Psych Exam 3

Nursing Interventions: Psychological Domain:

-Challenging the suicidal mindset -Developing new coping strategies -Committing to treatment

What are social theories of suicide?

Social distress, Suicide contagion, Economic disadvantage

Chronic self-destructive hair pulling that results in noticeable hair loss

Trichotillomania disorder

A nurse is preparing a plan of care for a client with anxiety. Which elements would the nurse likely include? Select all that apply. Using appropriate coping skills Identifying treatment modalities Involving family for support, if appropriate Providing supportive feedback Using restraint when panic develops

Using appropriate coping skills Identifying treatment modalities Involving family for support, if appropriate Providing supportive feedback

Liquids that vaporize at room temperature, such as paint thinners or removers, degreasers, dry-cleaning fluids, gasoline, and lighter fluid. Office supply solvents include correction fluids, felt-tip marker fluid, electronic contact cleaners, and glue.

Volatile Solvents

Which is most often the criterion for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa?

Weight gain

What is the HPA axis?

When it is activated under conditions of stress, the hypothalamus secretes corticotropin-releasing hormone, because of which the pituitary gland increases secretion of adrenocorticotropic hormone (corticotropin), which in turn stimulates the adrenocortical secretion of cortisol. -Over time, excessive exposure to cortisol contributes to the dysregulation of the autonomic nervous system.

What is referential thinking?

a belief that neutral stimuli have special meaning to the individual, such as a television commentator who is speaking directly to the individual

What is diathesis?

a genetic predisposition that increases susceptibility of developing a disorder

What are loose associations?

absence of the normal connectedness of thoughts, ideas, and topics; sudden shifts without apparent relationship to preceding topics

_____ occurs when a person uses alcohol or drugs for the purpose of intoxication or, in the case of prescription drugs, for purposes other than their intended use.

abuse

Initial Opioid Detoxification:

achieved by gradually reducing an opioid dose over several days or weeks -administering low doses of a substitute drug, such as buprenorphine, or methadone, which can help satisfy the drug craving without providing the same subjective high

Binging and purging are associated with _____ binging.

alcohol

Describe mania:

an abnormally and persistently oElevated mood: euphoria or elation oExpansive mood: lack of restraints in expression; overvalued self-importance oIrritable mood: easily annoyed and provoked to anger -Manic episode: distinct period of mania -Mood lability: rapid shifts in mood with little or no change in external events

Describe Type C Personalities:

are described as having difficulty expressing emotion and are introverted, respectful, conforming, compliant, and eager to please and avoid conflict. -They respond to stress with depression and hopelessness. -this personality type will experience more depression and difficult marital adjustment

The nurse is caring for a client with schizoaffective disorder with depression. The nurse should instruct the client that the most effective medication therapy for this disorder is:

atypical antipsychotic medications.

commonly abused CNS depressants:

benzodiazepines (diazepam, alprazolam, clonazepam, lorazepam), which are prescribed for anxiety and sleep -The DSM-5 diagnosis Sedative, hypnotic, or anxiolytic use disorder would be given when these drugs are abused.

How is blood glucose affected during the alarm stage of GAS?

client will have increased serum glucose levels due to the stimulation of the sympathetic nervous system. Other anticipated findings include dilated, not constricted, pupils; an increased, not decreased, respiratory rate; and an increased, not decreased, BP.

What is waxy flexibility?

posture held in an odd or unusual fixed position for extended periods of time

What is catatonia?

psychomotor disturbances, such as stupor, mutism, posturing, or repetitive behavior -catatonic excitement: a hyperactivity characterized by purposeless activity and abnormal movements, such as grimacing and posturing

What is echolalia?

repetition of another's words that is parrot-like and inappropriate

What is autistic thinking?

restricts thinking to the literal and immediate so that the individual has private rules of logic and reasoning that make no sense to anyone else

fetal alcohol syndrome (FAS):

results from drinking alcohol during pregnancy and is one of the leading causes of irreversible mental retardation.

caffeine intoxication:

scattered thoughts, excessive talking, inability to focus on anything, irritability, elevated blood pressure, increased heart rate, nausea, anxiety, heart palpitations (arrhythmias), insomnia, sweating, dizziness, vomiting, cardiac arrest

What are the affects of alcohol?

sedative effect by depressing the central nervous system (CNS); the effects can range from feelings of mild sedation and relaxation to confusion and serious impairment of motor functions and speech to severe intoxication that can result in coma, respiratory failure, and death. -relaxes inhibitions and heightens emotions -mood swings: gaiety to angry outbursts, aggression, and assaultive behavior -reduced concentration or attention span to impaired judgment and memory

Which of the following is a primary risk factor for suicide? Economic deprivation or Social isolation

social isolation

What is word salad?

stringing together words that are not connected in any way

What aspects are associated with appraisal?

the demands, constraints, and resources are balanced with personal goals and beliefs. A critical factor is the risk that the event poses to a person's well-being

Describe secondary appraisal:

the person determines if they possess the necessary coping mechanisms to overcome the event.

What is flight of ideas?

the topic of conversation changes repeatedly and rapidly, generally after just one sentence or phrase

What is tangentiality?

the topic of conversation is changed to an entirely different topic that is a logical progression but causes a permanent detour from the original focus

What is metonymic speech?

use of words with similar meanings interchangeably

What are neoglisms?

words that are made up that have no common meaning and are not recognizable

What are binge eating disorders characterized by?

•Binge eating similar to bulimia nervosa but no purging or compensation for binges through other behaviors •Most are obese •Criteria -Binge eating -Distress about the binge -Eating until uncomfortably full -Feelings of guilt or depression afterward •Interventions similar to those for bulimia nervosa

Assessment of the Suicidal Patient:

•History, assessment, and interventions •Presence or absence of suicidal thoughts, intent, plan, and available means •Use of drugs, alcohol, or prescription medications •Level of the patient's judgment •Prescribed medications, dosage, and number of pills dispensed •Plan for ongoing treatment

Which statement made by a client diagnosed with posttraumatic stress disorder (PTSD) leads a nurse to believe that the client is experiencing dissociative symptoms?

"I describe my feelings like I'm having an out-of-body experience." -Dissociation is a disruption in the normally occurring linkages among subjective awareness, feelings, thoughts, behavior, and memories. A person who dissociates is making them "disappear." That is, the person has the feeling of leaving their body and observing what happens to it from a distance. During trauma, dissociation enables a person to observe the event while experiencing no pain or only limited pain and to protect themselves from awareness of the full impact of the traumatic event. Flashbacks are common with PTSD; loud noises associated with the trauma cause flashbacks. Guilt is common for survivors.

The nurse is providing education to a client prescribed clomipramine to help with obsessive-compulsive disorder. Which statement by the client indicates the teaching was effective?

"I may have a risk of suicidal thoughts with the medication."

A client with post-traumatic stress disorder (PTSD) is scheduled to soon begin psychodynamic psychotherapy. What anticipatory guidance should the nurse provide to the client about this form of psychotherapy?

"The therapist will help you focus on the patterns of thinking that you're not consciously aware of."

Whereas males are more likely to respond to stress with a fight or flight response, females have less aggressive responses; they _____.

"tend and befriend." -To "tend and befriend" is a less aggressive response to stress. This response seeks to acknowledge the emotion rather than deny its existence.

Assessment of Suicidal Episode:

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Harm reduction skills:

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How Do Eating Disorders Happen?

(picture)

Etiology of Bipolar Disorder

-Biologic theories Chronobiologic theories Genetic factors Chronic stress, inflammation, and kindling -Psychological and social theories Focus on reducing environmental stress and trauma in genetically vulnerable individuals

Clinical judgement of schizophrenia:

-Consider: oThe point in time during the progression of schizophrenia oThe acceptability of its treatment to the individual, oThe availability of community resources in order to best plan care -Factors: oThe stage of the illness oThe type, mixture, and intensity of symptoms oThe medication effects and side effects oThe method and availability of treatment oSources of social support and recovery-based care

Anorexia Nervosa: Interdisciplinary Treatment:

-Nutritional rehabilitation -Conflict resolution related to body image -Effective coping -Healthy family functioning and communication -Hospitalization if needed -Intensive therapy -Family and interpersonal therapy -Refeeding protocol -Pharmacologic management: fluoxetine

What is Akathisia?

-client appears restless or anxious and agitated, often with a rigid posture or gain and a lack of spontaneous gestures. -usually develops when the antipsychotic is started or when the dose is increased

A client diagnosed with schizophreniform disorder must have symptoms present for at least 1 month but with a duration of less than how long?

6 months

A patient with PTSD startles easily and reacts irritably to small annoyances. The nurse interprets this as which of the following? Hyperarousal Intrusion Avoidance Numbing

A.Hyperarousal Hyperarousal is manifested by being hypervigilant for signs of danger, becoming easily startled, reacting irritably to small annoyances, and sleeping poorly. Intrusion refers to the individual continually experiencing the event through flashbacks and nightmares. Avoidance and numbing reflect complete powerlessness by the individual.

Like PTSD except that it is resolved within 1 month of the traumatic event

Acute stress disorder

_____ lead to loss of jobs and family relationships due to behaviors such as lying, stealing, and putting the addiction before the well-being of one's self and family.

Addictions

Sprays that contain propellant and solvents, such as spray paint, hair spray, fabric protector spray, aerosol computer cleaning products, vegetable oil spray, analgesics, asthma sprays, deodorants, and air fresheners.

Aerosols

A client taking a monoamine-oxidase inhibitor (MAOI) for depression should be instructed to avoid which of the following when taking the medication? Select all that apply. Aged cheese Beer Red meat Red wine Spinach

Aged cheese Beer Red wine

What are some examples of disorganized behavior in patients with schizophrenia?

Aggression Agitation Catatonia Catatonic excitement Echopraxia Regressed behavior Stereotypy Hypervigilance Waxy flexibility

Fear or anxiety triggered by situations such as using public transportation, being in open spaces, being in enclosed places, standing in line, being in a crowd, or being outside of the home alone

Agoraphobia

This is a term used to describe the wear and tear on a person's body and brain resulting from chronic stress.

Allostatic load (AL) -The greater the AL, the greater the state of chronic stress and, ultimately, the more negative changes in health

stimulants prescribed for ADHD that are also frequently abused or diverted for illicit purposes:

Amphetamines (Adderall, Dexedrine) and methylphenidate (Concerta, Ritalin)

Treatment of eating disorders often combines psychotherapy and psychopharmacology. Which classes of medications can be used to treat eating disorders?

Antidepressants

What are some comorbid conditions to bulimia nervosa?

Anxiety disorders, mood disorders, self-harm, and substance use

Therapeutic relationship (stress/trauma)

Basis of nurse-patient collaboration oNeeds and safety are defined by the survivor Takes time (See Box 29.7) o Trauma can have a lasting effect on the ability to trust others and form intimate relationships Coping behaviors may be misinterpreted as being "noncompliant" oleading to negative reactions by health care providers.

Evidence-Based Nursing Care for Persons With Substance-Related Disorders; Assessment

Behaviors and substance use history (refer to Box 31.6 and Nursing Care Plan 31.1) Denial of problem Motivation for change (see Box 31.8) Countertransference Codependence Substance Abuse Assessment See Box 31.7

Safe alcohol withdrawal usually is accomplished with the administration of which medication classification?

Benzodiazepines

Major Depressive Disorder Theories:

Biologic theories oGenetics oNeurobiologic hypotheses oNeuroendocrine and neuropeptide hypotheses oPsychoneuroimmunology Psychological theories oPsychodynamic factors oBehavioral factors oCognitive factors oDevelopmental factors Social theories oFamily factors oEnvironmental factors

Evidence-Based Nursing Care for Persons with Anorexia Nervosa Disorder; Physical Assessment:

Body system evaluation Weight and body mass index (BMI) Menstrual history

A client with bipolar disorder has been ordered a medication that is classified as an anticonvulsant. Which drug does the nurse know falls within this class of medications?

Carbamazepine -Carbamazepine is an anticonvulsant with mood-stabilizing effects. Lithium is a mood stabilizer. Mannitol and methyldopa are not used in the treatment of bipolar disorder.

Bipolar I Disorder Across the Life-Span:

Children and adolescents oDepression usually occurring first; marked by intense rage oSymptoms reflective of developmental level of the child Older adults oGreater neurologic abnormalities and cognitive disturbances oIncidence of mania decreased with agee

Family Response to Obsessive-Compulsive Disorder

Considerable caregiving burden on families o Linked to family distress -Family accommodation -Family assessment -Family involvement

When working with the family of a client with anorexia nervosa, which of the following issues must be addressed?

Control issues

What increases the risk for neuroleptic malignant syndrome (NMS)?

Dehydration

Which is the most common disorder found in clients diagnosed with bulimia nervosa?

Depression

Which client population has the highest risk for suicide?

Elderly men

In the United States, nearly 60 percent of male suicide victims die by which method?

Firearms

Household or commercial products, such as butane lighters and propane tanks, whipped cream aerosols or dispensers, and refrigerant gases, and medical anesthetics such as ether, chloroform, halothane, and nitrous oxide ("laughing gas")

Gases

Medication Interventions (Bipolar Disorder):

Goals: rapid control of symptoms and prevention of future episodes or, at least, reduction in their severity and frequency Mood stabilizers Lithium Divalproex sodium Carbamazepine Lamotrigine Antipsychotics Other: Electroconvulsive therapy, Transcranial magnetic stimulation

What is priority in care when dealing with a patient who is suicidal?

Initiate the least restrictive care possible

The nurse is providing teaching to a client diagnosed with schizoaffective disorder. The nurse should explain to the client that which is true about this disorder?

It is a mix of psychotic and mood symptoms.

This is the probability that a person will successfully complete suicide

Lethality

What is the priority nursing intervention when caring for a patient who is withdrawing from alcohol?

Observing for signs of seizure activity

What are some trauma and stress related disorders?

PTSD Acute stress disorder (ASD) Dissociative Disorders

Extreme, overwhelming form of anxiety often experienced when an individual is placed in a real or perceived life-threatening situation

Panic Disorder -Panic attacks: sudden, discrete periods of intense fear or discomfort accompanied by significant physical and cognitive symptoms

A client is admitted to a mental health unit with reports of fatigue, poor appetite, and difficulty making decisions. The client also reports having felt unhappy most of the time for "as long as I can remember." Which diagnosis should the nurse anticipate for this client?

Persistent depressive disorder -Persistent depressive disorder, or dysthymic disorder, is relatively mild compared to major depressive disorder but is chronic. It is diagnosed when the depressed mood exists for most days for at least 2 years with two or more of the following symptoms: poor appetite or overeating, insomnia or oversleeping, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness.

_____ influences the appraisal process and the ability to cope with the stress.

Personality

An irrational fear of an object, person, or situation that leads to a compelling avoidance

Phobias -May be the outcome of extreme anxiety -Are often present in anxiety disorders but may also develop into a specific phobia disorder -Defense mechanisms and anxiety -Used to reduce anxiety by preventing or diminishing unwanted thoughts and feelings

Evidence-Based Nursing Care of Persons with Depressive Disorder:

Physical Health oPhysical systems review and thorough history of medical problems oMedication history: prescribed and over-the-counter medications; alcohol and mood-altering substances; herbal substances oPhysical examination oSymptoms -Appetite and weight changes -Sleep disturbance -Tiredness, decreased energy, and fatigue Physical Functioning Psychosocial Assessment

Clinical Judgement and Therapeutic Relationship (Bulimia):

Priority is to address emerging medical problems Suicide or self-harm behaviors should also be addressed Staff must -Present a nonjudgmental, accepting approach -Stressing the importance of the relationship and outlining its purpose -Explaining the nature of the relationship and the goals of therapy will help clarify the boundaries Client feels -Shame and guilt -Strong need to please

Child is inhibited, emotionally withdrawn behavior toward an adult caregiver

Reactive attachment disorder

Some research has suggested that schizophreniform disorder may be an early manifestation of which other mental health condition?

Schizophrenia

Mental and Health assessment of bulimia:

Similar to those of anorexia nervosa Hypokalemia Tooth enamel erosion Current eating patterns Number of times per day of binging and purging Dietary-restraint practices Sleep patterns Exercise habits

A persistent fear of social or performance situations in which embarrassment may occur

Social Anxiety Disorder

Interventions for monitoring physical care (bulimia):

Strict monitoring of food intake Supervision of bathroom visits Sleep management

What is resilience?

The capacity to withstand stress and catastrophe. It develops over time and is the culmination of multiple internal and external factors.

A client with schizophrenia is prescribed an antipsychotic medication. Which immediate side effects would the nurse include in the education plan for this medication?

The potential for sedation

Psychosocial interventions for patients with eating disorders:

Therapeutic interactions Enhancing cognitive functioning Using behavioral intervention Similar to those used for depression and anxiety

Wernick-Korsakoff syndrome is a neurologic condition that can result from heavy drinking. Which of the following medications is used to prevent Wernicke-Korsakoff syndrome?

Thiamine (vitamin B1)

Clinical Judgement in patients with eating disorders:

Top priorities -Medical complications -Bradycardia -Hypotension -Electrolyte imbalances -Suicide ideation

A nurse is conducting a group session in the behavioral health unit for three clients on the topic of anxiety. The nurse determines that the session was successful based on which statement by the clients?

"Anxiety cannot be completely eliminated from my life." -Anxiety is distinguished from fear, which is feeling afraid or threatened by a clearly identifiable external stimulus that represents danger to the person. Anxiety is unavoidable in life and can serve many positive functions, such as motivating the person to take action to solve a problem or to resolve a crisis.

The nurse provides care for a client who is diagnosed with anorexia nervosa. Which question should the nurse ask to assess the client for neuropsychiatric complications associated with the diagnosed eating disorder?

"Do you experience abnormal taste sensations?" -There are many complications associated with eating disorders, including anorexia nervosa. The neuropsychiatric complications include abnormal taste sensations, often due to zinc deficiency. Other neuropsychiatric complications include apathetic depression, fatigue, mild organic mental symptoms, and sleep disturbances. Abnormal menstrual cycles and/or amenorrhea are reproductive complications associated with anorexia nervosa. Dermatologic complications include dry skin and brittle nails. Constipation and/or diarrhea are both gastrointestinal complications associated with anorexia nervosa.

During a therapy session, a client with anorexia tells the nurse, "I measured my thighs today. They are a quarter-inch larger than they were yesterday. I feel like a pig; I'm so fat." Which potential response by the nurse is most therapeutic?

"Has something occurred that caused you to measure your thighs?" -The nurse helps the client recognize the influence of maladaptive thoughts and identify situations and events that cause concern about physical appearance and weight. In discussing these situations, the nurse and client can begin to identify anxiety-provoking events and develop strategies for managing such situations without resorting to self-damaging behaviors.

The nurse is talking with the spouse of a client admitted for substance use disorder and overdose. Which statement(s) made by the spouse indicates that they are exhibiting enabling behaviors? Select all that apply. "I can't keep money in the house and have to lock up jewelry in a safe." "I am so scared about my spouse getting fired; I often call in sick so they won't." "If I don't give them money for the drugs, they will just steal it anyway." "My spouse had a terrible childhood and I would probably do the same things." "I told my spouse that in order to be able to come home, they will first have to go to rehab."

"I am so scared about my spouse getting fired; I often call in sick so they won't." "If I don't give them money for the drugs, they will just steal it anyway." "My spouse had a terrible childhood and I would probably do the same things."

A client on an in-patient psychiatric unit has been diagnosed with bulimia nervosa. The client states, "I'm going to the bathroom and will be back in a few minutes." Which response by the nurse is most appropriate?

"I will accompany you to the bathroom."

A client asks the nurse, "How can I tell if what I am experiencing is just regular worrying and not an anxiety disorder?" What is the nurse's best response?

"If you are unable to function occupationally and socially because of the anxiety" -Anxiety disorders comprise a group of conditions that share a key feature of excessive anxiety with ensuing behavioral, emotional, cognitive, and physiologic responses. It should viewed as a disorder when the anxiety impairs daily routines, a person's social life, and occupational functioning. For example, if anxiety is causing a person to be ineffective at work or impacting the quality of the person's relationships, the person can be identified as having an anxiety disorder. People can require medication, have trouble falling asleep, or feel nervous before a big event due to excessive worry or anxiety, however, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, these are not criteria used in determining the presence of this

The nurse is caring for a teenage client who has been inhaling over-the-counter solvents. The nurse is educating the client and family regarding inhalants and determines that education was effective when the client makes which statement?

"Inhalant effects are similar to those I experienced using alcohol." -They also depress the CNS

A nurse, sitting with a client diagnosed with anorexia nervosa, notices that the client has eaten 80 percent of lunch. The client asks the nurse, "What do you like better, hamburgers or spaghetti?" Which is the best response by the nurse?

"Let's focus on your continued improvement. You ate 80 percent of your lunch."

The nurse is working with a client who is suspected of having posttraumatic stress disorder after witnessing a violent crime. What statement by the client's spouse would suggest that the client is experiencing hyperarousal?

"My spouse always seems so irritated now, which isn't like my spouse." -Irritability is a hallmark of hyperarousal. Overeating, loss of sexual interest, and hypersomnia are not associated with hyperarousal.

The nurse working on a mental health unit is teaching a nursing student. The student asks the nurse about what constitutes a diagnosis for major depressive disorder. What is the nurse's best response?

"The primary diagnostic criterion is one or more major depressive episodes for at least 2 weeks with other symptoms present."

A client with obsessive-compulsive disorder has been taking fluoxetine for 1 month. The client tells a nurse, "These pills are making me sick. I think I'm getting a brain tumor because of the headaches." Which response by the nurse would be most appropriate?

"These medications have side effects that can cause increased headaches." -Individuals with obsessive-compulsive disorder need frequent reassurance that the side effects are a common response to the medication and that they are not becoming ill. Ignoring the client's concerns will only increase the client's anxiety.

The client has an order for an anxiolytic agent, lorazepam (Ativan). Which of the following statements by the client would indicate that client education about this medication has been effective?

"This medication will relax me so I can focus on problem solving." -Anxiolytics are designed for short-term use to relieve anxiety. These drugs are designed to relieve anxiety so that the person can deal more effectively with whatever crisis or situation is causing stress. Benzodiazepines have a tendency to cause dependence. Clients need to know that antianxiety agents are aimed at relieving symptoms such as anxiety but do not treat the underlying problems that cause the anxiety.

Bipolar I:

(major depressive, manic, or mixed episode) -Classic manic-depressive disorder with mood swings alternating from depressed to manic -Mania: a distinct period (of at least 1 week or less if hospitalized) of abnormally and persistently elevated, expansive, or irritable mood with abnormally increased goal-directed behavior or energy

Medical Complications of Alcohol Abuse:

(picture)

Warning Signs for Suicide:

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What is refeeding syndrome characterized by?

(severe electrolyte disturbances) Hypophosphatemia is a precursor -circulatory fluid overload, respiratory failure, and cardiac failure

What is the prodromal period of schizophrenia?

-(stage of early changes that are a precursor to the disorder) may begin in early childhood -tension and nervousness, lack of interest in eating, difficulty concentrating, disturbed sleep, decreased enjoyment and loss of interest, restlessness, forgetfulness, depression, social withdrawal from friends, feeling laughed at, more thinking about religion, feeling bad for no reason, feeling too excited, and hearing voices or seeing things

How does meth use affect children and parents?

-Babies born to meth-addicted mothers are highly irritable and frequently present with learning or other developmental delays. -Parents addicted to methamphetamine often cannot meet parenting responsibilities even after abstaining. -need continuing support to achieve the parenting role, including interdisciplinary support from child welfare and addiction treatment services

Etiology of bulimia nervosa:

-Biologic theories Neuropathologic factors Genetic and familial predispositions Biochemical: ↓ serotonin neurotransmission -Psychological and social theories Psychological factors + environmental or sociocultural factors Cognitive theory Family: chaotic, few rules, unclear boundaries

Therapeutic Relationship (Bipolar Disorder):

-Both interesting and exhausting Provide refocusing Remain calm and avoid power struggles Avoid confrontations (see Box 26.4) Respect personal space Meet with client "where they are" -Vital to preventing relapse

Nursing Management: Prevention of Suicide and Promotion of Mental Health; Assessment:

-Case finding: identifying people who are at risk for suicide to initiate proper treatment -Assessing risk: Identification of suicidal ideation Elicitation of a plan Determination of the severity of intent Evaluation of availability of means

Non-Substance-Related Addictive Disorders:

-Certain compulsive behaviors characterized by risky use, urges, cravings and "highs" make them similar to substance intoxication and dependence -Behavioral addictions may have similar neurocircuitry involved in reward, motivation as substance use disorders Gambling Internet addiction Sex addiction Food addiction See Table 31.5

Non-drug associated addictions

-Certain compulsive behaviors characterized by risky use, urges, cravings and "highs" make them similar to substance intoxication and dependence -Behavioral addictions may have similar neurocircuitry involved in reward, motivation as substance use disorders Gambling Internet addiction Sex addiction Food addiction See Table 31.5

Schizophrenia Across the Life-Span:

-Children: Diagnosis is rare in children before adolescence Hallucinations tend to be visual and delusions less developed Developmental abnormalities in childhood have been found to be present in individuals who experience schizophrenia in adulthood -Older adults: If present since young adulthood, this may be a time in which they experience some improvement in symptoms or decrease in relapse fluctuations Evidence that suggests may be more likely to develop cognitive impairment

What are psychological theories of suicide?

-Cognitive theories: cognitive triad; hopelessness, and other cognitive symptoms -Emotional factors, personality traits Interpersonal-psychological theory of suicidal behavior

Bipolar II

-Cyclothymic disorder (hypomania and depressive episodes not meeting full criteria for major depressive episode)

How does suicide affect families?

-Devastating effects on families -Increased risk for suicide death in another family if suicide death in a family occurs -Survivors with increased grief, anxiety, depression, guilt, shame, self-blame, and family dysfunction -Protective factors

Dissociative Disorders:

-Dissociative amnesia: Inability to recall important yet stressful information -Depersonalization/derealization disorder: Feeling of being detached from one's mental processes -Dissociative identity disorder (DID) (formerly called multiple personality disorder): Presence of at least two distinct personality or identity states

side affects of antipsychotics used in patients with schizophrenia:

-Extrapyramidal side effects Parkinsonism; anticholinergic effects Dystonic reactions Akathisia Tardive dyskinesia -Other side effects Orthostatic hypotension Hyperprolactinemia Sedation; weight gain New-onset diabetes Cardiac arrhythmias Agranulocytosis

What are ways to ensure safety in a suicidal patient?

-Help the patient feel more secure and hopeful -Observe regularly for suicidal behavior -Remove dangerous objects -Provide outlets for expression

Documentation and Reporting (Suicide)

-History, assessment, and interventions -Presence or absence of suicidal thoughts, intent, plan, and available means -Use of drugs, alcohol, or prescription medications -Level of the patient's judgment -Prescribed medications, dosage and number of pills dispensed -Plan for ongoing treatment

Treatment and Nursing Care for Suicide Prevention:

-Interdisciplinary treatment and recovery o Clinical judgment -Priority care: psychiatric emergency o Initiate the least restrictive care possible -Ensuring safety o Help the patient feel more secure and hopeful o Observe regularly for suicidal behavior o Remove dangerous objects o Provide outlets for expression

Epidemiology and Risk Factors for Bipolar Disorder:

-Lifetime prevalence: 1% to 4% -Symptom onset: ages 14 to 21; fewer cases after 40 -No gender differences in incidence -Female patients at greater risk for depression and rapid cycling than male patients -Male patients at greater risk for manic episodes -Ethnicity and culture links require additional study -Common comorbid conditions: anxiety disorders (most prevalent: panic disorder and social phobia) and substance use

Evidence-Based Nursing Care of Persons with Bipolar Disorder:

-Mental Health Nursing Assessment -Physical Health oChanges in activity, eating, and sleep patterns oDiet and body weight oLaboratory testing: thyroid function oChanges in sexual practices -Pharmacologic assessment oPrevious use of antidepressants oDiscontinuation of mood stabilizers

Maintenance Treatment of opioid dependance/abuse:

-Methadone maintenance: satisfies the opioid craving without producing the subjective high -Detoxification: setting the beginning methadone dose and then slowly reducing it during the next 21 days; receive this dose daily in conjunction with regular drug abuse counseling focused on the elimination of illicit drug use -Naltrexone & Buprenorphine: adding naloxone to buprenorphine is to protect the patient from an overdose -Subutex: safe in pregnant women

Signs of Chemical Dependency in Nurses:

-Mood swings; inappropriate behavior at work -Noncompliance with acceptable policies and procedures -Deteriorating appearance, job performance -Sloppy, illegible charting; errors in charting -Alcohol on breath -Forgetfulness; poor judgment and concentration -Lying -High achievement -Volunteering for overtime or extra duties -Onset after prescription after surgery or a chronic illness -Family history alcoholism or addiction

Recovery-oriented care for persons with schizophrenia:

-Pharmacologic management -Psychosocial interventions -Priority care issues -Suicide assessment -Aggression and safety of patient, staff, others -Antipsychotic medications

What is the diagnostic criteria for OCD?

-Presence of obsessions or compulsions -Patient recognition that thoughts and actions are unreasonable or excessive -Thoughts and rituals causing severe disturbance in daily routines, relationships, or occupational function; time consuming, taking longer than 1 hour a day to complete -Thoughts or behaviors not a result of another disorder -Thoughts or behaviors not a result of the presence of a substance or a medical condition

Biologic Responses to Cocaine:

-Rapid intoxication occurs when cocaine is injected intravenously or inhaled -Increased dopamine causes euphoria and psychotic symptoms -increases norepinephrine levels in the blood: tachycardia, hypertension, dilated pupils, and rising body temperatures -Serotonin excess: sleep disturbances and anorexia -With prolonged cocaine use, these neurotransmitters are eventually depleted.

Nursing Interventions: Imminent Risk:

-Reconnecting the patient to other people and instilling hope -Restoring emotional stability and reducing suicidal behavior -Ensuring safety

Evidence-Based Nursing Care for Persons With Substance-Related Disorders: Evaluation

-Recovery from alcoholism is a journey, often lasting a lifetime -Recovery involves a change in lifestyle and, often, new relationships -Short-term outcomes can be evaluated within the treatment setting -Long-term outcomes are established and evaluated by the patient who often continues to use professional and nonprofessional support as needed.

Chemical Dependency and Professional Nurses:

-Risk factors exist such as access and availability of drugs, training in the administration and injection of drugs, and a familiarity with and a frequency of administering drugs. -Working conditions, staffing shortages, acutely ill patients, inadequate patient to nurse ratios, shift rotation, shifts lasting longer than 8 hours, and increased overtime -Risk of loss of license; nurses reluctant to seek help -Some states with mandatory reporting laws -Any nurse who knows of any health care provider's incompetent, unethical, or illegal practice must report that information through proper channels -Peer assistance programs

Evaluation and Treatment Outcomes (Suicide)

-Short-term outcomes: Maintaining the patient's safety Averting suicide Mobilizing the patient's resources -Long-term outcomes: Continuum of care Maintaining the patient in psychiatric treatment Enabling the patient and family to identify and manage suicidal crises effectively Widening the patient's support network

Nursing Interventions: Social Domain:

-Social skills training -Development of support networks -Stigma reduction

Panic Disorder: Emergency Care

-Stay with the patient -Reassure him or her that you will not leave -Give clear, concise directions -Assist the patient to an environment with minimal stimulation -Walk or pace with the patient -Administer PRN anxiolytic medications -Afterward, allow the patient to vent his or her feelings

What are some characteristics of cocaine?

-Stimulant -Increases Dopamine, NE, and SER which may lead to euphoria, psychosis, elevated HR, HTN and dilated pupils, Temp. and problems with anorexia and sleep -Effect: sudden burst of mental alertness and energy, feelings of self-confidence, being in control, sociability -"Cocaine rush" lasts 10 to 20 minutes followed by an intense letdown effect "Cocaine Blues" irritability, depression, tiredness, and craving more drug

Recovery-Oriented Care for Persons with Anorexia Nervosa:

-Teamwork and collaboration: Working toward recovery Safety issues -High mortality -Suicide Ø Monitor for lethal plan -Cardiopulmonary arrest

What is diagnostic criteria and treatment options for binge eating disorder?

-The diagnostic criteria Binge eating Includes both the ingestion of a large amount of food in a short period of time and a sense of loss of control during the binge Distress regarding the binge Eating until uncomfortably full Feelings of guilt or depression after the binge -Treatment Psychotherapy Pharmacotherapy Weight loss treatment

Psychosocial Interventions (Bipolar Disorder):

-Therapeutic Interactions -Enhancing Cognitive and Behavioral Functioning oIndividual cognitive-behavioral therapy oIndividual interpersonal therapy oAdjunctive therapies -Psychoeducation oWellness strategies oSocial skills training -Providing Family Education -Promoting Safety -Implementing Milieu Therapy -Support Groups -Developing Recovery-Oriented Rehabilitation Strategies Evaluation and Treatment Outcomes

Nicotine Withdrawal and Smoking Cessation:

-Withdrawal: mood changes (e.g., craving, anxiety, irritability, depression) and physiologic changes (difficulty in concentrating, sleep disturbances, headaches, gastric distress, increased appetite) -nicotine transdermal patches, nicotine gum, nasal spray, and inhalers are successful to assist in withdrawal -Successful smoking cessation usually requires more than one type of intervention (social support and education) Treatment: -Auricular therapy, or ear acupressure -Meds: bupropion, varenicline tartrate

Emergency treatment of individuals:

-assessment of CNS functioning, specifically arousal and respiratory functioning -Naloxone (rescue drug when extreme drowsiness, slowed breathing, or loss of consciousness occurs); reverses respiratory depression, sedation, and hypotension caused by the opioid agent

What are examples of ineffective coping?

-emotion-focused coping when a problem-focused approach is appropriate, such as if a woman reinterprets an abusive situation as her fault instead of getting help to remove herself from the environment. -Some coping strategies actually increase the risk for mortality and morbidity, such as the excessive use of alcohol, drugs, or tobacco.

Who is Hans Selye?

-he defined stress as a nonspecific response to an irritant, a perceived danger, or a life threat -stress evoked by positive emotions or events eustress and stress evoked by negative feelings and events distress -showed that corticosteroid secretion from the pituitary gland increased during stress and contributed to development of illnesses (general adaptation syndrome (GAS))

What reactions occur when the "fight or flight" response is initiated?

-heart rate, blood pressure, and blood sugar increase -energy is mobilized for survival -sympathetic system is activated, the parasympathetic is muted -after there is no longer a need for more energy and the threat is over, the body returns to a state of homeostasis

Marijuana use:

-impairs the ability to form memories, recall events, and shift attention from one thing to another; disrupts coordination of movement, balance, and reaction time -irritant to the lungs, and can produce the same respiratory problems experienced by tobacco users -relaxation, euphoria, at times dyscoria (i.e., abnormal pupillary reaction or shape), spatial misperception, time distortion, and food cravings. -relaxation and drowsiness -decreased motivation after long-term use

high doses of anabolic steroids:

-increase irritability and aggression, "roid rage." -aggressive acts, such as physical fighting, armed robbery, using force to obtain something, committing property damage, domestic violence, stealing from stores, or breaking into a house or building. -euphoria, increased energy, sexual arousal, mood swings, distractibility, forgetfulness, and confusion

What is the acute illness period of schizophrenia?

-late adolescence or early adulthood -may be subtle; at some point become disruptive or bizarre -staying up all night for several nights, incoherent conversations, or aggressive acts against oneself or others -As symptoms worsen, patients are less and less able to care for their basic needs (e.g., eating, sleeping, bathing) -high risk for suicide; Substance use is common; Functioning at school or work deteriorates

pediatric acute-onset neuropsychiatric syndrome (PANS)

-link between infection with β-hemolytic streptococci and other infections and a subset of acute-onset OCD -First signs may be the dramatic (2 or 3 days) onset of obsessions and compulsions and overwhelming anxiety (fears); sudden eating restrictions and personality changes -Treatments such as antibiotics and immunomodulatory interventions have been suggested

Describe the use of disulfiram in the use of alcoholism:

-neither a treatment nor a cure for alcoholism -help deter some individuals from drinking; Disulfiram plus even small amounts of alcohol produces episodes of severe nausea and vomiting -Severe reactions: respiratory depression, cardiovascular collapse, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death

transcranial magnetic stimulation (TMS)

-noninvasive procedure that uses magnetic fields to stimulate brain cells -contraindicated for patients with implanted metallic objects or implanted stimulator devices in or near the head -During treatment, the patient wears earplugs to reduce exposure to the loud noises made by the device. -headaches and other muscle discomforts or pain are side effects

Describe major depressive disorder:

-one or more moods, which is either a depressed mood or a loss of interest or pleasure in nearly all activities for at least 2 weeks -disruption in sleep, appetite (or weight), concentration, or energy; psychomotor agitation or retardation; excessive guilt or feelings of worthlessness; and suicidal ideation -the initial onset may occur in puberty; the highest onset occurs within persons in their 20s

Inhalant Intoxication:

-range from mild impairment to severe dementia -diminished ability to focus attention, plan, and solve problems -change brain chemistry and may permanently damage the brain and CNS

Biologic Response to Nicotine:

-stimulates the central, peripheral, and autonomic nervous systems, causing increased alertness, concentration, attention, and appetite suppression -Smoking causes respiratory problems, lung cancer, emphysema, heart problems, and peripheral vascular disease -Repeated use of nicotine produces both tolerance and addiction. -most of those who quit relapse within 1 year

A client with bipolar disorder is receiving lithium therapy. The nurse is reviewing the client's serum plasma drug levels and determines that the client's level is therapeutic based on what?

1.0 mEq/L -Serum plasma lithium levels should range from 0.6 to 1.2 mEq/L. Levels above that suggest toxicity (moderate toxicity for levels 1.5 to 2.5 mEq/L; severe toxicity for levels greater than 2.5 mEq/L).

A client who was receiving a monoamine oxidase inhibitor (MAOI) is to be switched to a selective serotonin reuptake inhibitor (SSRI). The nurse would expect to begin administering the SSRI how many days after the MAOI is discontinued?

14 days

Research has shown that risk of suicide increases within which time frame for initiation of antidepressant therapy?

14 days

The mental health nurse appropriately provides education on light therapy to which client?

20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term -Phototherapy—or the exposure to bright artificial light—can markedly reverse the symptoms of seasonal affective disorder, which occurs in the fall and winter. Phototherapy would be most appropriate for a 20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term.

A client with alcohol abuse is to receive disulfiram. The client's last drink was at 4 PM. The client should receive the medication no earlier than at which time?

4 AM A client should not receive disulfiram until he or she has abstained from alcohol for at least 12 hours, in this case, 4 AM.

A nurse is engaged in case finding. Which activity would be involved? Identifying those at risk Assessing for suicidal ideation Ascertaining for a suicide plan Determining the severity of the intent

A Case finding involves identifying people who are at risk for suicide to initiate proper treatment. Identifying suicidal ideation, ascertaining a suicidal plan, and determining the severity of the intent are activities involved in risk assessment.

The medical-surgical nurse has worked with numerous clients who have had difficult and stressful courses of treatment. What client likely faces the greatest risk for developing post-traumatic stress disorder?

A child who has endured repeated treatments for cancer over multiple admissions -Medical problems and hospitalizations are known to be intensely stressful. However, the risk of PTSD is particularly high among cancer survivors, especially those with multiple admissions and prolonged treatment. In a landmark study, childhood cancer survivors have been found to have four times the risk of developing PTSD as their siblings.

Which sleep pattern is suggestive of a manic episode?

A client stays awake for several days and nights before "crashing" and sleeping for a long period.

Which client is most likely to be diagnosed with body dysmorphic disorder (BDD)?

A client who firmly believes that everyone who sees the client fixates on the size of the client's ears -BDD is characterized by a disproportionate focus on a minor physical characteristic. Clients with BDD do not necessarily binge and purge or engage in dangerous weight loss. Underestimation of obesity is not typical of BDD.

The mental health nurse explains that the difference between an obsession and a compulsion can correctly be identified as what?

A compulsion involves repeating a seemingly purposeful action. -An obsession is a persistent, painful, and intrusive thought, emotion, or urge that the client is unable to suppress or ignore, while a compulsion is the performance of a repetitious, seemingly purposeful act to prevent some future event or situation.

A nurse's colleague expresses sympathy for a client who is traumatized following a terrorist attack 1 week earlier. The colleague states, "I'm certain that the client has posttraumatic stress disorder (PTSD)." What is the nurse's best response?

A diagnosis of PTSD requires 1 month of symptoms. Acute stress disorder exists closer to the traumatic event and may develop into PTSD if not resolved. Anxiety is not necessarily self-limiting.

The parents of a teenage girl who has just been diagnosed with anorexia nervosa are distraught at this development, stating, "We have no idea where this all came from." The anorexia nervosa client is typically what?

A high achiever -The preanorectic client is generally considered to be a "model child and student" who is meek, compliant, perfectionistic, and overachieving.

Describe primary appraisal:

A person evaluates the events occurring in their life as a threat, harm, or challenge. During primary appraisal of an event, the person determines whether (1) the event is relevant, (2) the event is consistent with their values and beliefs, and (3) a personal commitment is present.

Anticholinergic Medication Effects and Abuse:

Abuse of anticholinergic medications Effects of these drugs on mood, memory, and perception considered pleasurable At toxic dosages, patients may experience a mild delirium with disorientation and hallucinations Lesser doses may cause patients to experience greater sociability and euphoria

This is a delayed-release tablet that decreases alcohol intake and reduces the risk of returning to drink alcohol in the person who is alcohol-dependent

Acamprosate calcium -maintenance of abstinence from alcohol in patients who are alcohol-dependent -only if the individual is abstinent from alcohol prior to its initiation

After being diagnosed with a chronic disease, a client has been feeling depressed. Which diagnosis has the strongest association with an increased suicide risk?

Acquired immunodeficiency syndrome -The World Health Organization notes that chronic physical illness and certain physical illnesses contribute to higher suicide risk in some individuals. Neurologic diseases such as epilepsy and spinal and brain injury have been associated with increased suicide risk. HIV infection and AIDS also pose increased suicide risk, particularly at the time of diagnosis. Pain also has been identified as a significant contributing factor.

Pervasive and sustained emotion that colors one's perception of the world and how one functions in it

Affect: expression of mood Blunted Bright Flat Inappropriate Labile Restricted or constricted

According to Hans Selye, which stage of reaction to stress stimulates the body to send messages from the hypothalamus to the glands and organs to prepare for potential defense needs?

Alarm reaction In the alarm reaction stage, stress stimulates the body to send messages from the hypothalamus to the glands and organs to prepare for potential defense needs. In the resistance stage, the digestive system reduces function to shunt blood to areas needed for defense. The exhaustion stage occurs when the person has responded negatively to anxiety and stress. There is no autonomic stage.

A client with a history of heavy alcohol use, whose last drink was 24 hours ago, is seen in the emergency department. The nurse assesses the client and finds the client is oriented but is tremulous, weak, sweaty and has some gastrointestinal (GI) symptoms. Which issue do these symptoms correlate with?

Alcohol withdrawal syndrome -Withdrawal from alcohol produces shakiness, weakness, diaphoresis, and GI symptoms. These are not symptoms of continuing intoxication. Delirium tremens produce hypertension, delusions, hallucinations, and agitated behavior. Wernicke-Korsakoff syndrome is a type of dementia caused by long-term, excessive alcohol intake that results in a chronic thiamine or vitamin B6 deficiency.

A client was admitted to the psychiatric intensive care unit with schizophrenia. Among the client's signs and symptoms, the client was experiencing nihilistic delusions. The nurse understands that these delusions involve a belief about what?

An impending calamity, such as death

What is is the individual perception that an event or situation is a threat?

Appraisal -One situation may be perceived as threatening to one person but not to another -The more important or meaningful the event, the more vulnerable the person is to stress. For example, chest pain is threatening not only because of the immediate pain and incapacitation but also because the pain may mean a heart attack is occurring. The individual is afraid that they may not have the physiologic resources to survive the attack.

A nurse is assessing a client who has come to the clinic for evaluation of anxiety. During the interview, the client states, "When I see a spider, my heart starts to pound, I can't breathe and I start perspiring profusely. I'm deathly afraid of them." The nurse interprets this client's statement as which type of phobia?

Arachnophobia -The client's statements reflect arachnophobia, a fear of spiders. Agoraphobia refers to a fear of open spaces; entomophobia refers to a fear of insects; cynophobia refers to a fear of dogs.

A client's depression is being treated in the community with phenelzine. The client has presented to the clinic stating, "I had a few beers and I'm feeling absolutely miserable." What is the nurse's best action?

Assess the client's blood pressure -Combining phenelzine with beer can precipitate a hypertensive crisis. There is no immediate indication that an emergency code is needed. The client's jugular venous pressure is less likely to be affected and is not a priority for assessment. Performing the MMSE is not a short-term priority.

The psychiatric mental health nurse is working with a client who has been diagnosed with posttraumatic stress disorder (PTSD). Assessment reveals that the client is experiencing frequent episodes of intrusion. The nurse should consequently prioritize what assessment?

Assessing the quantity and quality of the client's sleep -Intrusion almost always takes a toll on the client's sleep. Communication and social support are only peripherally related to episodes of intrusion. Intrusion will certainly affect the client's vital signs, but these changes are unlikely to be as problematic as sleep difficulties.

Nursing management for treating physiological response to stress:

Assessment • Emotions and their severity • How the person reacts to emotions Coping strategies • Problem focused • Emotion focused Nursing Diagnosis • Hopelessness • Powerlessness • Fear and low self Esteem Interventions • Assist patients to develop appropriate problem-solving strategies • Have the patient discuss the person-environment situation and develop alternative coping strategies

Nursing management for treating the social response to stress:

Assessment • Recent life changes • Social network • Nursing Diagnosis • Ineffective Role Performance • Impaired Social Interaction • Social Isolation Interventions • Facilitation of family functioning • Assistance in expanding social network • Support of family unit functioning • Parent education • Family therapy

Nursing process for identifying stress:

Assessment: • Physical and Psychosocial Nursing Dx: • Imbalanced Nutrition: Less Than Body Requirements • Disturbed Sleep Pattern • Impaired Mobility Nursing Interventions: • Nutrition • Exercise • Relaxation Techniques

Which intervention reflects the psychological domain when providing care to a patient who has attempted suicide? Providing care for the self-inflicted injury Challenging the patient's suicidal mindset Providing social skills training Administering medications

B Challenging the patient's suicidal mindset would be an intervention addressing the patient's psychological domain. Providing care for the self-inflicted injury and administering medications reflect the biologic domain. Providing social skills training reflects the social domain.

Which of the following would the nurse expect to assess in a patient experiencing akathisia? Resting tremor Motor restlessness Masklike face Shuffling gait

B. Akathisia is manifested by obvious motor restlessness such as rocking, pacing, or shifting from foot to foot. Resting tremor, masklike face, and a shuffling gait would characterize Parkinsonism.

Which agent would most commonly be prescribed for a patient with bipolar I disorder? Lamotrigine Lithium Carbamazepine Divalproex

B. Lithium Although divalproex, carbamazepine, and lamotrigine may be used as mood stabilizers, lithium is the most widely used mood stabilizer.

Which is a food that might be incorporated into the plan of care for a client diagnosed in the manic phase of bipolar disorder?

Bananas -For a client who is unable to sit long enough to eat, snacks and high-energy foods that can be eaten while moving should be provided.

Amphetamines (Biphetamine, Delcobese, dextroamphetamine) and other stimulants, such as phenmetrazine and methylphenidate (Ritalin, Focalin), act on the _____ and ______ nervous system.

CNS, peripheral -used to treat ADHD in adults and children, narcolepsy, depression, and obesity -abuse uses: alertness, increased concentration, a sense of increased energy, euphoria, and appetite suppression -tachycardia, arrhythmias, increased systolic and diastolic blood pressures, and peripheral hyperthermia -an overdose, are similar to those of cocaine.

A nurse is reviewing the medical records of several clients who have come to the community health center. The nurse most likely identifies a client experiencing which event as being at risk for developing posttraumatic stress disorder (PTSD)? Select all that apply. Being a survivor of a tsunami that resulted in thousands of deaths Being stranded at the office during a typical winter storm that was anticipated Being a marine in a combat situation where the entire platoon was wiped out, except for one person Being hidden in a closet and hearing the entire family murdered by someone who broke into the home Watching televised segments of the moment when the plane hit the second tower on 9/11

Being a survivor of a tsunami that resulted in thousands of deaths Being a marine in a combat situation where the entire platoon was wiped out, except for one person Being hidden in a closet and hearing the entire family murdered by someone who broke into the home

The nurse is assisting a client with an eating disorder to accept their body image and use effective coping skills. Which will the nurse discuss with the client in relation to body acceptance and coping skills?

Being able to cope in healthy ways improves the ability to accept a realistic body image.

Which medication classifications used in the treatment of panic disorder can cause physical dependence?

Benzodiazepines -SSRIs, SNRIs, TCAs, monoamine oxidase inhibitors (MAOIs), and antianxiety medication (benzodiazepines) have been shown to be effective in panic disorders. Benzodiazepines are well tolerated but physical dependence is a potential side effect, and they carry the risk of withdrawal symptoms upon discontinuation of use.

When a client with obsessive-compulsive disorder (OCD) has developed self-harming thoughts and actions, the emergency department nurse should expect to administer which medication to assist with the client's anxiety/panic?

Benzodiazepines such as lorazepam -Although only individuals with severely debilitating symptoms or self-harming thoughts and actions are hospitalized, clients may experience intense anxiety symptoms to the point of panic. In such an emergency, benzodiazepines and other anxiolytics can be used.

What are the components of the etiology of addiction?

Biologic components -Genetic predisposition: no genetic marker found -Psychosocial components -Temperament -Feelings about self; age -Motivation for change Environmental factors -Parental and family relationships -Peer pressure

Biological and psychological theories of panic disorder:

Biologic theories oSerotonin and Norepinephrine oGamma-Aminobutyric Acid oHypothalamic-Pituitary-Adrenal Axis Psychological and social theories oPsychoanalytic and psychodynamic theories oCognitive-behavioral theories

Other Bipolar and Related Disorders:

Bipolar II -Primarily depressed with brief periods of elevated, expansive, or irritable moods -Hypomania, a mild form of mania, is characteristic of bipolar II disorder. Cyclothymic Disorder -Less severe hypomanic symptoms alternating with numerous periods of depression -Can be triggered by illicit drug use, prescription medications, and some medical conditions

Which of the following would a nurse identify as a a symptom of depression? A.Impaired occupational functioning B.Flat affect C.Disturbed sleeping D.Hyperactivity

C. Such symptoms include appetite and weight changes; sleep disturbance; and decreased energy, tiredness, and fatigue.

Which of the following is used to treat a patient with an overdose of heroin? Methadone L-acetyl--methadol Naloxone Buprenorphine

C. Naloxone is used to treat a heroin (opioid) overdose. Methadone is typically used as maintenance therapy. Other drugs used for maintenance treatment include L-acetyl--methadol and buprenorphine.

The nurse would teach a patient receiving treatment for anorexia nervosa about which SSRI ? Fluvoxamine Paroxetine Fluoxetine Citalopram

C. Fluoxetine Fluoxetine is the SSRI approved for use in treating patients with anorexia nervosa. Fluvoxamine, paroxetine, and citalopram have not been approved for this use.

Catatonia as seen in clients with schizophrenia is unique in the existence of which feature?

Immobility like being in a trance -Catatonia, as seen in clients with schizophrenia, is a psychologically induced immobility occasionally marked by periods of agitation or excitement; the client seems motionless as if in a trance.

A patient with Obsessive-compulsive disorder (OCD) has a fear of contamination. Which nursing diagnosis would be a priority? Impaired Skin Integrity Hopelessness Ineffective Role Performance Social Isolation

Impaired Skin Integrity Although hopelessness, ineffective role performance, and social isolation may be appropriate, fear of contamination, the most common obsession, results in compulsive handwashing, placing the patient at risk for impaired skin integrity.

A client has a blood alcohol level of 0.05%. The nurse would expect which behavior to occur?

Impaired judgment -A blood alcohol level of 0.05% (1-2 drinks) would produce impaired judgment, giddiness, and mood changes. Difficulty driving occurs at a level of 0.10%. Stupor and coma occur at levels of 0.30% and 0.40%, respectively.

organic solvents, also known as volatile substances that are CNS depressants

Inhalants -euphoria, sedation, emotional lability, and impaired judgment -Intoxication: respiratory depression, stupor, and coma -glue, shoe polish, hair spray, spray paints, gasoline, and lighter fluids, nitrous oxide or "whippets" -inhalants other than nitrites depress the CNS in a manner similar to alcohol (e.g., slurred speech, lack of coordination, euphoria, dizziness)

What is bulimia nervosa characterized by?

Initially thought to be a type of anorexia nervosa; now a distinct disorder Few outward signs; binging and purging in secret Typically normal weight Overwhelmed and overly committed individuals "Social butterflies"; difficulty setting limits and appropriate boundaries Shame, guilt, disgust about binging and eating Also impulsivity in other aspects of life

_____ is determined by the level of alcohol in the blood, called blood alcohol level (BAL).

Intoxication

Cocaine Intoxication:

Intoxication causes CNS stimulation -steadily increasing doses: restlessness proceeds to tremors and agitation followed by convulsions and CNS depression -lethal overdose, death generally results from respiratory failure -Toxic psychosis: tachycardia, hypertension, cardiac arrhythmias, sweating, hyperpyrexia, convulsions

PTSD diagnostic criteria

Intrusion Avoidance and numbing (Dissociative symptoms) Mood and cognition Hyperarousal and hypervigilance Sleep disturbance

Which statements identify positive aspects of methadone as a substitute for heroin? Select all that apply. It is available in IV form. It is a legal medication. It is controlled by a health care provider. It is available in tablet form.

It is a legal medication. It is controlled by a health care provider. It is available in tablet form. -Methadone is safer than heroin because it is legal, controlled by a health care provider, and available in tablet form. It is not available in IV form.

Which characteristic of the 12-step program distinguishes it from other programs?

It is a self-help group that focuses on total abstinence.

Using Cognitive and Behavioral Interventions (bulimia)

Journaling, self-monitoring Behavioral techniques: cue elimination; self-monitoring

psychosocial assessment of bulimia:

Knowledge deficits Body dissatisfaction Mood Ability to set boundaries, control impulsivity, and maintain quality relationships

Anticholinergic Crisis:

Life-threatening condition: overdose or sensitivity to drugs with anticholinergic properties Also called anticholinergic delirium Signs and symptoms (refer to Box 24.13): "hot as a hare, blind as a bat, mad as a hatter, dry as a bone" Self-limiting, usually 3 days after drug discontinued Treatment: Discontinuation of medication Physostigmine Gastric lavage, charcoal, catharsis for intentional overdoses

A psychiatric-mental health nurse is preparing a review class for a group of nurses at the community mental health center. The topic is mood-stabilizing drugs. After teaching the class about the different drugs that may be prescribed, the nurse determines that the teaching was successful when the group identifies which drug as being prescribed most often?

Lithium

Which psychotropic medication is administered based on an individualized dosage according to blood levels of the drug?

Lithium carbonate

A client diagnosed with bipolar disorder and experiencing mania is admitted to the inpatient psychiatric setting. During the acute phase of mania, which medication(s) would the nurse expect to administer? Select all that apply. Lithium carbonate Carbamazepine Fluoxetine Paroxetine Divalproex sodium

Lithium carbonate Carbamazepine Divalproex sodium -The goal of treatment in the acute phase is symptom reduction and stabilization. Therefore, mood stabilizers, such as lithium carbonate, carbamazepine, and divalproex sodium, are the mainstays of pharmacotherapy. Antidepressants, such as fluoxetine or paroxetine, are not recommended in bipolar depression because of a risk of switching to mania.

A client diagnosed with panic disorder has been receiving medication therapy, which is being discontinued. A nurse would be alert for possible withdrawal symptoms if the client was receiving what?

Lorazepam -Discontinuation of benzodiazepines, such as lorazepam, places the client at risk for withdrawal symptoms. Withdrawal is not associated with duloxetine, a serotonin-norepinephrine reuptake inhibitor, or escitalopram or fluvoxamine, selective serotonin reuptake inhibitors.

A client taking lithium therapy has a serum therapeutic level of 0.8 mEq/L. What priority dietary instruction should the nurse include in the teaching plan?

Maintain daily sodium intake.

Cocaine Withdrawal:

Major symptoms are severe anxiety, along with restlessness and agitation -seek more cocaine or other drugs (alcohol, marijuana, or sleeping pills -intense depression, craving drug-seeking behavior that may last for weeks; often relapse

Mental Health Nursing Interventions (Bipolar Disorders):

Management of Complications oSuicidality oSerotonin Syndrome (see Box 25.9) Monitoring for Drug Interactions oTeaching Points Other Somatic Therapies oElectroconvulsive Therapy oLight Therapy oRepetitive Transcranial Magnetic Stimulation Promoting Safety Convening Support Groups Implementing Milieu Therapy oUsing Behavioral Interventions

What are some risk factors for suicide?

Medical illnesses Psychological: internal distress, low self-esteem, interpersonal distress, childhood physical and sexual abuse Social: social isolation Gender: males > females for suicide completion Sexuality: homosexual men most likely to have experienced harassment because of their sexual orientation Race and ethnicity: whites > other groups

Evidence-Based Nursing Care for Persons with Anorexia Nervosa Disorder; Psychosocial Assessment:

Mental status and appearance: Behavioral responses -Body distortion; fear of weight gain -Unrealistic expectations or thinking; ritualistic behaviors -Difficulty expressing negative feelings -Inability to experience visceral cues and emotions -Self-concept -Stress and coping patterns -Social assessment

This is an illegal potent CNS stimulant that releases excess dopamine responsible for the drug's toxic effects, including damage to nerve terminals

Methamphetamine -Highly addictive; smoked, snorted, orally ingested, or injected -A brief rush, is reported by those who smoke or inject methamphetamine; Oral ingestion or snorting = long-lasting high instead of a rush (long as half a day) -High doses can elevate body temperature and stimulate seizures. -often used in a "binge and crash" pattern

A client has been diagnosed with major depression. The client reports of waking up during the night and has trouble returning to sleep. A nurse interprets this finding as suggesting what?

Middle insomnia -three categories: initial insomnia (difficulty falling asleep), middle insomnia (waking up during the night and having difficulty returning to sleep), and terminal insomnia (waking too early and being unable to return to sleep).

Anxiety has both healthy and harmful aspects depending on its degree and duration as well as on how well the person copes with it. Which level of anxiety helps the client focus attention to learn, problem solve, think, act, feel, and protect himself or herself?

Mild -In mild anxiety, sensory stimulation increases and helps the person focus attention to learn, solve problems, and think. Moderate anxiety causes the person to have difficulty concentrating independently but can be redirected to the topic. Severe anxiety causes the person to have a reduced perceptual field, and he or she cannot complete tasks. Panic anxiety reduces the perceptual field to focus on the self, and the client cannot process any environmental stimuli.

Severity of Anorexia Nervosa:

Mild: BMI ≥17 kg/m2 Moderate: BMI 16 to 16.99 kg/m2 Severe: BMI 15 to 15.99 kg/m2 Extreme: BMI <15 kg/m2

A client with bipolar disorder takes lithium 300 mg 3 times daily. The nurse is educating the client on its use, side effects, and need for compliance. Which outcome does the nurse evaluate that indicates the dose is having the beneficial response for the client?

Minimal mood swings

A client with a history of alcohol use disorder has presented to the emergency department with hallucinations and relays being followed by the police. Which action will the nurse take given this information?

Monitor for Korsakoff syndrome from long-term effects of alcohol use. The nurse must monitor for Korsakoff syndrome, which is a physiologic effect of long-term alcohol use and manifests with hallucinations and making up or confabulating stories to mask the fact that there is significant memory loss. Wernicke encephalopathy is seen in some individuals with history of alcohol abuse. This problem is associated with long-term heavy alcohol use. Chronic alcohol consumption can lead to a variety of nutritional deficiencies such as folic acid and thiamine (not B12), but these deficiencies can be caused by conditions other than alcohol abuse and be present before cognitive impairment.

Overview of Anxiety Disorders

Most common of the psychiatric illnesses; chronic and persistent Women experience anxiety disorders more often than men Association with other mental or physical comorbidities such as depression, heart disease, and respiratory disease. Anxiety disorders across the life span Children Older adults

When a client is experiencing panic, which is the priority intervention?

Move the client to a quiet environment.

Myths and Facts about Suicide:

Myth: Suicide only affects individuals with a mental health condition. Fact: Many individuals with mental illness are not affected by suicidal thoughts, and not all people who attempt or die by suicide have mental illness. Myth: Most suicides happen suddenly without warning. Fact: Warning signs, verbally or behaviorally, precede most suicides. Myth: People who die by suicide are selfish and take the easy way out. Fact: Typically, people do not die by suicide because they do not want to live. People die by suicide because they want to end their suffering. Myth: When people become suicidal, they will always be suicidal. Fact: Active suicidal ideation is often short term and situation specific. While suicidal thoughts can return, they are not permanent. Myth: Talking about suicide will lead to and encourage suicide. Fact: Talking about suicide not only reduces the stigma but also allows individuals to seek help, rethink their opinions, and share their story with others.

This drug was originally used as a treatment for heroin abuse, but it is now approved for the treatment of alcohol dependence

Naltrexone: : (1) it can reduce craving (the urge or desire to drink or use drugs despite negative consequences), (2) it can help maintain abstinence, and (3) it can interfere with the tendency to want to drink more -does not treat withdrawal symptoms; its effects are due to blocking the mu receptors (opioid) in the brain -may be particularly useful in patients who continue to drink heavily.

A client with schizophrenia is receiving antipsychotic therapy. The nurse understands that which is a medical emergency should it develop in the client?

Neuroleptic malignant syndrome -

Organic nitrites include cyclohexyl, butyl, and amyl nitrites. When marketed for illicit uses, organic nitrates are sold in small brown bottles labeled "video head cleaner," "room odorizer," "leather cleaner," or "room deodorizer"

Nitrite -enhance sexual pleasure by dilating and relaxing blood vessels -thought to be antagonistic at the NMDA receptor and may cause neuronal damage in the mesolimbic system

What are some physical care components for patients with eating disorders?

Nutritional rehabilitation -Refeeding syndrome -Promotion of sleep -Medication interventions (See Box 32.7) -Management of complications

Obsessive Compulsive Disorder:

Obsessions oExcessive, unwanted, intrusive, and persistent thoughts, impulses, or images causing anxiety and distress oNot under the patient's control; incongruent with the patient's usual thought patterns Compulsions oRepeatedly performed behaviors in a ritualistic fashion oGoal of preventing or relieving anxiety and distress caused by obsessions

Nursing Management in treating physiological or human response to stress:

Overall goals: • Resolve stressful person- environment situations • Reduce the stress response • Develop positive coping skills Goals for those at high risk for stress: • Recognize the potential for stressful situations • Strengthen positive coping skills

voluntary, apparent attempt at suicide, commonly called a suicidal gesture, in which the aim is not death

Parasuicide

Other Depressive Disorders Overview:

Persistent depressive disorder (dysthymia): oMajor depressive disorder symptoms lasting for 2 years (adult) and 1 year (children and adolescents) Premenstrual dysphoric disorder: oRecurring mood swings, feelings of sadness, or sensitivity to rejection in the final week prior to menses Disruptive mood dysregulation disorder: oSevere irritability and outbursts of temper oBegins before the age of 10 oSimilar to pediatric bipolar disorder

When presenting a discussion of posttraumatic stress disorder (PTSD) to a group of emergency department nurses, the psychiatric-mental health nurse provides examples of traumatic events that may precede PTSD. Which event(s) does the nurse include? Select all that apply. Personal assault by a family member Military combat mission where there were casualties Surviving an EF 4 tornado Falling off a playground swing Urinary incontinence due to a prolapsed bladder

Personal assault by a family member Military combat mission where there were casualties Surviving an EF 4 tornado -Examples of traumatic events are violent personal assault, rape, military combat, natural disasters, terrorist attacks, being taken hostage, incarceration as a prisoner of war, torture, an automobile accident, or being diagnosed with a life-threatening illness. Falling off a swing is not necessarily a trauma, but a typical accident common to many children. Prolapsed bladder is not a traumatic event and can be easily corrected with various surgical procedures.

During a client interview, a client diagnosed with delusional disorder states, "I know my spouse is being unfaithful to me with a colleague from work."The nurse interprets the client's statements as suggesting which type of delusion?

Persucatory/paranoid -The client's statements reflect persucatory/paranoid delusions that focus on the unfaithfulness or infidelity of a spouse or lover. Such delusions involve the belief that others are untrustworthy in some way. With referential delusions, the ideas of reference involve the client's belief that television broadcasts, music, or newspaper articles have special meaning for him or her. In the sexual delusion subtype, ideas involve the belief that the client's sexual behavior is known to others. With grandiose delusions, individuals believe that they have a great, unrecognized talent or have made an important discovery.

What is trauma?

Physical trauma: From an accident, self-inflicted damage, or violence perpetrated by others Psychological trauma: An emotional injury caused by an overwhelmingly stressful event that threatens one's survival and sense of security

Electroconvulsive Therapy:

Possible alternative when schizophrenia is not being successfully treated by medication alone Not indicated unless the patient is catatonic or has depression that is not treatable by other means May be useful for those persons who are medication resistant, assaultive, and psychotic

When caring for a client who is experiencing the symptomology of acute stress disorder, the nurse recognizes the importance of minimizing the client's risk for developing which condition?

Posttraumatic stress disorder

A visitor comes to see a client who is suicidal. Upon entering the unit, the nurse notices that the visitor has brought the client a can of the client's favorite soda. Which action should the nurse take at his time?

Pour the soda into a plastic cup -For clients who are suicidal, staff members remove any item they can use to commit suicide, such as sharp objects, shoelaces, belts, lighters, matches, pencils, pens, and even clothing with drawstrings. The client could tear open the soda can and commit self-harm with the sharp metal edges. The soda itself is not a threat so there is no need to withhold the beverage from the client.

The nurse is caring for clients in the outpatient unit that have anxiety disorders. Which action is most important for the nurse to employ when working with these clients?

Practice techniques to manage stress and anxiety in the nurse's own life.

disorder is characterized by recurring mood swings, feelings of sadness, or sensitivity to rejection in the final week before the onset of menses

Premenstrual dysphoric -The mood begins to improve a few days after menses begins. Stress, history of interpersonal trauma, seasonal changes are associated with this disorder

Medication Assessment for Bipolar Disorders:

Prescribed medications, over-the-counter (OTC) medications, and use of herbal or culturally related medication treatments SAMe (S-adenosyl-L-methionine) use of alcohol, marijuana, and other mood-altering medications Substance Use Assessment

Management of Complications (Schizophrenia):

Promoting patient safety Convening support groups Implementing milieu therapy Developing recovery-oriented rehabilitation strategies See Box 24.15 Evaluation and Treatment Outcomes Successful treatment and management with significant improvement or recovery

Alcohol relapse prevention:

Psychosocial interventions (self-help groups, psychoeducation, and cognitive behavioral therapy (CBT)) Psychopharmacologic agents: disulfiram, naltrexone Health promotion: adequate nutrition, vitamin supplementation (Multivitamins) -Thiamine (vitamin B1) is initiated during detoxification, given to decrease ataxia and other symptoms of deficiency -Magnesium sulfate, which enhances the body's response to thiamine and reduces seizures, is given prophylactically for patients with histories of withdrawal seizures

Bulimia Nervosa: Diagnostic Criteria and Epidemiology:

Recurrent episodes of binge eating and compensatory behaviors -Purging: vomiting or use of laxatives, diuretics, or emetics -Nonpurging: fasting or overexercising Episodes occurring at least once a week for at least 3 months No severe weight loss or amenorrhea as with anorexia nervosa (Box 31.1) Lifetime prevalence: 2% (less than 1/3 of cases have been detected) Onset is between 15 and 24 years Females to males: 10:1 Higher rates in Hispanic and white women Comorbid conditions, including substance abuse, depression, and OCD Disengaged Family- family members are so separate from each other they come and go without the knowledge of what is occurring with each other

Relaxation techniques help clients with anxiety disorders because they can promote what?

Reduction of autonomic arousal

Anorexia Nervosa: Diagnostic Criteria:

Refusal to maintain body weight Intense fear of gaining weight Disturbance in body image Undue influence of body weight or shape on self-evaluation Absence of three or more menstrual cycles

The nurse is caring for a client admitted with anorexia nervosa. When creating the nursing interventions for the plan of care, which is the primary objective?

Restoring nutritional status to normal

What is the priority nursing care for patients with trauma/stress disorders:

Risk for suicide Establish a recovery plan that addresses areas that interfere with coping and functioning A loss of impulse control that results in angry outbursts or aggressive behavior characterizes their difficulty with their quality of life and well-being.

Behavioral Interventions and Interactions (OCD)

Routines Assess anxiety Monitor comorbidities and suicide risk Initially allow rituals Avoid increase of frustration Encourage discussions Balance private and social time Identify triggers Self-talk and cognitive restructuring

Schizophrenia Spectrum Disorders:

Schizoaffective Disorder (SADS) oPeriods of intense symptom exacerbation alternating with periods of adequate psychosocial functioning Delusional Disorder oStable and well-systematized delusions that occur in the absence of other psychiatric disorders presence of one or more delusions for at least 1 month Schizophreniform Disorder oFeatures identical to those of schizophrenia, with the duration of the illness lasting less than 6 months Brief Psychotic Disorder oLength of the episode is at least 1 day but less than 1 month Psychotic Disorders Attributable to a Substance oAttributable to a substance

When reviewing the diagnostic criteria for schizophrenia based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V), which would be most accurate?

Schizophrenia lasts at least 6 months and includes at least 1 month of two or more characteristic symptoms.

Medication management (panic disorder):

Selective Serotonin Reuptake Inhibitors Serotonin-Norepinephrine Reuptake Inhibitors Benzodiazepine Therapy (see Box 27.7) Administering and Monitoring Benzodiazepines Monitoring Side Effects Management of Complications

A nursing student is caring for an elderly client who is taking sertraline for depression. The instructor quizzes the student about the medication and its actions. To what classification of drugs should the student assign sertraline?

Selective serotonin reuptake inhibitor

A psychiatric-mental health nurse is conducting a pharmacology review class for a group of nurses. The topic is antidepressant medications. The nurse determines that the review was successful when the group identifies which class of antidepressant as associated with fewer side effects?

Selective serotonin reuptake inhibitors (SSRIs)

The nurse is reviewing the history of a client diagnosed with bipolar I disorder. The history reveals that the client, in between manic episodes, consistently uses self-negating statements when describing the self, expresses feelings of being ashamed, and describes self as being unable to deal with events. The client also demonstrates little to any eye contact during interactions. The nurse interprets this information as reflecting a problem in which area?

Self-esteem

Excoriation disorder:

Skin-picking disorder Prevalence varies from 1.4% to 5.4% Behavioral and pharmacologic interventions

The nurse is performing a physical health assessment of a client who has been diagnosed with posttraumatic stress disorder (PTSD). What aspect of this assessment should the nurse prioritize?

Sleep assessment -All of the listed components should be included in a comprehensive physical assessment. However, sleep is a major concern in clients with PTSD and is likely disrupted to a greater degree than respiratory function, bowel function, or nutrition.

Administration of lithium affects which of the following electrolytes?

Sodium -Clients should drink adequate water and continue with the usual amount of dietary salt. Having too much salt in the diet because of unusually salty foods or the ingestion of salt-containing antacids can reduce receptor availability for lithium and increase lithium excretion, so that the lithium level is too low to be therapeutic.

A nurse is assessing a client who is reporting the sensation of "bugs crawling under the skin" and intense itching and burning. The client states, "I know bugs have invaded my body." There is no evidence to support the client's report. The nurse interprets this as which type of delusion?

Somatic -Somatic delusions involve bodily functions or sensations, such as insects having infested the skin. The client vividly describes crawling, itching, burning, swarming, and jumping on the skin surface or below the skin. Nihilistic delusions focus on impending death or disaster. Clients presenting with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery. The central theme of persecutory delusions is the client's belief that he or she is being conspired against, cheated, spied on, followed, poisoned, drugged, maliciously maligned, harassed, or obstructed in pursuit of long-term goals.

Phobic objects can include animals, natural environment, blood injection injury (e.g., fear of blood, injections), and situations

Specific Phobia

This is the body's tendency to resist physiologic change and hold bodily functions relatively consistent, well-coordinated, and usually stable.

Stress -introduced by Walter Cannon in the 1930s. -regulated by physiologic processes such as blood glucose, pH, and oxygen

Comorbidities of Schizophrenia:

Substance abuse and depression Diabetes mellitus and obesity

thinking about and planning one's own death

Suicidal ideation

This term is used to describe all suicide-related behaviors and thoughts of completing or attempting suicide and suicidal ideation

Suicidality

Fluoxetine includes a black box warning concerning which of the following?

Suicidality in children and adolescents

nonfatal, self-inflicted destructive act with explicit or implicit intent to die

Suicide attempt

What is the stabilization period of schizophrenia?

Symptoms become less acute but may still be present -Treatment is intense during this period as medication regimens are established, and patients and their families begin to adjust to the idea of a family member having a long-term severe mental illness. Ideally, the use of substances is eliminated. Socialization with others begins to increase, so that rehabilitation begins.

abuse of prescription and OTC drugs occurs when one of the following criteria is met:

Taking a medication that has been prescribed for someone else Taking a drug in higher quantity or in another manner than prescribed Taking a drug for another purpose than prescribed

A client tells the nurse, "I'm taking care of a friend who is ill." The nurse interprets thist statement as reflecting which function of social support?

Tangible

Recovery-Oriented Care for Persons with Bipolar Disorder:

Teamwork and Collaboration: Working Toward Recovery Goals of treatment" -Minimize and prevent either manic or depressive episodes; Managing stress; medication adherence; maintaining social rhythms -Help the patient and family learn about the disorder and manage it throughout a lifetime -Primary treatment modalities: medications, psychotherapy, education, and support -Priority care issues; Safety Suicide Injury Poor judgement, Impulsivity

Recovery-Oriented Care for Persons with Depressive Disorders:

Teamwork and Collaboration: Working Toward Recovery oGoals of treatment -Reduce or control symptoms and, if possible, eliminate signs and symptoms of the depressive syndrome -Improve occupational and psychosocial function as much as possible -Reduce the likelihood of relapse and recurrence through recovery-oriented strategies oCognitive and Interpersonal Therapies oCombination Therapies oAlternative Therapies Safety Issues

Recovery oriented care (OCD):

Teamwork and collaboration: Working toward recovery (see Box 28.2) Electroconvulsive Therapy (ECT) Transcranial Magnetic Stimulation (TMS) Psychosurgery Safety Issues

The nurse is assessing a 42-year-old client who is experiencing depression. The client's mother died by suicide 20 years ago. Which statement regarding this client's risk for suicide is correct?

The client has a greater risk for suicide than the general population.

What assessment finding would suggest to the nurse that the client with posttraumatic stress disorder (PTSD) is experiencing dissociation?

The client is often "staring into space" and has no idea how much time has passed -"Spacing out" is an example of dissociation (depersonalization). It is not uncommon for the client with PTSD to experience failure of coping skills, sleep disturbances, and reluctance to acknowledge moods, but these are not evidences of dissociation.

The psychiatric-mental health nurse is working with a young adult client who has complex mental health and psychosocial needs. The nurse should identify what characteristic as constituting a risk factor for suicide?

The client was abused as a child by her stepfather -Childhood abuse is linked to suicide. The use of sleep aids, being from a Latin American culture or being unable to quit smoking are not identified as independent risk factors for suicide.

Research related to the development of schizophrenia has shown what?

The disorder is thought to arise from the interaction of a biological predisposition and environmental stressors.

A client with opioid addiction is prescribed methadone maintenance therapy. When explaining this treatment to the client, which of the following would the nurse need to keep in mind?

The drug helps to satisfy the craving for the opioid.

The nurse is talking with the friend of a client with alcoholism. The friend tells the nurse that the friend's relationship with the client was codependent and enabling. Which behavior identified does the nurse correlate with codependent behavior?

The friend called the client every night to make sure the client got home safely and looks for the client if not at home. -Codependent behavior appears helpful on the surface but actually prolongs the drinking behavior. Watching out for the client's safety may appear helpful but it facilitates the client's behavior because it releases the client from being responsible. Calling Alcoholics Anonymous, confronting the client and refusing to participate are actions that show personal support for the client while not enabling or accepting their harmful behaviors.

What is the recovery period of schizophrenia?

The goal is recovery; schizophrenia is not treatable, but a reduction in symptoms -obtained by maintaining a healthy lifestyle, managing the stresses of life, and developing meaningful interpersonal relationships -Family support and involvement are extremely important at this time

A client with post-traumatic stress disorder (PTSD) has just been prescribed sertraline by her primary care provider. What topic should the nurse include during health education?

The importance of avoiding alcohol use during treatment -Alcohol intake should be eliminated during treatment with a sustained serotonin reuptake inhibitor. There is no need to avoid tyramine-containing foods or grapefruit. SSRIs do not normally affect blood pressure significantly.

This model views stress as an interactive process arising from real or perceived internal or external environmental demands that are appraised as threatening or benign.

Transactional Stress Model -the psychological experience of stress -external environment- physical aspects such as air quality, cleanliness of food and water, temperature, and noise and social aspects such as living arrangements and personal contacts.

T/F: THC can be stored for weeks in fat tissue and in the brain and is released extremely slowly.

True

T/F: Type C personalities are initially associated with the development of cancer, specifically breast cancer in women, presumably due to the changes that occur within endocrine and immune function.

True

T/F: high AL is more often associated with depression in Black men and White women than their corresponding counterpart.

True

T/F: smoking is the largest preventable cause of premature death and disability

True

T/F: Mountain regions have the highest rate of suicide

True -can be disguised as vehicular accidents or homicide, especially in young people

T/F: Methadone treatment combined with behavioral therapy and counseling has been used effectively and safely to treat opioid addiction for more than 40 years

True Combined with behavioral therapy and counseling, methadone enables patients to stop using heroin.

Is the following statement true or false? Individuals with anorexia nervosa experience a significant disturbance in body image.

True. A disturbance in body image is one of the key diagnostic characteristics for anorexia nervosa

Is the following statement true or false? Children experiencing depression commonly exhibit an irritable mood.

True. Children commonly exhibit an irritable mood rather than a sad mood with depression.

Is the following statement true or false? Protecting the patient from self-harm is crucial during a manic phase.

True. During mania, patients usually violate others' boundaries, and they may miss the cues indicating anger and aggression from others. Thus, protecting the patient from self-harm as well as harm from others is important.

Is the following statement true or false? Individuals with bulimia nervosa often display cognitive distortions

True. Individuals often engage in dietary restraint, binge eating, and purging that results from their distorted thinking process.

Is the following statement true or false? Social theories contribute to changes in brain function that result in schizophrenia.

True. Social factors can contribute to the changes in brain function that result in schizophrenia and add to the day-to-day challenges of living with a mental illness

T/F: In chronic stress, the immune system is suppressed.

True: Cortisol is primarily immunosuppressive and contributes to reduction in lymphocyte numbers and function (primarily T-lymphocyte and monocyte subsets) and natural killer activities. -Over time, chronic stress compromises health and increases susceptibility to illnesses.

T/F: Treatment for hoarding in older adults may need to continue over a long period of time to reach successful outcomes.

True: It is likely that even with treatment, the hoarding behaviors will continue.

T/F: Bulimia is generally not as life threatening as anorexia nervosa

True: Outcomes are better for bulimia nervosa than for anorexia nervosa, and mortality rates are lower.

T/F: Acute stress is associated with the "fight or flight" response.

True: When the brain (amygdala and hippocampus) interprets an event as a threat, the hypothalamus and autonomic nervous system are signaled to secrete adrenaline, cortisol, and epinephrine. These hormones activate the sympathetic nervous system and physiologic stability is challenged

T/F: Alcohol is a CNS depressant.

True; mild sedation= coma, respiratory failure, and death •Adverse effects on all body systems with excessive or long-term abuse

Describe anxiety:

Uncomfortable feeling of apprehension or dread in response to internal or external stimuli -Factors that determine if anxiety is a symptom of mental disorder: oIntensity of anxiety relative to situation oTrigger for anxiety Symptom clusters manifested

Which statement about the assessment of persons with anxiety and anxiety disorders is most accurate?

When an older adult experiences anxiety for the first time in his or her life, the anxiety may be associated with another condition. -Anxiety that starts for the first time in late life is frequently associated with another condition such as depression, dementia, physical illness, or medication toxicity or withdrawal. Phobias, particularly agoraphobia, and generalized anxiety disorder are the most common late-life anxiety disorders. Most people with late-onset agoraphobia attribute the start of the disorder to the abrupt onset of a physical illness or as a response to a traumatic event such as a fall or mugging. Ruminative thoughts are common in late-life depression and can take the form of obsessions such as contamination fears, pathologic doubt, or fear of harming others.

A nurse is working in a mental health clinic and cares for various clients. Which client should the nurse recognize as having the greatest risk for the development of drug dependence? an 80 year old man who just lost his wife of 45 years or a 12 year old girl who was raped by a family friend

a 12 year old girl who was raped by a family friend -Adverse and traumatic events that occur during childhood increase the risk for drug and alcohol dependence, eating disorders, affective disorders, posttraumatic stress disorder, and suicide. Therefore the 12 year old girl who was raped should be recognized as the highest risk for drug dependence. Losing a job, going through a divorce, and the loss of a family member are all stress events for clients. However, they are not at the highest risk in this situation.

Three years ago, the nurse's parent died in an intensive care unit (ICU). The nurse is caring for a client in the ICU with the same diagnosis and similar features to the nurse's parent. Which manifestation of posttraumatic stress disorder (PTSD) did the nurse likely experience when feeling a sense of panic confronting the client?

a flashback

In chronic stress, the continuous sustained activation of the sympathetic nervous system; HPA axis; cardiovascular, metabolic, and immune systems contribute to:

a hormonal overload, leading to impairment in memory, immunity, cardiovascular, and metabolic function

Describe adaptation.

a person's capacity to survive and flourish -Adaptation or lack of it affects three important areas: health, psychological well-being, and social functioning.

A client has been diagnosed with posttraumatic stress disorder (PTSD) after witnessing an explosion at the client's industrial worksite. The client will soon begin exposure therapy, so the nurse should prepare the client for:

a visit with the therapist to the place where the explosion occurred. -Exposure therapy may involve a visit to the place where a traumatic event occurred. Reflection, family meetings, and support groups may be components of the client's broader treatment plan, but they are not exposure therapy.

One of the most detrimental long-term side effects of heroin is _____ itself, which causes neurochemical and molecular changes and profoundly alters brain structure and composition.

addiction -Enlarged ventricular spaces and loss of frontal volume are reported -tolerance and physical dependence, which are powerful motivating factors for compulsive use and abuse

People who use alcohol regularly usually develop _____ _____, the ability to ingest an increasing amount of alcohol before they experience a "high" or a "buzz" and show cognitive and motor effects.

alcohol tolerance

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies 10 diagnostic categories of substances including what?

alcohol, caffeine, cannabis (marijuana), hallucinogens, inhalants, opioids, sedative-hypnotics, stimulants, tobacco, and others -Gambling disorder is included within the substance use disorder category because gambling behaviors can activate the brain's reward system similar to the substance use disorders.

This is a term used to describe how the body adapts to maintain physiologic stability.

allostasis -involves the functions of the autonomic nervous system, the hypothalamic-pituitary-adrenal (HPA) axis, and the cardiovascular, metabolic, and immune systems to respond to internal and external stimuli

What is acute stress?

an intense biopsychosocial reaction to a threatening event, is time limited (usually less than a month) but can occur repeatedly -can lead to physiologic allostatic load/overload, which in turn can have a negative impact on a person's health

What is Chronic Stress?

an ongoing physiologic reaction to events resulting in "wear and tear" on the body and negatively impacts health and well-being -adaptive physiologic changes that occur during acute stress become maladaptive when prolonged and contribute to the risk for illness

A psychiatric-mental health nurse is assessing a client who is suspected of experiencing depression. During the interview, the client says, "I just don't care any more. I used to enjoy doing all sorts of things outdoors, but now, I don't. Nothing seems to make me happy." The nurse interprets this statement as:

anhedonia. -The patient's statement reflects a loss of interest or pleasure in activities that previously brought enjoyment . This is termed anhedonia. Labile mood is the outward emotional expression that is varied, rapid, and abruptly shifts. Affect is the outward emotional expression of a person that gives clues to the person's mood. Aphasia involves a difficulty with speaking or communicating.

When does symptoms of alcohol withdrawal syndrome begin?

begins within 12 hours after abrupt discontinuation or attempt to decrease consumption. -If seizures occur, they usually do so within the first 48 hours of withdrawal.

What is regressed behavior?

behaving in a manner of a less mature life stage; childlike and immature behavior

What medications are used for withdrawal of alcohol?

benzodiazepines, antidepressants, sleep medications, antipsychotics

This drug reduces the craving and rewarding effects of nicotine by preventing nicotine from accessing one of the acetylcholine receptor sites involved with nicotine dependence, but it can cause depression and related psychiatric symptoms in some people

bupropion

A nurse is working with a client diagnosed with schizophrenia who is not participating in group. The client seems to be indifferent to other people, and the nurse interprets this as a negative symptom. Which other negatives symptom(s) will the nurse assess for? Select all that apply. catatonia anhedonia blunted affect ideas of reference ambivalence

catatonia anhedonia blunted affect -The following are negative symptoms: Alogia: Tendency to speak very little or to convey little substance of meaning (poverty of content) Anhedonia: Feeling no joy or pleasure from life or any activities or relationships Apathy: Feelings of indifference toward people, activities, and events Asociality: Social withdrawal, few or no relationships, lack of closeness Blunted affect: Restricted range of emotional feeling, tone, or mood Catatonia: Psychologically induced immobility occasionally marked by periods of agitation or excitement; the client seems motionless, as if in a trance Flat affect: Absence of any facial expression that would indicate emotions or mood Avolition or lack of volition: Absence of will, ambition, or drive to take action or accomplish tasks Inattention: Inability to concentrate or focus on a topic or activity, regardless of its importance.

Describe Type A Personalities:

characterized as competitive, aggressive, ambitious, impatient, alert, tense, and restless. They think, speak, and act at an accelerated pace and reflect an aggressive, hostile, and time-urgent style of living that is often associated with increased psychophysiologic arousal

Health disparities found in lower socioeconomic groups, racial and ethnic minorities, and older adults may be partly explained by the _____ _____ they tend to experience.

chronic stress -they have elevated AL

After _____ is inhaled or injected, the user experiences a sudden burst of mental alertness and energy and feelings of self-confidence, being in control, and sociability, which last 10 to 20 minutes

cocaine -Enhanced sexual experiences and drive -panic attacks in some individuals and may also contribute to sexual assault -Long-term cocaine use leads to increased anxiety

Treating individuals with ______ ______ is complex because it involves assessing the psychobiologic, social, and pharmacologic aspects of abuse.

cocaine addiction

CAGE Questionnaire:

consists of four self-report responses to questions about respondents' beliefs of cutting down on their drinking, their experience of others criticizing their drinking, the presence of guilt about drinking, and early morning drinking

The psychiatric mental health nurse has taught a client with obsessive-compulsive disorder (OCD) about the use of cue cards. This intervention will allow the client to:

counter obsessive thinking with positive messages. -Cue cards are succinct reminders of positive messages aimed at empowering the client in his or her resistance to obsessive thinking. Cue cards do not record specific goals and do not focus on negative consequences. They do not directly address the harm of compulsions.

Mixture of cocaine and alcohol is a common two-drug combination that frequently results in drug-related _____.

death

What can result from long time use of meth?

dependence and addiction psychosis (e.g., paranoia, hallucinations), mood disturbances, violent behavior, repetitive motor activity, stroke, contracting HIV and hepatitis, intense itching leading to skin sores from scratching, weight loss, and extensive tooth decay -cardiac arrhythmias, similar to cocaine use

A nurse is seeing a client who is having severe to panic level anxiety after a physical assault months previously. The client tells the nurse, "When the panic starts I feel like I am watching myself through a window." The nurse can most accurately describe this experience as:

depersonalization. -Depersonalization is a feeling that the client may describe as being disconnected from herself, such as watching oneself. This is common when individuals experience panic levels of anxiety. Derealization refers to the sensation that things are not real or surreal during panic levels of anxiety. Decatastrophizing refers to a treatment approach used by therapists in which the client is asked questions in order to urge the client to develop a more realistic appraisal of the situation causing the anxiety. Automatisms are automatic, unconscious mannerisms that are geared toward relief of anxiety and increase in intensity and frequency with a rise in the client's anxiety level.

This is period of time where the patient is observed, usually in a hospital setting, and given medications to avoid withdrawal symptoms

detoxification -Uncomplicated alcohol withdrawal is usually completed within 48 to 96 hours. -Assessing for vital sign changes, nausea, vomiting, tremors, perspiration, agitation, headache, and change in mental status are important nursing interventions.

When stress is associated with the development or exacerbation of a mental illness, the _____ model can be applied.

diathesis-stress -model describes how stress can trigger the development or exacerbation of an illness -Exposure to childhood trauma can lead to negative long-term health consequences on mental and physical health throughout life

What did Kurt Schneider do?

differentiated behaviors -"First-rank" symptoms (psychotic delusions, hallucinations) -"Second-rank" symptoms (all other experiences and behaviors associated with the disorder)

The psychiatric-mental health nurse is providing care for a client who has obsessive-compulsive disorder (OCD). The nurse can best promote the client's recovery and enhance therapeutic rapport by:

disguising any surprise at the client's rituals and demonstrating empathy.

the person reduces the stress by reinterpreting the situation to change its meaning

emotion-focused coping

A client with obsessive-compulsive disorder has just been prescribed sertraline. When administering this medication, the nurse should:

ensure the client knows that benefits will not be sensed for several weeks. -Sertraline is a sustained serotonin reuptake inhibitor (SSRI); SSRIs take weeks or months to have a therapeutic effect. Dietary modifications are unnecessary and the risk of weight gain is low. SSRIs do not cause anticholinergic effects.

What is circumstantiality?

extremely detailed and lengthy discourse about a topic

What is one major reason people with schizophrenia relapse?

failure to take medication consistently. -Discontinuing medications will almost certainly lead to a relapse

Recently, there has been a sharp increase in opioid deaths, attributed to illegally produced ______.

fentanyl

A client with a specific phobia of spiders is seeing a therapist for the first session of treatment. The therapist hands the client a clear container with a large house spider inside. This activity is repeated continuously until the client's fear subsides. Which strategy is being used to treat the client's specific phobia?

flooding -Flooding is a form of rapid desensitization in which a behavioral therapist confronts the client with the phobic object until it no longer produces anxiety. The goal is to rid the client of the phobia within two sessions. Biofeedback is a slower form of therapy that uses reframing of thought. Decatastrophizing helps the client confront a "worst-case" scenario but is not used in confronting phobias. Assertiveness training would not be used for phobia treatment since it will not be effective.

Describe Type B Personalities:

generally are more relaxed, easygoing, and easily satisfied -less likely than Type A personalities to engage in risky health behaviors such as alcohol consumption and smoking. -more likely to practice preventative care measures and wellness activities -described as accepting and relaxed; they are unlikely to experience a lack of time for commitments and are able to commit time for relaxation

refers to drugs that produce euphoria or dysphoria, altered body image, distorted or sharpened visual and auditory perception, confusion, lack of coordination, and impaired judgment and memory.

hallucinogen -hallucinations and profound distortions -rapid, intense emotional swings and seeing images, hearing sounds, and feeling sensations that seem real but are not -severe: paranoia, fear of losing one's mind, depersonalization, illusions, delusions, and hallucinations -increasing heart rate and body temperature, and slightly elevating blood pressure -dry mouth, dizziness, and subjective feelings of being hot or cold.

Caffeine withdrawal syndrome:

headache, drowsiness, and fatigue, sometimes with impaired psychomotor performance; difficulty concentrating; craving; and psychophysiologic complaints, such as yawning or nausea

What can long term use of anabolic steroids result in?

heart attacks and strokes, blood clotting, cholesterol changes, hypertension, depressed mood, fatigue, restlessness, loss of appetite, insomnia, reduced libido, muscle and joint pain, and severe liver problems (including hepatic cancer) -perm production, shrinking of the testes, and difficulty or pain in urinating -breast enlargement in men and masculinization of women's bodies -Both sexes may experience hair loss and acne

A patient is being treated for depression on the psychiatric mental health unit. The nurse can best promote the patient's development of an effective crisis management plan by:

helping the patient create a written outline of strategies that can be applied. -A written crisis management plan, developed by the patient, is a proven strategy for countering some of the thinking that leads to suicide. The plan must be individualized and cannot be imposed from a unit policy. Teaching about the thinking that characterizes depression is appropriate, but does not directly result in a crisis management plan. Similarly, presenting evidence will not necessarily lead to the development of a plan.

The nurse provides care to an adolescent client who presents to the emergency department (ED) after losing consciousness during a marching band performance. A differential diagnosis of anorexia nervosa is documented by the practitioner. Which finding noted when reviewing the client's laboratory data indicates a need for hospitalization?

hypokalemia

Alcohol withdrawal syndrome:

increased heart rate and blood pressure, diaphoresis, mild anxiety, restlessness, and hand tremors. most severe: delirium tremens (autonomic hyperarousal, disorientation, hallucinations), grand mal (tonic-clonic) seizures, and even status epilepticus (continuous seizures, lasting more than 30 minutes) -these symptoms can be life threatening

Electroconvulsive therapy would be contraindicated for a client with:

increased intracranial pressure. -ECT is contraindicated for clients with increased intracranial pressure. Other high-risk clients include those with recent myocardial infarction, recent cerebrovascular accident, retinal detachment, or pheochromocytoma (a tumor on the adrenal cortex or other tumors) and those at risk for complications of anesthesia

What is echopraxia?

involuntary imitation of another person's movements and gestures

What is concrete thinking?

lack of abstraction in thinking; inability to understand punch lines, metaphors, and analogies

The ______ _____, which normally inhibits the action of ethanol, is believed to be instrumental in the development of alcohol tolerance.

locus coeruleus

Many people who abuse substances have other _____ disorders.

mental -Some disorders are in part a byproduct of long-term substance use; others predispose the individual to alcohol or drug abuse. -nurses should be aware that patients who abuse substances often have psychotic, anxiety, mood, or personality disorders

This drug is known as a "club drug" because it is used by teens and young adults as part of the nightclub, bar, and rave scenes.

methylenedioxymethamphetamine (MDMA); Ecstasy or Molly -activity of dopamine, norepinephrine, and serotonin to increase. -increased energy, pleasure, emotional warmth, and distorted sensory and time perception -hallucinations, confusion, depression, paranoia, sleep problems, drug craving, severe anxiety, nausea, muscle cramping, involuntary teeth clenching, blurred vision, chills, and sweating

In higher doses, MDMA can sharply increase body temperature leading to what?

muscle breakdown, kidney and cardiovascular failure, and death. MDMA effects last about 3 to 6 hours

the addictive chemical mainly responsible for the high prevalence of tobacco use, is the primary reason tobacco is named a public health menace.

nicotine -two to three times more prevalent in persons with mental illnesses than the general population and is two to six times higher among those with schizophrenia, bipolar disorder, post-traumatic stress disorder (PTSD), and alcohol/illicit drug use disorders

Long-term cocaine use depletes _____, resulting in a "crash" when use of the drug is discontinued that causes the user to sleep 12 to 18 hours,

norepinephrine -On awakening, withdrawal symptoms may occur: sleep disturbances with rebound rapid eye movement (REM) sleep, anergia (i.e., lack of energy), decreased libido, depression with possible suicidality, anhedonia, poor concentration, and cocaine craving.

Etiology of Anorexia Nervosa

o Biologic theories -Neurobiological features; genetic theories -Neuroendocrine and neurotransmitter changes o Psychological theories -Psychoanalytic paradigm -Peer pressure internalization -Body dissatisfaction o Social theories (see Box 32.4) -Societal influences: media; conflicting messages; obesity; feminism and roles

Cholinergic rebound:

o If an anticholinergic agent is abruptly stopped -Rebound symptoms including vomiting, excessive sweating, and altered dreams and nightmares Should be reduced gradually (tapered) over several days

What is the diagnostic criteria for schizophrenia?

o Positive symptoms: -Excessive or distorted thoughts and perceptions -Delusions and hallucinations o Negative symptoms -Emotions and behaviors that should be present but are diminished o Neurocognitive impairment -Involving memory, vigilance, verbal fluency, and executive function (i.e., disorganized symptoms)

Administering medications in patients with schizophrenia:

o1 to 2 weeks to effect a change in symptoms; usually, trial of 6 to 12 weeks before a change oClozapine used when no other second-generation agent effective oAdherence

Diagnostic Criteria for Bipolar I:

oA chronic multisystemic cyclic disorder oEarlier onset results in more frequent episodes than persons who develop the illness later in life oA progressive condition with prodromal, symptomatic, and residual states oCan be arrested with an early diagnosis, proper treatment, and individually tailored management oAn early onset and a family history of illness are associated with multiple episodes or continuous symptoms oSymptoms of the illness can be unpredictable and variable oCan lead to severe functional impairment such as alienation from family, friends, and coworkers; indebtedness; job loss; divorce; and other problems of living oPresences of mood lability and rapid cycling oDiagnosis reliant upon the occurrence of at least one manic episode or mixed episode and a depressive episode

Epidemiology of Major Depressive Disorder:

oAges 18 and 29 have a 3× higher prevalence than those persons aged 60 and older oTwice as common in adolescent and adult women as in adolescent and adult men oCultural and ethnic variations oOften co-occurring with other psychiatric and substance-related disorders -A variety of chronic medical conditions, particularly endocrine disorders, cardiovascular disease, and neurologic disorders

Drug interactions (antipsychotics):

oAntipsychotic medications have the potential to interact with other medications, nicotine, and grapefruit juice oAffected by smoking

What is the clinical course of anorexia nervosa?

oBody image distortion oDrive for thinness oEmotional dysregulation oPerfectionism oGuilt and anger

Depressive Disorders Across the Life-Span:

oChildren and Adolescents -Symptoms similar to those seen in adults with a few exceptions -More likely to have anxiety symptoms •Risk of suicide, which peaks during the mid-adolescent years, is very real oOlder Adults (see Box 25.1) -Often undetected or inadequately treated -Estimated that 8% to 20% of older adults -Suicide rates peak during middle age, but a second peak occurs in those aged 75 years and older

Anorexia nervosa across the life span:

oDiagnosed as young as 8 years old oThe most common eating disorder diagnosed in individuals over 50 years of age oLate-onset is mostly diagnosed in women oIn older adults is associated with significant psychiatric comorbidities and overall morbidity

Hoarding disorder

oDifficulty parting with or discarding possessions o2% to 6% prevalence oMay start in childhood oBehavioral and pharmacologic interventions oCognitive behavior therapy (CBT) and medication for co-occurring mental disorders

Body dysmorphic disorder

oFocus on real (but slight) or imagined defects in appearance oExtremely debilitating disorder and can significantly impair an individual's quality of life oCognitive-behavioral therapy is the primary treatment approach oOccurs in men and women oThe risk of depression, suicide ideation, and suicide is high

Mental Health Nursing Assessment (Bipolar Disorders):

oFocuses on the physical consequences and the psychosocial aspects of the depression oThe symptoms of depression are similar to those of some medical problems or medication side effects oOften, the mental health nurse is the only clinician who provides holistic care to a person with depression who is often treated by other disciplines

Purging Disorder:

oFrequent purging, but not binging oDo not overeat oFear of eating, gaining weight, and/or appearing "fat." oIncreased levels of body image disturbance, higher levels of general psychopathology, distress, eating pathology, and personality disorders oPurging disorder may be the midpoint with bulimia nervosa the more severe

Neuroleptic Malignant Syndrome (NMS):

oLife-threatening condition: -Severe muscle rigidity, elevated temperature with a rapidly accelerating cascade of symptoms (refer to Box 24.12) -Early recognition of symptoms; withholding of any antipsychotic medication oDopamine agonists (bromocriptine); muscle relaxants (dantrolene or benzodiazepine) oFrequent vital signs monitoring, treating fever, laboratory testing oSupportive measures and promoting safety

Biological and Psychosocial theories of schizophrenia:

oNeuroanatomic findings: larger lateral and third ventricles; smaller total brain volume oFamilial patterns oGenetic associations oNeurodevelopment oNeurotransmitters, pathways, and receptors -Dopamine hyperactivity; transmitter or neural systems -Other neurotransmitter involvement Psychosocial theories oSocial stressors contributing to changes in brain function oSocial stigma oAbsence of good, affordable, and supportive housing oFragmented mental health care delivery system

What is PTSD characterized by?

oOccurs following exposure to an actual or threatened traumatic event oTraumatic events include those that are directly experienced, witnessed, learned about from others, or due to repeated exposure to aversive events.

Diagnostic Criteria for Major Depressive Disorder:

oOne or more moods (either a depressed mood or a loss of interest or pleasure) in nearly all activities for at least 2 weeks oFour of seven additional symptoms: -Disruption in sleep, appetite (or weight), concentration, energy -Psychomotor agitation or retardation -Excessive guilt or feelings of worthlessness -Suicidal ideation

Risk Factors for Depression

oPrior episode of depression oFamily history of depressive disorder oLack of social support oLack of coping abilities oPresence of life and environmental stressors oCurrent substance use or abuse oMedical and/or mental illness comorbidity Ethnicity and Culture

Epidemiology and risk factors of schizophrenia:

oRisk factors: genetics; environment oAge of onset: usually late adolescence or early adulthood oGender differences: earlier diagnosis and poorer prognosis in men oEthnic and cultural differences oFamilial differences: first-degree biologic relatives with greater risk

What should nurses be aware of in patients with schizophrenia?

oSafety issues oGeneral Functioning oNutrition oHygiene oGrief and Loss oMood oMotivation oMedication management oCommunity resources

Therapeutic Relationship (Bipolar Disorders):

obased on the incorporation of culturally competent interventions and strategies oAvailability in times of crisis oVigilance regarding danger to self and others oEducation about the illness and treatment goals oEncouragement and feedback concerning progress oGuidance regarding the patient's interactions oRealistic goal setting and monitoring

Schizophrenia relapse:

occur at any time during treatment and recovery -With each relapse, a longer period of time is needed to recover; Combining medications and psychosocial treatment greatly diminishes the severity and frequency of recurrent relapses -Impairment in cognition and coping leaves patients vulnerable to stressors. -Limited accessibility of community resources, such as public transportation, housing, entry-level and low-stress employment, and limited social services, leaves individuals without access to social support.

What is a substance induced disorder?

occur when medications used for other health problems or medical/mental health disorders cause intoxication, withdrawal, or other health-related problems.

What is a substance use disorder?

occurs when an individual continues using substances despite cognitive, behavioral, and physiologic symptoms.

refers to any substance that binds to an opioid receptor in the brain to produce an agonist action

opioid -opium, heroin, fentanyl, morphine, and codeine -most effective pain relievers -CNS depression, sleep, stupor, pleasure (or reward) -tolerance and physical dependence

commonly abused prescription medications:

opioids (e.g., oxycodone, hydrocodone, morphine, fentanyl, codeine); prescribed for pain

What is stilted language?

overly and inappropriately artificial formal language

Diagnosis of this disorder is made if major depressive disorder symptoms last for 2 years for an adult and 1 year for children and adolescents. These individuals are depressed for most of each day.

persistent depressive -A major depressive disorder may precede the persistent depressive disorder or co-occur with it.

Describe Type D Personalities:

personalities experience a tendency toward negative emotions and pessimism; likely to be socially inhibited and are unlikely to show their emotions to others. -There is mixed research support for an association between a type D personality and mental health disorders and poor physical health status -Emerging data suggest that type D personality is related to outcome

The nurse is seeing a male client who is obese and wants to lose weight. The client discusses why he wants to lose weight, how he recognizes that being obese is unhealthy, and that he plans to remain committed to a healthy lifestyle. The nurse recognizes that the client is engaging in which activity?

primary appraisal

the person addresses the source of stress and solves the problem (eliminating it or changing its effects).

problem-focused coping

What are some comorbid disorders secondary to addiction?

psychotic, anxiety, or mood disorders

What is verbigeration?

purposeless repetition of words or phrases

Recovery-Oriented Care for Persons with a Panic Disorder

recovery oPanic Control Treatment oSystematic Desensitization oImplosive Therapy oExposure Therapy oCognitive-Behavioral Therapy Safety

What is the primary intervention for a patient in the acute intoxication state of hallucinogens?

reduce stimuli, maintain a safe environment for the patient and others, manage behavior, and observe the patient carefully for medical and psychiatric complications. -Instructions to the patient should be clear, short, and simple, and delivered in a firm but nonthreatening tone.

What is clang association speech?

repetition of words or phrases that are similar in sound but in no other way, for example, "right, light, sight, might"

What is stereotypy?

repetitive purposeless movements that are idiosyncratic to the individual and to some degree outside of the individual's control

A school health nurse is meeting with the parents of a 6-year-old child who has been selectively mute. The nurse is offering the parents education regarding this problem. The nurse can tell the parents that what is true about selective mutism?

selective mutism is associated with social anxiety

People with schizophrenia experience disruption of ones ______.

self -self-disturbance: leads to significant difficulty determining what thoughts and experiences are internal versus external to the individual -Delusions and hallucinations Treatment that focuses on self-disturbance aims to help clients to become active agents in their own care.

opioids are abruptly withdrawn:

severe physical symptoms occur, including body aches, diarrhea, tachycardia, fever, runny nose, sneezing, sweating, yawning, nausea or vomiting, nervousness, restlessness or irritability, shivering or trembling, abdominal cramps, weakness, elevated blood pressure, and severe distress.

Consists of linkages among a defined set of people with whom an individual has personal contacts.

social network -Contacts can be categorized according to three levels: Level I consists of 6 to 12 people with whom the person has close contact. Level II consists of a larger number of contacts, 30 to 40 people whom the person sees regularly. Level III consists of an even larger number of people with whom a person has direct contact, such as the grocer and mail carrier, and can represent several hundred people.

One of the important functions of the social network is to provide _____ _____ in the form of positive interpersonal interactions as part of a dynamic process that is in constant flux and varies with life events and health status

social support -Social support serves three functions: Emotional support contributes to a person's feelings of being cared for or loved. Tangible support provides a person with additional resources. Informational support helps a person view situations in a new light (Table 19.2).

A client diagnosed with delusional disorder who uses excessive health care resources most likely has which type of delusions?

somatic -Persons who have somatic delusions believe they have a physical ailment. Clients with somatic delusions use excessive health care resources. The central theme of the jealous subtype is the unfaithfulness or infidelity of a spouse or lover. Erotomanic delusions are characterized by the delusional belief that the client is loved intensely by the "loved object," who is usually married, of a higher socioeconomic status, or otherwise unattainable. Clients presenting with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery; a less common presentation is the delusion of a special relationship with a prominent person or actually being a prominent person.

A sad, irritable, or empty mood is present with ______ and ______ changes that interfere with functioning

somatic, cognitive

What is pressured speech?

speaking as if the words are being forced out

This is the voluntary act of killing oneself, a fatal, self-inflicted destructive act with explicit or inferred intent to die, sometimes called suicide completion

suicide

What is the 10th leading cause of death in the US?

suicide -Most people who die by suicide have a mental disorder or emotional problem with depression as the most common underlying disorder -A suicide occurs every 13 minutes in the United States -Suicides possibly disguised as vehicular accidents or homicides -Occurrence across the life span -The second leading cause of death among those aged 10 to 34; Ranking the fourth leading cause of death among adults aged 35 to 54.; Suicide rates peak during middle age, and a second peak occurs in those aged 75 years and older

What is hypervigilance?

sustained attention to external stimuli as if expecting something important or frightening to happen

Increased heart rate is a ______ medullary response to stress.

sympathetic-adrenal

One major difference between posttraumatic stress disorder (PTSD) and the other anxiety disorders is that ...

symptoms begin after exposure to a traumatic stressor.

Anabolic steroid:

synthetic substances related to the male sex hormones (androgens) -late 1930s to treat hypogonadism, they are also used to treat delayed puberty, some types of impotence, and wasting of the body caused by HIV infection or other diseases -promote growth of skeletal muscle and the development of male sexual characteristics -dehydroepiandrosterone (DHEA) and androstenedione (Andro)

Describe relapse

the recurrence of alcohol- or drug-dependent behavior in an individual who has previously achieved and maintained abstinence for a significant time beyond the period of detoxification. -an expected part of the chronic disease of addiction, and the cycle of use-detoxication-sobriety and relapse will likely continue for years.

What is reappraisal?

the same as appraisal except that it happens after coping strategies are implemented, provides feedback about the outcomes and allows for continual adjustment and actions to new information.

What is anorexia nervosa characterized by?

•Low body weight •Intense fear of gaining weight or becoming fat •Disturbance in experiencing body weight or shape Two types: •Restricting •Binge eating and purging

Anorexia: Risk and Protective Factors:

•Risk factors -↑ BMR; overexercising; elite athlete -Low self-esteem, body dissatisfaction, feelings of ineffectiveness -Family: overprotective, enmeshed, rigid boundaries, inability to solve conflicts •Protective factors -Healthy eating attitudes, acceptance of body size -Positive self-evaluation

Nursing Diagnoses and Outcome Identification:

•Risk for Suicide •Interrupted Family Processes •Anxiety •Ineffective Health Maintenance •Risk for Self-directed Violence •Impaired Social Interaction •Ineffective Coping •Chronic Low Self-esteem •Insomnia •Social Isolation •Spiritual Distress

Bulimia Nervosa: Risk Factors:

•Society's influence •Factors à behaviors (dietary restraint and overexercising) à binge eating and purging from fear of becoming fat •Anorexia nervosa •Possible link to sexual abuse

Bulimia Nervosa: Interdisciplinary Treatment:

•Stabilization and then normalization of eating •Restructuring of dysfunctional thoughts or attitudes •Education about healthy boundary setting •Conflict resolution about separation-individuation •Cognitive-behavioral therapy (CBT) or interpersonal therapy (IPT) •Antidepressants: SSRIs •Nutrition counseling •Group psychotherapy and support groups

is a stimulant found in many drinks (coffee, tea, cocoa, soft drinks), chocolate, and OTC medications, including analgesics, stimulants, appetite suppressants, and cold relief preparations

Caffeine

Therapeutic relationship (schizophrenia):

Centers on developing trust oAccepting the person as a worthy human being oInfusing the relationship with hope vPatients are often reluctant to engage in any relationship because of previous rejection and suspiciousness Approach the patient in a calm and caring manner Being consistent in interactions and following through on promises Patients are more likely to agree to and continue treatment if these recommendations are made within the context of a safe, trusting relationship Treatment should be focused on strengths and the empowerment of the individual

OCD across the lifespan:

Children and adolescents oMay go unnoticed oOften one additional mental disorder oPediatric acute onset neuropsychiatric syndrome (PANS) Older Adults oLinked to higher rates of depression oPoorer mental and social functioning oThose engaged in checking compulsions and hoarding may have more thought disturbances and communication difficulties

OCD clinical course

Chronic waxing and waning course Often begin in childhood; misdiagnosed Later onset = better outcomes Rituals Dissociative absorption

A nurse is reading a journal article about binge eating disorder and how it compares with bulimia nervosa. Which information would the nurse likely find being discussed? Select all that apply. Clients with binge eating disorder are typically obese, unlike those with bulimia Like those with bulimia, clients with binge eating disorder also purge. Clients with binge eating disorder have lower dietary restraint than those with bulimia Clients with bulimia and binge eating disorder experience a feeling of loss of control Clients with binge eating disorder use behaviors other than purging to compensate for binge eating.

Clients with binge eating disorder are typically obese, unlike those with bulimia Clients with binge eating disorder have lower dietary restraint than those with bulimia

Which of the following terms, according to Lazarus, refers to the process through which an event is evaluated, with respect to what is at stake and what might/can be done?

Cognitive appraisal

Which intervention has been found to be most effective reducing the initial symptoms of bulimia?

Cognitive behavior therapy and pharmacologic interventions

Individuals with anorexia nervosa concentrate on which body cue?

Controlling food intake

A client responds to bad news regarding test results by crying uncontrollably. What is the term for this response to a stressor?

Coping mechanism -When a person is in a threatening situation, immediate responses occur. Those responses, which are often involuntary, are called coping responses. The change that takes place as a result of the response to a stressor is adaptation.

A nurse is helping a male client recognize the impact of stressful events on his health. Using the Recent Life Changes Questionnaire, the client learns that the most stressful life change is which type?

Correct response: His mother was just diagnosed with cancer Explanation: According to the Recent Life Changes Questionnaire, a change in the health status of a family member has a life stress value of 52. This is following by sex difficulties which has a life stress value of 49, then personal injury or illness which has a life stress value of 42 and finally a change in residence is given a life change value of 33.

A nurse is reviewing the events that occur in the body as it responds to stress. The nurse demonstrates understanding of the information by identifying which hormone as primarily secreted by the adrenal cortex during stress?

Cortisol

Therapeutic Relationship (Panic Disorder)

Critical aspect of helping the person work toward recovery The nurse should help the patient relax and be comfortable with discussing fears and anxiety A calm, understanding approach in a comfortable environment will help the person relax and be willing to engage in a therapeutic relationship

Which of the following would the nurse be alert for in a patient receiving fluoxetine? A.Hypertensive crisis B.Sedation C.Weight gain D.Serotonin syndrome

D. Fluoxetine is an selective serotonin reuptake inhibitors (SSRI) and may lead to the development of serotonin syndrome. Tricyclic antidepressants are commonly associated with sedation and weight gain. Hypertensive crisis occurs with monoamine oxidase inhibitors (MAOIs) if they are coadministered with food or other substances containing tyramine.

Which of the following would the nurse be least likely to assess in a patient experiencing neuroleptic malignant syndrome? Diaphoresis Muscle rigidity Incontinence Unreactive dilated pupils

D. Unreactive dilated pupils would suggest anticholinergic crisis. Diaphoresis, muscle rigidity, and incontinence would be associated with neuroleptic malignant syndrome.

Which agent would a nurse least likely expect to administer to a patient experiencing panic disorder? Fluoxetine Sertraline Imipramine Buspirone

D. Buspirone Buspirone is more likely to be prescribed for a patient experiencing generalized anxiety disorder. Fluoxetine, sertraline, and imipramine are used to treat panic disorder.

Which neurotransmitter would the nurse identify as being possibly involved in the development of bulimia nervosa? A. Dopamine B. Gamma-aminobutyric acid C. Norepinephrine D. Serotonin

D. Serotonin Individuals with bulimia nervosa are thought to have altered serotonin neurotransmission. Dopamine, gamma-aminobutyric acid, and norepinephrine have not been implicated in this disorder.

A 42-year-old client was recently diagnosed with hypertension. Which of the following occurrences would be a positive reaction to the acute stress of this new diagnosis?

Decreasing dietary sodium and fat intake -In an acute stress, a healthy or positive response to a diagnosis such as hypertension would be to redirect attention to promoting health (i.e., decreased sodium and fat). The other options are not positive responses.

The client has been diagnosed with depression and asks the nurse several questions regarding depression and how it came to be diagnosed. Which explanation would the nurse include when describing the psychodynamic view of the etiology of depression?

Depression is anger turned inward.

What are biologic components of suicide?

Depression, Severe childhood trauma, Genetic factors

A client is experiencing a panic attack. Which term describes sensing that things are not real?

Derealization -Derealization is sensing that things are not real. Automatisms are automatic, unconscious mannerisms. Depersonalization describes feelings of being disconnected from oneself, as seen in a panic attack. Agoraphobia is a fear of being outside.

The nurse is interviewing a client who has recently been diagnosed with posttraumatic stress disorder (PTSD). What action by the nurse best addresses the client's experience of intrusion?

Dialoguing with the client about the frequency and intensity of the client's nightmares -Intrusion is the involuntary appearance of thoughts, memories, and dreams related to the traumatic event. Nightmares are a common example of intrusion. The use of hypnotics, the client's coping strategies, and the effect of the trauma on relationships are important areas for assessment but do not directly address intrusion.

Therapeutic relationship in patients with eating disorders:

Difficult initially -Tend to be suspicious and mistrustful especially of authority figures and health personnel -State of paranoia -Impatient and irritable A firm, accepting, and patient approach is important -Providing a rationale for all interventions -Consistent, nonreactive approach -Avoid power struggles; Always think about personal feelings of frustration and need for control

A client is brought to the emergency department by law enforcement after suspicion of driving under the influence. A blood alcohol level is drawn and is found to be 0.10 mg%. Which of the following would the nurse expect to assess?

Difficulty coordinating movements -A blood alcohol level of 0.10 mg% would be manifested by difficulty driving and coordinating movements. Impaired judgment, giddiness and mood changes would be seen with a blood alcohol level of 0.05mg%.

Child is overly familiar with others in ways uncharacteristic of cultural norms

Disinhibited social engagement disorder

characterized by severe irritability and outbursts of temper

Disruptive mood dysregulation disorder -begins before the age of 10 when children have verbal rages and/or are physically aggressive toward others or property -behavior disrupts family functioning as well as the child's ability to succeed in school and social activities -similar deficits in recognition of emotion through facial expression, decision-making, and control as those with bipolar disorder

characterized by the inability to recall an extensive amount of important personal information because of physical or psychological trauma.

Dissociative amnesia

occurs when a person suddenly and unexpectedly leaves home or work and is unable to recall the past.

Dissociative fugue

occurs when a person is dominated by at least one of two or more definitive personalities at one time.

Dissociative identity disorder (DID)

A nurse is assessing a client and determines that the client is experiencing severe anxiety based on which finding?

Distorted sensory awareness -In severe anxiety, perception becomes increasingly distorted, sensory input diminishes, and processing of sensory stimuli becomes scattered and disorganized.

A client with schizophrenia is exhibiting hallucinations and delusions. The mental health nurse knows that these symptoms are associated with hyperactivity of which neurotransmitter?

Dopamine

The ingestion of mood-altering substances stimulates which neurotransmitter pathway in the limbic system to produce a "high" that is a pleasant experience?

Dopamine

binge eating and purging (anorexia nervosa)

During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

restricting type of anorexia nervosa

During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.

The nurse is assessing a client with an eating disorder. Which personality characteristic would the nurse identify when interacting with the client?

Eager to please

These tests can help identify the most significant symptoms for an individual patient with eating disorders and indicate a focus for interventions, especially therapy.

Eating Attitudes Test and CHEAT -In clinical settings, the Eating Disorder Examination Questionnaire (EDEQ) is most often used

Which statement best describes the theories of the etiology of eating disorders?

Eating disorders involve dysregulation of multiple neurotransmitter systems, whether as a cause or an effect of the eating disorder, and may be influenced by behavioral, cultural, and familial factors.

Night Eating Syndrome:

Eats after awakening from sleep or consumes an excessive amount of food after the evening meal -Causes: Significant distress Feeling of loss of control over consumption Sleep fragmentation Morning anorexia A disorder of circadian modulation of food intake and sleep

Disorganized thinking in those with scizophrenia:

Echolalia, Circumstantiality, Loose associations, Tangentiality, Flight of ideas, Word salad, Neologisms, Paranoia, Referential thinking, Autistic thinking, Concrete thinking, Verbigeration, Metonymic speech, Clang association, Stilted language, and Pressured speech

This person described the disorder dementia praecox.

Emil Kraepelin

Evidence-Based Nursing Care for Persons With Substance-Related Disorders; Therapeutic Relationship

Encourage honest expression of feelings. Listen to what the individual is really saying. Express caring for the individual. Hold the individual responsible for their behavior. Provide fair and consistent consequences for negative behavior. Talk about specific objectionable actions. Do not compromise your own values or nursing practice. Communicate the treatment plan Monitor your own reactions to the patient.

A client has been taking a tricyclic antidepressant (TCA) for several months and is now reporting urinary hesitation. What is the nurse's best action?

Encourage the client to increase fluid intake -Urinary hesitation is best addressed by increasing fluid intake. Diuretics are not normally necessary and acidic beverages are of no particular benefit.

A group of at-risk teenagers have successfully completed an outdoor training program in which they had to collaborate and conquer a number of challenges. The nurse should identify what likely outcome of this program?

Enhanced resilience for the participants -Facing and conquering challenges increases self-worth, self-efficacy, and resilience. This type of activity is unlikely to have a direct effect on participants' risks of somatic symptom disorders or personality disorders, which have complex etiologies. Participants' coping is likely to be enhanced, but hyperarousal is associated with poor coping and low resilience.

Epidemiology and comorbidities to panic disorder:

Epidemiology and Risk A moderately high lifetime prevalence in the general population Associated with being female; middle aged; of low socioeconomic status; and widowed, separated, or divorced Comorbidity Other anxiety disorders, depression, eating disorder, substance use disorder, or schizophrenia Medical conditions, including vertigo, cardiac disease, gastrointestinal disorders, asthma, and those related to cigarette smoking

A client states that the client has just had an argument with the client's spouse over the phone. What can the nurse expect that the client's sympathetic nervous system has stimulated the client's adrenal gland to release?

Epinephrine -In the sympathetic-adrenal-medullary response to stress, the sympathetic nervous system stimulates the adrenal gland to release epinephrine and norepinephrine. Corticotropin-releasing factor, adrenocorticotropic hormone (ACTH), and glucocorticoids are released in the hypothalamic-pituitary response to stress. Reference:

Describe Trauma/Stressor related disorders.

Essential feature of these disorders involves a failure to integrate identity, memory, and consciousness oUnwanted intrusive thoughts disrupt contact with the here and now or memories that are normally accessible are lost These disorders are closely related to the trauma- and stressor-related disorders but are categorized separately Persons with dissociative disorders may also have comorbid substance abuse, mood disorders, personality disorders, or PTSD

Following the failure of a woman's recent in vitro fertilization (IVF), the nurse recognizes that she may be at risk of depression. Which intervention is considered a primary suicide prevention measure?

Establishing a support system for the woman and teaching her some coping measures -Primary prevention involves the identification and elimination of factors that cause or contribute to the development of an illness or disorder that could lead to suicide. Medication management, psychotherapy, and suicide precautions are more aggressive measures that would not be classified as primary prevention.

Mental Health Nursing Interventions in patients with eating disorders:

Establishing mental health and wellness goals -Positive wellness habits of nutrition, physical activity, sleep, coping with stress, and developing a support system -Prioritize long- and short-term goals -Setting realistic goals

Renamed disorder schizophrenia; identified a group of schizophrenias.

Eugen Bleuler - began to determine that there was not just one type of schizophrenia (meaning split minds) but rather a group of schizophrenias.

A nursing student learning about mood disorders correctly identifies which of the following to mean exaggerated feelings of well-being?

Euphoria

Parents visit the clinic with their teenager to discuss the teen's skin picking. Many bleeding wounds and various stages of scabs located up and down both of the teenager's arms. The parents are very upset about this behavior and want it to stop. Which would the health care provider document?

Excoriation disorder -Excoriation disorder (skin picking) is the inability to stop recurrent picking at skin for emotional release or anxiety release. Body dysmorphic disorder is a preoccupation with slight or imagined physical defects that are not apparent to others. There is not enough information to diagnose disrupted family dynamics or control issues within the family unit.

The psychiatric mental health nurse is planning the care of a client whose elaborate room entry and exit rituals have led to a diagnosis of obsessive-compulsive disorder (OCD). What action by the nurse best addresses possible psychodynamic aspects of the etiology?

Exploring the characteristics of the client's defense mechanisms -Psychodynamic theory focuses on the role of defense mechanisms in the etiology of obsessive-compulsive disorder. Personality type and family relationships are not central to psychodynamic theory. Hyper- and hypoglycemia are not recognized etiologic factors.

Overview of Trauma- and Stressor-Related Disorders:

Exposure to a traumatic or otherwise stressful event can lead to a trauma- and stressor-related disorder oReactive attachment disorder- characterized by inhibited, emotionally withdrawn behavior toward an adult caregiver; rarely seek or respond to comfort; primary caregiver frequently changes oDisinhibited social engagement disorder- child is overly familiar with others in ways uncharacteristic of cultural norms; child does not hesitate to go somewhere with an unfamiliar adult oPosttraumatic stress disorder (PTSD) oAcute stress disorder oAdjustment disorder

Is the following statement true or false? Women account for more cases of deaths from suicide than men.

False More men complete suicide resulting in death than women

Is the following statement true or false? The aim of parasuicide is death.

False Parasuicide refers to a voluntary, apparent attempt at suicide in which the aim is not death.

Is the following statement true or false? An expansive mood is characterized by euphoria.

False. An elevated mood is characterized as euphoria. An expansive mood is one involving a lack of restraint in expression and overvalued self-importance.

Is the following statement true or false? A patient with depression is at greatest risk for suicide when his or her mood is at the lowest point.

False. As patients begin to feel better and have increased energy, they may be at greater risk for suicide.

Is the following statement true or false? Hallucinations are considered positive symptoms, but delusions are considered negative symptoms.

False. Hallucinations and delusions are considered positive symptoms

Is the following statement true or false? Inhalants are considered a central nervous system stimulant.

False. Inhalants depress the central nervous system and thus are considered central nervous system depressants

Is the following statement true or false? Panic is considered abnormal regardless of the situation and degree of threat.

False. Panic is considered normal during periods of threat; it is considered abnormal when it is continuously experienced in situations of no real physical or psychological threat

Is the following statement true or false? To meet the diagnostic criteria, a person with GAD must experience excessive worry and anxiety for a minimum of 3 months.

False. To be diagnosed with GAD, a person must experience excessive worry and anxiety for at least 6 months.

Which statement regarding gender and suicide is correct?

Females engage in suicidal behaviors more frequently than males. -While females engage in suicidal behaviors approximately three times more frequently than males, males are at least four times more likely to die from suicide. This outcome may be because men generally tend to choose more violent methods. In the United States, two thirds of male suicide victims die by firearm. The most common cause of death by suicide in women is overdose or poisoning.

Posttraumatic stress disorder (PTSD) has been diagnosed in a sexually assaulted female client. Which manifestations is the most consistent with PTSD?

Flashbacks -In PTSD, the person re-experiences all or some of the traumatic event through dreams or waking recollections and responds defensively to these flashbacks. Denial, humiliation, and self-blame are normal feelings of rape.

Which antidepressant medication is classified as a selective serotonin reuptake inhibitor (SSRI)?

Fluoxetine -Fluoxetine is included among the SSRIs. Phenelzine, isocarboxazid, and tranylcypromine are monoamine oxidase inhibitors (MAOIs).

Exacerbation of anorexia nervosa results from the client's effort to do what?

Gain control of one part of life -A client with anorexia nervosa is unconsciously attempting to gain control over the only part of the client's life the client feels the client can control. Anorexia does not incorporate manipulation of family members or work as a means of diminishing conflict. This eating disorder carries with it a high incidence in families that emphasize achievement.

A client who comes to the emergency department has a blood alcohol level of 0.05. Which finding would the nurse expect to assess?

Giddiness -A client with a blood alcohol level of 0.05 would most likely exhibit impaired judgment, giddiness, and mood changes. With a blood alcohol level of 0.10, a client would exhibit difficulty driving and coordinating movements. With a level of 0.20, a client would exhibit severely impaired motor functions, resulting in ataxia as well as emotional lability.

A 21-year-old client has been recently diagnosed with agoraphobia. Which situation is most likely to cause the client anxiety?

Going to a crowded, outdoor market independently -Agoraphobia is the fear of being alone in public places from which the person thinks escape would be difficult or help would be unavailable if he or she were incapacitated.

A client with delusional disorder tells the nurse that the client has discovered how to jump to the moon. The nurse would document this belief as what?

Grandiose delusion -Clients presenting with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery. A less common presentation is the delusion of a special relationship with a prominent person (i.e., an adviser to the president) or of actually being a prominent person (i.e., the president). The central theme of the jealous delusion is the unfaithfulness or infidelity of a spouse or lover. The central theme of somatic delusions involves bodily functions or sensations. These clients believe they have physical ailments. Erotomanic delusions are characterized by the delusional belief that the client is loved intensely by the "loved object," who is usually married, of a higher socioeconomic status, or otherwise unattainable. The client believes that the loved object's position in life would be in jeopardy if his or her true feelings were known.

The police bring a client to the hospital. They found the client in a hospital gown, swimming in a local creek. The client states that the client was "being baptized by Mother Nature, who loves and worships me." How would the nurse describe the client's current alterations in mental status?

Grandiose delusions -Disturbed thinking marked by expanded sense of self with false beliefs, such as religious connections or physical powers, are grandiose delusions. Visual hallucinations are perceptual disturbances. Neologisms are made-up words. Also, the client is not experiencing dysphoria (low mood) at this time.

A client in the clinic appears to have elevated self-esteem, is more talkative than usual, and is easily distracted. This client is exhibiting symptoms of what?

Grandiosity -Grandiosity is elevated self-esteem and may range from unusual self-confidence to grandiose delusions. Speech is pressured; the person is more talkative than usual and at times is difficult to interrupt. There is often a flight of ideas or racing thoughts.

This is an illegal, highly addictive drug that is mostly abused and the most rapidly acting of the opioids.

Heroin -sniffed, snorted, and smoked but is most frequently injected (HIV) -warm flushing of the skin, dry mouth, and a heavy feeling in the limbs -nausea, vomiting, and severe itching -drowsiness, clouded mental function, slowing of the heart rate, and extreme slowing of breathing can occur

The tendency for suicide to have a "contagious" effect is most likely to occur among what age group?

High school students -Suicide contagion is a phenomenon that has been seen most notably among high school students.

Nurse's Reflection (Suicide)

Highly stressful Possible secondary trauma for nurse Need for regular sharing of experiences and feelings Role-modeling for patients by demonstrating how to effectively manage stressors in own lives

A nurse is reviewing the laboratory test results of a client with anorexia nervosa. Which result would alert the nurse to a possible problem?

Hypercholesterolemia -Laboratory findings that may be associated with anorexia nervosa are hypercholesterolemia, low levels of follicle-stimulating hormone, hypochloremic alkalosis with purging, and leukopenia.