384 Exam 3

Key assessment findings of MDD

*A depressed mood and anhedonia (loss of pleasure) are key symptoms in depression *Anxiety is a common symptom of depression

Normal Axiety

*A health reaction necessary for survival *Provides the energy needed to carry out the tasks involved in living and striving toward goals

SSRI Serotonin Syndrome

*Abdominal pain *Fever *Tachycardia *Elevated BP

Assessment Guidelines of MDD

*Always evaluate the patient's risk of harm to self or others. (Over hostility is highly correlated with suicide) *A thorough medical and neurological examination helps determine if the depression is primary or secondary to another disorder (has the patient taken drugs or has a medical condition?)

SSRI (FIRST LINE OF TREATMENT!)

*Blocks the synaptic reuptake of serotonin ** Escitalopram, Celexa, Fluoxetine, Sertraline *Low-side effects compared to older ones

Labs to be monitored with eating disorders

*CBC *CMP (electrolytes- sodium and potassium) *Hepatic and pancreatic panel *Renal Panel and UA *EKG *Bone densitometry

What are appropriate nursing dx for anorexia?

*Decreased cardiac output *Risk for injury *Risk for imbalanced fluid volume *Disturbed body image *Ineffective coping *Powerlessness

Lithium (Slows everything down)

*Drink lots of fluid *Watch lithium levels (0.6-1.2) **Above 1.5 = Lithium Toxicity *Watch sodium level **Low sodium = lithium toxicity **High sodium = sub-therapeutic range

What are the potentially life-threatening symptoms of refeeding syndrome?

*Fluid balance abnormalities *Hypokalemia *Hypomagnesemia *Abnormal glucose metabolism *Hypophosphatemia

Risks for Suicide

*Hopelessness *Substance use problems *Loss or separation *History of past suicide attempts *Acute suicidal ideation

Tricyclic Antidepressants (TCAs) Amytriptiline and Amipomine

*Inhibit the reuptake of norepinephrine and serotonin by the presynaptic neurons in the CNS, increasing the amount of time norepinephrine and serotonin (feel good neurotransmitter) are available to the postsynaptic receptors **Anticholinergic actions (Can't see, can't spit, can't shit- DRY!!) **Get IMMEDIATE medical attention if urinary retention or constipation occurs

Patient and Family teachings of SSRIs

*May cause sexual dysfunction *May cause insomnia and nervousness *Tell provider any other medications you are taking *AVOID ALCOHOL! *SSRI should not be taken within 14 days of the last dose of MAOIs *Liver and renal function tests should be performed and blood counts checked periodically *DO NOT discontinue medication abruptly (Serotonin withdrawal)

Severe Anxiety

*May focus on one particular detail or many scattered details and have difficulty noticing what is going on in the environment, even when someone else points it out. **Learning and problem solving are not possible at this level

Panic

*Most extreme level of anxiety and results in markedly dysregulated behavior **Cannot do client teaching because they cannot focus.

What chemical imbalances are present in MDD?

*Norepinephrine *Dopamine *Acetylcholine *GABA *Glutamate

Mild Anxiety

*Occurs in the normal experiences of everyday living and allows an individual to perceive reality in sharp focus (Example: anxiety before exam)

Nursing interventions of Serotonin Syndrome

*Remove offending agent *Initiate symptomatic treatment (antihypertensive drugs if hypertensive) *Anticonvulsants *Induction of paralysis

Second generation antipsychotics

*Risperidone *Olanzapine *Quetiapine *Ziprasidone *Clozapine

When is lithium recommended?

*SEVERE agitation (Big guns!) Depakote, Zyprexa, or Resperidone are also recommended.

Moderate Anxiety

*Sees, hears, and grasps less information that may demonstrate selective inattention in which only certain things in the environment are seen or heard unless they are pointed out *The ability to think clearly is hampered **Learning and problem solving can still take place but not at the same optimal level

Patient and Family Teaching of TCAs

*Should be told that mood elevation may take from 7-28 days *Up to 6-8 weeks may require before full effects take place *Drowsiness, dizziness, and hypotension get better after a few weeks (Do not use heavy machinery while experiencing these symptoms) *NO ALCOHOL *If possible, have the patient take the full dose at bedtime due to drowsiness and dizziness *Suddenly stopping TCAs cause nausea, altered heartbeat, nightmares, and cold sweats in 2-4 days.

What are the primary risk factors for depression?

-Female gender -Stressful life event -First-degree family members with MDD -Substance use

Major Depressive Disorder

-One of the most common psychiatric disorders -Characterized by a persistently depressed mood lasting for a minimum of 2 weeks.

Therapeutic Lithium levels

0.6-1.2 mEq/L 1.5 - TOXIC

Implementation of MDD: Maintenance Phase

1 year or more *Directed at preventing further episodes of depression

What should you ask a patient with suicidal ideation?

1. Do you want to kill yourself? 2. Do you have a plan? (What is your plan) 3. Do you have access? **Patient's diagnosed with MDD should ALWAYS be evaluated for suicidal ideation

What are short term goals for a patient with MDD?

1. Patient will remain safe while in the hospital (Observe every 15 minutes with suicidal and remove all dangerous objects from the patient) 2. Patient expresses at least one reason to live, and this is apparent by the second day of hospitalization (Spend regularly scheduled periods of time with patient throughout the day) 3. Encourage appropriate expression of angry feelings **Anger is good! 4. Accept patient's negativism (acceptance enhances feelings of self-worth)

Phobias

1. Unreasonable fear 2. Panic: fear is so high that the patient can no longer think clearly

A weight gain of ________ per week is medically acceptable

2-3lbs per week

Implementation of MDD: Continuation Phase

4-9 months *Directed at prevention of relapse through pharmacotherapy, education, and depression specific psychotherapy

Implementation of MDD: Acute Phase

6-12 weeks *Directed at reduction of depressive symptoms and restoration of psychosocial and work function MOST DANGEROUS TIME!! (Have more energy to kill themselves)

Refeeding syndrome

A dangerous shift of fluids and electrolytes that occurs within the body when calories are reintroduced too quickly **Can result in heart failure and death

What is anxiety?

A feeling of apprehension, uneasiness, uncertainty, or dread resulting from a real perceived threat

Somatic Disorders

A person has physical symptoms but they blow it out of proportion Example: A patient has really bad abdominal gas from eating taco bell, and their first thought is they have stomach cancer.

Factitious Disorder

A person makes up the symptoms or purposely induces symptoms (Munch Housing)

What is anergia?

Abnormal lack of energy (Do not want to eat or move)

What are compulsions?

Actions to relieve the anxiety from the obsessions that won't get out of their mind

What is lithium used for?

Acute mania and maintenance treatment **Takes 10-21 days to start working because the onset of action is so slow **Supplemented in early phased of treatment by atypical antipsychotics, anticonvulsants, or anti-anxiety medications (Bridge Therapy)

What are vegetative signs of depression?

Alterations in those activities necessary to support physical life and growth, eating, sleeping, elimination, and sex

Anorexia Nervosa

An eating disorder in which an irrational fear of weight gain leads people to starve themselves

Advanced signs of lithium toxicity 2.0-2.5

Ataxia (walking like drunk), blurred vision, clonic movements, large output of dilute urine *Hospitalization *Drug stopped and excretion is hastened (Bowel irrigation)

Bulimia Nervosa

Binge eating and then purging

Bulimia

Binge eating but they do not purge

What is a cardinal sign of depression?

Change in sleep pattern **Total reduction in sleep, especially deep-stage sleep

Dissociative Identify

Completely zone out and have a separate identity

Severe toxicity >2.5

Convulsions, producing none or small amounts of urine, and death can occur *Hemodialysis

What is the most dangerous aspect of MDD?

Death

Delusions

False beliefs

DSM-5

Five or more of the following symptoms have been present during the same 2-week period *Depressed mood *Loss of interest in pleasure *Weight loss or weight gain *Sleep disturbance Psychomotor changes = agitation or retardation *Fatigue *Diminished ability to think, concentrate, or make decisions *Recurrent thoughts of death

Early signs of lithium toxicity 1.5-2.0

GI upset, confusion, hyper-irritability of muscles **Medication should be withheld, blood lithium levels measured

Depersonalization

I don't feel real

If a benzodiazepine is prescribed, what in the client's history could make the nurse question the medication ordered?

If the patient has a history of addiction or substance abuse

What are psychological factors of depression?

In cognition theory, the underlying assumption is that a person's thoughts will result in emotions Example: "I'm a failure"- negative emotions Beck found that people with depression process information in negative ways, and tend to ignore positive aspects of their lives

Thought process of MDD

Judgement or ability to make reasonable decisions is poor *Leads to indecisiveness, which makes it difficult to make simple decisions such as what to wear or what to eat

Anorexia

Loss of appetite

What is a drawback of antidepressants?

May take 4-6 weeks to start working

Nursing Diagnosis Exaggerates negative feedback of self, guilt, indecisive, poor eye contact, feeling shame

Nursing Diagnosis: Chronic self-esteem

Nursing Diagnosis Feelings of hopelessness or powerless

Nursing Diagnosis: Hopelessness; powerlessness

Nursing Diagnosis Difficult with simple tasks

Nursing Diagnosis: Ineffective coping

Nursing Diagnosis Previous suicide attempt, putting affairs in order, giving away prized possessions

Nursing Diagnosis: Risk for self-directed violence/suicide

Nursing Diagnosis Vegetative signs of depression: Do not want to move

Nursing Diagnosis: Self-care deficit, insomnia, imbalanced nutrition, constipation, sexual dysfunction

Nursing Diagnosis Dull/sad affect; not making eye contact; self-isolation

Nursing Diagnosis: Social isolation

Nursing Diagnosis Questioning the meaning of life or anger at great power

Nursing Diagnosis: Spiritual Distress

Interventions Targeting the Vegetative Signs of Depression

Nutrition: anorexia *Offer small, high calorie, high protein snacks and drinks *Include patient in choosing foods and drinks *Weight patient weekly and observe eating patterns Sleep: Insomnia *Provide periods of rest after activities *Encourage the patient to get up and get dressed and stay out of bed during the day *Provide decaffeinated coffee Self-Care Deficits *Encourage the patient to use a toothbrush, washcloth, soap, makeup, shaving supplies Elimination (constipation) *Monitor Is and Os *Provide periods of exercise *Provide high fiber foods *Encourage intake of fluids *Evaluate the needs for laxatives and enemas

What is affect?

Outward expression of emotions (Objective) **Feelings of hopelessness and despair are readily reflected in the person's affect **Patient may not make eye contact, may speak in a monotone voice, little or no facial expression

What is a general assessment tool of depression?

PHQ-9 (The Patient Health Questionnaire 9) *A short inventory that highlights predominant symptoms seen in depression

What is PDD?

Persistent Depressive Disorder *Mild form of depression that usually has an early onset and lasts at least 2 years for adults (1 for children *Can become MDD later in life *Also known as dysthymia

What is psychomotor agitation?

Restlessness, pacing, finger/toe tapping

What is psychomotor retardation?

Slowed physical movement and slumped posture. **Changes in bowel habits are common (constipation)

Derealization

The world doesn't feel real

True or False: Therapy is always the first line, then medication.

True **EXCEPT in schizophrenia and bipolar (Medication, then therapy)

Guidelines for Communication with Severely Withdrawn Persons

When a patient is silent, use the technique of making observations "There are many new pictures on the wall" *Use concrete words *Allow patient time to respond *Listen for cover messages and ask questions about suicidal plans ("The end is almost over" "My suffering will end soon") *Avoid platitudes ("Things are going to look up soon")

A client is prescribed phenelzine (Nardil- MOAI). What statements by the client should indicate to a nurse that discharge teaching about this medication has been successful? (Select all that apply)

a. "I'll have to let my surgeon know about this medication before I have my cholecystectomy" b. "Guess I will have to give up my glass of red wine with dinner" c. "I'll have to be very careful about reading food and medication labels" d. "I'm going to miss my caffeinated coffee in the morning" e. "I'll be sure not to stop this medication abruptly"

A client who has been taking fluvoxamine (Luvox) without significant improvement asks a nurse, "I heard about something called a monoamine oxidase inhibitor (MAOI). Can't my doctor add that to my medications?" Which is an appropriate nursing response?

a. "This combination of drugs can lead to delirium tremens b. "A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis" *Do not like to give MAOI's with other medications c. "That's a good idea. There have been good results with the combination of these two drugs" d. The only disadvantage would be the exorbitant cost of MAOI"

A nurse discovers a client's suicide note that details the time, place, and means to commit suicide. What should be the priority nursing action, and why?

a. Administering lorazepam prn, because the client is angry at exposure of plan b. Establishing room restrictions, because the client's threat is an attempt to manipulate the staff c. Placing this client on one-to-one suicide precautions, because the more specific the plan, the more likely the patient will attempt suicide d. Calling an emergency treatment meeting because the client's threat must be addressed

A client is diagnosed with major depressive disorder. Which nursing diagnosis should a nurse assign to this client to address a behavioral symptom of this?

a. Altered communicated r/t feelings of worthlessness AEB anhedonia b. Social isolation r/t poor self-esteem AEB secluding self in room c. Altered thought processes r/t hopelessness AEB persecutory delusions (schizophrenic) d. Altered nutrition: less than body requirements r/t high anxiety AEB anorexia

A client diagnosed with a history of anorexia nervosa comes to an outpatient clinic after being medically cleared. The client states "My parents watch me like a hawk and never let me out of their site." Which nursing diagnosis would take priority at this time?

a. Altered nutrition less than body requirements b. Alerted social interaction c. Impaired verbal communication d. Altered family processes

A client has a history of excessive fear of water. What is the term that a nurse should use to describe the specific phobia, and what is the subtype of the specific phobia?

a. Aquaphobia, a natural environment type of phobia **See naturally in the environment (the beach) b. Aquaphobia, a situational type of phobia **Unnatural (waterpark) c. Acrophobia, a natural environment type of phobia d. Acrophobia, a situational type of phobia

When assessing a client for suicidal risk, which of the following methods of suicide should the nurse identify as most lethal?

a. Aspirin overdose b. Use of a gun c. Head-banging d. Wrist-cutting

A nurse is attempting to differentiate between symptoms of anorexia nervosa and the symptoms of bulimia. Which statement should the nurse identify as correct?

a. Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia do not b. Clients diagnosed with bulimia nervosa experience amenorrhea (periods stop), whereas clients diagnosed with anorexia nervosa do not i. Anorexia nervosa experience amenorrhea c. Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo, whereas clients diagnosed with anorexia do not. i. Anorexia experience hypotension and lanugo d. Clients diagnosed with anorexia nervosa have eroded teeth enamel, whereas clients diagnosed with bulimia nervosa do not.

Which nursing statement to a client about social phobias versus schizoid personality disorder is most accurate?

a. Clients diagnosed with social phobia can manage anxiety without medications, whereas clients diagnosed with SPD can only manage anxiety with medications b. Clients diagnosed with SPD are distressed by the symptoms experienced in social settings, whereas clients diagnosed with social phobia are not. c. Clients diagnosed with social phobia avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life d. Clients diagnosed with SPD avoid interactions only in social settings, whereas clients diagnosed with social phobias tend to avoid interactions in all areas of life.

A nursing instructor is teaching about the medications used to treat panic disorder. Which student statement indicates that learning has occurred?

a. Clonazepam is particularly effective in the treatment of panic disorder b. Clozapine is used off-label in long-term treatment of panic disorder c. Doxepin can be used in low doses to relieve symptoms of panic attacks d. Buspirone is used for its immediate effect to lower anxiety during panic attacks

A morbidly obese client is prescribed an anorexiant medication. About which medication should a nurse teach the client?

a. Diazepam b. Redux c. Meridia (Sibutramine) d. Cylert

What symptoms should a nurse use to differentiate a client diagnosed with panic disorders from a client diagnosed with generalized anxiety disorder (GAD)?

a. GAD Is acute in nature, and panic disorder is chronic **Panic is acute, GAD is chronic b. Chest pain is a common GAD symptom, whereas this symptom is absent in panic disorders c. Hyperventilation is a common symptom in GAD and rare in panic disorder d. Depersonalization is commonly seen in panic disorder and absent in GAD **Depersonalization: person detaches from their own body

A client with a history of suicide attempts who has been taking fluoxetine (Prozac) for 1 month. The client suddenly presents with a bright affect, rates mood 9/10, and is much more communicative. Which action should be the nurse's priority at this time?

a. Give the client off-unit privileges as positive reinforcement b. Encourage the client to share mood improvement in group c. Increase the level of this client's suicide precautions *Only been taking it for 4 weeks *They figure out how they could harm themselves d. Request that the psychiatrist reevaluate the current medication protocol.

A nurse should explain to a client diagnosed with an eating disorder that behavior-modification programs are the treatment of choice because these programs:

a. Help the client correct a distorted body image b. Address the underlying client anger c. Manage the client's uncontrollable behaviors d. Allows clients to maintain control (gives patient's a sense of power)

Which of the following questions should the nurse ask to best determine the seriousness of a client's suicidal ideation?

a. How are you planning on harming yourself? b. Have you made out a will? c. Does your family know you're here? d. How long have you been thinking about harming yourself?

The client has been hospitalized for major depression and suicidal ideation. Which of the following statements indicates to the nurse that the client is improving?

a. I couldn't kill myself because I don't want to go to hell b. I don't think about killing myself as much as I used to c. I'm of no use to anyone anymore d. I know my kids don't need me anymore since they are grown.

A client diagnosed with panic disorder states, "When an attack happens, I feel like I am going to die." Which is the most appropriate nursing response?

a. I know it's frightening, but try to remind yourself that this will only last a short time. b. Death from a panic attack happens so infrequently that there is no need to worry c. Most people who experience panic attacks have feelings of impending doom. d. Tell me why you are going to die every time you have a panic attack.

The nursing assistant states to the nurse "My client talks about how awful and useless she is. Sometimes she sounds angry for no reason. I'm tired of listening to her." Which of the following responses by the nurse is most appropriate?

a. I'll switch your assignment to someone who's less depressed and less tiring. b. It's important for you to listen to her because she needs to verbalize how she is feeling (It is important to listen to your patient for any signs of suicidal plans) c. Don't worry about it. I know you haven't done anything to make her angry d. Clients with depression are hard to deal with, but don't take what they say seriously.

A client states "I'm so tired of living and just want to end it all." Which of the following responses is most therapeutic?

a. I'll walk with you to your room so you can get some rest b. Perhaps after your son visits you'll feel better about things c. You're in a lot of pain now but you will feel better. I'm here to help you. d. You are very depressed right now and want to die but you need to focus on life.

The nurse manager overhears two staff members talking in the snack room. One of the staff members states, "Her superficial cuts are just a means of getting attention. She never should have been admitted. I hope she's out of here soon." Which of the following responses by the nurse manage is more appropriate?

a. It's our job to help her no matter how we feel about her or what she did. She'll be discharged soon. b. I won't tolerate that kind of discussion from my staff. Now, it is time for you to go back to work. c. I know it's hard to understand, but we need to do the best we can even though she'll be back. d. No matter what the intent, all suicidal behavior is serious and deserves our serious consideration

A client diagnosed with bipolar disorder is distraught over insomnia experienced over the last 3 nights and a 12-pound weight loss over the past 2 weeks. Which should be this client's priority nursing diagnosis?

a. Knowledge deficit r/t bipolar disorder AEB concern about symptoms b. Alerted nutrition: less than body requirements r/t hyperactivity AEB weight loss c. Risk for suicide r/t powerlessness AEB insomnia and anorexia d. Altered sleep patterns r/t mania AEB insomnia for the past 3 nights

Which treatment should a nurse identify as most important for clients diagnosed with generalized anxiety disorder?

a. Long-term treatment with diazepam (Valium) b. Acute symptom control with citalopram (Celexa) c. Long-term treatment with burspirone (BuSpar) d. Acute symptom control with ziprasidone (Geodon)

A family member is seeking advice about an older parent who seems to worry unnecessarily about everything, The family member states "Should I seek psychiatric help for my mother?" Which is an appropriate nursing response?

a. My mother also worries unnecessarily. I think it is part of the aging process b. Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning c. From what you have told me, you should get her to a psychiatrist as soon as possible d. Anxiety is a complex phenomenon and is effectively treated only with psychotropic medications

A college student is unable to take a final exam due to severe test anxiety. Instead of studying, the student relieves stress by attending a movie. Which priority nursing diagnosis should a campus nurse assign for this client?

a. Noncompliance r/t test taking b. Ineffective role performance r/t helplessness c. Altered coping r/t anxiety d. Powerlessness r/t fear

A client diagnosed with major depression with psychotic features hears voices commanding self-harm. A nurse is unable to elicit a contract for safety. What should be the nurse's priority intervention at this time?

a. Obtaining an order for locked seclusions until client is no longer suicidal b. Conducting 15-minute check to ensure safety c. Placing the client on one-to-one observation while continuing to monitor suicidal ideations d. Encouraging client to express feelings related to suicide.

Immediately after electroconvulsive therapy, in which position should a nurse place the client?

a. On his or her side to prevent aspiration b. In high fowler's position to promote consciousness c. In Trendelenburg's position to promote blood flow to vital organs d. In prone position to prevent airway blockage

A nurse is planning care for a child who is experiencing depression. Which medication is approved by the Food and Drug Administration (FDA) for the treatment of depression in children and adolescents?

a. Paroxetine (Paxil) b. Sertraline (Zoloft) c. Citalopram (Celexa) d. Fluoxetine (Prozac)

A psychiatrist prescribes a MOAI for a client. Which foods should the nurse teach the client to avoid?

a. Pepperoni pizza and red wine (Contains tyramine) b. Bagels with cream cheese and tea c. Apple pie and coffee d. Potato chips and diet cola

A nurse recently admitted a client to an inpatient unit after a suicide attempt. A health-care provider orders amitriptyline for the client. Which intervention, related to this medication, should be initiated to maintain the client's safety upon discharge?

a. Provide a 6-month supply of Elavil to ensure long-term compliance b. Provide 1-week supply of Elavil with refills contingent on follow-up appointments *Should really only give a 3-day supply to reduce risk of ingestion and suicide c. Provide pill dispenser as a memory aid d. Provide education regarding the avoidance of foods containing tyramine

A client is diagnosed with bipolar disorder: manic phase. Which nursing intervention would be implemented to achieve the outcome of "client will gain 2lb by the end of the week?"

a. Provide client with high-calorie finger foods throughout the day b. Accompany client to cafeteria to encourage adequate dietary consumption c. Initiate total parenteral nutrition to meet dietary needs d. Teach the importance of a varied diet to meet nutritional needs

A highly agitated client paces the unit and states "I could buy and sell this place." The client's mood fluctuates from fits of laughter to outbursts of anger. Which is the most accurate documentation of this client's behavior?

a. Rates mood 8/10. Exhibiting looseness of association. Euphoric. b. Mood euthymic. Exhibiting magical thinking. Restless. c. Mood labile. Exhibiting delusions of reference. Hyperactive. d. Agitated and pacing. Exhibiting grandiosity (Believe you are God or the President). Mood labile (mood is happy then sad).

A client who was recently discharged from the psychiatric unit telephones the unit to speak to the nurse. The client states that she took her children to the neighbors' house and has turned on the gas to kill herself. She is home alone and gives the nurse her address. Which of the following actions should the nurse do next?

a. Refer the caller to a 24- hour suicide hotline b. Tell the caller that another nurse will telephone the police c. Ask the caller whether she telephoned her physician d. Instruct the caller to telephone her family for help

A client diagnosed with bipolar disorder: depressive phase intentionally overdoses on sertraline (Zoloft). Family members report that the client has experienced anorexia, insomnia, and recent job loss. What should be the priority nursing diagnosis for this client?

a. Risk for suicide r/t hopelessness b. Anxiety: severe r/t hyperactivity c. Imbalanced nutrition: less than body requirements r/t refusal to eat d. Dysfunctional grieving r/t loss of employment

A client walks into the clinic and tells the nurse she wants to die because her boyfriend broke up with her. The client states "I'll show him, he'll be sorry." The nurse notes which of the following as the underlying theme and method to deal with the client?

a. Sadness-ask client to reveal how long she has felt this way b. Escape-ask client to indicate from what she wants to escape c. Loneliness- ask client to state who she believes to be her friends d. Retaliation- ask client about her specific plans to harm herself and/or her boyfriend.

When developing a plan of care for a client with suicidal ideation, developing goals to address which of the following is a priority?

a. Self-esteem b. Sleep c. Hygiene d. Safety

A client diagnosed with bipolar 1 disorder: manic episode refuses to take lithium carbonate due to excessive weight gain. In order to increase compliance, which medication should a nurse anticipate that a physician will prescribe?

a. Sertraline (Zoloft) b. Valproic Acid (Depakote) **This can help with weight gain c. Trazodone (Desyrel) d. Paroxetine (Paxil)

A potential Olympic figure skater collapses during practice and is hospitalized for severe malnutrition. Anorexia nervosa is diagnosed. Which client statement best reflects insight related to this disorder?

a. Skaters need to be thin to improve their daily performance b. All the skaters on the team are following approved 1200 calorie diet c. The exercise of skating reduced my appetite but improves my energy level d. I am angry at my mother. I can only get her approval when I win competitions

A client diagnosed with bipolar disorder has been taking lithium carbonate for 1 year. The client presents in an emergency department with a temperature of 101, severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms?

a. Symptoms indicate consumption of foods high in tyramine b. Symptoms indicate lithium carbonate discontinuation syndrome c. Symptoms indicate the development of lithium carbonate tolerance d. Symptoms indicate lithium carbonate toxicity.

A client is experiencing a severe panic attack. Which nursing intervention would meet this client's physiological need?

a. Teach deep breathing relaxation exercises b. Place the client in a Trendelenburg position c. Have the client breathe into a paper bag d. Administer the ordered prn buspirone

Patient's with bulimia overeat to help with stress, then they feel guilty about eating so much and then they throw up.

a. Teeth erode and sore throat b. Fluid and electrolyte imbalances

The family of a client diagnosed with anorexia nervosa becomes defensive when the treatment team calls for a family meeting. Which is the appropriate nursing response?

a. Tell me why this family meeting is causing you to be defensive. All clients are required to participate in two family sessions b. Eating disorders have been correlated to certain familial patterns; without addressing these, your child's condition will not improve c. Family dynamics are not linked to eating disorders. The meeting is to provide your child with family support d. Clients diagnosed with anorexia nervosa are part of the family system, and any alteration in family processes needs to be addressed

A client began taking lithium for treatment of bipolar disorder approximately 1 month ago. The client asks if it is normal to have gained 12 pounds in this time frame. Which is appropriate nursing response?

a. That's strange. Weight loss is the typical pattern. b. What have you been eating? Weight gain is not usually associated with lithium c. Weight gain is common, but troubling side effect d. Weight gain only occurs during the first month of treatment with this drug.

What is the rationale for a nurse to perform a full physical health assessment on a client admitted with a diagnosis of MDD?

a. The attention during the assessment is beneficial in decreasing social isolation b. Depression can generate somatic symptoms that can mask actual physical disorders c. Physical health complications are likely to arise from antidepressant therapy d. Depressed clients avoid addressed physical health and ignore medical problems.

A client diagnosed with bulimia nervosa has been attending a mental health clinical for several months. Which factor should a nurse identify as an appropriate indicator of a positive client behavioral change?

a. The client gained 2 pounds in 1 week b. The client focused conversations on nutritious food c. The client demonstrated healthy coping mechanisms that decreased anxiety d. The client verbalized an understanding of the etiology of the disorder

The nurse assesses a client suspected of having major depressive disorder. Which client symptom would eliminate this diagnosis?

a. The client is disheveled and malodorous b. The client refuses to interact with others c. The client is unable to feel any pleasure d. The client has maxed-out charge cards and exhibits promiscuous behavior (Mania)

A client's altered body image is evidence by claims of "feeling fat" even though the client is emaciated. Which is the appropriate outcome criterion for this client's disorder?

a. The client will consume adequate calories to sustain normal weight b. The client will cease strenuous exercise programs c. The client will perceive personal ideal body weight and shape as normal d. The client will not express a preoccupation with food.

When counseling a client diagnosed with bulimia nervosa, a nurse explains that the client's teeth will deteriorate because:

a. The emesis produced during purging is acidic and corrodes the tooth enamel b. Purging causes the depletion of dietary calcium c. Food is rapidly ingested without proper mastication d. Poor dental and oral hygiene lead to dental caries

Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which statement regarding a client's home environment should a nurse associate with the development of anorexia nervosa?

a. The home environment maintains loose personal boundaries b. The home environment places an overemphasis on food c. The home environment is overprotective and demands perfection d. The home environment condones corporal punishment

A nursing instructor is teaching about specific phobias. Which student statement should indicate to the instructor that learning has occurred?

a. These clients recognize that their fear is excessive and seek treatment to promote change b. These clients have a panic level of fear that is overwhelming and unreasonable c. These clients experience symptoms that mirror a cerebrovascular accident (CVA). d. These clients experience the symptoms of tachycardia, dysphagia, and diaphoresis.

A high school senior is diagnosed with anorexia nervosa and hospitalized with severe malnutrition. Her treatment team is planning to use behavior modification. What rationale should a nurse identify as the reasoning behind this therapy choice?

a. This therapy will increase the client's motivation to gain weight b. This therapy will reward the client for perfectionist achievements c. This therapy will provide the client with control over behavior choices d. This therapy will protect the client from parental overindulgence.

A nursing instructor is discussing various challenges in the treatment of clients diagnosed with bipolar disorder. Which student statement demonstrates an understanding of the most critical challenge in the care of these clients?

a. Treatment is compromised when clients can't sleep b. Treatment is compromised when irritability interferes with social interactions c. Treatment is compromised when clients have no insight into their problems d. Treatment is compromised when clients choose not to take their medications

The history of a female client who has just been admitted to the unit, and is very depressed reveals a weight loss of 10lb in 2 weeks, sleeping 3 hours a night, and poor hygiene. The client states "I'm no good to anyone. Everyone would be better off without me." Which of the following questions should the nurse ask first?

a. What do you mean? b. Are you thinking about hurting yourself? c. Doesn't your family care about you? d.What happened to make you think that?

The nurse manager in the ED is conducting an in-service for the nursing staff about screening clients for suicide. One of the nurse's states "Questioning adolescents about suicide will only increase their thinking about self-harm and they would not admit it to me anyhow." How should the nurse manager respond?

a. You could be correct. Let's assess only adults because they'll be more honest b. We will limit the assessment to adolescents with psychiatric diagnoses c. It's a myth that talking about suicide leads to suicide attempts. Adolescents will disclose suicidal thoughts when asked directly. d. If you think the adolescent is not telling you the truth, you can question the parents.

A client diagnosed with bipolar 1 disorder is exhibiting severe manic behaviors. A physical prescribes lithium carbonate and olanzapine. The client's spouse questions the Zyprexa order. What is the appropriate nursing response?

a. Zyprexa in combination with Eskalith (Lithium) cures manic symptoms b. Zyprexa prevents extrapyramidal side effects c. Zyprexa ensures a good night's sleep d. Zyprexa calms hyperactivity until Eskalith (Lithium) takes effect. **Give Zyprexa until lithium kicks in

Hallucinations

false sensory experiences, such as seeing something in the absence of an external visual stimulus

Anticonvulsants Treats mania (slows everything down- Makes the nerve cells less excitable)

prevent or control seizures *Valproic Acid *Carbamethazine *Lamotrazine (Long term) *Weight Gain *Hepatotoxicity