TCAT Nashville LPN 082015 Psychiatric - Mental Health
Gamma Aminobutyric Acid (GABA) Function/Mental Implications
- GABA interrupts the progression of the electrical impulse at the synaptic junction, producing a significant slowdown of body activity. -decreased levels of GABA have been implicated in the etiology of anxiety disorders, movement disorders such as Huntington's Disease, and various forms of epilepsy.
Trazodone and Nefazodone -action on neurotransmitter/receptor -physiological effect -side effect
-5-HT reuptake block, 5-HT2 receptor antagonism, adrenergic receptor blockade -reduces depression and anxiety -nausea, sedation, orthostasis, priapism
Antianxiety: Buspirone -action on neurotransmitter/receptor -physiological effect -side effect
-5-HT1A agonist, D2 agonist, D2 antagonist -relief of anxiety -nausea, headache, dizziness, restlessness
Which of the following is not a negative symptom of schizophrenia? -Inappropriate affect -Emotional Ambivalence -Delusions -Waxy Flexibility
-Delusions. Other negative symptoms include: bland or flat affect, apathy, autism, deteriorated appearance, anergia, posturing, pacing and rocking, anhendonia, regression.
What are the competing biological theories of depression?
-Dysregulation of limbic system, -Imbalance of neurotransmitters such as serotonin, dopamine, and norepinephrine -Thyroid dysfunction
Phases of Schizophrenia
-Phase I Premorbid Phase- social maladjustment, social withdrawal, irritability, and antagonistic thoughts and behavior -Phase II Prodromal Phase- certain signs and symptoms that precede the characteristic manifestations of the acute, fully developed illness. -Phase III Schizophrenia- active phase of the disorder. Two or more of the following present for a significant amount of time during one month: delusions, hallucinations, social/occupational dysfunction, duration, schizoaffective and mood disorder exclusion, substance/general medical condition exclusion, relationship to a pervasive developmental disorder Phase IV Residual Phase- characterized by periods of remission and exacerbation. A residual phase usually follows an active phase of the illness.
A 60 year old client with chronic schizophrenia presents in to ER with uncontrollable tongue movements, stiff neck, and difficulty swallowing. What is happening and how is it resolved? -Neuroleptic malignant syndrome treated by discontinuing antipsychotic medications -Angranulocytosis treated by administration of clozapine -extrapyramidal dyskinesia treated by discontinuing antipsychotic medications -tardive dyskinesia treated by discontinuing antipsychotic medications
-Tardive dyskinesia treated by discontinuing antipsychotic medications
Progressive relaxation exercise therapy focuses on: -use of instrumentation to become aware of processes in the body -use of own imagination as frame of reference - hair-thin, sterile, disposable, stainless steel needles -tensing and relaxing groups of muscles
-Tensing and relaxing groups of muscles
What is a self help group?
-allow clients to talk about their fears and relieve feelings of isolation, while receiving comfort and advice from others undergoing similar experiences
Define Altruism
-assimilated by group members through mutual sharing and concern for each other. Providing assistance and support to others creates a positive self image and promotes self growth.
Antianxiety: Benzodiazepines -action on neurotransmitter/receptor -physiological effect -side effect
-binds to BZ receptor sites on the GABA-A receptor complex, increases receptor affinity for GABA -relief of anxiety, sedation -dependence, confusion, memory impairment, motor incoordination
Therapeutic Relationships, The Orientation (Introductory) Phase
-create environment for the establishment of trust and rapport -contract for intervention that details expectations/responsibilities - gathering assessment data to build strong client database. -identify strengths/weakness of client -formulating nursing dx -set goals that are mutually agreeable -develop a plan of action that is realistic for meeting the established goals -explore feelings of both the client and nurse
Histamine Function/Mental Implications
-exact processes mediated by histamine within CNS are unclear -some data suggest that histamine may play a role in depressive illnesses
Crises occur when an individual: -is exposed to a precipitating stressor -perceives a stressor to be threatening -has no support systems -experiences a stressor and perceives coping strategies to be ineffective
-experiences a stressor and perceives coping strategies to be ineffective
What is a task group?
-function is to accomplish a specific outcome or task. The focus is on solving problems and making decisions to achieve this outcome. Often, a deadline is placed.
Acetylcholine Functions/Mental Implications
-implicated in sleep, arousal, pain perception, the modulation and coordination of movement, and memory acquisition and retention -cholinergic mechanisms may have some role in certain disorders of motor behavior and memory, such as Parkinson's, Huntington's, and Alzheimer's disease. Increased levels of acetylcholine have been associated with depression
MAO Inhibitors -action on neurotransmitter/receptor -physiological effect -side effect
-increase NE and 5-HT by inhibiting the enzyme that degrades them -reduces depression and anxiety -sedation, dizziness, sexual dysfunction, hypertensive crisis
SSRI -action on neurotransmitter/receptor -physiological effect -side effect
-inhibit reuptake of serotonin -reduces depression, controls anxiety, controls obsessions -nausea, agitation, headache, sexual dysfunction
Tricyclic Antidepressants -action on neurotransmitter/receptor -physiological effect -side effect
-inhibit reuptake of serotonin, norepinephrine, block NE receptor, ACh receptor, histamine receptor -reduces depression, relief of severe pain, prevent panic attacks -sexual dysfunction, sedation, weight gain, dry mouth, constipation, blurred vision, urinary retention, postural hypotension, and tachycardia
Bupropion -action on neurotransmitter/receptor -physiological effect -side effect
-inhibits reuptake of NE and dopamine -reduces depression, aid in smoking cessation, decrease in symptoms of ADHD -insomnia, dry mouth, tremor, seizures
Dopamine Function/Mental Implications
-involved in regulation of movements and coordination, emotions, voluntary decision-making ability, and because of its influence on the pituitary gland, it inhibits the release of prolactin -decreased levels of dopamine have been implicated in the etiology of Parkinson's disease and depression. Increased levels of dopamine are associated with mania and schizophrenia.
Therapeutic Relationships, The Preinteraction Phase
-involves preparation for the 1st encounter -obtain available info about the client. Initial assessment -Examine one's own feelings, fears, and anxieties about working with particular client
Therapeutic Relationships, The Working Phase
-maintain trust/rapport -promote client's insight and perception of reality -problem solving using the model -overcoming resistance behaviors on the part of the client as the level of anxiety rises in response to discussion of painful issues -continuously evaluating progress toward the goal
A nurse assesses a patient with suspected of having major depression disorder. Which symptom would eliminate the diagnosis? -Maxed out charge cards and exhibits perniscuous behaviors -refuses to interact with others -unable to feel any pleasure 0disheveled and malodorous
-maxed out charge cards and exhibits perniscuous behavior. Depressed mood, loss of interest or pleasure in usual activities and significant weight loss are signs of major depressive disorder.
Norepinephrine Function/Mental Implications
-may have role in the regulation of mood, cognition, perception, and in cardiovascular functioning, and in sleep and arousal. -implicated in certain mood disorders such as depression and mania, anxiety states, and in schizophrenia. Levels of the neurotransmitter are thought to be decreased in depression and increased in mania, anxiety disorders, and in schizophrenia
Define Transference:
-occurs when the client unconsciously attributes to the nurse feelings and behavioral predispositions formed toward a person from his or her past.
Serotonin Function/Mental Implications
-play a role in sleep and arousal, libido, appetite, mood, aggression, and pain perception -increased levels of serotonin have been implicated in schizophrenia and anxiety states. Decreased levels of the neurotransmitter have been associated with depression
SSNRIs: venlafaxine, desvenlafaxine, and duloxetine -action on neurotransmitter/receptor -physiological effect -side effect
-potent inhibitor of serotonin and norepinephrine reuptake. Weak inhibitor of dopamine reuptake. -Reduces depression, relieves pain of neuropathy, relieves anxiety -nausea, increase sweating, insomnia, tremors, sexual dysfunction
What is a supportive/therapeutic group?
-prevent future upsets by teaching participants effective ways to deal with emotional stress rising from situational of developmental crises. -focus on group relations, interactions among group members, and the consideration of a selected issue
Therapeutic Relationships, The Termination Phase
-progress has been made toward attainment of mutually set goals -a plan for continuing care or assistance during stressful life situations -feelings about termination of the relationship are recognized and explored.
Antipsychotics: Novel: clozapine, olanzepine, aripiprazole, quetiapine, risperdone, ziprasidone, paliperidone, iloperidone, and asenapine -action on neurotransmitter/receptor -physiological effect -side effect
-receptor antagonism of 5-HT1 and 5-HT2, D1-D5, H1, alpha-adrenergic, muscarinic -relief of psychosis, relief of anxiety, and acute mania -potential with some of the drugs for mild EPS, sedation, weight gain, orthrostasis and dizziness, blurred vision, dry mouth, sweating, constipation, urinary retention, tachycardia
Define Countertransference:
-refers to the nurse's behavioral and emotional response to the client. These responses may be related to unresolved feelings toward significant others form the nurse's past, or they may be generated in response to transference feelings on the part of the client.
Antipsychotics: phenthiazines and haloperidol -action on neurotransmitter/receptor -physiological effect -side effect
-strong D2 receptor blockade, weaker blockade of ACh, H1, alpha-adrenergic and 5-HT2 receptors -relief of psychosis, relief of anxiety, some provide relief from nausea and vomiting and intractable hiccoughs
What is a teaching group?
-teaching/educational groups to convey knowledge and information to a number of individuals. nurses can be involved in teaching groups of many varieties, such as medication education, childbirth, breast exams, and parenting. usually have a set number of meetings
Aaron, age 27, was brought to the E.D by police. he smelled strongly of alcohol and was combative. His B.A.C was measured 293 mg/dL. His girlfriend reports that he drinks excessively every day and is verbally and physically abusive. The nurses give John the nursing dx of Risk for other-directed violence. What would be appropriate outcome objectives for this diagnosis? Select all that apply. -client will not verbalize anger or hit anyone -will verbalize anger rather than hit others -client will not harm self or others -client will be restrained if becomes verbally/physically abusive
-will verbalize anger rather than hit others -client will not harm self or others
A nurse is reviewing that stat labs of a client in the ER. At what minimum blood alcohol level should a nurse expect intoxication to occur? o 50 mg/dL o 100 mg/dL o 250 mg/dL o 300 mg/dL
100 mg/dL
Which of the following is a correct assumption regarding the concept of crisis? -Crises occur only in individuals with psychopathology -The stressful event that precipitates crisis is seldom identifiable -A crisis situation contains the potential for psychological growth or deterioration -Crises are chronic situations that recur many times during an individual's life
A crisis situation contains the potential for psychological growth or deterioration
Define Empathy
A process wherein an individual is able to see beyond outward behavior and sense accurately another's inner experience at a given point in time.
On the 1st day of a clients alcohol detox, which nursing intervention should take priority? o Administer chloiazepoxide (Librium) in a dosage according to protocol. o Strongly encourage the client to attend 90 AA meetings in 90 days o Educate the client about the biopsychosocial consequences of alcohol abuse
Administer chloiazepoxide (Librium) in a dosage according to protocol
Anna has been a widow for 20 years. Her maladaptive grief response to the loss of her dog may be attributed to which of the following? Select all that apply. -unresolved grief over the loss of her husband -loss of several relatives and friends over the last few years -repressed feelings of guilt over the way in which Lucky died -inability to prepare in advance for the loss
All answers are correct. Unresolved grief over the loss of her husband; loss of several relatives and friends of the last few years; repressed feelings of guilt over the way in which Lucky died; inability to prepare in advance for the loss.
An aging patient with a dx of chronic schizophrenia takes an antipsychotic and beta blocker for HTN. Which statement made by the nurse is the most important? -Make sure you concentrate on taking slow, deep, cleansing breaths - Rise slowing after sitting or laying down -Watch your diet and try to engage in physical activity -Wear sunscreen when outside
All of these side effects are true for antipsychotic medications. However, with consideration of the beta blocker, rising slowing from a sitting or lying position is most important.
A decrease in acetylcholine may play a significant role in which illness?
Alzheimer's disease
George is diagnosed with Major Depression. She is most likely fixed in which stage of the grief process? -denial -depression -anger -acceptance
Anger
A nurse understands that abnormal secretion of growth hormone may play a role in which illness? -Schizophrenia -Anorexia -Schizophrenia -Anxiety Disorder
Anorexia
A normal life cycle transition that may be anticipated but over which the individual may feel a lack of control is what type of crisis? -Crisis reflecting psychopathology -Anticipated Life Transitions -Traumatic Stress -Maturational/Developmental
Anticipated Life Transitions
During a therapeutic group, 2 clients engage in an angry verbal exchange. The nurse leader interrupts the exchange and excuses both the clients from the group. Which leadership style has the nurse demonstrated? -Autocratic -Democratic -Bureaucratic
Autocratic
David, who is 72 years old is of the age at which she may have experienced many losses coming close together. What is this called? -Bereavement overload -isolation -Normal mourning - cultural relativity
Bereavement overload
Catatonic Schizophrenia
Characterized by marked abnormalities in motor behavior and may be manifested in the form of stupor or excitement.
Paranoid Schizophrenia
Characterized mainly by the presence of delusions of persecution or grandeur and auditory hallucinations related to a single theme. Individual is often tense, suspicious, guarded, and my be argumentative, hostile, and aggressive. Onset of symptoms is usually later, (20-30s) and less regression of mental faculties, emotional response, and behavior is seen than in the other subtypes of schizophrenia.
John is on the alcohol treatment unit. He walks into the dayroom where other clients are watching a program on TV. He picks up the remote and changes the channel and says, "That's a stupid program! I want to watch something else!" In what stage of development is John fixed according to Sullivan's interpersonal theory? -Juvenile because he is learning to form satisfactory peer relationships. -Childhood because he has not learned to delay gratification. -Early adolescence because he is struggling to form an identity. -Late adolescence because he is working to develop a lasting relationship.
Childhood because he has not learned to delay gratification.
When planning group therapy, which configuration should a nurse identify as most optimal for a therapeutic group? o Circle of chairs, 5-10 people o Members choose chair placement o Chairs around a table, 5-10 people
Circle of chairs, 5-10 people
The most essential task for a nurse to conduct before forming a therapeutic relationship with a client is: o Clarifying one's attitudes, values, and beliefs o Ensuring therapeutic termination o Promoting client insight
Clarifying one's attitudes, values, and beliefs
A nurse evaluates a client PCA pump and notices 100 attempts within a 30 min period. Which is the best rationale for assessing this client for substance dependence? o Clients who are dependent on alcohol or benzodiazepines may have developed cross tolerance to analgesics and required increased doses to achieve effective pain control o Narcotic pain medication is contraindicated for all clients with active substance abuse problems o There is no need to assess the client o The client is experiencing symptoms of withdrawal, and needs to be accurately assed for lorazepam dosage
Clients who are dependent on alcohol or benzodiazepines may have developed cross tolerance to analgesics and required increased doses to achieve effective pain control
Which of the following tasks are associated with the orientation phase of relationship development? Select all that apply? -Promoting the client's insight and perception of reality -Creating an environment for the establishment of trust and rapport -Using the problem solving model toward goal fulfillment -Obtaining available information about the client from various sources -Formulating nursing diagnoses and setting goals
Creating an environment for the establishment of trust and rapport, and formulating nursing diagnoses and setting goals
A decrease in norepinephrine may pay a significant role in: o Bipolar disorder o Schizophrenia o Alzheimer's o Depression
Depression
Paul is the member of an anger management group. He knew that people did not want to be his friend because of his violent temper. In the group, he has learned to control his temper and form satisfactory interpersonal relationships with others. This is an example of which curative factor. -catharsis -altruism -imparting of information -development of socializing techniques
Development of socializing techniques
Based on the last question about Anna, Anna's grieving behavior would most likely be considered to be: -delayed -inhibited -prolonged -distorted
Distorted.
Undifferentiated Schizophrenia
Do not meet the criteria for any other subtypes, or they may meet the criteria for more than one subtype. Behavior is clearly psychotic-evidence of delusions, hallucinations, incoherence, and bizarre behavior.
A client is admitted to a psych unit with a dx of catatonic schizophrenia. Which neurotransmitter should the nurse expect to be elevated in the client? o Dopamine o Serotonin o GABA o Histamine
Dopamine
Delusion Disorder Types
Erotomanic- individual believes that someone of higher status is in love with them Grandiose- irrational ideas regarding the person's worth, talent, knowledge, or power Jealous- centers on the idea that the person's sexual partner is unfaithful. Persecutory- most common; they believe they are malevolently treated in some way, frequently they believe they are being conspired against, cheated, spied on, followed, drugged or poisoned. Somatic- believe they have some physical defect, disorder, or disease
Schizophreniform Disorder
Essential features of this disorder are identical to those of schizophrenia, with the exception that the duration, including prodromal, active, and residual phases, is at least 1 month but less than 6 months. Thought to have good prognosis if the individual's affect not blunted or flat, if there is a rapid onset of psychotic symptoms from the time the unusual behavior is noticed, or if the premorbid social and occupational functioning was satisfactory.
Psychotropic medications that are strong blockers of the D2 receptor are more likely to result in which of the following side effects? -sedation -urinary retention -extrapyramidal symptoms -hypertensive crisis
Extrapyramidal symptoms
Which of the following parts of the brain is associated with voluntary body movement, thinking and judgment, and expression of feeling? -frontal lobe -parietal lobe -temporal lobe -occipital lobe
Frontal Lobe
Mr. J is a new client on the psychiatric unit. He is 35 years old. Theoretically, in which level of psychosocial development (according to Erikson) would you place Mr. J? - Intimacy vs Isolation - Generativity vs. Self-Absorption - Trust vs. Mistrust - Autonomy vs. Shame and Doubt
Generativity vs. Self-Absorption
When there is congruence between what the nurse is feeling and what is being expressed the nurse is conveying: o Genuineness o Respect o Sympathy o Rapport
Genuineness
Three years ago, Anna's dog Lucky, whom she had for 16 years, was run over by a car and killed. Anna's daughter reports that since that time, Anna has lost weight, rarely leaves her home, and just sits and talks about Lucky. Anna's behavior would be considered maladaptive because: - it has been more than 3 years since Lucky died -her grief is too intense just over the loss of a dog -her grief is interfering with her functioning -people in this culture would not comprehend such behavior
Her grief is interfering with her functioning.
Dorothy was involved in an automobile accident while under the influence of alcohol. she swerved her car into a tree and narrowly missed hitting a child on a bicycle. She is in the hospital with multiple abrasions and contusions. She is talking about the accident with the nurse. Which of the following statements by the nurse is most appropriate? -Now that you know what can happen when you drink and drive, I'm sure you won't let it happen again -You know that was a terrible thing you did. That child could have been killed -I'm sure everything is going to be okay now that you understand the possible consequences of such behavior -How are you feeling about what happened?
How are you feeling about what happened?
Which of the following parts of the brain has control over the pituitary gland and autonomic nervous system? It also regulates appetite and temperature. -temporal lobe -parietal lobe -cerebellum -hypothalamus
Hypothalamus
A client on an inpatient psych unit comes to the nurse to complain about another patient (Peter) not cleaning up after himself in the community restroom. The patient is angry and upset. What is the best response by the nurse? -Why don't you go discuss that with Peter -I will go take care of it so Peter does not get upset -I can see that you are angry. Let's discuss ways to approach Peter with your concerns.
I can see that you are angry. Let's discuss ways to approach Peter with your concerns.
A client states: "I refuse to shower in this room. I must be very cautious. The FBI placed a camera in here to monitor my every move." Which of the following is the therapeutic response? -That's not true -I have a hard time believing that's true -Surely you don't believe that -I will help you search this room so that you can see there is no camera
I have a hard time believing that's true
Henry is a member of an AA group. he learned about the effects of alcohol on the body when a nurse from the chemical dependency unit spoke to the group. This is an example of which curative factor? -Catharsis -Altruism -Imparting of information -Universality
Imparting of information
Which of the following hormones has been implicated in the etiology of mood disorder with seasonal pattern? -increased levels of melatonin -decreased levels of oxytocin -decreased levels of prolactin -increased levels of thyrotropin
Increased levels of melatonin
Residual Schizophrenia
Individual has a history of at least one previous episode of schizophrenia. Individual who has a chronic form of the disease and is the stage that follows an acute episode. Residual symptoms may include social isolation, eccentric behavior, impairment in personal hygiene and grooming, blunted or inappropriate affect, poverty of or overly elaborate speech, illogical thinking, or apathy.
What is the major difference between anger and aggression?
Intent; aggression refers to behavior that is intended to inflict harm or destruction
A client with OCD spends many hours each day washing his hands. The most likely reason he washes his hands so much is that:
It relieves his anxiety.
Which of the following is not part of SOLER acronym for active listening? -Lean away from client -Sit squarely facing the client -Establish eye contact
Lean away from client
Which of the following part of the brain is associated with multiple feelings and behaviors and is sometimes referred to as the "emotional brain"? -frontal lobe -thalamus -hypothalamus -limbic system
Limbic system
Which therapeutic communication technique is being used in the following example? Patient: "Every time I get angry, I wind up getting into a fistfight with my wife or I take it out on the kids." Nurse: "I notice that you are you are smiling as you talking this physical violence." o Making observations o Restating o Formulating a plan of action
Making Observations
Schizoaffective Disorder
Manifested by schizophrenic behaviors, with a strong element of symptomatology associated with the mood disorders (depression or mania). Client may appear depressed, with psychomotor retardation and suicidal ideation, or symptoms may include euphoria, grandiosity, and hyperactivity.
The nurse-client therapeutic relationship includes all of the following characteristics except: -Meeting the social needs of both the nurse and the client -Ensuring therapeutic termination -Promoting client insight into problematic behavior -Collaboration on a set of goals
Meeting the social needs of both the nurse and the client
Laura is a nurse in an inpatient psychiatric unit. Much of her time is spent observing client activity, talking with clients, and striving to maintain a therapeutic environment in collaboration with other health care providers. This specific example of the implementation step of the nursing process is called: o Health teaching o Case management o Milieu therapy o Self care activities
Milieu therapy
Nancy, a depressed client who has been unkempt and untidy for weeks, today comes to group therapy wearing makeup and a clean dress and having washed and combed her hair. Which of the following responses by the nurse is most appropriate? -Nancy, I see you have put on a clean dress and combed your hair -Nancy, you look wonderful today! -Nancy, I'm sure everyone will appreciate that you have cleaned up for the group today -Now that you see how important it is, I hope you will do this everyday
Nancy, I see you have put on a clean dress and comber your hair
A patient with physical dependence of opiates is likely to experience which symptoms of withdrawal? o Nausea, vomiting, diarrhea, and piloerection o Tremors, hallucinations, seizures o Incoordination and unsteady gait
Nausea, vomiting, diarrhea, and piloerection
At a synapse, the determination of further impulse transmission is accomplished by means of which of the following? -potassium ions -interneurons -neurotransmitters -the myelin sheath
Neurotransmitters
A decrease in which of the following neurotransmitters has been implicated in depression? -GABA, acetylcholine, and aspartate -Norepinephrine, serotonin, and dopamine -Somatostatin, substance P, and glycine -Glutamate, histamine, and opioid peptides
Norepinephrine, serotonin, and dopamine
Which of the following parts of the brain is concerned with visual reception and interpretation? -frontal lobe -parietal lobe -temporal lobe -occipital lobe
Occipital Lobe
Disorganized Schizophrenia
Onset of symptoms before age 25, behavior is markedly regressive and primitive, contact with reality is extremely poor, affect is flat or grossly inappropriate, often with periods of silliness and incongruous giggling. Facial grimaces and bizarre mannerisms are common, and communication is consistently incoherent. Personal appearance is generally neglected.
The nurse asks the patient to identify the date, the time of day and the location of the clinic. The nurse is assessing the patient's: o Mental status o Perception o Orientation o Thought
Orientation
Which client dx should a nurse associate with a decrease in GABA? -Depression -Alzheimer's -Panic Disorder -Schizophrenia
Panic disorder
Flat affect, paranoid delusions, anhedonia, anergia, neologisms, and echolalia. Which of these symptoms are correctly placed as negative/positive symptoms of schizophrenia? -(+) Paranoid delusions, anhendonia, anergia -(+) Paranoid delusions, neologisms, echolalia - (-) Paranoid delusions, anergia, echolalia - (-) Paranoid delusions, flat affect, anhedonia
Paranoid delusions, neologisms, echolalia
Which of the following parts of the brain deals with sensory perception and interpretation? -hypothalamus -cerebellum -parietal lobe -hippocampus
Parietal Lobe
John, a veteran of the war in Iraq, is diagnosed with PTSD. Which therapy regimen is most appropriate for John?
Paroxetine and group therapy.
Nursing intervention that is most appropriate for caring for an acutely agitated client diagnosed with paranoid schizophrenia? o Provide neon light and soft music o Maintain continual eye contact through interventions o Use therapeutic touch to increase trust and rapport o Provide personal space to respect client boundaries
Provide personal space to respect client boundaries
Depressed divorcee has been self medicating with cocaine for the past year. What should a nurse use to best describe the individual's situation? o Physical dependency o Social dependency o Psychological dependency o Substance dependency
Psychological dependency
Which of the following statements is not true about milieu therapy? o Punishments are used to eliminate negative behaviors o One to one relationship between the patient and the nurse is a major focus o The goal is for the client to eliminate negative behaviors
Punishments are used to eliminate negative behaviors
Lucky sometimes refused to obey Anna and, indeed, did not come back to her when she called to him on the day he was killed. But Anna continues to insist "he was the very best dog. He always minded me. He did everything I told him to do" This represents the defense mechanism of: -sublimation -reaction formation -compensation - undoing
Reaction Formation
From which of the following symptoms might the nurse identify a chronic cocaine user? -Clear, constricted pupils -Red, irritated nostrils -Muscle aches -Conjunctival redness
Red, irritated nostrils
Define Genuineness
Refers to the nurse's ability to be open, honest, and "real" in interactions with the client.
Anna, age 72, has been grieving the death of her dog, Lucky, for 3 years. She is not able to take care of her activities of daily living, and wants only to make daily visits to Lucky's grave. Her daughter has likely put off seeking help for Anna because: -women are less likely to seek help for emotional problems than men are -relatives often try to "normalize" the behavior, rather than label it mental illness -she knows that all older people are expected to be a little depressed -she is afraid that the neighbors "will think her mother is crazy"
Relatives often try to "normalize" the behavior, rather than label it a mental illness
A patient is brought to the E.R after being violently raped. Which nursing action is most appropriate?
Remain nonjudgmental and actively listen to the client's description
Anna's dog, Lucky got away from her while they were taking a walk. He ran into the street and was hit by a car. Anna cannot remember any of these circumstances of his death. This is an example of what defense mechanism? -Rationalization -Denial -Supression -Repession
Repression
Promoting an atmosphere of privacy during therapeutic interactions, always being open and honest, striving to understand motivation behind the client's behavior and calling the client by name all demonstrate what? -Trust -Respect -Genuineness
Respect
A 18 year old female was sexually assaulted while on her way home from work. She is brought to the ER by her mom. Sexual assault is an example of the following type of crisis: o Resulting from traumatic stress o Dispositional o Developmental crisis o Reflecting psychopathology
Resulting from traumatic stress
The nurse considers a client's response to crisis intervention successful if the client is at a minimum: o Returns to his previous level of functioning o Learns to relate better to others o Develops insight into the reasons why the crisis occurred.
Returns to his previous level of functioning
Most anti-depressants work by blocking ___________ of certain neurotransmitters, like serotonin, after they are released into the synaptic cleft: -Retransmission
Reuptake
What should be the priority nursing dx for a client experiencing alcohol withdrawal? o Disturbed thought process r/t tactile hallucinations o Ineffective denial e/t continued alcohol despite negative consequence o Risk for injury r/t CNS stimulation
Risk for injury r/t CNS stimulation
A client is diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication administered addresses this positive symptom?
Risperidone
An increase in dopamine activity may play a significant role in which of the following illness? o Schizophrenia o Anxiety disorders o Depression o Alzheimer's
Schizophrenia
The initial care plan for a client with OCD who washes her hands obsessively would include which nursing intervention?
Sets limitations on the amount of time the client may engage in the ritualistic behavior.
What may be influential in the predisposition to PTSD?
Severity of the stressor and availability of support systems.
Psychotropic medications that block the reuptake of serotonin may result in which of the following side effects? -dry mouth -constipation -blurred vision -sexual dysfunction
Sexual dysfunction
Janet, a psychiatric client diagnosed with Borderline Personality Disorder, has just been hospitalized for threatening suicide. According to Mahler's theory, Janet did not receive the critical "emotional refueling" required during the rapprochement phase of development. That are the consequences of this deficiency? -she has not yet learned to delay gratification -she does not feel guilt about wrong doings to others -she is unable to trust others -she has internalized rage and fears of abandonment
She has internalized rage and fears of abandonment
A patient diagnosed with schizophrenia is prescribed Clozapine (Clozaril). Which symptoms present should the nurse intervene immediately? -Sore throat, fever, malaise -Akathisia and hypersalivation -Akinesia and insomnia -Dry mouth and urinary retention
Sore throat, fever, malaise
John, a veteran of the war in Iraq, is diagnosed with PTSD. He experiences a nightmare during his first night in the hospital. He explains to the nurse that he was dreaming about gunfire all around and people being killed. The nurse's most appropriate initial intervention is to:
Stay with John and reassure him of his safety.
Brief Psychotic Disorder
Sudden onset of symptoms that may or may not be preceded by a sever psychological stressor. Symptoms last at least 1 day but less than 1 month. Individual experiences emotional turmoil or overwhelming perplexity or confusion. Evidence of impaired reality testing may include bizarre behavior, and disorientation.
Kristine is a psychiatric nurse who has been selected to lead a group for women who desire to lose weight. The criterion for membership it that they must be at least 20 lbs overweight. All have tried to lose weight on their own many times in the past without success. At their first meeting, the nurse provides suggestions as the members determine what their goals will be and how they plan to achieve the goals. They decided how often they wanted to meet and what they planned to do at each meeting. Which type of group and style of leadership is described in this situation? -Task/autocratic -Teaching/democratic -Self-help/laissez faire -Supportive-therapeutic/democratic
Supportive-therapeutic/democratic
John, a veteran of the war in Iraq, is diagnosed with PTSD. he says to the nurse, "I can't figure out why God took my buddy instead of me." From this statement, the nurse assesses that John suffers from:
Survivor's guilt.
Joyce is the nurse leader of a childbirth preparation group. Each week she shows various films and sets out various reading materials. She expects the participants to utilize their time on a topic of their choice or practice skills they have observed on the films. Two couples have dropped out of the group stating "This is a big waste of time." Which type of group and style of leadership is described int his situation? -Task/democratic -Teaching/laissez-faire -Self-help/democratic -Supportive-therapeutic/autocratic
Teaching/laiseez-faire
Which of the following parts of the brain is concerned with hearing, short term memory, and sense of smell? -temporal lobe -parietal lobe -cerebellum -hypothalamus
Temporal Lobe
The phase of the nurse patient relationship that may be the most difficult for the patient because of anxieties may reappear and feelings of past losses are triggered is the_____________phase.
Termination
Which of the following parts of the brain integrates all sensory input (except smell) on the way to the cortex? -temporal lobe -thalamus -limbic system -hypothalamus
Thalamus
The patient says the shopatouliens took my shoes! What is the appropriate charting to describe the patient's actions/statements? o The client is experiencing command hallucinations o The client is expressing neologism o The client is experiencing an erotic delusion o The client is verbalizing word salad
The client is expressing neologism
In planning care for a suicidal client, which outcome is the first priority? -The client will not physically harm self -The client will verbalize feeling on why he wants to commit suicide - The client's mood and affect will improve over the next 3 days -The client will work well with others
The client will not physically harm self
Which of the following best describes the role of the nurse in the therapeutic milieu of a psychiatric unit? o The treatment team member who is responsible for management of therapeutic milieu. o The treatment team member who develops the medical diagnosis for all the clients in the unit o The treatment team member who provides for the spiritual and comfot needs of the client and his or her family.
The treatment team member who is responsible for management of therapeutic milieu.
A statement made by a client that indicates the client is experiencing a somatic delusion is: o I see my dead husband everywhere I go o The IRS may audit my taxes o I'm not eating my food, it smells like brimstone o There is an alien growing in my liver
There is an alien growing in my liver.
Sarah has been living in a shelter with her four children after escaping her abusive husband. Sarah's move-out date is getting closer. Sarah states, I'm afraid to leave here. I'm afraid for my safety and the safety of my children." The nurse's best response is: o This is a difficult and scary transition. Let's work together to summarize what you've learned into a plan to keep you and your family safe in the community. o It's the policy that clients are here only 30 days o You've had a month to come up with a plan o You're husband has probably moved on by now.
This is a difficult and scary transition. Let's work together to summarize what you've learned into a plan to keep you and your family safe in the community.
A despondent client who has just lost her husband of 30 years tearfully states "I'll feel better if I sell my house and move" Which nursing response is appropriate? o I'm confident you know what's best for you. o Tell me why you want to make this change o This may not be the best time for you to make such an important decision
This may not be the best time for you to make such an important decision-crisis situation, requires nurse to be more upfront so no rash decisions are made.
What is the best nursing rationale for holding a debriefing session with client and staff after a take down intervention has taken place on an inpatient unit? o To reinforce the unit rules with the clients o To process the feelings and alleviate fears of undeserved seclusion and restraint o To discuss client problems that led to inappropriate expression of anger
To discuss client problems that led to inappropriate expression of anger
The client is very hostile toward one of the staff for no apparent reason. The client is probably manifesting what:
Transference
Precipitated by unexpected external stressor over which the individual has little or no control and from which he or she feels emotionally overwhelmed and defeated is what kind of crisis? -Dispositional -Psychiatric emergency -Traumatic Stress -Maturational/Developmental
Traumatic stress
A patient is diagnosed with schizophrenia. The physician orders Haldol 50 MG BID and Benztropine 1 MG PRN. Which behaviors warrants administration of Benztropine? -Hallucinations -Tremors and shuffling gait - Shouting and screaming
Tremors and shuffling gait
Providing food when the client is hungry, providing a blanket when the client is cold, being consistent in adhering to unit guidelines, and ensuring confidentiality are all ways to enhance __________ with a client. -Trust -Respect -Genuineness
Trust
Mr. J has been diagnosed with Paranoid Schizophrenia. He refuses to eat and told the nurse he knew he was "being poisoned." According to Erikson's theory, in what development stage would you place Mr. J? - Intimacy vs. Isolation - Generativity vs. Self-Absorption -Trust vs. Mistrust -Autonomy vs. Shame and Doubt
Trust vs. Mistrust
A single, pregnant teenager in a parenting class discloses her ambivalence toward the pregnancy and the subsequent guilt that these thoughts generate. o Universality o Altruism o Imparting of information
Universality
Judy has been in the hospital for 3 weeks. she has used Valium "to settle my nerves" for the past 15 years. She was admitted by her psychiatrist for safe withdrawal from the drug. She has passed the physical symptoms of withdrawal at this time, but states to the nurse "I don't know if I will make it without Valium after I go home. I'm already starting to feel nervous. I have so many personal problems." Which of the following is the most appropriate response by the nurse? -Why do you think you have to have drugs to deal with your problems? -Everybody has problems, but not everybody uses drugs to deal with them. You'll just have to do the best that you can. -We will just have to think about some things that you can do to decrease your anxiety without resorting to drugs -Just hang in there. I'm sure everything is going to be okay.
We will just have to think about some things you can do to decrease your anxiety without resorting to drugs
Mrs. S asks the nurse, "Do you think I should tell my husband about my affair with my boss?" Which is the most appropriate response by the nurse? -What do you think would be best for you to do? -Of course you should. Marriage has to be based on truth. -Of course not. That would only make things worse. -I can't tell you what to do. You have to decide for yourself?
What do you think would be best for you to do?
Resistance, although potentially present in all stages, is most often found in the following phase: o Preinteraction o Working o Orientation o Termination
Working
Nancy says to the nurse "I worked as a secretary to put my husband through college, and as soon as he graduated, he left me. I hate him! I hate all men!" Which is an empathetic response by the nurse? -You are angry now. This is a normal response to your loss. -I know what you mean. Men can be very insensitive. -I understand completely. My husband divorced me too. -You are depressed now, but you will feel better in time.
You are angry now, this is a normal response to your loss.
Carol, an adolescent, just returned from group therapy and is crying. She says to the nurse, "All the other kids laughed at me! I try to fit in, but I always seem to say the wrong thing. I've never had a close friend. I guess I never will." Which is the most appropriate response by the nurse? -What makes you think you will never have any friends? -You're feeling pretty down on yourself right now -I'm sure they didn't mean to hurt your feelings -Why do you feel this way about yourself?
You're feeling pretty down on yourself right now
What is a crisis?
a sudden event in one's life, during which usual coping mechanisms cannot resolve the problem; the crisis disturbs homeostasis
Define Dispositional Crisis
an acute response to an external situational stressor
John has a history of violence and is hospitalized with substance use disorder. One evening, the nurse hears John yelling in the day room. The nurse observes increased agitation, clenched fists, and loud, demanding voice. he is challenging and threatening staff and other clients. The nurse's priority intervention is to: -call for assistance -draw up a syringe of prn haloperidol -ask John if he would like to talk about his anger -tell John that if he does not calm down, he will need to be restrained
call for assistance
Amanda's home was destroyed by a tornado. Amanda received only minor injuries, but is experiencing disabling anxiety in the aftermath of the event. This type of crisis is called: -crisis resulting from traumatic stress -maturational/developmental crisis -dispositional crisis -crisis of anticipated life transitions
crisis resulting from traumatic stress
Jenny reported to the high school nurse that her mother drinks too much. She is drunk every afternoon when Jenny gets home. jenny is afraid to invite friends over because of her mother. This type of crisis is called: -crisis resulting from traumatic stress -maturational/developmental crisis -dispositional crisis -crisis of anticipated life transitions
dispositional crisis
Psychotropic medications that block the acetylcholine receptor may result in which of the following side effects? -dry mouth -sexual dysfunction -nausea -priapism
dry mouth
A patient diagnosis with dysthymic disorder. Which symptom should the nurse classify as an affective symptom of this disorder? -Gloomy and pessimistic outlook on life -Low energy level -Difficulty concentration -Social isolation with a focus on self
gloomy, pessimistic outlook on life
Functions of a therapeutic group include all of the following except: -support -comaraderie -informational -governance -hope
hope
Define Rapport
implies special feeli8ngs on the part of both the client and the nurse based on acceptance, warmth, friendliness, common interest, a sense of trust, and a nonjudgmental attitude.
A man diagnosed with alcohol dependence experiences his first relapse. During his AA meeting, another group member states, I relapsed three times, but now have been sober for 15 years. Which of Yalom's curative group factors does this illustrate? o Instillation of hope o Catharisis o Universality
instillation of hope
Nurse Jones is the leader of a bereavement group for widows. Nancy is a new member. She listens to the group and sees that Jane has been a widow for 5 years now. Jane has adjusted well, and Nancy thinks maybe she can too. This is an example of which curative factor? -universality -imitative behavior -instillation of hope -imparting of information
instillation of hope
Ginger, age 19 and only child, left 3 months ago to attend college of her choice 500 miles away from home. It is Ginger's first time away. She has difficulty making decisions and will not undertake anything new without first consulting her mother. They talk on the phone almost every day. Ginger has recently started having anxiety attacks. She consults the nurse practitioner in the student health center. This type of crisis is called: -crisis resulting from traumatic stress -maturational/developmental crisis -dispositional crisis -crisis of anticipated life transitions
maturational/developmental crisis
Sandra is the nurse leader of a supportive therapeutic group for individuals with anxiety disorders. In this group, Nancy talks incessantly. When someone else tries to make a comment, she refuses to allow him or her to speak. What type of member role is Nancy assuming in this group? -aggressor -monopolizer -blocker -seducer
monopolizer
Define Maturation/developmental crisis:
occurs in response to a situation that triggers emotions related to unresolved conflicts in one's life
Immediately after ECT, which position is best for the client? -On their side -In high fowler's -Trendelenburg's -Prone position
on side, to prevent aspiration
Characteristics of aggression include:
pacing, restlessness, verbal/physical threats, threats of homicide or suicide, loud voice, argumentative, tense facial expression and body language, increased agitation with overreaction to environmental stimuli, panic anxiety, leading to misinterpretation of the environment, disturbed thought process, suspiciousness, and angry mood, often disproportionate to the situation
Nurse discovers clients suicide note that details the time, place and means. What is the priority intervention? -Placing client on one to one suicide precautions -Administer lorazepam (Ativan) prn, because the client is angry at the exposure of the plan -Calling an emergency treatment team meeting, because the client's threat must be addressed -Establishing room restrictions, because the client's threat is an attempt to manipulate the staff
place client on one to one suicide precautions
A crisis situation in which general functioning has been severely impaired and the individual rendered incompetent or unable to assume personal responsibility is called what?
psychiatric emergency
A nurse admits an older client with memory loss, confused thinking, and apathy. A psychiatrist suspects depression. What is the rationale for performing a mini mental status exam? -rule out bipolar disorder -rule out schizophrenia -rule out senile dementia -rule out personality disorder
rule out senile dementia
Reality therapy emphasizes: - decrease visual and auditory hallucinations - personal responsibility over choices - confronting unconscious conflicts - increasing assertive behavior
tensing and relaxing groups of muscles
The nurse leader is explaining about group "curative factors" to members of the group. She tells the group that group situations are beneficial because members can see that they are not alone in their experiences. This is an example of which curative factor? -alturism -imitative behavior -universality -imparting of information
universality
