Mental Health
In response to a question posed during a group meeting, the nurse explains that the superego is that part of the self that says: "I like what I want." "I want what I want." "I shouldn't want that." "I can wait for what I want."
"I shouldn't want that." Conscience and a sense of right and wrong are expressed in the superego, which acts to counterbalance the id's desire for immediate gratification. "I like what I want" does not reflect any part of the self. "I want what I want" is the id seeking satisfaction. A healthy ego can delay gratification and is in balance with reality.
A client asks the nurse how psychotropic medications work. The nurse correctly replies: "These medications decrease the metabolic needs of your brain." "These medications increase the production of healthy nervous tissue." "These medications affect the chemicals used in communication between nerve cells." "These medications regulate the sensory input received from the external environment."
"These medications affect the chemicals used in communication between nerve cells." Most psychotropic medications affect neurotransmitters such as dopamine and norepinephrine, which enter the synapses between neurons, allowing them to signal each other. Psychotropic medications do not work by changing the metabolic needs of the brain. Psychotropic medications do not increase the production of nervous tissue. Although there may be some effect on sensory input, this is because of the change in neurotransmitters.
A client who had to be cut out of a car after a motor vehicle collision has no visible physical effects from the ordeal. The client responds to the emergency department nurse's questions factually in a soft voice with a composed manner. This behavior may indicate that the client: Is controlling the expression of feelings Has repressed the details of the accident Has blocked out the events of the last few hours Is experiencing the reorganization phase of the trauma experience
Is controlling the expression of feelings The ability to respond to questions in a composed manner indicates that the client is using intellectualization and withholding feelings to maintain emotional control. Reorganization is a long-term process that starts several days or weeks after the trauma. The fact that the client is answering questions regarding the incident indicates that he or she is not engaging in repression or blocking out the accident.
When working with clients who use manipulative socially acting-out behaviors, the nurse should be: Strict, punishing, and restrictive Sincere, cautious, and consistent Supportive, accepting, and friendly Sympathetic, nurturing, and encouraging
Sincere, cautious, and consistent A sincere, cautious, and consistent attitude limits this individual's ability to manipulate both situations and staff members. A strict, punishing, and restrictive approach may create a power struggle and limit the development of a therapeutic nurse-client relationship. When accepting the person, the nurse should not support negative behavior; a friendly attitude may encourage further problem behavior. A sympathetic, nurturing, and encouraging approach may encourage the client to continue in her lifestyle rather than learn appropriate ways to relate to others.
A client with the diagnosis of schizophrenia is given one of the antipsychotic drugs. The nurse understands that antipsychotic drugs can cause extrapyramidal side effects. Which effect is cause for the greatest concern? Akathisia Tardive dyskinesia Parkinsonian syndrome Acute dystonic reaction
Tardive dyskinesia Tardive dyskinesia, an extrapyramidal response characterized by vermicular movements and protrusion of the tongue, chewing and puckering movements of the mouth, and puffing of the cheeks, is often irreversible, even when the antipsychotic medication is withdrawn. Akathisia, motor restlessness, usually can be treated with antiparkinsonian or anticholinergic drugs while the antipsychotic medication is continued. Parkinsonian syndrome (a disorder featuring signs and symptoms of Parkinson disease such as resting tremors, muscle weakness, reduced movement, and festinating gait) can usually be treated with antiparkinsonian or anticholinergic drugs while the antipsychotic medication is continued. Dystonia, impairment of muscle tonus, can usually be treated with antiparkinsonian or anticholinergic drugs while the antipsychotic medication is continued
A client with a history of violence is becoming increasingly agitated. Which nursing intervention will most likely increase the risk of acting-out behavior? Being assertive Responding early Providing choices Teaching relaxation
Teaching relaxation Once the client is agitated, teaching will not be effective and may increase the client's anxiety. Teaching relaxation techniques can be done once the client calms down. Being assertive (not aggressive) shows the client that the nurse is confident in handling the situation. This may help reduce the client's anxiety. Responding before agitation escalates makes interventions more likely to be successful. Providing choices may help the client feel less threatened and avoids a power struggle.
A client with schizophrenia is actively psychotic, and a new medication regimen is prescribed. A student nurse asks the nurse, "Which of the medications will be the most helpful against the psychotic signs and symptoms?" What response should the nurse give? Citalopram (Celexa) Ziprasidone (Geodon) Benztropine (Cogentin) Acetaminophen with Hydrocodone (Lortab)
Ziprasidone (Geodon) Ziprasidone (Geodon) is a neuroleptic, which will reduce psychosis by affecting the action of both dopamine and serotonin. Citalopram (Celexa) is a selective serotonin reuptake inhibitor antidepressant. Benztropine (Cogentin) is an anticholinergic. Acetaminophen with hydrocodone (Lortab) is an analgesic/opioid.
After a traumatic event, a client is extremely upset and exhibits pressured and rambling speech. What therapeutic technique can the nurse use when a client's communication rambles? Touch Silence Focusing Summarizin
focusing Focusing is indicated when communication is vague; the nurse attempts to concentrate or focus the client's communication on one specific aspect. Touch invades the client's space and will not help focus the client's communication. Silence prolongs the rambling communication; the client needs to be focused. Until the concern is identified and explored, summarizing is impossible.
When talking with a client who has alcoholism, the nurse notes that the client becomes irritable, makes excuses, and blames family and friends for the drinking problem. Which defense mechanisms does the nurse conclude that the client is using? (Select all that apply.) Projection Suppression Sublimation Identification Rationalization
projection rationalization Projection is the unconscious denial of unacceptable feelings and emotions in one's self while attributing them to others. This defense mechanism commonly is used by clients with alcoholism because it helps make reality more acceptable. Rationalization is making acceptable excuses for behavior; this defense is used by people with alcoholism because it makes reality more acceptable. Suppression keeps uncomfortable thoughts, feelings, and wishes in the subconscious; suppression is used rarely by people with alcoholism. Sublimation (the rechanneling of anxiety into constructive activities) is rarely used by these clients. Identification is the unconscious wish to be like another person; it is not commonly used by clients with an alcohol problem.
