Psych EAQ Mod 4

A 2½-year-old child is admitted for treatment of injuries supposedly sustained in a fall down a flight of stairs. Child abuse is suspected. What statements might the nurse expect from a parent who engages in child abuse?

"Every time I turn around the kid is falling over something." "I can't understand it. He didn't have a problem using the stairs without my help before this." Abusive parents often have a poor understanding of the expected growth and development of children and tend to blame the child. Toddlers generally need supervision and some assistance when climbing stairs, but abusive parents have little understanding of toddlers' abilities

A nurse is caring for clients who are undergoing therapy for dependence on alcohol. Which member of the health team has the primary responsibility for their rehabilitation?

According to the philosophy of Alcoholics Anonymous, clients who have problems with alcohol must identify their own need to seek help and therefore become the primary rehabilitators. The nurse can give support but is not the primary rehabilitator. The counselor can give direction but is not the primary rehabilitator. The psychiatrist can give support, but the client is the primary rehabilitator when it comes to coping with alcoholism.

Amitriptyline (Elavil) is an antidepressant medication used to treat anxiety disorders. Which class of antidepressant medications does it belong to?

Amitriptyline (Elavil) is one of several tricyclic antidepressants used to treat anxiety disorders . It is not an MAOI (e.g., isocarboxazid [Marplan], phenelzine [Nardil], tranylcypromine [Parnate), SSRI (e.g., citalopram [Celexa], Fluoxetine [Prozac], Paroxetine [Paxil]), or SNRI (e.g., venlafaxine [Effexor], Duloxetine [Cymbalta], norepinephrine).

How should a nurse characterize a sudden terrorist act that causes the deaths of thousands of adults and children and negatively affects their families, friends, communities, and the nation?

An adventitious crisis is a crisis or disaster that is unplanned and accidental; its subcategories include national disasters and crimes of violence. Recurring crisis is not considered a category in crisis theory. A situational crisis results from an external source and involves the loss of self-concept or self-esteem of an individual or family group. A maturational crisis occurs as an individual moves into a new stage of development and prior coping styles are no longer effective; these crises are usually predictable.

A client has recently started taking a new neuroleptic drug, and the nurse notes extrapyramidal effects. Which drug does the nurse anticipate will be prescribed to limit these side effects?

Benztropine (Cogentin), an anticholinergic, helps balance neurotransmitter activity in the central nervous system (CNS) and helps control extrapyramidal tract symptoms. Zolpidem (Ambien) is a sedative-hypnotic drug used for short-term insomnia. Hydroxyzine (Vistaril) is a sedative that depresses activity in the subcortical areas in the CNS; it is used to reduce anxiety. Dantrolene (Dantrium), a muscle relaxant, has a direct effect on skeletal muscle by acting on the excitation-contraction coupling of muscle fibers and not at the level of the CNS as do most other muscle relaxation drugs.

A nurse is teaching a client about side effects of medications. Which drug will cause a heightened skin reaction to sunlight?

Clients taking chlorpromazine should be instructed to stay out of the sun. Photosensitivity makes the skin more susceptible to burning. Photosensitivity is not a side effect of lithium, sertraline, or methylphenidate.

When a person who is nonathletic and uncoordinated is successful in a musical career, it may be related to the defense mechanism of:

Compensation is replacing a weak area or trait with a more desirable one. Sublimation is rechanneling unacceptable desires and drives into those that are socially acceptable. Transference is the unconscious tendency to assign to others in the current environment feelings and attitudes associated with another person. Rationalization is the use of justification to make tolerable certain feelings, behaviors, and motives.

One afternoon the nurse on the unit overhears a young female client having an argument with her boyfriend. A while later the client complains to the nurse that dinner is always late and the meals are terrible. The nurse identifies the defense mechanism that the client is using as:

Displacement reduces anxiety by transferring the emotions associated with an object or person to another emotionally safer object or person. Projection is the attempt to deal with unacceptable feelings by attributing them to another. Dissociation is an attempt to detach emotional involvement or the self from an interaction or the environment. Intellectualization is the use of facts or other logical reasoning rather than feelings to deal with the emotional effect of a problem; it is a form of denial.

According to Erikson, a person's adjustment to the period of senescence will depend largely on the adjustment the individual made to the earlier developmental stage of:

Erikson theorized that how well people adapt to the current stage depends on how well they adapted to the stage immediately preceding it—in this instance, adulthood. Although Erikson believed that the strengths and weaknesses of each stage are present in some form in all succeeding stages, their influence decreases with time.

A client with a diagnosis of schizophrenia is discharged from the hospital. At home the client forgets to take the medication, is unable to function, and must be rehospitalized. What medication may be prescribed that can be administered on an outpatient basis every 2 to 3 weeks?

Fluphenazine can be given intramuscularly every 2 to 3 weeks to clients who are unreliable about taking oral medications; it allows them to live in the community while keeping the disorder under control. Lithium is a mood-stabilizing medication that is given to clients with bipolar disorder. This drug is not given for schizophrenia. Diazepam (Valium) is an antianxiety/anticonvulsant/skeletal muscle relaxant that is not given for schizophrenia. Fluvoxamine (Luvox) is a selective serotonin reuptake inhibitor; it is administered for depression, not schizophrenia.

A client is admitted to the emergency department after ingesting a tricyclic antidepressant in an amount 30 times the daily recommended dose. What is the immediate treatment anticipated by the nurse?

Gastric lavage with charcoal may help decrease the level of tricyclic antidepressant overdose. Supportive measures such as mechanical ventilation may be needed until the medical crisis passes

A nurse reminds a client that it is time for group therapy. The client responds by shouting, "You're always telling me what to do, just like my father!" What defense mechanism is the client using

In transference a client assigns to someone the feelings and attitudes originally associated with an important significant other. In regression a client reverts to past levels of coping to reduce anxiety. In reaction formation a client displays the exact opposite behavior, attitude, or feeling to that which is demonstrated in a given situation. Cognitive distortions are thought patterns that exaggerate reality or are irrational, such as black-and-white thinking or overgeneralization.

A 65-year-old man is admitted to the hospital with a history of depression. The client, who speaks little English and has had few outside interests since retiring, says, "I feel useless and unneeded." The nurse concludes that the client is in Erikson's developmental stage of:

Integrity versus despair is the task of the older adult; the client has difficulty accepting what life is and was, resulting in feelings of despair and disgust. Initiative versus guilt is the task of the preschool-aged child. Intimacy versus isolation is the task of the young adult. Identity versus role confusion is the task of the adolescent.

A client with diabetes mellitus is able to discuss in detail the diabetic metabolic process while eating a piece of chocolate cake. What defense mechanism does the nurse identify when evaluating this behavior?

Intellectualization is the avoidance of a painful emotion with the use of a rational explanation that removes the event from any personal significance. Projection is the attribution of unacceptable thoughts and feelings to others. Dissociation is a temporary alteration of consciousness or identity used to handle conflict; amnesia is an example. Displacement is the discharge of a pent-up feeling, generally hostility, on an object or person perceived to be weaker than the person who aroused the feelings.

The nurse anticipates that the medication that will be used to prevent symptoms of withdrawal in clients with a long history of alcohol abuse is:

Lorazepam (Ativan) is most effective in preventing the signs and symptoms associated with withdrawal from alcohol. It depresses the central nervous system by potentiating γ-aminobutyric acid, an inhibitory neurotransmitter. Phenobarbital (Luminal) is used to prevent withdrawal symptoms associated with barbiturate use. Chlorpromazine (Thorazine), an antipsychotic medication, is not used for alcohol withdrawal. Methadone hydrochloride (Methadone) is used to prevent withdrawal symptoms associated with opioid use.

A client is receiving a monoamine oxidase inhibitor (MAOI). What should the nurse teach the client?

MAOIs interact with many other medications to produce harmful side effects. Clients must be taught to check with the prescribing health care provider before taking any new medications. Photosensitivity has not been reported in clients who are taking MAOIs. Drowsiness is not an expected side effect, but it may occur as an adverse reaction. The therapeutic and toxic levels of the drug are not close for these medications.

Olanzapine (Zyprexa) is prescribed for a client with bipolar disorder, manic episode. What cautionary advice should the nurse give the client?

Olanzapine (Zyprexa), a thienobenzodiazepine, can cause orthostatic hypotension. Blurred, not double, vision may occur. Decreased salivation is an effect of Olanzapine. It may also cause nausea and other gastrointestinal upsets and should be taken with fluid or food.

A client is admitted for treatment of obsessive-compulsive disorder that is interfering with activities of daily living. Which medication should the nurse anticipate the health care provider will prescribe?

*Clomipramine (Anafranil) potentiates the effects of serotonin (antiobsessional effect) and norepinephrine in the central nervous system; it diminishes obsessive-compulsive behaviors. Benztropine (Cogentin) is an antiparkinsonian agent, not an antianxiety agent. Amantadine (Symmetrel) is an antiparkinsonian agent, not an antianxiety agent. Diphenhydramine (Benadryl) is an antihistamine, not an antianxiety agent.

A client tells the nurse in the mental health clinic that the practitioner said that the cornerstone of therapy used in the clinic is cognitive therapy. The client asks what this therapy entails. What concept should the nurse explain as the basis of cognitive therapy?

Cognitive therapy seeks to discover underlying thoughts that lead to feelings of depression and anxiety; also, it teaches the client to replace these thoughts with more positive, realistic thinking. The response "Unconscious feelings influence actions" reflects a psychoanalytical approach to treatment. The response "People can act their way into a new way of thinking" reflects a behavioral approach to treatment. The response "Maladaptive behaviors will continue as long as they are reinforced" reflects a behavioral approach to treatment. *Negative thoughts can precipitate anxiety

A client is admitted to the psychiatric hospital with a diagnosis of obsessive-compulsive disorder. The client's anxiety level is approaching a panic level, and the client's ritual is interfering with work and daily living. Which selective serotonin reuptake inhibitor (SSRI) should the nurse anticipate that the health care provider may prescribe?

Fluvoxamine (Luvox) inhibits central nervous system neuron uptake of serotonin but not of norepinephrine. Haloperidol (Haldol) is not an SSRI; it is an antipsychotic that blocks neurotransmission produced by dopamine at synapses. Imipramine (Tofranil) is a tricyclic antidepressant, not an SSRI. Benztropine (Cogentin) is an antiparkinsonian agent, not an SSRI.

What is the most important information for a nurse to teach to prevent relapse in a client with a psychiatric illness?

Following the prescribed medication regimen is important because side effects and denial of illness may cause clients to stop taking their medications; this is a common cause of relapse or recurrence of symptoms. Although a close support system is beneficial, it may not always be possible to achieve. It is impossible to create a stress-free environment; clients need to learn better ways to cope with stress. Refraining from any activity that may cause anxiety is too restrictive.

A client has been taking escitalopram (Lexapro) for treatment of a major depressive episode. On the fifth day of therapy the client refuses the medication, stating, "It doesn't help, so what's the use of taking it?" What is the best response by the nurse?

It usually takes 1 to 4 weeks to attain a therapeutic blood level of escitalopram (Lexapro). Six to 8 weeks is too long. The client needs more time, not an increased dosage, to see an effect of the medication. There is no need for the nurse to notify the health care provider yet.

What conflict associated with Erikson's psychosocial stages of development should the nurse remember when caring for a client 30 years of age?

Intimacy versus isolation The major task of the young adult is to develop close, sharing relationships that may include a sexual partnership; the person develops a sense of belonging and avoids isolation. During the integrity-versus-despair stage the adjusted older adult can look back with satisfaction and acceptance of life and resolve the inevitability of death; failure at these tasks results in despair. The middle school-aged child gains a sense of competence and self-assurance as social interactions and academic pursuits are mastered; failure in these tasks leads to feelings of inferiority. During adolescence the individual develops a sense of self, self-esteem, and emotional stability; failure to establish self-identity results in a lack of self-confidence and difficulty with occupational choices.

Survivors of a major earthquake are being interviewed on admission to the hospital. The nurse notes that they exhibit a flattened affect, make minimal eye contact, and speak in a monotone. These behaviors are indicative of the defense mechanism known as:

Isolation is the separation of thought or memory from feeling. Splitting is the polarization of positive and negative feelings. Introjection is the integration of the beliefs and values of another into one's own ego. Compensation is making up for a real or imagined lack in one area by overemphasizing another.

Incidences of child molestation often are revealed years later when the victim is an adult. Which defense mechanism reflects this situation?

Repression is a coping mechanism in which unacceptable feelings are kept out of conscious awareness; later, under stress or anxiety, thoughts or feelings surface and come into one's conscious awareness. Regression is the use of an unconscious coping mechanism through which a person avoids anxiety by returning to an earlier, more satisfying, or comfortable time in life.

After an automobile collision involving a fatality and a subsequent arrest for speeding, a client has amnesia regarding the events surrounding the accident. Which defense mechanism is being used by the client?

Repression is coping with overwhelming emotions by blocking awareness or memory of the stressful event. Projection is attributing one's own unacceptable feelings and thoughts to others. Suppression is consciously keeping unacceptable feelings and thoughts out of awareness. Rationalization is the attempt to mask unacceptable feelings or behaviors by providing excuses and explanations.

A client who is taking lithium arrives at the mental health center for a routine visit. The client has slurred speech, has an ataxic gait, and complains of nausea. The nurse knows that these signs and symptoms are:

The classic signs and symptoms of lithium toxicity include slurred speech, ataxia, nausea, and vomiting. When the lithium level is low the client presents with recurring signs and symptoms of the mood disorder. These are not signs and symptoms of a mood disorder. If the lithium level is within the therapeutic range, the client's mood is more stable; the client may experience gastrointestinal symptoms but will not experience slurred speech or an ataxic gait.

A client in the hyperactive phase of a mood disorder, bipolar type, is receiving lithium. A nurse sees that the client's lithium blood level is 1.8 mEq/L. What is the most appropriate nursing action?

The lithium level should be maintained between 0.5 and 1.5 mEq/L. The lithium level is currently unsafe but does not need to drop to 0.5 mEq/L before being resumed. Continuing the drug and asking the health care provider to prescribe a higher dosage are both unsafe options.

A nurse is evaluating a young adult for evidence of achievement of the age-related developmental stage set forth in Erikson's developmental theory. What developmental crisis is associated with this age group?

The major task of young adulthood is centered on human closeness and sexual fulfillment; lack of love results in isolation. The trust-versus-mistrust stage is associated with infancy. The industry-versus-inferiority stage is associated with middle childhood (school age). The generativity-versus-stagnation stage is associated with middle adulthood.

What is the most important tool a nurse brings to the therapeutic nurse-client relationship?

The nurse brings to a therapeutic relationship the understanding of self and basic principles of therapeutic communication; this is the unique aspect of the helping relationship. Knowledge of psychopathology, advanced communication skills, and years of experience in the field all support the psychotherapeutic management model, but none is the most important tool used by the nurse in a therapeutic relationship.

A client on the psychiatric unit who has suicidal ideas says to the nurse, "I signed myself in. I'll sign myself out." What concept provides the basis for the nurse's response?

The priority is to keep the client safe; a client admitted on a voluntary basis may be kept involuntarily if professional judgment indicates that the client may harm him- or herself or others. Clients who admit themselves voluntarily may leave if they are not suicidal or homicidal and if unit procedures are followed. The nurse has a duty to maintain the client's safety; a suicidal client may not leave under any circumstances.

A client's hands are raw and bloody from a ritual involving frequent handwashing. Which defense mechanism does the nurse identify?

Undoing is an act that partially negates a previous one; the client is using this primitive defense mechanism to reduce anxiety. Clients who wash their hands compulsively may be having thoughts that they consider "dirty." Projection is the attribution of one's thoughts or impulses to another. Introjection is treating something outside the self as if it is actually inside the self. Suppression is a process that is often listed as a defense mechanism, but it is actually a conscious, intentional exclusion of material from one's awareness.

A client with schizophrenia is actively psychotic, and a new medication regimen is prescribed. A student nurse asks the nurse, "Which of the medications will be the most helpful against the psychotic signs and symptoms?" What response should the nurse give?

Ziprasidone (Geodon) is a neuroleptic, which will reduce psychosis by affecting the action of both dopamine and serotonin. Citalopram (Celexa) is a selective serotonin reuptake inhibitor antidepressant. Benztropine (Cogentin) is an anticholinergic. Acetaminophen with hydrocodone (Lortab) is an analgesic/opioid.

A child in the first grade is murdered, and counseling is planned for the other children in the school. What should a nurse identify first before evaluating a child's response to a crisis?

Developmental level of the child Knowledge of the developmental level is essential to understanding a child's response to a crisis situation; the variety of coping abilities usually increases as the child progresses through the stages of growth and development.