ATI: Mental Health
Which of the following is expected with delerium: SATA - Altered LOC - Impaired judgement - Rapid change in personality - Disturbances in perception
- Altered LOC - Rapid change in personality
Dependent, Obsessive-Compulsive, Avoidant? Social inhibition and feelings of inadequacy, hypersensitive to negative evaluation
Avoidant Meeting a friendly, accepting, reassuring approach Do not push client into social situations
Obsessive compulsive disorder
Obsessions: Persistent, intrusive thoughts Compulsions: Repetitive behaviors that a client feels driven to perform (such as hand washing)
Dependent, Obsessive-Compulsive, Avoidant? Preoccupied with orderliness, perfectionism, and control, rigid and inflexible, fears failure
Obsessive compulsive Guard against Power struggles with client as the need to control his high,assess for the client's use of intellectualization, rationalization, and reaction formation is defense mechanisms Be aware of the client's critical nature towards self and others
When a client is in mechanical restraints, the nurses should remove how many restraints at a time as the client regains control
One at a time
What kind of ended questions should a nurse ask when assessing a psych patient?
Open ended questions
Overt vs. Covert
Overt: P's know they're being observed Covert: P's don't know they're being observed
Unable to focus on the environment, may feel unreal, cannot process what is happening, hallucinations or delusions may occur, somatic reports increase What level of anxiety is this
Panic
Paranoid, Schizoid, or Schizotypal? Distrust suspiciousness of others and hypervigilance
Paranoid -- avoid being too nice or too friendly, give clear explanations, warn about changes in treatment plan and explain reasons for delays
Which of the following should be included in the plan of care of a client who is experiencing delirium Permit the client to perform daily rituals to decrease anxiety Maintain environment that has low lighting
Permit the client to perform daily rituals to decrease anxiety
Which of the following indicates the working phase? SATA - identify the clients perception of the reason for the therapy - Ask the client to provide a detailed description of the hallucinations - Assist the clients with the development of problem-solving skills - Explore the client's relationship with family members
- Ask the client to provide a detailed description of the hallucinations - Assist the clients with the development of problem-solving skills - Explore the client's relationship with family members
Which of the following meals should be provided to a manic client: - Spaghetti and meat balls, a salad, and apple pie - Beef and vegetable stew, rice, and vanilla pudding - Chicken nuggets, crackers with cheese sticks, and a cookie - Broiled fish fillets, stewed tomatoes, and ice cream
- Chicken nuggets, crackers with cheese sticks, and a cookie These are easy to handle as they are finger foods
Which of the following is modeling a behavioral intervention strategy? - Demonstrating performance of hand hygiene at scheduled times - Instructing the client to practice muscle relaxation when experiencing the urge to perform hand hygiene
- Demonstrating performance of hand hygiene at scheduled times
What should you do first for an OCD patient? - Encourage the client to verbalize her feelings - Determine anxiety level
- Determine anxiety level
Which of the following is expected with psychosis: - Altered LOC - Impaired judgement - Rapid change in personality - Disturbances in perception
- Disturbances in perception
Identification
Taking on the characteristics of another person
Tertiary prevention
actions taken to contain damage once a disease or disability has progressed beyond its early stages
Somatic delusion
belief that something highly unusual is happening to one's body or internal organs "My internal organs have turned to stone"
How often should a restrained client be visually observed
continuously
Which lithium level is outside the normal range? - 1.2 - 1.6
- 1.6
A nurse has completed medication teaching regarding methylphenidate with a client. Which of the following client statements indicates an understanding of the nurse's teaching? Select one: a. "Avoiding afternoon doses of methylphenidate will help me sleep better." b. "If I don't like how I feel on methylphenidate, I may stop it at any time." c. "Weight gain is common if I take methylphenidate long term." d. "Methylphenidate is a safe drug with very few side effects."
"Avoiding afternoon doses of methylphenidate will help me sleep better." Prolonged therapy with methylphenidate is associated with weight loss because of appetite suppression.
Which of the following is an example of secondary prevention (SATA)? - Offer substance use treatment options for adolescents from low income households - Encourage the use of random testing for substance use for adolescents participating in extracurricular activities - Educate high school teachers about how to detect the manifestations of substance use. - Provide a presentation at area high schools on resisting pressure for substance use
- Encourage the use of random testing for substance use for adolescents participating in extracurricular activities - Educate high school teachers about how to detect the manifestations of substance use.
Which of the following is an covert statement indicating the client's risk for suicide? SATA - Everything will be better soon - Soon no one will have to worry about me - There's no point in living any longer - I want to donate my organs to help others
- Everything will be better soon - Soon no one will have to worry about me - I want to donate my organs to help others
Which of the following is a risk factor for depression - Only child - Female
- Female
Bipolar one
A week long manic episode followed by depression
A nurse is caring for an adolescent client who is recovering from a traumatic below the knee amputation. The day after surgery, the client refuses to look at or touch the affected leg. Which of the following nursing interventions would be most beneficial to this client? Select one: a. Gently examine and redress the stump without frowning or grimacing. b. Insist that the client participate in bathing and examining his affected leg. c. Avoid discussing the amputation until the client initiates conversation. d. Remind the client that full mobility is possible once fitted for a prosthesis.
A. This client is exhibiting avoidance behaviors which are expected with a sudden body image change and should resolve over a period of a few days. It is inappropriate to insist that the client participates in seeing and touching the leg affected leg, especially the first day after surgery.
Introjection
Adopting the values and beliefs of another person
A client presents with nausea involving, tachycardia, diaphoresis, Tremors, Grandma seizures, restlessness, and irritability What drugs are they withdrawing from
Alcohol, barbiturates, or benzodiazepines
What is the purpose of restating in therapeutic communication?
Allows the nurse to mirror covert and overt messages. Client: I can't focus Nurse: "You are having problems focusing?"
Benztropine
Anticholinergic that helps relieve acute dystonia associated with chlorpromazine
Antisocial, Borderline, Narcissistic, or histrionic? Disregard to the rights of others, impulsive risk taking behaviors, lacks empathy
Antisocial -- be aware of and assess for substance abuse. Set clear limits on specific behavior. Be cautious of manipulation through guilt when the client doesn't get what he wants
The client presents with slurred speech, and unsteady gait, drowsiness, and impaired judgment. What drug are they possibly intoxicated with
Barbiturates, benzodiazepines, or alcohol
Reference dolusion
Believing occurrences in the environment are about or because of him
Naltrexone does what
Blocks the pleasurable effects of ETOH
Which of the following is a manifestation of alcohol withdrawal Somnolence Blood pressure 154 over 96
Blood pressure 154 over 96 Somnolence is consistent with alcohol and toxication
Antisocial, Borderline, Narcissistic, or histrionic? Extreme emotional ability, impulsivity, and self-image disproportions that severely impair functioning
Borderline -- provide clear and consistent boundaries, use Clear communication, review therapeutic goals and boundaries when the behavior issues are evidence, and assess for self-mutilating behaviors
A client presents with fatigue, depression, agitation, apathy, anxiety, Cravings, and increase appetite. What drugs are they most likely withdrawing from
Cocaine, amphetamines, and methamphetamines
A client presents with tachycardia, dilated pupils, elevated blood pressure, grandiosity, impaired judgment, paranoia with delusions What drug is this client most likely Intoxicated by
Cocaine, amphetamines, methamphetamines
Suppression
Conscious denial of a disturbing feeling
Delirium or Dementia? Cognition includes impaired memory, judgment, and attention span that can fluctuate
Delirium
Delirium or Dementia? Contributing factors include fever, hypotension, infection, hypoglycemia, adverse drug reaction, head injury, emotional stress, and seizures
Delirium
Delirium or Dementia? Sudden onset, over hours days
Delirium
Delirium versus dementia
Delirium disturbs the Consciousness has a change in cognition that develops over a short period of time Dementia is a progressive deterioration of cognitive functioning and a global impairment of intellect with no change in consciousness
Delirium or Dementia? Cognition includes impaired memory, judgment, and attention span; with abstract thinking
Dementia
Delirium or Dementia? Contributing factors include Alzheimer's disease, neurological disease, vascular disease, alcohol use disorder, and head trauma
Dementia
Delirium or Dementia? Slow onset, over months to years
Dementia
Dependent, Obsessive-Compulsive, Avoidant? Excessive cleaning and need to be taken care of, submissive
Dependent Be aware of counter-transference that can occur due to the clients cleaning Behavior period identify current stresses, and satisfy client needs when setting limits
Cocaine, amphetamines, methamphetamines do what to the pupils
Dilate them
Which of the following is a manifestation of delirium Slow on set Aphasia Confabulation Easily distracted
Easily distracted
How often should a client whose place in seclusion between toileted
Every 30 minutes
What is melatonin do to a client who has delirium
Helps enforce a proper sleep week cycle
A client presents with constricted pupils, decrease respirations, decreased heart rate, decrease blood pressure, and it show your for your Fall by dysphoria. What drugs are they most likely intoxicated from
Heroin, fentanyl, hydromorphone, Meperidine
A client presents with yawning, insomnia, Panic, diaphoresis, cramps, nausea and vomiting, chills, fever, diarrhea. What drugs are they most likely withdrawing from
Heroin, fentanyl, hydromorphone, Meperidine
Antisocial, Borderline, Narcissistic, or histrionic? Attention-seeking, frustrates easily, often melodramatic and seductive
Histrionic -- understand seductive Behavior as a response to distress, assess for suicidal Behavior if admiration is withdrawn, model concrete descriptive versus vague language
Alzheimer's disease
Impaired memory and thinking skills that is classified with three stages Mild; losing or misplacing items, still able to perform ADLs, some difficulty concentrating an organizing Moderate; forgetting events of One's Own history, with difficulty performing tasks that require planning and organizing such as paying bills Severe; losing ability to converse with others, requires assistance for ADLs and has periods of incontinence and losing awareness of their own abilities or environment
Antisocial, Borderline, Narcissistic, or histrionic? Lack of empathy and pairs relationships, may appear arrogant due to over inflated sense of self, difficulty with criticism
Narcissistic -- remain neutral and avoid power struggles, convey unassuming self-confidence
Transcranial Magnetic Stimulation
None of treatment that uses magnetic pulses to stimulate the cerebral cortex period No neurological deficits or memory problems noted
A client is stating the CIA is spying on his every move period is this a positive or negative symptom of schizophrenia
Positive
Panic disorder
Recurrent episodes of panic attacks that can include palpitations, chest pain, breathing difficulties, nausea, and feelings of choking
Displacement
Redirection of thoughts, feelings, and impulses from an object that causes anxiety to an acceptable one. i.e. redirecting anxiety about a poor diagnosis to the staff providing their care.
Paranoid, Schizoid, or Schizotypal? Emotional Detachment, isolate self, few close relationships Content about being an observer
Schizoid -- not impacted by approval rejection of others, do not try to increase socialization
Paranoid, Schizoid, or Schizotypal? May exhibit extreme anxiety and social situations related to severe social and interpersonal deficits
Schizotypal -- respect clients need for social isolation, be aware of client suspicious Behavior, be aware that Superstition magical thinking are common
Greatly reduced perceptual field, problem solving feels impossible, feelings of dread, confusion, chest discomfort, diaphoresis, loud and rapid speech, threats and demands What level anxiety is this?
Severe
Tacrine and donepezil do what
Slow the progression of dementia by inhibiting cholinesterase
Persecutory delusion
Something wants to hurt you something wants to hurt you something wants to hurt you
Nursing interventions for a client who is suffering from schizophrenia
Structured safe environment Ask the client about their hallucinations without agreeing or disagreeing that they exist Do not argue with the client's delusions Attempt to focus conversations on reality based subjects
A nurse is preparing to discharge an older adult client to the home of a family member while recovering from hip surgery. Which of the following may negatively affect the client's adjustment to living with family members? Select one: a. The client is unable to complete all ADLs. b. The family is insisting on maintaining financial control for the client. c. The family is actively involved in the discharge plans. d. Older clients often recover more quickly when encouraged to interact with family.
The family is insisting on maintaining financial control for the client. While gaining independence is very important, the inability to complete all the ADLs would not necessarily interfere with an adaptation to living with family.
Amitriptyline and clomipramine are what kind of rx
Tricyclic antidepressants
Transference
Unconscious displacement of feelings towards the nurse
Countertransference
Unconsciously attributing feelings towards a client, AS THE NURSE
Projection
When the client attributes undesired impulses to another factor.
Dissociation
When the client compartmentalizes undesirable personal attributes
Can benzodiazepines be habit forming?
Yes
Stereotypic Movement disorder
a disorder in which the individual voluntarily repeats nonfunctional behaviors, such as rocking or head banging, that can be damaging to his or her physical well-being
A nurse is caring for an adolescent client admitted to the nursing unit three days ago. The client is withdrawn, unwilling to eat, and does not interact with the staff. The nurse correctly understands which of the following would provide the best support for this client? a. An opportunity to view a popular DVD. b. A call from the client's sibling. c. A visit with a parent. d. A visit with friends from school.
d. A popular DVD may be entertaining and distracting for the adolescent, but will not provide support. A better choice would be to encourage the adolescent to phone a friend.
What is the first stage of grief
denial
Doxepin
depressive disorder, anxiety, insomnia, as well as in the management of skin pruritus. It is in the tricyclic antidepressant class of medications.
grandiose delusions
false, persistent beliefs that one has superior talents and traits
Anhedonia
inability to experience pleasure
Apraxia
inability to perform particular purposive actions, as a result of brain damage.
remote memory
memory for experiences in the distant past
Which of the following is an example of primary prevention? - Educate high school teachers about how to detect the manifestations of substance use. - Provide a presentation at area high schools on resisting pressure for substance use
- Provide a presentation at area high schools on resisting pressure for substance use
What should the RN do for a mom who lost their kid to a MVC? - Stay with the client and allow the client to cry - Express sympathy for the client's loss
- Stay with the client and allow the client to cry
Which of the following is appropriate for a domestic abuse victim: - The next time this occurs, what might you do to ensure your safety? - You need to remove yourself and your children from the abusive situation
- The next time this occurs, what might you do to ensure your safety? Do not provide opinions
Which of the following is assessing a remote memory? - What year did you graduate from high school - What is your favorite childhood memory - What did you have for supper yesterday - What is todays date
- What year did you graduate from high school Remove memory is recalling something in the far past
Which of the following is priority in a client who just started taking an antidepressant? - I have it all figured out. Everything is going to be okay now. - I don't feel like showering. I'd rather just stay in bed today.
- I have it all figured out. Everything is going to be okay now. This indicates the energy needed to carry out suicide.
Which of the following is expected with dementia: - Impaired judgement - Rapid change in personality
- Impaired judgement
Which of the following should the RN do first to a client experiencing panic level anxiety? - Identify the cause of the anxiety - Instruct the client to take slow, deep breaths
- Instruct the client to take slow, deep breaths
Which of the following indicates tardive dyskinesia? - Muscle spasms - Involuntary tongue protrusion
- Involuntary tongue protrusion
Which of the following would indicate an 18 month old is being abused after he endures a femur fx? - My child fell down the stairs - My child was riding a bicycle and fell off
- My child was riding a bicycle and fell off 18 month olds cannot ride bicycles
Which of the following is an example of tertiary prevention (SATA)? - Offer substance use treatment options for adolescents from low income households - Encourage the use of random testing for substance use for adolescents participating in extracurricular activities - Educate high school teachers about how to detect the manifestations of substance use. - Provide a presentation at area high schools on resisting pressure for substance use
- Offer substance use treatment options for adolescents from low income households
Which of the following is a characteristic of anorexia nervosa? - Possesses feelings of decreased self worth - Preoccupied with concerns about personal health
- Possesses feelings of decreased self worth Anorexia patients are concerned about weight WITHOUT REGARD to personal health consequences
Which of the following indicates the orientation phase? - identify the clients perception of the reason for the therapy - Ask the client to provide a detailed description of the hallucinations - Assist the clients with the development of problem-solving skills - Explore the client's relationship with family members
- identify the clients perception of the reason for the therapy
Lithium level
0.6-1.2
The client stop speaking to everyone period is this a positive or negative symptom of schizophrenia
Negative
tardive dyskinesia
involuntary movements of the facial muscles, tongue, and limbs; a possible neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine receptors
akathisia
motor restlessness
Confabulation
the act of filling in memory gaps
benzotropine
Muscarinic antagonists Organ systems: CNS Clinical use: Parkinson, acute dystonia "park my Benz"
Can you take benzodiazepines while pregnant?
NO
A flat affect would be a positive for negative schizophrenia symptom
Negative
A nurse has completed medication teaching for disulfiram with an adult child of an alcoholic parent. Which of the following statements made by the adult child indicate an understanding of the nurse's teaching? Select one: a. "My dad's last drink was eight hours ago, so he may take his the first dose immediately." b. "Before being discharged from the hospital, dad will have at least one supervised alcohol-drug reaction." c. "I am so glad my dad has agreed to take this drug, I want it to cure his drinking problem." d. "Dad may have to take this medication for a long time until he gains self-control over alcohol use."
"Dad may have to take this medication for a long time until he gains self-control over alcohol use." Supervised alcohol-drug reactions have largely been abandoned and should never be administered to a client over 50 years of age because of the risk of severity of the reaction.
Which of the following is an overt statement indicating the client's risk for suicide? - Everything will be better soon - Soon no one will have to worry about me - There's no point in living any longer - I want to donate my organs to help others
- There's no point in living any longer
Which of the following is assessing a recent memory? - What year did you graduate from high school - What is your favorite childhood memory - What did you have for supper yesterday - What is todays date
- What did you have for supper yesterday
Compensation
Attempting to focus on a strength to compensate for a perceived weakness
A nurse is planning care for a client newly admitted to an inpatient mental health unit for treatment of a gambling addiction. The client is having difficulty concentrating and is worried about the future. Which initial intervention will maximize the client's success for recovery? a. Administer an anti-anxiety medication to the client. b. Suggest the client replace work out on the treadmill. c. Recommend the client participate in group discussion. d. Arrange for the client to attend Gamblers Anonymous.
Administer an anti-anxiety medication to the client. While attending Gamblers Anonymous may be suggested as par to of the client's recovery process, the initial intervention should be to treat the symptoms of the client's anxiety.
A client diagnosed with schizophrenia and experiencing frequent auditory hallucinations is admitted to an inpatient psychiatric unit. Which of the following would be the most effective, initial strategy for the nurse to implement? Select one: a. Agree with the client that the voices are audible. b. Ask the client to rest in a quiet area until the voices are gone. c. Ask the client to describe the components of the hallucination. d. Explain to the client that the hallucination is not real.
Ask the client to describe the components of the hallucination. Do not attempt to convince the client that the hallucination is not real because it is real to the client. Do not argue with the client or respond directly to the voices.
During a group therapy session on a psychiatric unit, the nurse leader observes that one of the clients frequently interrupts the session. Which of the following nursing actions is the most appropriate for this situation? Select one: a. Ask the client to speak privately with a nurse after the meeting. b. Discuss this observation during the post-meeting evaluation. c. Encourage another group member to reprimand the client. d. Tell the client that the interrupting behavior must be discontinued.
Ask the client to speak privately with a nurse after the meeting. A therapeutic milieu group aims to help increase self-esteem, decrease social isolation, encourage appropriate social behaviors, and educate clients in basic living skills. Confronting the client during the meeting could negatively affect self-esteem and increase social isolation. The behavior needs to be addressed, but not in an openly confrontational way.
Undoing
Attempting to make up an unacceptable action
A nurse is admitting a client diagnosed with posttraumatic stress disorder (PTD) to the mental health unit. The client is confused and disoriented. When developing a plan of care, which of the following would be the priority intervention for this client? Select one: a. Stabilize the client's psychiatric needs. b. Accept and make the client feel safe. c. Explain unit rules to the client. d. Orient the client to the unit.
B. Stabilizing the client's psychiatric needs with therapy and medications will take some time, and therefore this is not the priority.
Sublimation
Conversion of unacceptable drives into socially sanctioned activities
Rationalization
Covering up a perceived problem or weakness "I drink alcohol to forget the pain"
Which of the following indicates moderate anxiety: - Difficulty concentrating - Heightened perceptual field - SOB - Sense of impending doom
Difficulty concentrating
Regression
Dysfunctional attempt to reduce anxiety and conflict by returning to less mature behaviors - such as bed wetting.
Secondary prevention
Efforts to limit the effects of an injury or illness that you cannot completely prevent.
Primary prevention
Efforts to prevent an injury or illness from ever occurring.
A nurse is admitting a client diagnosed with schizophrenia. In order to establish a therapeutic nurse-client relationship with the client, the nurse's initial actions should include which of the following? Select one: a. Maintain consistency b. Develop a contract c. Establish trust d. Provide confidentiality
Establish trust Once the relationship has been established the client has a right to know that shared information will be kept confidential unless something is shared that is harmful to the client, client threatens self-harm, or the client does not intend to follow through with the treatment plan.
Reaction formation
Exhibiting a behavior or emotion that is opposite of what the client actually feels.
Risk factors for major depressive disorder
Female, unmarried, low socioeconomic status, Early Childhood trauma, and postpartum period
What lab value should a schizo patient who takes quetiapine fumarate be monitoring
Glucose
How long do benzodiazepines take to work?
Immediate effect
Splitting
Inability to integrate the positive and negative qualities of oneself or others into a combined idea. I.e. a client with a favorite nurse, the nurse calls in sick, the client then says "He's the worst nurse that's ever taken care of me."
What is the goal of reminiscence therapy for an older adult client?
Increased self esteem
Electroconvulsive therapy
Induce seizure for clients who have major depressive disorder Short-term memory losses common and temporary
Phobias
Irrational fear of an object or situation that persists
Phenelzine
MAOI used to treat depression in people who have not been helped by other medications. Phenelzine is in a class of medications called monoamine oxidase inhibitors (MAOIs). It works by increasing the amounts of certain natural substances that are needed to maintain mental balance.
Heightened perceptual field, alert, and can grasp what is going on, restless, irritable or impatient, foot or finger tapping... What level anxiety is this?
Mild
Narrow perceptual field, voice tremors, difficulty concentrating, increased respiratory and heart rate, pacing, hanging hands on table What level anxiety is this?
Moderate
Anxiety is moderate when the client's perceptual field is narrowed or widened?
narrowed
SOB is a severe level or panic level of anxiety
panic
A sense of impending doom is a severe level or panic level of anxiety
severe
behavior intervention
strategies or actions used to extinguish, change, or redirect an inappropriate behavior, three types are positive reinforcement, negative reinforcement, and aversive reinforcement.
Agnosia
the inability to recognize familiar objects.
How many fingers should be able to fit in restraints?
two
