' pain, injuries or death.

A 16-year-old female is bought to the emergency department following a suicide attempt. The client reports to the nurse that she is doing poorly in school, is engaging in high-risk sexual activity, and has a history of running away from home. Which assessment is the priority at this time? -Sexual abuse. -Pregnancy. -Physical abuse. -Sexually transmitted infections.

Sexual Abuse

excoration

Skin sore or abrasion produced by scratching or scraping

Coping Style Sublimation

Substitution of an unacceptable feeling with a more socially acceptable one EX: A student who feels too small to play football becomes a champion marathon swimmer

which clinical manifestation accompanies meth use? -bradypnea -tachycardia -hyperthermia -constricted pupils -decreased BP

Tachycardia Hyperthermia respirations will increase, pupils will dilate BP will increase

Coping Style Suppression

The intentional exclusion of feelings and ideas EX: When about to lose their car, the couple says, I'll think about it tomorrow.

Coping Style Repression

The involuntary exclusion of a painful thought or memory from awareness. EX: A young client whose parent died when the client was 12 years old cannot tell you how old the client was or the year the parent died

Coping Style Displacement

The transference of feelings to another person or object EX: After being scolder by his supervisor at work, a man comes home and kicks the dog for barking.

Antianxiety Drugs Nonbenzodiazepines EX: Busprone, Zolpidem, Ramelteon

USE: 1. Reduce anxiety 2. Help to control symptoms such as insomnia, sweating, and palpitations associated with anxiety 3. used for short term treatment of insomnia (Z) 4. approved for long term treatment of insomnia (R) selectively binds to melatonin receptors (R) REACTIONS 1. Dizziness (R & B) 2. Daytime drowsiness (Z) NURSING 1. Takes several weeks for antianxiety effects to become apparent 2. intended for short term use 1. give with food 1-1.5 before bed 1. appro. for a client with delayed sleep onset.

Antianxiety Drug Benzodiazepines EX: Chlodiazepoxide, Diazepam, Clorazepate dipotassium, Lorazepam

USE: 1. reduce anxiety 2. Induce sedation, relax muscles, inhibit convulsions 3. treat alcohol and drug withdrawal symptoms 4. Safer than sedative-hypnotics REACTIONS 1. Sedation 2. Drowsiness 3. Ataxia 4. Dizziness 5. Irritability 6. Blood dyscrasias 7. Habitation and increased tolerance NURSING 1. Admin at bedtime to alleviate daytime sedation 2. Greatest harm occurs when combined with alcohol or other CNS depressants 3. Instruct to avoid driving or working around equipment 4. gradually taper drug therapy due to withdrawal effects: do not stop suddenly 5. used only as a short term drug and as a supplement to other meds

Carbamazepine

Used: used in bipolar disorders as an alternative to lithium Reactions 1. dizziness 2. ataxia 3. blood dyscrasias Nursing 1. maintain serum levels at 8-12 g/ml 2. stop if WBC drops below 3000 or neutrophil count goes below 1500 3. monitor hepatic and renal function

Coping Style Intellectualization

Using reason to avoid emotional conflicts EX: The wife of a substance abuser describes in detail the dynamics of enabling behavior yet continues to call her husband's workplace to report his Monday-morning absences as an illness.

Alcohol deterrent Disulfiram (Antabuse)

What: 1. Treatment of alcoholism; aversion therapy 2. interferes with the breakdown of alcohol, causing an accumulation of acetaldehyde (a by-product of alcohol in the body) Reactions: 1. severe side effect occur if alcohol is consumed: A. nausea and vomiting B. hypotension, headaches C. rapid pulse and respirations D. flushed face and bloodshot eyes E. confusion F. chest pain G. Weakness, dizziness Nursing 1. teach the client what to expect if alcohol is consumed while on drug 2. be aware that some alcoholic clients use the side effects as a means of "punishing" themselves or as a form of masochism and if a client repeatedly consumes alcohol while taking the drug, the doc should be told 3. person with serious heart disease, diabetes, epilepsy, liver, impairment, mental illness, should not take Antabuse. 4. use in motivated clients who have shown the ability to stay sober.

alcohol deterrents acamprosate

What: 1. treatment of alcohol dependence by reducing anxiety and unpleasant effects that trigger resuming drinking. 2. balances GABA and glutamate neurotransmitters Reactions 1. headache 2. nausea and diarrhea Nursing: 1. Helps reduce cravings 2. Does not reduce or eliminate ate withdrawal symptoms

Delirium

What: Acute process that, if treated, is usually reversible. It is recognized by its sudden onset. A. It occurs in response to a specific stressor, such as 1. infection 2. Drug reaction 3. Substance intoxication or withdrawal 4 electrolyte imbalance 5 head trauma 6 sleep deprivation B. The treatment of choice is the correction of the causative disorder.

Lithium Carbonate

What: Bipolar Disorders, especially the manic phase Reactions: 1. Nausea, fatigue, thirst, polyuria, and fine hand tremors. 2. Weight gain 3. Hypothyroidism 4 Early signs of toxicity: diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination 5. possible renal impairment. Nursing: 1. it is excreted by the kidneys. Maintain adequate serum levels. 2. assess electrolytes, especially sodium. 3. Teach client early signs of toxicity 4. use with diuretics is contraindicated. diuretic-induced sodium depletion can increase lithium levels causing toxicity.

Dementia

What: Cognitive impairments characterized by gradual, progressive onset, it is irreversible. Judgment, memory, abstract thinking, and social behavior are affected. Some examples of symptoms are aphasia, apraxia, and agnosia. A. It is most commonly seen in 1. Alzheimer disease 2. Mulitinfarctions (brain) B. It also occurs in 1. Huntington chorea 2. Parkinson disease 3. multiple sclerosis and brain tumors 4. Wernicke-korsakoff syndrome (chronic alcoholics)

Valproic Acid

What: Used in Bipolar alone or with lithium Reactions: 1. GI distress: nausea, anorexia, vomiting 2. hepatotoxicity 3. Neurologic symptoms: tremor, sedation, headache, dizziness Nursing: 1. Admin with food 2. Monitor blood levels 3. maintain serum levels 50-125 ug/ml

Lamotrigine

What: used in bipolar alone or with mood stabilizers Reactions: 1. headache 2. dizziness 3. double vision 4. rash (Steven Johnson) Nursing 1. to min. risk of severe rash, give low dose, 25-50 mg/day initially, then gradually increase to maintenance dose of 200 mg/day (used alone) or 100 mg/day (with valproate) or 400 mg/day (with carbamazepine)

encopresis

a childhood disorder characterized by repeated defecating in inappropriate places, such as one's clothing

Schizophrenia

a disorder characterized by thought disturbance, altered affect, withdrawal from reality, regressive behavior, difficulty with communication, and impaired interpersonal relationships, as well as ability to perceive reality

postive symptoms

add something

which side effect would the nurse include when preparing a teaching paln for a client prescribed sertraline? -seizures -agitation -tachycardia -agranulocytosis

agitation others include anxiety, confusion, dizziness, drowsiness, headache

Which feeling would be the basis for the ritualistic behavior seen in clients with the obessive-compulsive disorder? -anxiety and guilt -anger and hostility -embarrassement and shame -hopelessness and powerlessness

anxiety and guilt

which adverse effect would the nurse anticipate receive lithium therapy for the treatment of depression? -ataxia -confusion -blurred vision -paradoxical anxiety

ataxia

The nurse finds that a child has inattention, hyperactivity, and impulsivity upon assessment. What Does the nurse anticipate which medication to be most beneficial for the child? -modafinil -doxapram -armodafinil -atomoxetine

atomoxetine is a nonstimulant second-line med used to treat ADHD. the other meds are used to treat shift work sleep disorders.

obessive-compulsive disorder

component of personality disorder Anxiety associated with repetitive thoughts (obsession's) or irresistible impulses (compulsion) to perform an action Fear of losing control is a major symptom of this disorder Things included: hoarding, excoriation, trichotillomania, an obsessive-compulsive and related disorder due to medical condition, and substance or medication-induced obsessive compulsive and related disorder.

Mood disorders

disturbances in mood manifested by extreme sadness or extreme elation

a depressed client is given 50 mg of sertraline at bedtime. For which medicaiton-related side effects will the nurse monitor the client? -dry mouth -weight gain -constipation -photosensitivity -paralytic ileus

dry mouth constipation

agoraphobia

fear of crowds or open places

thantohobia

fear of death

claustrophobia

fear of enclosed or narrow spaces

acrophobia

fear of heights

hydrophobia

fear of water

The nurse understands that clients with certain conditions who are given haloperidol must be monitored for additional adverse reactions. Which client conditions would warrant additional monitoring? -Glaucoma -Coma -adynamic ileus -Parkinson Diease -Prostatic hypertrophy

glaucoma adynamic ileus prostatic hyertrophy

Trichotillomania

hair pulling disorder

teaching for olanzapine

i need to be careful not to gain too much weight this medication should help me enjoy fun actvities again

apraxia

impaired ability to carry out motor activities despite intact motor function

aphasia

impairment of language, usually caused by left hemisphere damage either to Broca's area (impairing speaking) or to Wernicke's area (impairing understanding).

anhedonia

inability to experience pleasure

Delusions

is a personal belief based on an incorrect inference of external reality.

ataxia

lack of muscle coordination

Lab reports reveal that the client's thyroxine levels are low. Which med might have led to this condition? -lithium -fluxetine -risperidone -carbamazepine

lithium decreased levels of thyroxine and triiodothronine my indicate hypothyroidism. Lithium may causes a goiter which can causes hypothyroidism.

which feeling will result from withdrawn behavior -anger -paranoia -loneliness -boredom

loneliness

schizoaffective disorder

must include the presence of a major mood episode for the majority of the disorder's total duration

a client in the ER is sweating and appears anxious. His pupils are dilated: eyes are teary and he has a runny nose. Physical exam shows a BP of 150/90, P 110. what is he withdrawing from -cocaine -opioids -amphetamines -benzodizepines

opioids

Depressive disorders

pathologic grief reactions ranging from mild to severe states

Doxepin is prescribed for a 74-year-old client to treat depressive episodes. Which side effects would the nurse include when teaching the client about doxepin? -Diarrhea -Loss of appetite -Photosensitivity -Urine retention -Suicidal ideation

photosensitivity Urine retention suicidal ideation may also cause constipation, increase appetite.

Which defense mechanism is the client using when she constantly complains about her health problems and then says those old crabby people just want to talk about their aches and pains and doctor appointments -projection -introjection -somatizaion -rationalzation

projection The client is assigning to other those feeling and emotions that are unacceptable to herself.

The health care provider prescribes an atypical antipsychotic med to a client and asks to nurse to set up an appointment with an ophthalmologist. Which med was prescribed to the client? -clozapine -Quetiapine -zipraxione -Chlorpmazine

quetiapine is a second gen antipsychotic med that may pose a risk of cataracts.

Substance abuse disorder

regular use of psychoactive substances that affect the CNS resulting in significant impairment or distress occurring in a 12 month time frame. Clients diagnosed with substances abuse disorder demonstrate a problematic pattern of behaviors. The DSM-5 lists nine known classes of psychoactive substances : alcohol, caffeine, cannabis, hallucinogens (phencyclidine or other hallucinogens) inhalants, opioids, sedatives, hypnotics, and anxiolytics, stimulant's and tobacco.

first line treatment for PTSD

sertraline paroxetine

side effects of paroxetine

sexual dysfunction insomnia and restlessness urinary frequnecy dizziness tremors nervousness headache

Cocaine overdose symptoms

tachycardia, pupillary dilation, increased BP, cardiac arrhythmia, preparation, chills, N/V

Negative symptoms

take something away

An older client describes the current situation then offers information that goes further and further off the topic. Which pattern of communication is the client using? -preservation -thought blocking -pressured speech -tangential thinking

tangential thinking the person never answers the questions or returns to the central point of conversation it is often is seen with people with dementia or schizophrenia.

adverse effect of clozapine (schizphrenia)

temperature rise due to agranulocytosis which can promote infection.

agnosia

the inability to recognize familiar objects.

Coping Style Denial

unconscious failure to acknowledge an event, thought, or feeling that is too painful for conscious awareness EX: A woman with cancer tells her family all her tests her negative.

MAOIs should not be

used within 14 days of taking SSRIs.