Mental Health ATI, 334 Mental Health ATI, Mental Health ATI Practice Assessment B
A nurse is teaching the parent of a 10-year-old child who has ADHD and a new prescription for dextroamphetamine. Which of the following instructions should the nurse include in the teaching
"Administer the last dose of medication to your child 6 hours before bedtime R: A/E of dextro. is insomnia
What are the personality disorders in Cluster B
-antisocial -borderline -histrionic -Narcissistic
criteria for acute care treatment of a client with an eating disorder
- rapid weight loss of greater than 30% of body weight over 6 months - unsuccessful weight gain in outpatient treatment, failure to adhere to treatment contract - vital signs demonstrating HR less than 40/min, systolic BP less than 70, body temp less than 36 C - ECG changes - electrolyte disturbances - psychiatric criteria (depression, SI, family crisis, psychosis)
A nurse is admitting a client who has alcohol use disorder. Which of the following statements by the client indicates that the client is using denial as a defense mechanism
"I am able to go to work every day, so I don't have a problem
A nurse is assisting a client who has a terminal illness adjust to progressive loss of independence. Which of the following statements by the client indicates acceptance of her illness
"I am going to order a wheelchair for when I'm unable to walk." R: pt is recognizing the reality of continued loss of independence and is anticipating the need for assistive devices, indicative of acceptance.
grandiosity
"I am grand" narcissistic behavior
A nurse in a clinic is assessing a client whose partner died 4 months ago. Which of the following statements indicates that the client is at risk for complicated grief?
"I feel so empty without my wife that it's hard to get up every morning"
A nurse in a clinic is assessing a client whose partner died 4 months ago. Which of the following statements indicates that the client is at risk for complicated grief
"I feel so empty without my wife that it's hard to get up every morning." R: difficulty carrying on w normal activities indicates a risk for complicated grief
A nurse is providing teaching to the partner of a client who is in a rehabilitation program for alcohol use disorder. The nurse should identify that which of the following statements by the client's partner indicates an understanding of the teaching
"I will not take charge of my partner's work responsibilities *person needs to take care of their own repsonsibilities
A nurse is teaching coping strategies to a client who is experiencing depression related to intimate partner abuse. Which of the following statements by the client indicates an understanding of the teaching
"I will talk about my feelings with a close friend." R: discussion feelings w a support person is effective coping
"All or Nothing" Thinking
"If I eat any dessert, I will gain 50 lbs"
A nurse in a community health center is counseling a family of two parents and two children. Which of the following statements by a family member indicates manipulative behavior
"If you do my homework for me, I won't bother you for the rest of the day R: this is an ex of manipulative behavior
A nurse is teaching the parents of a client about their daughter's diagnosis of bulimia nervosa. Which of the following statements made by the parents indicates an understanding of their daughter's illness
"It is important for our daughter to have regular dental checkups R: repeated vomiting erodes tooth enamel and predisposes the teeth to caries.
A nurse is teaching the parents of a client about their daughter's diagnosis of bulimia nervosa. Which of the following statements made by the parents indicates an understanding of their daughter's illness
"It is important for our daughter to have regular dental checkups R: repeated vomiting erodes tooth enamel and predisposes the teeth to caries. likely: ortho hypotension monitor weight but not daily can exacerbate pts worry amenorrhea
A nurse is caring for an older adult client who begins to cry and states, "I knew God would punish me and I deserve this horrible sickness!" Which of the following responses should the nurse make
"Let's talk about what is upsetting you." R: nurse is acknowledging the ot concerns and is showing desire to understand what the pt is thinking and feeling
A nurse is caring for a client who is undergoing electroconvulsive therapy (ECT) and will receive succinylcholine. The client asks the nurse about this medication. What is an appropriate response by the nurse
"Succinylcholine is given to reduce muscle movements during therapy R: succinylocholine is a muscle paralyzing agent that will decrease muscle movement during the procedure so that injury is less likely to occur
A nurse is teaching a client who has bipolar disorder and a prescription for lithium. Which of the following instructions should the nurse include in the teaching
"Take this medication with food R: Lithium can cause GI distress
A nurse is teaching a client who has bipolar disorder and a prescription for lithium. Which of the following instructions should the nurse include in the teaching
"Take this medication with food R: Lithium can cause GI distress -lithium need adequate sodium to decrease lithium tox need NA 1,500 mg/day -consume 2,000-3,000 ml of fluids -not addictive
A nurse is caring for a client who has acute stress disorder and is experiencing severe anxiety. Which of the following statements actions should the nurse make?
"Tell me about how you are feeling right now."
What client teaching is needed with a depressive patient that is taking atypical antidepressants
- watch for HA, dry mouth, GI distress, constipation, increased HR, nausea restlessness or insomnia. Notify DR -monitor diet -dont give to seizure patients
What are the anxiolytics/ bento's used for psychotic disorders?
-Ativan -Klonopin -sedative effects -need to get blood tests for ANC -use caution in older adults
What personality disorders are in cluster C
-Avoidant -Dependent -Obsessive compulsive
What client teaching is needed with a depressive patient when they are taking TCA?
-Change positions slowly -Chew sugarless gum, eat foods high in fiber, increase fluids to reduce anticholinergic effects
Standardized screening tools for cognitive disorders
-Functional Dementia Scale -Mental or Mini Mental staus Examination -Functional Assessment Screening tool -Global Deterioration Scale -Blessed dementia Scale
Risk factors of Bipolar
-Genetics having an immediate family member who has a bipolar disorder -psychological such as a stressful event or major life event -physiological such as neurobiological or neuroendocrine disorder. -substance use disorder
What are the standardized screen tools for psychotic disorders
-Global assessment of functioning scale -scale for assessment of negative symptoms -Brief psychiatric rating scale -abnormal involuntary movement scale (AIMS)
What are the conventional antipsychotics for psychotic disorders
-Haldol -Loxitane -Thorazine -Prolixin Minimize anticholinergic effects get up slowly
What are the standardized screen tools for depressive disorders?
-Hamilton depression scale -beck depression inventory -geriatirc depression scale (short form) -zung self rating depression scale
What standardized screen tools would be used for anxiety disorders?
-Hamilton rating scale for anxiety -modified speilberger state anxiety scale -Yale brown obsessive compulsive scale -hoarding scale self report -national stressful events survey
Common Anorexia Labs
-Hypokalemia -Anemia/leukopenia/lymphhocytosis, thrombocytopenia -Hypoalbuminemia -Elevated cholesterol / BUN/ carotene -Decreased bone density -Abnormal blood glucose -Decreased serum bicarb = laxative use acidosis -Elevated serum bicarb = vomiting alkalosis
Common Bulimia labs
-Hypokalemia -Hyponatremia -Hypochloremia -Hypomagnesemia -Hypophosphatemia -Decreased estrogen, testosterone
Alzheimer's Severe Symptoms
-Losing ability to converse w/ others -Assistance required for ADLs -Incontinence -Losing awareness of one's environment -Progressing difficulty w/ physical abilities -Eventually losses all ability to move -Death related to choking/infection
Alzheimer's Mild Symptoms
-Memory Lapses -Losing or misplacing items -Difficulty concentrating and organizing -Unable to remember material just read -Still able to perform ADLs -Short term memory loss noticeable to close relations
Personality d/o - Cluster A (odd/eccentric)
-Paranoid (Distrust/suspiciousness toward others based on beliefs that others want to harm/exploit/deceive the person. -Schizoid (Emotional detachment, disinterest in relationships, uncooperative) -Schizotypal (Odd beliefs leading to interpersonal difficulties, eccentric appearance, perceptual distortions, hallucinations/delusions
Depersonalization
The feeling that a person is observing one's own personality or body from a distance
Derealization
The feeling that outside events are unreal or part of a dream or that objects appear larger or smaller than they should
C. The client has COPD. Clients who have a medical illness are at an increased risk for the development of depression.
The nurse is assessing a client for risk factors for the development of depression. The nurse should identify that which of the following factors places the client at an increased risk for depression? A. The client is married. B. The client recently received a promotion at work. C. The client has COPD. D. The client is a male.
Classical psychoanalysis
Therapeutic process of assessing unconscious thoughts and feelings, focuses on past relationships; clients attend many sessions over the course of months to years
Eye Movement Desentization and Reprocessing (EMDR)
Therapy for clients who have PTSD. Encourages eye focus on a separate stimuli while thinking of or talking about the traumatic event
Eye movement desensitization and reprocessing (EMDR)
Therapy using rapid eye movements during desensitization techniques in a multi-phase process; contraindicated for clients who have acute suicidal ideation, psychosis, severe dissociative disorders, detached retina or glaucoma, or severe substance use disorder
tricyclic antidepressants expected pharmacological action
These medications block reuptake of norepinephrine and serotonin in the synaptic space, thereby intensifying the effects of these neurotransmitters
individual role
These roles tend to prevent teamwork, because individuals take on roles to promote their own agenda. Examples include the dominator, who tries to control other members, and the recognition seeker, who boasts about personal achievements
Open-ended questions to ask for a nursing history of substance use and addiction disorders
Type of substance or addictive behavior Pattern and frequency of substance use Amount of substance used Age at onset of substance use Changes in occupational or school performance Changes in use patterns Periods of abstinence in history Previous withdrawal manifestations Date of last substance use or addictive behavior
Situational loss
Unanticipated loss caused by an external event
Repression
Unconsciously putting unacceptable ideas, thoughts, and emotions out of awareness
Generalized Anxiety d/o
Uncontrollable excessive worry for more than 6 months. S/S: Restlessness, muscle tension, avoidance of stressful activities, increased time and effort to prepare, procrastination in decision making, seeks repeated assurance.
A nurse is caring for a client who was admitted following an overdose of amitriptyline. The nurse should monitor the client for which of the following adverse effects associated with this medication
Urinary retention R: OD can result in anticholinergic effects and other anticholinergic effects: constipation
A nurse is caring for a client who was admitted following an overdose of amitriptyline. The nurse should monitor the client for which of the following adverse effects associated with this medication
Urinary retention R: OD can result in anticholinergic effects and the pt is more likely to experience constipation rather than loose stools
Biofeedback
Use of a sensitive mechanical device to assist the client to gain voluntary control of such autonomic functions as heart rate and blood pressure
Glasgow coma scale
Used to obtain a baseline assessment of a client's level of consciousness; highest score is 15 and indicates that the client is awake and responding appropriately; a score of 7 or less indicates that the client is in a coma
WHODAS
World Health Organization Disability Assessment Schedule; Scale helps to determine client's level of global functioning
A nurse is teaching a client who has a depressive disorder about fluoxetine. Which of the following information should the nurse include in the teaching?
You may experience difficulties with sexual functioning while taking this medication.
anterograde amnesia
a condition in which people lose the ability to form new memories
intellectualization
a coping mechanism in which the person analyzes a situation from an emotionally detached viewpoint
somatic symptom disorder
a disorder characterized by physical symptoms that do not have an underlying medical cause Excessive anxiety that a serious illness is present or will be acquired. This anxiety is present for more than 6 months though the actual illness the client fears can change.
conduct disorder
a pattern of behavior in which the rights of others or basic social rules are violated
Borderline personality disorder
a personality disorder characterized by lack of stability in interpersonal relationships, self-image, and emotion; impulsivity; angry outbursts; intense fear of abandonment; recurring suicidal gestures, self mutilation
Refeeding syndrome
a potentially fatal complication that can occur when fluids, electrolytes, and carbs are introduced to a severely malnourished client
dissociation
a split in consciousness, temp compartmentalization or lack of connection betweeen person's identity, memory, or how they perceieve the environment A woman forgets who she is following a sexual assault.
modeling therapy
a type of therapy characterized by watching and imitating models that demonstrate desirable behaviors (for example, a nurse demonstrating the performance of hand hygiene at scheduled times to a client with OCD who performs hand hygiene to decrease anxiety)
antidote for lithium
aminophylline
TCA
amitriptyline, doxepinm imipramine Treats depression AE orthostatic hypotension anticholinergic effects urinary retention increase fluids
memantine
an expected prescription for a client with moderate to severe alzheimer's (an NMDA receptor agonist, is shown to slow the progression of manifestations and to improve cognitive function)
buspirone
antianxiety, GAD, does not cause sedation, does not cause dependence, do not take as PRN, and this med will become effective in 2-4 weeks
Cluster B
antisocial, borderline, histrionic, narcissistic Pattern of disregard for the rights of others, repeated violations of law
For schizos what increases hallucinations?
anxiety
clients who have dependent and histrionic personality disorders often benefit from
assertiveness training and modeling
What is injected before ECT to decrease secretions and counteract any vagal stimulation?
atropine sulfate or robinul
olanzapine
atypical antipsychotic Caution when rising Drowsiness Take w/o regards to meals
A nurse in a substance use disorder program is interacting with a client. Which of the following statements indicates the client is using intellectualization as a means of coping with the anxiety of admission? a. "I was just using the medication to help me during a rough time in my life. I can stop whenever I want." b. "this all happened because my spouse is unemployed. That puts an enormous amount of stress on me." c. "I've read that problems with substances can have a variety of predisposing factors" d. "I just don't want to talk. Anyway, there is nothing you can do to help."
c.- this response uses intellectualization to avoid expressing the emotions stemming from stressful situations a represents denial b represents rationalization (making up excuses to justify unacceptable behavior) d represents suppression (the client consciously avoiding a discussion of substance use disorder)
Schizoaffective d/o
d/o that meets criteria for schizo and depressive or bipolar d/o.
Atomoxetine adverse
dark urine sweating fatigue reduced app
Initial phase of group development includes:
define the purpose and goals of the group -leader sets tone of respect, trust and confidentiality -members get to know each other and the group leader -there is a discussion about termination
The client experiences delusional timing for atlas 1 month. Self or interpersonal function is not markedly impaired
delusional disorder
This style supports group interacting and decision making to solve problems
democratic
pretending the truth is no reality to manage the anxiety of acknowledging what is real. Ex: A parent who is informed that his son was killed in combat tells everyone he is coming home for the holidays.
denial
comorbidities of eating disorders
depression, personality disorders, substance use disorder, anxiety
Major Depressive Disorder
depressive disorder characterized by two weeks or more of low energy and mood
projection
disguising one's own threatening impulses by attributing them to others
neurocognitive disorder
disorder marked by a significant decline in at least one area of cognitive functioning
Conversion disorder
disorder results when a client exhibits neurologic manifestations in the absence of a neurologic diagnosis. Clients who have conversion disorder transmit emotional or psychological stressors into physical manifestations.
during mania
disorganized, chaotic, unable to focus on detail inability to sleep talk and joke incessantly highly interactive
Shifting feelings related to an object, person, or situation to another less threatening object, person, or situation Ex: A person who is angry about losing his job destroys his child's favorite toy
displacement
temporarily blocking memories and perceptions from consciousness Ex: an adolescent witnesses a shooting and is unable to recall any details of the vent
dissociation
Benzo side effect
dizziness, sedation, drowsiness
Misconstrues trivial events and attaches personal significance to them, such as believing that others, who are discussing the next meal, are talking about them
ideas of reference
opioid use disorder
impaired coordination, euphoria, decreased respirations, drowsiness. think clumsy sleepy person
methylphenidate
improved attention AE tachycardia
ADHD
inability of a person to control behaviors requiring sustained attention
emotional violence
includes behavior that minimizes an individual's feelings of self‑worth or humiliates, threatens, or intimidates a family member
Child abuse pattern
inconsistency between history and child's injury
A nurse is caring for a client who has alcoholic cardiomyopathy. Which of the following laboratory findings should the nurse expect?
increased creatine phosphokinase (CPK)
body dysmorphic disorder
involves excessive preoccupation with an imagined defect in physical appearance
chlordiazepoxide
is for alcohol use disorder
Clients who have schizoid or schizotypal personality disorders ten to
isolate themselves the nurse should respect this need
schizo affective symptoms
it involved emotions they feel hopelessness and suidical ideation
A nurse is caring for a client whose child has a terminal illness. The client requests information about how to deal with upcoming loss. Which of the following statements should the nurse make?
it is not uncommon to feel angry toward yourself or others
avolition
lack of emotion
the group process progresses without any attempt by the leader to control the direction
laissez-faire
What screen tools do you use for Stress management?
life changing events questionnaire -Holmes -Rahe scale -Lazarus Cognitive Appraisal
wrist restraints
limited every 4 hours prescription renewal every 24 hours doctor needs to assess upon 1st hour of restraints
A nurse is obtaining a health history from the parents of a 12‑year‑old client who has conduct disorder. Which of the following findings should the nurse expect? (Select all that apply.)
low self esteem suicidal ideation bullying temper outbursts
definition of: neolgisms echolalia anhedonia echopraxia
made-up words repeating of someone else's words inability to enjoy pleasurable activities mimicking someone else's movements
Working phase
maintain relationship perform ongoing assessment encourage problem solving promote self esteem
Lithium
maintain sodium levels watch for vomiting, diarrhea, sweating
which disorders are appropriate for ECT?
major depressive disorder suicidal or homicial that need rapid therapeutic response schizo spectrum disorders acute manic episodes with rapid cycling
DSM-5
manual to diagnose and classify mental disorders
behavioral therapy
meditation diaphragmatic breathing
This therapy uses various techniques to control pain tension and anxiety
meditation, guided imagery, diaphragmatic breathing, muscle relaxation, and biofeedbacks
remote memory
memory for experiences in the distant past
psychobilogical intervention
monitor for adverse effects of medications
Tourette syndrome
motor and verbal tics
These are emotional issues or themes within a family that continue for atlas three generations such as a pattern of substance use or addictive behavior when the families is under stress, dysfunctional grief pattern triangulation patterns and divorce
multigenerational issues
antidote for opioids
naloxone then methadone, clonidine
Characterized by arrogance, grandiose views of self importance, the need for consistent admiration and a lack of empathy for others that strains most relationships; often sensitive to criticism
narcissistic
What are the adverse effects of neurocognitive disorder medications
nausea diarrhea bradycardia
Made up words that have meaning only to the client such as i tranged and flitted.
neologisms
PTSD
nightmares, indecisive, lack of emotion during a event lasting longer than 1 month following the event and can last for years
intial phase of group
nurse identifies purpose of group discuss termination of group set tone of group, expectation, and confidentiality
emergency situation restraints
nurse needs a written prescription within 15-30 minutes
A nurse is admitting a female client who had anorexia nervosa. Which of the following manifestations should the nurse expect during the admission assessment?
orthostatic hypotension
Signs of anorexia nervosa
orthostatic hypotension, constipation, amenorrhea (decreased body fat and poor nutrition) tachycardia
Alprazolam (xanax)
panic disorder med. anticholingeric
Amphetamine
paranoia AE akathisia-agitation, restlessness
conduct disorder
patterns of behavior in which the rights of others or basic social rules are violated ◯◯ Aggression to people and animals ◯◯ Destruction of property ◯◯ Deceitfulness or theft ◯◯ Serious violations of rules
biofeedback
people learn to control one or more body functions by monitoring their body's responses like HR and BP
anorexia nervosa
persistent energy intake restriction leading to significantly low body weight in context of age, sex, developmental path, and physical health
Schizo positive symptoms
r/t behavior, thought, perception, speech. Agitation, bizarre behavior, delusions, hallucinations, flight of ideas, loose associations
delirium
rapid fluctuations of loc
creating reasonable and acceptable explanations for unacceptable behavior Ex: A young adult explains he had to drive home from a party after drinking alcohol because he had to feed his dog.
rationalization
Overcompensating or demonstrating the opposite behavior of what is felt. Ex: a person who dislikes her sisters daughter offers to babysit so that her sister can go out of town
reaction formation
binge eating disorder
recurrently eat large quantities of food over a short period of time without the use of compensatory behaviors associated with bulimia nervosa
bulimia nervosa
recurrently eat large quantities of food over a short period of time, which can be followed by inappropriate compensatory behaviors, such as self-induced vomiting to rid the body of the excess calories
A nurse working on an acute mental health unit is caring for a client who has posttraumatic stress disorder (PTSD). Which of the following findings should the nurse expect? (Select all that apply.)
recurring nightmares difficulty concentrating on tasks negative self image
is obsessed with religious beliefs
religiosity
autonomy
respecting clients right to make independent choices
preventing a client from performing a compulsive behavior with the intent that anxiety will diminish
response prevention
First priority for alcohol withdrawal
rest and nutrition
Characterized by odd beliefs leading to interpersonal difficulties, an eccentric appearance, and magical thinking or perceptual distortions that are not clear delusions or hallucinations
schizotypal
Fluoxetine
selective seratonin reuptake inhibitor can cause sexual dysfunction such as anorgasmia and impotence -dry mouth, takes 1-3 weeks to work, visual disturbances
SSRI expected pharmacological action
selectively block reuptake of the monoamine neurotransmitter serotonin in the synaptic space, thereby intensifying the effects of serotonin first line treatment for depression
orientation phase
set boundaries and expectations, determine client's needs
OCD
set time limits , cannot have a pleasant moment
opioid abuse signs
slurred speech, impaired memory decreased RR, LOC withdrawal: gooseflesh, insonia, pain, N/V
demonstrating an inability to reconcile negative and positive attributes of self or others Ex:a client tells a nurse that she is the only one who cares about her, yet the following day the same client refuses to talk to the nurse
splitting
Free association
spontaneous, uncensored verbalization of whatever comes to client's mind
The use of lorazepam (a benzodiazepine) for a client experiencing alcohol withdrawal (what are the expected outcomes?)
stabilize vital signs prevent seizures treating delirium tremens
What is ECT not successful in?
substance use personality disorder dysthymic disorder
A community health nurse is planning an education program about depressive disorders. Which of the following factors should the nurse include as increasing the risk for depression
substance use disorder not male gender (female) , marriage (single), hyperthyroidism (actually hypo)
methadone
substitute for heroin use disorder
What muscle relaxant is used
succinylcholine (anectine)
This therapy is the planned, progressive, or graduate exposure to anxiety providing stimuli in relief situation, or by imagining events that case anxiety during exposure the client uses relaxation
systematic desensitization
Depersonalization disorder
temporary change in awareness displaying depersonalization, derealization, or both. Depersonalization is the feeling that a person is observing one's own personality or body from a distance.
interpersonal communication
the exchange of thoughts, feelings, and beliefs between two or more people
anhedonia
the inability to experience pleasure (this is especially concerning when a client no longer enjoys activities that once produced pleasure)
nursing considerations for working with a client with antisocial personality disorder
the nurse should set clear and realistic limits on behavior that ALL staff members adhere to identify undesirable behaviors and communicate consequences
Battery
the unlawful beating of a person; act of beating or pounding; any large group of related things
derealization versus depersonalization
the word person separates the two depersonalization you could be floating above the ground looking at yourself where derealization is you feel far away from that surrounding
teaching a client, when negative thoughts or compulsive behaviors arise, to say or shout, "stop" and substitute a positive thought. this goal over time is for the client to use the command silently
thought stopping
Believe that her thoughts have been removed form her mind by an outside agency
thought withdrawal
anergia
total passivity or lack of energy
justice
treating all equally and fairlu
cognitive therapy
treatment for psychological disorders that centers on changing self-defeating thinking
SNRI antidepressants
venlafaxine duloxetine cymbalta effexor for anxiety disorders AE Tremors Nausea Headache increased BP blurred vision, dry mouth don't give to patients who are hypertensive
A nurse is planning care for a client following surgical implantation of a VNS device. The nurse should plan to monitor for which of the following adverse effects? (Select all that apply.)
voice changes dysphagia neck pain
At what age is Erikson's Trust vs. Mistrust? ATI Comprehensive NCLEX-RN Review: Mental Health
• 0 - 1 year ATI Comprehensive NCLEX-RN Review: Mental Health
At what age does the Oral stage of Sigmund Freud's theory occur? ATI Comprehensive NCLEX-RN Review: Mental Health
• 0 - 1 year old ATI Comprehensive NCLEX-RN Review: Mental Health
What is mental health nursing? ATI Comprehensive NCLEX-RN Review: Mental Health
• A type of nursing that employs a purposeful use of self as its art and a wide range of nursing, psychosocial, and neurobiological theories and research evidence as its science. ATI Comprehensive NCLEX-RN Review: Mental Health
What is anxiety? ATI Comprehensive NCLEX-RN Review: Mental Health
• A universal human experience that is considered the most basic of human emotions. ATI Comprehensive NCLEX-RN Review: Mental Health
What are the 3 phases of treatment and recovery for major depressive disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Acute: . . . ○ 6 - 12 weeks: ↓ depressive symptoms • Continuation: . . . ○ 4 - 9 months: prevention of a relapse through pharmacotherapy, education, and psychotherapy. • Maintenance: . . . ○ 1+ year: prevention of further episodes ATI Comprehensive NCLEX-RN Review: Mental Health
What are examples of benzodiazepines used for anxiety? ATI Comprehensive NCLEX-RN Review: Mental Health
• Alprazolam • Clonazepam • Diazepam ATI Comprehensive NCLEX-RN Review: Mental Health
What is Fluoxetine used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• Antidepressant ATI Comprehensive NCLEX-RN Review: Mental Health
What is Citalopram used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• Antidepressant • MDD ATI Comprehensive NCLEX-RN Review: Mental Health
What is Imipramine used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• Antidepressant • MDD ATI Comprehensive NCLEX-RN Review: Mental Health
What is Sertraline used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• Antidepressants ATI Comprehensive NCLEX-RN Review: Mental Health
What are medications for anxiety disorders? ATI Comprehensive NCLEX-RN Review: Mental Health
• Antidepressants • Antianxiety agents • Anticonvulsants ATI Comprehensive NCLEX-RN Review: Mental Health
What is risperidone used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• Antipsychotics . . . ○ for both Positive & Negative symptoms • Bipolar Disorder . . . ○ Atypical Antipsychotic ATI Comprehensive NCLEX-RN Review: Mental Health
What is Clozapine used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• Antipsychotics . . . ○ for both Positive and negative symptoms ATI Comprehensive NCLEX-RN Review: Mental Health
What nursing interventions are used for a client with Schizoid personality disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Approval or rejection of others does not impact client • Do not try to increase socialization. ATI Comprehensive NCLEX-RN Review: Mental Health
What are atypical antipsychotics for Bipolar Disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Aripiprazole • Risperidone ATI Comprehensive NCLEX-RN Review: Mental Health
What nursing interventions are used for a patient who is suicidal? ATI Comprehensive NCLEX-RN Review: Mental Health
• Asses for: . . . ○ suicidal ideation with intent . . . ○ lethal suicide plan . . . ○ coexisting psychiatric or medical illness . . . ○ family history of suicide . . . ○ recent lack of support . . . ○ feelings of hopelessness and helplessness. . . . ○ covert statements such as, "Things will never work out" . . . ○ overt statement such as, "I can't take it anymore" ATI Comprehensive NCLEX-RN Review: Mental Health
What are nursing interventions for an intellectual development disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Assess cognitive and physical development and functioning. • Individualize care and teaching to the client's needs. • Make appropriate referrals (e.g., early intervention program, social work, ST, PT, OT). • Add visual cues with verbal instruction. • Give one-step instructions. ATI Comprehensive NCLEX-RN Review: Mental Health
What are CNS Stimulants? ATI Comprehensive NCLEX-RN Review: Mental Health
• Cocaine • Amphetamines • Methamphetamines ATI Comprehensive NCLEX-RN Review: Mental Health
What describes a client with Schizoid personality disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Emotional detachment • Isolates self • Few close relationships • Content on being an observer. ATI Comprehensive NCLEX-RN Review: Mental Health
What are nursing interventions for major depressive disorder (MDD)? ATI Comprehensive NCLEX-RN Review: Mental Health
• Evaluate the client's risk of harm to self or others. • Evaluate the client's use of drugs and alcohol. • Assess client's history of depression. • Assess client's support systems. ATI Comprehensive NCLEX-RN Review: Mental Health
What are primary risk factors of major depressive disorder (MDD)? ATI Comprehensive NCLEX-RN Review: Mental Health
• Female gender • Unmarried status • Low socioeconomic class • Early childhood trauma • Family history of depression • Postpartum period • Medical illness ATI Comprehensive NCLEX-RN Review: Mental Health
What types of medication are used for schizophrenia? ATI Comprehensive NCLEX-RN Review: Mental Health
• First-Generation Antipsychotics • Second-Generation Antipsychotics ATI Comprehensive NCLEX-RN Review: Mental Health
What are nursing interventions for mild and moderate anxiety? ATI Comprehensive NCLEX-RN Review: Mental Health
• Help the client identify the anxiety. • Anticipate anxiety-provoking situations. • Demonstrate interest in client by leaning forward and maintaining eye contact. • Ask questions to clarify what is said. • Encourage problem solving. ATI Comprehensive NCLEX-RN Review: Mental Health
What are opiate drugs? ATI Comprehensive NCLEX-RN Review: Mental Health
• Heroin • Meperidine • Fentanyl • Hydromorphone ATI Comprehensive NCLEX-RN Review: Mental Health
What are nursing interventions for motor disorders? ATI Comprehensive NCLEX-RN Review: Mental Health
• Maintain a safe environment for the client. • Provide positive reinforcement for correct behavior response. • Assess parents' understanding of the motor disorder. • Encourage participation in behavioral therapy and support groups. ATI Comprehensive NCLEX-RN Review: Mental Health
What is transcranial magnetic stimulation (TMS)? ATI Comprehensive NCLEX-RN Review: Mental Health
• Noninvasive treatment that uses magnetic pulses to stimulate the cerebral cortex. • There have been no neurological deficits or memory problems noted. ATI Comprehensive NCLEX-RN Review: Mental Health
What are nursing interventions for ADD and ADHD? ATI Comprehensive NCLEX-RN Review: Mental Health
• Observe for level of physical activity, attention span, talkativeness, frustration tolerance, and the ability to follow directions. • Assess social skills, problem-solving skills, and school performance. • Assess for comorbidities (e.g., anxiety, depression). ATI Comprehensive NCLEX-RN Review: Mental Health
What does active listening include? ATI Comprehensive NCLEX-RN Review: Mental Health
• Observing the client's nonverbal behaviors • Understanding and reflecting on the client's verbal message. ATI Comprehensive NCLEX-RN Review: Mental Health
What describes a client with a Cluster A personality disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Odd/Eccentric ATI Comprehensive NCLEX-RN Review: Mental Health
What is a maladaptive use of a defense mechanism? ATI Comprehensive NCLEX-RN Review: Mental Health
• One that occurs when one or several are used in excess, disallowing goals to be achieved. ATI Comprehensive NCLEX-RN Review: Mental Health
What is in the assessment of schizophrenia? ATI Comprehensive NCLEX-RN Review: Mental Health
• Positive symptoms • Negative symptoms • Cognitive symptoms ATI Comprehensive NCLEX-RN Review: Mental Health
What describes patients with Schizotypal personality disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Possible extreme anxiety in social situations . . . ○ related to severe social & interpersonal deficits. ATI Comprehensive NCLEX-RN Review: Mental Health
What describes clients with Obsessive-Compulsive personality disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Preoccupied with orderliness, perfectionism, and control • Rigid and inflexible • Fears failure. ATI Comprehensive NCLEX-RN Review: Mental Health
What is electroconvulsive therapy? ATI Comprehensive NCLEX-RN Review: Mental Health
• Procedure inducing seizure activity found to be helpful in treating clients who have MDD. • Clients may experience temporary short-term memory loss after several ECT treatments. ATI Comprehensive NCLEX-RN Review: Mental Health
What are nursing interventions associated with schizophrenia? ATI Comprehensive NCLEX-RN Review: Mental Health
• Provide a structured, safe environment (milieu) to ↓ anxiety and to distract the client from constant thinking about hallucinations. • Promote therapeutic communication to ↓ anxiety, ↓ defensive patterns, and ↑ participation in the milieu. • Establish a trusting relationship with the client. • Communication: . . . ○ Ask directly about hallucinations. . . . ○ Do not agree or agree with client's view of the situation. . . . ○ Do not argue with a client's delusions. . . . ○ Focus on client's feelings. . . . ○ Possibly offer reasonable explanations. . . . ○ Assess for paranoid delusions (↑ risk of violence). . . . ○ Attempt to focus conversations on reality-based subjects. ATI Comprehensive NCLEX-RN Review: Mental Health
What nursing interventions are used for a client with Borderline personality disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Provide clear and consistent boundaries • Use clear communication • Review therapeutic goals and boundaries when behavior issues are evident • Assess for self-mutilating behaviors. ATI Comprehensive NCLEX-RN Review: Mental Health
What are types of psychology theoretical models? ATI Comprehensive NCLEX-RN Review: Mental Health
• Psychoanalytic • Behavioral • Humanistic ATI Comprehensive NCLEX-RN Review: Mental Health
What is mental illness? ATI Comprehensive NCLEX-RN Review: Mental Health
• Refers to all mental disorders with definable diagnoses and includes developmental, biological, and psychological disturbances in mental functioning. ATI Comprehensive NCLEX-RN Review: Mental Health
What nursing interventions are used for clients with Narcissistic personality disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Remain neutral and avoid power struggles • Convey unassuming self-confidence. ATI Comprehensive NCLEX-RN Review: Mental Health
What are nursing interventions used for a client with Schizotypal personality disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Respect client's need for social isolation • Be aware of client's suspicious behavior • Be aware that superstition and magical thinking is common. ATI Comprehensive NCLEX-RN Review: Mental Health
What is the defense mechanism of regression? ATI Comprehensive NCLEX-RN Review: Mental Health
• Reverting to an earlier developmental level. ATI Comprehensive NCLEX-RN Review: Mental Health
What are the levels of the Hierachy of Needs according to Abraham Maslow? ATI Comprehensive NCLEX-RN Review: Mental Health
• Self-actualization • Self-esteem • Love and belonging • Safety and security • Physiological ATI Comprehensive NCLEX-RN Review: Mental Health
What is the definition of ADD and ADHD? ATI Comprehensive NCLEX-RN Review: Mental Health
• Showing an inappropriate degree of inattention and impulsiveness. These symptoms are present for children with ADHD with the addition of hyperactivity. ATI Comprehensive NCLEX-RN Review: Mental Health
What are symptoms of CNS Depressant intoxication? ATI Comprehensive NCLEX-RN Review: Mental Health
• Slurred speech • Unsteady gait • Drowsiness • Impaired Judgment ATI Comprehensive NCLEX-RN Review: Mental Health
What describes clients with Avoidant personality disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Social inhibition and feelings of inadequacy • Hypersensitive to negative evaluation. ATI Comprehensive NCLEX-RN Review: Mental Health
What are examples of cognitive symptoms in schizophrenia? ATI Comprehensive NCLEX-RN Review: Mental Health
• Subtle changes in memory or thinking, leading to an inability to cope and effectively make decisions. ATI Comprehensive NCLEX-RN Review: Mental Health
What are signs of CNS Stimulant intoxication? ATI Comprehensive NCLEX-RN Review: Mental Health
• Tachycardia • Dilated pupils • Elevated blood pressure • Grandiosity • Impaired judgment • Paranoia with delusions ATI Comprehensive NCLEX-RN Review: Mental Health
What is suicide? ATI Comprehensive NCLEX-RN Review: Mental Health
• The intentional act of killing oneself by any means. ATI Comprehensive NCLEX-RN Review: Mental Health
What are examples of positive symptoms in schizophrenia? ATI Comprehensive NCLEX-RN Review: Mental Health
• The presence of something that is not normally present: . . . ○ Alterations in thought . . . . . . • delusions being false, fixed beliefs . . . ○ Alterations in speech . . . . . . • word salad, echolalia . . . ○ Alterations in perception . . . . . . • hallucination: sensory experience w/o external stimulus. ATI Comprehensive NCLEX-RN Review: Mental Health
Describe clients with anxiety disorders. ATI Comprehensive NCLEX-RN Review: Mental Health
• These clients use ineffective behaviors to try to control their anxiety. ATI Comprehensive NCLEX-RN Review: Mental Health
What medications are first-generation antipsychotics used in schizophrenia? ATI Comprehensive NCLEX-RN Review: Mental Health
• Thioridazine • Haloperidol • Loxapine ATI Comprehensive NCLEX-RN Review: Mental Health
What are the stages of growth and development according to Erik Erikson? ATI Comprehensive NCLEX-RN Review: Mental Health
• Trust vs. Mistrust: 0 - 1 year (Infancy) • Autonomy vs. Shame and Doubt: 1 - 3 years (Early Childhood) • Initiative vs. Guilt: 3 - 6 years (Preschooler) • Industry vs. Inferiority: 6 - 12 years (School Age) • Identity vs. Role Confusion: 12 - 20 years (Adolescence) • Intimacy vs. Isolation: 20 - 35 years (Young Adult) • Generativity vs Stagnation: 35 - 65 years (Middle Adult) • Integrity vs. Despair: 65 years and older (Older Adult) ATI Comprehensive NCLEX-RN Review: Mental Health
What nursing interventions are used for clients with Histrionic personality disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Understand seductive behavior as a response to distress • Assess for suicidal behavior if admiration is withdrawn • Model concrete, descriptive vs. vague language. ATI Comprehensive NCLEX-RN Review: Mental Health
What is an anticonvulsant medication for Bipolar Disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Valproic Acid ATI Comprehensive NCLEX-RN Review: Mental Health
What SNRIs are used for MDD? ATI Comprehensive NCLEX-RN Review: Mental Health
• Venlafaxine • Duloxetine ATI Comprehensive NCLEX-RN Review: Mental Health
What SSRI and Serotonin Receptor Agonist is used for MDD? ATI Comprehensive NCLEX-RN Review: Mental Health
• Vilazodone ATI Comprehensive NCLEX-RN Review: Mental Health
What are signs of opiate withdrawal? ATI Comprehensive NCLEX-RN Review: Mental Health
• Yawning, • Insomnia • Panic • Diaphoresis • Cramps • N/V • Chills • Fever • Diarrhea ATI Comprehensive NCLEX-RN Review: Mental Health
A nurse is caring for four clients in an inpatient mental health facility. Which of the following clients can give informed consent
A 35-year-old client who has major depressive disorder R: pt w majar depressive d/o can make decisions unless legally incompetent
Fidelity
A client asks a nurse to be present when he talks to his mother for the first time in a year. The nurse remains with the client during this interaction.
A. Allow the client time to collect her thoughts. Slowed response time is common in clients who have depression. The nurse should allow the client time to comprehend and formulate an answer to the question.
A client who has a diagnosis of depression is attending group therapy. During the group meeting, the nurse asks each member to identify one goal for the day. When it is the client's turn, she does not respond. Which of the following actions should the nurse take before repeating the request to the client? A. Allow the client time to collect her thoughts. B. Prompt the client to give a response. C. Move on to the next client. D. Offer the client a suggestion for a goal.
A. Move the client who has bipolar disorder to a private room. Clients who have bipolar disorder can disrupt the therapeutic milieu for other clients. Therefore, the nurse should move this client to a private room.
A client who has a recent diagnosis of bipolar disorder is placed in a room with a client who has severe depression. The client who has depression reports to the nurse, "That man in my room never sleeps and he keeps me up too." Which of the following is an appropriate action for the nurse to take? A. Move the client who has bipolar disorder to a private room. B. Administer sleep medication to the client who has bipolar disorder. C. Move the client who has severe depression to a private room. D. Administer sleep medication to the client who has severe depression.
A. "I should eat a regular diet with normal amounts of salt and fluids." This statement indicates that the client understands the teaching because normal levels of sodium and fluid need to be maintained to ensure adequate excretion of lithium. If sodium levels are low, the body compensates by decreasing lithium excretion, which can lead to toxicity.
A client who has bipolar disorder is to be discharged home with a prescription for lithium. Which of the following statements indicates that client teaching regarding the medication has been effective? A. "I should eat a regular diet with normal amounts of salt and fluids." B. "I should discontinue the lithium when I begin to feel better." C. "I need to be careful to avoid becoming addicted to the lithium." D. "I can skip a dose of medication if my stomach is upset."
A nurse is planning care for four clients in a mental health facility. Which of the following clients is at the greatest risk for injury when performing ADLs?
A client who has severe Alzheimer's disease
A nurse is planning care for four clients in a mental health facility. Which of the following clients is at the greatest risk for injury when performing ADLs
A client who has severe Alzheimer's disease R: these pt are typically confused, have memory difficulties, tend to wander, and will need assistance
Temporary emergency admission
A client who is a current danger to self or others is a candidate for a temporary emergency admission.
stuporous
A client who is stuporous requires vigorous or painful stimuli to elicit a response.
A nurse who works with newborns is assessing the potential for abuse or neglect. Which of the following family groups should the nurse identify as the highest potential for future child abuse?
A family where one or both parents witnesses intimate partner violence in the home as children
Seasonal affective disorder (SAD)
A form of depression that occurs seasonally, usually during the winter, when there is less daylight; best treated with light therapy
Cognitive-behavioral therapy
A form of therapy that combines behavior therapy and restructuring of negative thought patterns
Homogeneous group
A group in which all members share a certain chosen characteristic, such as diagnosis or gender
D. Inappropriate dress Clothing that is soiled or clothing that is not appropriate for weather conditions is a possible indicator of neglect.
A home nurse is assessing an older adult client whose sibling is the primary caregiver. Which of the following findings should the nurse identify as a possible indicator of neglect? A. Increased confusion B. Sleep disturbances C. Cluttered environment D. Inappropriate dress
hypomania
A less severe episode of mania that lasts at least 4 days accompanied by three or more manifestations of mania.
Dissociative fugue
A man unexpectedly flies across the country, takes a new name, and has no memory of his prior life.
B. Greater risk of attempting suicide as affect and energy improve. An initial response to amitriptyline can develop in one week. For a client who has been severely depressed with suicidal ideation, the energy to carry out a plan is more possible after 1 week of treatment.
A nurse assessing a client who has major depressive disorder and has been receiving amitriptyline for 1 week. Which of the following outcomes should the nurse expect? A. Rapid improvement in affect within 30-60 minutes after taking the medication. B. Greater risk of attempting suicide as affect and energy improve. C. Onset of frequent loose stools. D. Development of physiologic dependence on the medication.
C. Experiences feelings of isolation Clients who have PTSD often feel estranged and detached from others.
A nurse in a community health center is teaching families of clients who have posttraumatic stress disorder (PTSD) about expected clinical manifestations. Which of the following manifestations should the nurse include? A. Repeatedly talks about traumatic incident B. Sleeps excessively C. Experiences feelings of isolation D. Uses repetitive speech
B. Instruct the client to avoid driving during initial therapy. The greatest risk to this client is injury resulting from dizziness or drowsiness. Therefore, the nurse's priority intervention is to instruct the client to avoid activities that require mental alertness during initial medication therapy.
A nurse in a mental health clinic is planning care for a client who has a new prescription for olanzapine. Which of the following interventions should the nurse identify as the priority? A. Advise the client to take frequent sips of water. B. Instruct the client to avoid driving during initial therapy. C. Consult a dietitian for a calorie-controlled diet plan. D. Recommend that the client exercise regularly.
D. Command hallucinations A client who has schizophrenia and is experiencing command hallucinations can hear voices telling him to hurt himself or others. Therefore, a client who is experiencing command hallucinations is at the greatest risk for self-directed injury or injuring others.
A nurse in a mental health facility is caring for a client who has schizophrenia. Which of the following places the client at the greatest risk for self-directed injury or injuring others? A. Inability to communicate with others B. Feeling of absence of self-worth C. Lack of motivation to perform daily tasks D. Command hallucinations
C. Call for a team of staff members to help with the situation. The greatest risk is injury to the client and others. Therefore, the first action the nurse should take is to call for assistance to prevent further injury to himself or others.
A nurse in a mental health unit observes a client who has acute mania hit another client. Which of the following actions should the nurse take first? A. Call the provider to obtain an immediate prescription for restraint. B. Prepare to administer benzodiazepine IM. C. Call for a team of staff members to help with the situation. D. Check the client who was hit for injuries.
B. "She won't let me take the trash from her room. I'm concerned about what she has in there." The client might be binge eating and attempting to hide her food containers, which is a common behavior among clients who have bulimia nervosa. The mother's statement indicates awareness of her daughter's behavior.
A nurse in an emergency department is caring for a female adolescent who has a diagnosis of bulimia nervosa and had a fainting episode during a ballet performance. Which of the following statements by the mother acknowledges her daughter's diagnosis? A. "She works so hard at ballet. Will she still be able to perform?" B. "She won't let me take the trash from her room. I'm concerned about what she has in there." C. "She told me she was tired, so I did her chores for her today." D. "She is happier with her appearance now that she's lost some weight."
A. St. John's wort St. John's wort is an herbal preparation that decreases the reuptake of serotonin. The nurse should advise the client that taking St. John's wort with another medication that also inhibits the reuptake of serotonin, such as paroxetine, places the client at risk for serotonin syndrome.
A nurse in an outpatient mental health setting is collecting a health history from a client who is taking paroxetine for depression. The client reports to the nurse that he also takes herbal supplements. The nurse should advise the client that which of the following supplements interacts adversely with paroxetine? A. St. John's wort B. Saw palmetto C. Echinacea D. Ginkgo
A. Encourage the client to drink 125 mL of fluid each hour while awake. The nurse should encourage the client to drink 125 mL of fluid each waking hour to maintain hydration.
A nurse is admitting a client who has anorexia nervosa and is at 60% of ideal body weight. Which of the following interventions should the nurse include in the plan of care? A. Encourage the client to drink 125 mL of fluid each hour while awake. B. Allow the client to eat independently in his room. C. Weigh the client twice weekly. D. Measure the client's vital signs once each day.
D. Phenylephrine Clients who are taking tranylcypromine, an MAOI antidepressant, should not take Phenylephrine and other over-the-counter medications for sinus congestion, colds, or allergies due to their actions on the sympathetic nervous system, which can result in severe hypertension.
A nurse is admitting a client who has major depressive disorder and a new prescription for tranylcypromine. Which of the following over-the-counter medications that the client reports taking should alert the nurse to a potential adverse reaction? A. Lansoprazole B. Naproxen C. Magnesium hydroxide D. Phenylephrine
A. Emotional lability Emotional lability is the rapid transition from one emotion to another and is a primary feature of borderline personality disorder. Clients who have borderline personality disorder react to situations with emotional responses that are out of proportion to the circumstances.
A nurse is assessing a client who has borderline personality disorder. Which of the following findings should the nurse expect? A. Emotional lability B. Self-sacrificing C. Suspicious of others D. Graniosity
D. Tooth erosion A client who has bulimia nervosa is likely to have dental carries and tooth erosion caused by frequent exposure to gastric acid from vomiting.
A nurse is assessing a client who has bulimia nervosa. The nurse should expect which of the following findings? A. Amenorrhea B. Lanugo C. Cold extremities D. Tooth erosion
C. Anhedonia Negative symptoms of schizophrenia affect a person's ability to interact with others and are less dominant than positive symptoms. These symptoms develop over time. Examples of negative symptoms include flat affect, anergia (lack of energy), anhedonia (inability to enjoy otherwise pleasurable activities), and thought blocking.
A nurse is assessing a client who has schizophrenia. Which of the following findings should the nurse document as a negative symptom of this disorder? A. Delusions B. Neologisms C. Anhedonia D. Echopraxia
C. Older children who are responsible for their younger siblings. This is an example of enmeshed boundaries in which there are no distinctions between roles of family members.
A nurse is assessing a family's dynamics during a counseling session. The nurse should recognize which of the following findings as an indication of a boundary issue? A. An adolescent family member who questions parental authority. B. A family with three generations in the same household. C. Older children who are responsible for their younger siblings. D. Two adults and their children from prior relationships in the same household.
D. Reduce environmental stimuli. The greatest risk to the child and others is harm. Therefore, the nurse's priority intervention is to use a therapeutic holding technique to deescalate the behavior and prevent injury.
A nurse is caring for a child who has conduct disorder and is behaving in a destructive manner, throwing objects and kicking others. Which of the following therapeutic nursing interventions is the priority? A. Encourage expression of feelings. B. Promote attendance at an assertiveness training group. C. Assist the client to perform relaxation breathing. D. Reduce environmental stimuli.
C. Tachycardia The nurse should monitor the child for tachycardia, which is an adverse effect of methylphenidate.
A nurse is caring for a child who is taking methylphenidate. The nurse should monitor the child for which of the following findings as an adverse effect of methylphenidate? A. Weight gain B. Tinnitus C. Tachycardia D. Increased salivation
D. Report the occurrence to the charge nurse. It is the charge nurse and the nurse manager's responsibility to confront the staff member about her behavior toward the client.
A nurse is caring for a client in a mental health facility. The nurse overhears another staff member make derogatory comments to the client. Which of the following actions should the nurse take? A. Confront the staff member. B. Encourage the client to report the incident. C. Document the incident in the client's health record. D. Report the occurrence to the charge nurse.
B. "I'll stay with you in case you want to talk." This response indicates the nurse's interest in the client and a desire to understand the client's feelings.
A nurse is caring for a client who gave birth to a stillborn baby. Which of the following statements should the nurse make? A. "You probably want to hold your baby." B. "I'll stay with you in case you want to talk." C. "I know how you must be feeling." D. "It hurts now, but things will be better soon."
D. Frequently misplaces objects According to evidence-based practice, the nurse should identify that mild cognitive impairment, such as frequently misplacing objects, is one of the first manifestations expected to occur for a client who has Alzheimer's disease. As the disease progresses, other manifestations of moderate and severe cognitive impairment will occur.
A nurse is caring for a client who has a recent diagnosis of Alzheimer's disease. The client's partner asks the nurse about expected manifestations. The nurse should teach the partner to expect which of the following manifestations to occur first? A. Inability to recognize family members B. Chooses clothing that is inappropriate for the weather C. Exhibits a change in personality D. Frequently misplaces objects
D. I imagine myself lying on a quiet beach when I start to feel anxious." Envisioning oneself in a peaceful, calm environment enhances relaxation and is an example of using guided imagery.
A nurse is caring for a client who has an anxiety disorder. Which of the following statements by the client indicates successful use of guided imagery? A. "I consciously decrease my breathing rate when I feel anxious." B. "I am riding my bike around the neighborhood every day." C. "I find at least one positive thing in situations that upset me." D. "I imagine myself lying on a quiet beach when I start to feel anxious."
C. Temperature 35.6 degrees Celsius (96.1 degrees Fahrenheit) Severe hypothermia, a temperature lower than 36 degrees Celsius (96.8 degrees Fahrenheit) due to loss of subcutaneous tissue or dehydration, requires hospitalization.
A nurse is caring for a client who has anorexia nervosa. Which of the following criteria requires hospitalization? A. Weight loss 10% of total body weight in 3 months. B. Potassium 3.8 mEq/L C. Temperature 35.6 degrees celsius (96.1 degrees Fahrenheit) D. Heart rate 54/minute
C. Refrains from manipulating others to earn dining-room privileges. The goal of operant conditioning is to provide positive reinforcement in return for a desired behavior. Refraining from manipulative behavior is a desired response.
A nurse is caring for a client who has antisocial personality disorder and is receiving behavioral therapy through operant conditioning. Which of the following client behaviors indicates effectiveness of the therapy? A. Controls anger outbursts to avoid being placed in seclusion. B. No longer exhibits a fear of social or public situations C. Refrains from manipulating others to earn dining-room privileges. D. Imitates the therapist's use of a relaxation technique
D. "I will attend daily group therapy sessions to practice relaxation techniques." Relaxation techniques decrease the risk for self-harm by decreasing stress, anxiety, and depression
A nurse is caring for a client who has attempted suicide and has alcohol use disorder. Which of the following statements indicates that the client is using a positive coping mechanism? A. "I will limit my drinking to the weekends." B. "I will stay in my room and avoid others when I'm feeling down." C. "I will be dependent on others for the time being." D. "I will attend daily group therapy sessions to practice relaxation techniques."
A. Shuffling gait Benztropine is used to treat parkinsonism manifestations, such as shuffling gait.
A nurse is caring for a client who has schizophrenia and was prescribed a conventional antipsychotic medication yesterday. Which of the following findings indicates the nurse should administer benztropine 2 mg IM? A. Shuffling gait B. Hypotension C. Decreased WBC count D. Blurred vision
B. Assist the client with deep-breathing exercises. Relaxation techniques, such as deep, abdominal breathing exercises, help defuse manifestations of anxiety.
A nurse is caring for a client who is experiencing a panic attack. Which of the following actions should the nurse take? A. Orient the client to person, place, and time. B. Assist the client with deep-breathing exercises. C. Calm the client by using therapeutic touch. D. Have the client sit alone in a quiet room.
A. Diazepam 5 mg IV bolus The greatest risk to the client who is experiencing alcohol withdrawal is seizures, an elevated heart rate, and elevated blood pressure. IV diazepam acts rapidly to prevent seizures, stabilize vital signs, and decrease the intensity of withdrawal manifestations.
A nurse is caring for a client who is experiencing alcohol withdrawal. The client has a heart rate of 110/min, blood pressure of 170/96 mm Hg, and temperature of 38.9 degrees Celsius( 102 degrees Fahrenheit). Client history and physical include that the client states he consumed alcohol 12 hours prior to admission and the client has a 2 pack/day smoking history. Client progress notes include bilateral tremors of the hands and finger, emesis of 30 mL bile-colored fluid, restlessness, unable to sit still, diaphoresis, and flushed skin. Which of the following medications should the nurse administer first? A. Diazepam 5 mg IV bolus B. Clonidine 0.1 mg transdermal patch C. Naltrexone 380 mg IM D. Bupropion 150 mg PO
B. "You're saying that you think you are fat and are using laxatives because you are afraid of gaining weight." The nurse is using the therapeutic technique of summarizing to review the key points of the discussion.
A nurse is counseling an adolescent who has anorexia nervosa and reports excessive laxative use and a fear of gaining weight. The client states, "I'm so fat I can't even stand to look at myself." Which of the following therapeutic responses demonstrates the nurse's use of summarizing? A. "You've discussed several concerns about your weight. Let's go back and talk about your belief that you are fat." B. "You're saying that you think you are fat and are using laxatives because you are afraid of gaining weight." C. "You don't want to look at yourself because you think you are fat." D. "You and I can work together to overcome your fears of gaining weight."
C. Renew the prescription for the client every 4 hours. The nurse should assess the client's behavior frequently during seclusion and should renew the prescription for seclusion for an adult client every 4 hours, for a maximum of 24 hours.
A nurse is creating a plan of care for a client who has been placed in seclusion after threatening to harm others on the unit. Which of the following interventions should the nurse include in the plan? A. Document the client's behavior every 8 hours. B. Limit the client's fluid intake to 50 mL/hour. C. Renew the prescription for the client every 4 hours. D. Toilet the client every 4 hours.
B. The client should obtain a sponsor before discharge for an increased chance of recovery. The nurse should teach the client to secure a sponsor because the client-sponsor relationship has been shown to increase program attendance and chances of recovery.
A nurse is discussing a 12-step program with a client who has alcohol use disorder and is in an acute care facility undergoing detoxification. Which of the following information should the nurse include in the teaching? A. The program will help the client accept responsibility for his disorder. B. The client should obtain a sponsor before discharge for an increased chance of recovery. C. The client will need to identify individuals who have contributed to his disorder. D. The program will need a prescription from the client's provider prior to attendance.
B. Ask group members to discuss their feeling about this client's monopolizing behavior. This intervention will validate other members' feelings toward the client who is dominating the meeting. It also should encourage group problem-solving.
A nurse is facilitating a community meeting for acute care clients. One client is constantly talking and using the majority of the group's time. Which of the following interventions should the nurse implement? A. Tell the client that he must talk less or he will be removed from the meeting. B. Ask group members to discuss their feeling about this client's monopolizing behavior. C. End the group meeting and take the client aside to discuss his behavior. D. Focus on other group members and ignore the client who is doing all the talking.
C. Offer the client high-calorie finger foods frequently. The nurse should frequently offer the client, high-calorie foods that can be eaten while the client is on the go. Client's experiencing mania might be unable to sit down for meals and can experience weight loss and dehydration
A nurse is planning care for a client who has bipolar disorder and is experiencing mania. Which of the following interventions should the nurse include in the plan of care? A. Encourage the client to participate in group therapy. B. Instruct the client to avoid napping during the day. C. Offer the client high-calorie finger foods frequently. D. Decrease the client's daily fiber intake.
D. Mild The nurse should plan to teach the client relaxation techniques during the mild level of anxiety, The is when the client will be able to concentrate and process information.
A nurse is planning care for a client who has generalized anxiety disorder. At which of the following levels of anxiety should the nurse plan to teach the client relaxation techniques? A. Panic B. Moderate C. Severe D. Mild
D. Remove unnecessary equipment from the child's surroundings. The risk to the child who has ADHD is injury from impulsive behavior and the decreased ability to perceive self-harm. Therefore, the priority intervention is to remove unnecessary equipment from the child's surroundings.
A nurse is planning care for a preschool-age child who has ADHD. Which of the following interventions should the nurse identify as the priority? A. Decrease distractions during meal times. B. Provide positive feedback when the child completes a task. C. Clearly identify consequences for unacceptable behavior. D. Remove unnecessary equipment from the child's surroundings.
A. Arrange one-to-one observation of the client. The greatest risk to the client is self-injury, Therefore, the priority nursing intervention is one-to-one observation to promote client safety.
A nurse is planning care for an adolescent who is being admitted to an acute care unit following a suicide attempt. Which of the following interventions should the nurse identify as the priority? A. Arrange one-to-one observation of the client. B. Encourage interaction with the client's peers. C. Administer medication for depressive disorder. D. Encourage the client to attend a support group.
B. Establish screening programs to identify at-risk clients. This is an example of secondary prevention. By establishing screening programs, the nurse can identify individuals who are at risk for intimate partner abuse in the community and take the necessary steps to address individual client needs.
A nurse is planning prevention strategies for intimate partner abuse in the community. Which of the following strategies should the nurse include as a method of secondary prevention? A. Provide teaching about the use of positive coping mechanisms. B. Establish screening programs to identify at-risk clients. C. Refer survivors of intimate partner abuse to a legal advocacy program. D. Organize rehabilitation therapy for clients who have experienced intimate partner abuse.
14 mL 110 lb x (1 kg/2.2 lb) = 50 kg 50 kg x 0.55 mg = 27.5 mg 27.5 mg x(5 mL/10 mg) = 14 mL
A nurse is preparing to administer chlorpromazine 0.55 mg/kg PO to an adolescent who weighs 110 lb. Available is chlorpromazine syrup 10 mg/5 mL. How many mL should the nurse administer? (Round the answer to the nearest whole number)
A, B, D, E An occupational therapist can assist the client to perform ADLs. Meal deliver services are necessary due to the client's difficulty performing ADLs. A physical therapist can assess the client's mobility needs and assist with ADLs. Home health services provide a nursing assessment of the client's physical and mental status, as well as assistance with ADLs.
A nurse is preparing to discharge an older adult who attempted suicide to his home where he lives alone and has difficulty performing ADLs. Which of the following referrals should the nurse initiate? (Select all that apply." A. Occupational therapy B. Meal delivery services C. Speech therapy D. Physical therapy E. Home health services
D. Wear sunglasses when outdoors. Light therapy, or phototherapy can cause eye strain and sensitivity to light.
A nurse is providing teaching to a client who is to begin undergoing light therapy at home to treat seasonal affective disorder. Which of the following should the nurse include in the teaching? A. Have a family member present during treatment. B. Increase fluid intake. C. Change position slowly. D. Wear sunglasses when outdoors.
A. WBC 2500/mm3 Clozapine can cause agranulocytosis, which can be fatal due to overwhelming infection. The nurse should identify a WBC count below 3000/mm3 as a possible manifestation of agranulocytosis and should withhold the medication and notify the provider.
A nurse is reviewing laboratory results for a client who has schizophrenia and is taking clozapine. Which of the following values should the nurse identify as a contraindication for receiving clozapine. A. WBC 2500/mm3 B. Hbg 11.5 mg/dL C. Platelets 150,000/mm3 D. RBC 3.5 million/mm3
B. A client who has a sodium level of 128 mEq/L A sodium level of 128 mEq/L should alert the nurse that the client is at risk for lithium toxicity because renal excretion of lithium is decreased in the presence of a low sodium level.
A nurse is reviewing routine laboratory values for several clients who are taking lithium carbonate. Which of the following clients should the nurse assess further for findings indicating lithium toxicity? A. A client who has a fasting blood sugar of 80 mg/dL B. A client who has a sodium level of 128 mEq/L C. A client who has a BUN of 18 mg/dL D. A client who has a potassium level of 3.6 mEq/L.
A. The client was seriously injured while under the influence of alcohol. A traumatic event that causes stress is a trigger for dissociative amnesia.
A nurse is reviewing the chart of a client who has dissociative amnesia. Which of the following should the nurse expect? A. The client was seriously injured while under the influence of alcohol. B. The client has a history of panic attacks. C. The client chose to drop out of college a few months ago. D. The client works a stressful job at an international bank.
A. "Take this medication in the evening at bedtime." The client should take this medication in the evening at bedtime for optimal effectiveness.
A nurse is teaching a family member and a client who has a new diagnosis of Alzheimer's disease and is to start taking donepezil. Which of the following statements should the nurse include in the teaching? A. "Take this medication in the evening at bedtime." B. "Expect this medication to reverse the effects of Alzheimer's disease." C. "If you miss a dose, double the next dose." D. "You can crush this medication in applesauce."
C. "I will update the plan of care as a client's manifestations of depression change." The nurse should update the plan of care as a client's status and needs change.
A nurse is teaching a newly licensed nurse about nursing care plans for clients who have depressive disorders. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. "I will use the same plan of care and interventions for each client who has depression." B. "Each individual nurse will develop a separate plan of care when managing clients who have depression." C. "I will update the plan of care as a client's manifestations of depression change." D. "An assistive personnel can use the plan of care for client teaching."
C. Suggest forming a weekly support group for parents who have experienced the loss of a child. Support groups are a positive resource in the process of recovery for parents who have lost a child.
A nurse is working with a group of parents who recently lost a child. Which of the following actions should the nurse take? A. Encourage the parent to avoid discussing the death with other children in order to protect their feelings. B. Recommend each parent grieve in private to avoid hindering each other's healing. C. Suggest forming a weekly support group for parents who have experienced the loss of a child. D. Advise the parents to begin counseling if they are still grieving in a few months.
A. "It appears as though you would like to open the door." This statement is an example of the therapeutic technique of making observations. This technique encourages the client to notice the behavior so that she can describe thoughts and feelings related to that behavior.
A nurse observes a client on a mental health unit pushing on a locked unit door. Which of the following statements should the nurse make? A. "It appears as though you would like to open the door." B. "You will feel more comfortable after you've been here a while." C. "It is okay to not want to be here." D. "You really shouldn't be pushing on the door."
B. Blood pressure 154/96 mm Hg Physical manifestations of alcohol withdrawal occur in addition to psychological effects. A client who is experiencing alcohol withdrawal is expected to have hypertension, tachycardia, and fever greater than 38.3 degrees Celsius (101 degrees Fahrenheit). It will be important for the nurse to rule out infection in the client who has a fever.
A nurse on a medical-surgical unit is assessing a client who sustained injuries 12 hours ago following a motor-vehicle crash. The client's admission blood alcohol level was 325 mg/dL. Which of the following findings should indicate to the nurse that the client is experiencing alcohol withdrawal? A. Somnolence B. Blood pressure 154/96 mm Hg C. Pinpoint pupils D. Blood glucose 210 mg/dL
D. Spending adequate time with a client who is verbally abusive By spending adequate time with a client who is verbally abusive, the nurse is demonstrating the ethical principle of justice. When the nurse spends an appropriate amount of time with each client regardless of their behavior and in keeping with their individual needs, the nurse guarantees that all clients receive care.
A nurse on a mental health unit is caring for a group of clients. Which of the following actions by the nurse is an example of the ethical principle of justice? A. Allowing a client to choose which unit activities to attend B. Attempting alternative therapies instead of restraints for a client who is combative C. Providing a client with accurate information about his prognosis D. Spending adequate time with a client who is verbally abusive
A nurse working in an acute mental health facility is caring for a 35-year-old female client who has manifestations of depression. The client lives at home with her partner and two young children. She currently smokes and has a history of chronic asthma. Which of the following factors put the client at risk for depression? (Select all that apply) A. Age B. Gender C. History of chronic asthma D. Smoking E. Being married
A, B, C, & D. Being between the ages of 15-40, being female, having a chronic illness, and substance use are risk factors for depression.
A nurse is working in a community mental health facility. Which of the following services does this type of program provide? (Select all that apply) A. Educational groups B. Medication dispensing programs C. Individual counseling programs D. Detoxification programs E. Family therapy
A, B, C, & E. Community mental health facilities provide educational programs, medication dispensing programs, individual counseling programs, and family therapy. Detoxification programs are provided in a partial hospitalization program.
A nurse is discussing the use of methadone with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? (Select all that apply) A. "Methadone is a replacement for physical dependence to opioids." B. "Methadone reduces the unpleasant effects associated with abstinence syndrome." C. "Methadone can be used during opioid withdrawal and to maintain abstinence." D. "Methadone increases the risk for acetaldehyde syndrome." E. "Methadone must be prescribed and dispensed by an approved treatment center."
A, B, C, & E. Methadone replaced the opioid the client is dependent on, prevents abstinence syndrome from occurring, is used for both withdrawal and long-term maintenance, and must be prescribed by an approved treatment center. Disulfiram places the client at risk acetaldehyde syndrome.
A nurse is caring for a client who has a new prescription for disulfiram for treatment of alcohol use disorder. The nurse informs the client that this medication can cause nausea and vomiting if he drinks alcohol. Which of the following types of treatment is this method an example? A. Aversion therapy B. Flooding C. Biofeedback D. Dialectical behavior therapy
A. Aversion therapy pair a maladaptive behavior with unpleasant stimuli to promote a change in behavior.
A nurse is providing teaching to a client who has alcohol use disorder and a new prescription for carbamazepine. Which of the following information should the nurse include in the teaching? A. "This medication will help prevent seizures during alcohol withdrawal." B. "Taking this medication will decrease your cravings for alcohol." C. "This medication maintains your blood pressure at a normal level during alcohol withdrawal." D. "Taking this medication will improve your ability to maintain abstinence from alcohol."
A. Carbamazepine is used during withdrawal to decrease the risk for seizures. Carbamazepine promotes safe withdrawal rather than a decrease in cravings or abstinence. Clonidine and propranolol are used to maintain BP.
A nurse is caring for a client who has avoidant personality disorder. Which of the following statements is expected from a client who has this type of personality disorder? A. "I'm scared that you're going to leave me." B. "I'll go to group therapy if you'll let me smoke." C. "I need to feel that everyone admires me." D. "I sometimes feel better if I cut myself."
A. Clients who have avoidant personality disorder often have fear of abandonment. This type of statement is expected. B occurs in antisocial personality disorder. C occurs in narcissistic personality disorder. D occurs in borderline personality disorder.
A nurse is teaching a client about stress-reduction techniques. Which of the following client statements indicates understanding of the teaching? A. "Cognitive reframing will help me change my irrational thoughts to something positive." B. "Progressive muscle relaxation uses a mechanical device to help me gain control over my pulse rate." C. "Biofeedback causes my body to release endorphins so that I feel less stress and anxiety." D. "Mindfulness allows me to prioritize the stressors that I have in my life so that I have less anxiety."
A. Cognitive reframing helps the client look at irrational thoughts in a more realistic light and to restructure those thoughts in a more positive way. B is biofeedback. C is physical exercise. D is priority restructuring.
A charge nurse is discussing mental status exams with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? (Select all that apply) A. "To assess cognitive ability, I should ask the client to count backward by sevens." B. "To assess affect, I should observe the client's facial expression." C. "To assess language ability, I should instruct the client to write a sentence." D. "To assess remote memory, I should have the client repeat a list of objects." E. "To assess the client's abstract thinking, I should ask the client to identify our most recent presidents."
A. Counting backward by sevens is an appropriate technique to assess a client's cognitive ability. B. Observing a client's facial expression is appropriate when assessing affect. C. Writing a sentence is an indication of language ability. Remote language is tested by asking the client to state a fact from his past that his verifiable (date of birth). Abstract thinking is tested by asking the client to interpret something.
A nurse is preparing to provide an educational seminar on stress to other nursing staff. Which of the following information should the nurse include in the discussion? A. Excessive stressors cause the client to experience distress. B. The body's initial adaptive response to stress is denial. C. Absence of stressors results in homeostasis. D. Negative, rather than positive, stressors produce a biological response.
A. Distress is the result of excessive or damaging stressors, such as anxiety or anger.
A nurse is caring for a client who is experiencing extreme mania due to bipolar disorder. Prior to administration of lithium carbonate, the client's lithium blood level 1.2 mEq/L. Which of the following actions should the nurse take? A. Administer the next dose of lithium carbonate as scheduled. B. Prepare for administration of aminophylline. C. Notify the provider for a possible increase in the dosage of lithium carbonate. D. Request a stat repeat of the client's lithium blood level.
A. During a manic episode, the lithium blood level should be 0.8-1.4 mEq/L. It is appropriate to administer the next dose as scheduled.
A nurse is providing teaching to an adolescent client who has a new prescription for clomipramine for OCD. Which of the following information should the nurse provide? A. Eat a diet high in fiber B. Check temperature daily C. Take medication first thing in the morning before eating D. Add extra calories to the diet as between-meal snacks
A. Eating a diet high in fiber will decrease constipation, an anticholinergic effect associated with TCA use. Checking temp daily is unnecessary. The med should be taken at bedtime. Following a well-balanced diet plan rather than adding extra calories as snacks will help prevent weight gain.
A nurse is discussing routine follow-up needs with a client who has a new prescription for valproate. The nurse should inform the client of the need for routine monitoring of which of the following? A. AST/ALT and LDH B. Creatinine and BUN C. WBC and granulocyte counts D. Serum sodium and potassium
A. Routine monitoring of liver function tests is necessary due to the risk for hepatotoxicity. Routine monitoring of the others is not necessary.
A nurse is reviewing the medical record of a client who has conversion disorder. Which of the following findings should the nurse identify as placing the client as risk for conversion disorder? A. Death of a child 2 months ago B. Recent weight loss of 30 lb C. Retirement 1 year ago D. History of migraine headaches
A. The death of a child 2 months ago is an acute stressor that places the client at risk for conversion disorder.
A nurse working on an acute mental health unit is admitting a client who has major depressive disorder and comorbid anxiety disorder. Which of the following actions is the nurse's priority? A. Placing the client on one-to-one observation B. Assisting the client to perform ADLs C. Encouraging the client to participate in counseling D. Teaching the client about medication adverse effects
A. The greatest risk for a client who has MDD and comorbid anxiety is injury due to self harm. The highest priority intervention is placing the client on one-to-one observation.
A nurse is caring for a client who has body dysmorphic disorder. Which of the following actions should the nurse plan to take first? A. Assessing the client's risk for self harm B. Instilling hope for positive outcomes C. Encouraging the client to participate in group therapy sessions D. Encouraging the client to participate in treatment decisions
A. The greatest risk to a client who has an anxiety or obsessive-compulsive disorder is self-harm or suicide. This should be assessed first.
A nurse is caring for an adult client who has injuries resulting from intimate partner abuse. The client does not wish to report the violence to law enforcement authorities. Which of the following nursing actions is the highest priority? A. Advise the client about the location of women's shelters B. Encourage the client to participate in a support group for survivors of abuse C. Implement case management to coordinate community and social services D. Educate the client about the use of stress management techniques
A. The greatest risk to this client is injury from intimate partner abuse. Therefore, the priority action the nurse should take is to assist the client with the development of a safety plan that includes the identification of safe places to live.
A nurse is discussing the care of a client following a sexual assault with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. "I will administer prophylactic treatment for sexually transmitted infections." B. "I am not required to obtain informed consent before the sexual assault nurse examiner collects forensic evidence." C. "I can expect manifestations of rape-trauma syndrome to be similar to bipolar disorder." D. "I should use narrative documentation when documenting subjective data."
A. The nurse should administer prophylactic treatment for STIs. Informed consent is required before collecting forensic evidence. Manifestations of rape-trauma syndrome are similar to PTSD. The nurse should document subjective data using the client's verbatim statements.
A nurse is caring for an adolescent client who has anorexia nervosa with rapid weight loss and a current weight of 90 lb. Which of the following statements indicates the client is experiencing the cognitive distortion catastrophizing? A. "Life isn't worth living if I gain weight." B. "Don't pretend like you don't know how fat I am." C. "If I could be skinny, I know I'd be popular." D. "When I look in the mirror, I see myself as obese."
A. This reflects catastrophizing because the client's perception of her appearance or situation is much worse than her current condition. B is personalization. C is overgeneralization.
A nurse is caring for a client who lost his mother to cancer last month. The client states, "I'd still have my mother if the doctor would have diagnosed her sooner." Which of the following responses should the nurse make? A. "You sound angry. Anger is a normal feeling associated with loss." B. "I think you would feel better if you talked about your feelings with a support group." C. "I understand just how you feel. I felt the same when my mother died." D. "Do other members of your family also feel this way?"
A. This response acknowledges the client's emotion and provides education on the normal grief response. B offers advice. C minimizes the client's feelings. D takes the focus away from the client.
A nurse is caring for a client who is screaming at staff members and other clients. Which of the following is a therapeutic response by the nurse to the client? A. "Stop screaming, and walk with me outside." B. "Why are you so angry and screaming at everyone?" C. "You will not get your way by screaming." D. "What was going through your mind when you started screaming?"
A. This sets limits and the use of physical activity, such as walking, to deescalate anger. B is a "why" question. C is a close-ended statement, which is nontherapeutic. The client is not ready to discuss this issue.
A nurse is preparing to obtain a nursing history from a client who has a new diagnosis of anorexia nervosa. Which of the following questions should the nurse to include in the assessment? (select all that apply.) A. "What is your relationship like with your family?" B. "Why do you want to lose weight?" C. "Would you describe your current eating habits?" D. "At what weight do you believe you will look better?" E. "Can you discuss your feelings about your appearance?"
ACE
A nurse is teaching a client who has a new prescription for imipramine how to minimize anticholinergic effects. Which of the following instructions should the nurse include in the teaching? (select all that apply.) a. void just before taking the medication. B. increase the dietary intake of potassium. c. wear sunglasses when outside. d. change positions slowly when getting up. e. chew sugarless gum
ACE
Alcohol withdrawal manifestations
Abdominal cramping, vomiting, tremors, restlessness, inability to sleep, increased HR/RR/BP/temp, transient hallucinations or illusions, anxiety, and tonic clonic seizures
Binge-eating expected finding
Abdominal pain
AIMS
Abnormal involuntary movement scale; tool used to monitor involuntary movements and tardive dyskinesia in clients who take antipsychotic medication
Negative symptoms of psychotic disorders
Absence of things that are normally present affect alogia anergia anhedonia avolition
Negative symptoms of psychotic disorders
Absence of things that are normally present, more difficult to treat; blunted or flat affect, alogia (poverty of thought or speech), anergia (lack of energy), anhedonia (lack of pleasure or joy), avocation (lack of motivation)
NEGATIVE psychotic symptoms
Absence of: -Affect -Alogia (poverty of thought/speech) -Anergia -Anhedonia -Avolition (lack of motivation)
Nicotine withdrawal manifestations
Abstinence syndrome evidenced by irritability, craving, nervousness, restlessness, anxiety, insomnia, increased appetite, difficulty concentrating, anger, and depressed mood
Opioid withdrawal manifestations
Abstinence syndrome which begins with sweating and rhinorrhea progressing to piloerection, tremors, and irritability followed by severe weakness, diarrhea, fever, insomnia, pupil dilation, nausea, vomiting, pain in the muscles and bones, and muscle spasms
Honeymoon Phase
Abuser becomes loving, promises to change, and is sorry for behavior
Tension Phase (Violence)
Abuser has minor episodes of anger and may be verbally abusive and responsible for some minor physical violence
Anorexia Reproductive status
Accompanied by amenorrhea for at least 3 consecutive cycles
Maturational/internal crisis
Achieving new developmental stages, which requires learning additional coping mechanisms
Transpersonal Communication
Addresses an individual's spiritual needs and providers interventions to meet those needs
Transpersonal communication
Addresses an individual's spiritual needs and provides interventions to meet those needs.
A nurse is teaching the parent of a 10-year-old child who has ADHD and a new prescription for dextroamphetamine. Which of the following instructions should the nurse include in the teaching
Administer the last dose of medication to your child 6 hours before bedtime R: A/E of dextro. is insomnia Not to give 30 min before eating (lose appetite) Expect -weight loss constipation
A nurse is teaching the parent of a 10-year- old who has ADHD and a new prescription for dextroamphetamine. Which of the following instructions should the nurse include in the teaching?
Administer the last dose of medication to your child 6 hrs before bedtime
Flumazenil use
Administered to counteract sedation and reverse the adverse effects of benzos Benzo antidote
Individuals with highest risk of suicide
Adolescents Native American Clients with depressive disorder
Depressive disorders are most prevalent in...
Adults between ages of 15-40
A nurse is assessing a school-age child who has conduct disorder. Which of the following characteristics should the nurse expect the child to demonstrate
Aggression toward animal
Dissociative fugue
Amnesia in which client travels to a new area and is unable to remember one's own identity and at least some of one's past. Lasts weeks to months following traumatic event. S/S: Lack of memory from name to DOB
Chlorpromazine (thorazine)
Anticholinergic side effects constipation, urinary retention, blurred vision, dry mouth. Suck on hard candy. It does not alter skin perfusion.
What medications maybe used for personality disorders
Antidepressant anxiolytic antipsychotic mood stabilizers
Medications for ASD and PTSD
Antidepressants to decrease depression and anxiety (fluoxetine, venlafaxine, mirtazapine, amitriptyline), prazosin (decreases manifestations of hypervigilance and insomnia), propranolol (decreases vital signs and manifestations of anxiety, panic, hypervigilance, and insomnia)
Medications for personality disorders
Antidepressants, anxiolytics, antipsychotics, and mood stabilizers
What medications would you give for a patient that has Delirium
Antipsychotic Antianxiety
Characterized by disregard for others with exploitation, repeated unlawful actions, deceit, and failure to accept personal responsibility
Antisocial
Phase 2 of a crisis
Anxiety continues escalating as defense responses fail, functioning becomes disorganized, and the client resorts to trial-and-error attempts to resolve anxiety
Effects of hallucinogen intoxication
Anxiety, depression, paranoia, impaired judgment, impaired social functioning, pupil dilation, tachycardia, diaphoresis, palpitations, blurred vision, tremors, incoordination, and panic attacks
Benzodiazepine withdrawal manifestations
Anxiety, insomnia, diaphoresis, hypertension, possible psychotic reactions, hand tremors, nausea, vomiting, hallucinations or illusions, psychomotor agitation, and possible seizure activity
How to assess a client's ability to calculate
Ask the client to count backward from 100 in sevens
How to assess a client's ability to think abstractly
Ask the client to interpret something complex such as, "A bird in the hand is worth two in the bush."
How to test a client's recent memory
Ask the client to recall recent events, such as visitors from the current day, or the purpose of the current mental health appointment or admission
How to test a client's immediate memory
Ask the client to repeat a series of numbers or a list of objects
How to test a client's remote memory
Ask the client to state a fact from his past that is verifiable, such as his birth date or his mother's maiden name
A nurse in a mental health unit is admitting a client who is anxious because he often hears voices telling him what to do. Which of the following actions should the nurse take?
Ask the client what the voices are saying
A client who has paranoid schizophrenia is attending a treatment planning conference with a family member. During the discussion of the medication adherence portion of the plan, the nurse notices that the family member seems distracted. Which of the following actions should the nurse take
Ask the family member if she has any thoughts or questions about the treatment plan
A client who has paranoid schizophrenia is attending a treatment planning conference with a family member. During the discussion of the medication adherence portion of the plan, the nurse notices that the family member seems distracted. Which of the following actions should the nurse take?
Ask the family member if she has any thoughts or questions about the treatment plan
A client who has paranoid schizophrenia is attending a treatment planning conference with a family member. During the discussion of the medication adherence portion of the plan, the nurse notices that the family member seems distracted. Which of the following actions should the nurse take
Ask the family member if she has any thoughts or questions about the treatment plan (involves fam to communicate)
Barriers to effective communication
Asking irrelevant personal questions Offering personal opinions Giving advice Giving false reassurance Minimizing feelings Changing the topic Asking why questions Offering value judgments Excessive questioning Responding approvingly or disapprovingly
A nurse is planning care for a client who has body dysmorphic disorder. Which of the following actions should the nurse plan to take first?
Assessing the client's risk for self-harm
Interpersonal psychotherapy (IPT)
Assists clients in addressing specific problems
Clonidine
Assists with opioid withdrawal effects related to autonomic hyperactivity (diarrhea, nausea, vomiting) but does not reduced the craving; avoid activities that require mental alertness until drowsiness subsides; encourage the client to chew sugarless gum, suck on hard candy, sip on small amounts of water, or suck on ice chips to treat dry mouth
A nurse observes a client who has OCD repeatedly applying, removing, and then reapplying makeup. The nurse identifies that repetitive behavior in a client who has OCD is due to which of the following underlying reasons?
Attempt to reduce anxiety
A nurse is caring for a client who is experiencing moderate anxiety. Which of the following actions should the nurse take when trying to give necessary information to the client? (Select all that apply.) A. Reassure the client that everything will be okay. B. Discuss prior use of coping mechanisms with the client. C. Ignore the client's anxiety so that she will not be embarrassed. D. Demonstrate a calm manner while using simple and clear directions. E. Gather information from the client using closed-ended questions.
B & D. Discussing the prior use of coping mechanisms assists the client in identifying ways of effectively coping with the current stressor. Providing a calm presence assists the client in feeling secure and promotes relaxation. Clients experiencing moderate levels of anxiety often benefit from the direction of others.
A nurse is caring for a client who is in mechanical restraints. Which of the following statements should the nurse include in the documentation? (Select all that apply) A. "Client ate most of his breakfast." B. "Client was offered 8 oz of water every hr." C. "Client shouted obscenities at assistive personnel." D. "Client received chlorpromazine 15 mg by mouth at 1000." E. "Client acted out after lunch."
B, C, & D. Documentation must include how much water was offered and how often, a description of the client's verbal communication, and the dosage and time of medication administration. Intake and behavior should be documented in the client's medical record.
A nurse is discussing acute vs prolonged stress with a client. Which of the following effects should the nurse identify as an acute stress response? (Select all that apply) A. Chronic pain B. Depressed immune system C. Increased blood pressure D. Panic attacks E. Unhappiness
B, C, & E. Depressed immune system, increased blood pressure, and unhappiness are responses to acute stress. Chronic pain and panic attacks are responses to prolonged stress.
A nurse is assessing a client who is currently taking perphenazine. Which of the following findings should the nurse identify as an extrapyramidal symptom (EPS)? (Select all that apply) A. Decreased LOC B. Drooling C. Involuntary arm movements D. Urinary retention E. Continual pacing
B, C, & E. Drooling, involuntary arm movements, and continual pacing are EPS.
A nurse is planning group therapy for clients dealing with bereavement. Which of the following activities should the nurse include in the initial phase? (Select all that apply) A. Encourage the group to work toward goals B. Define the purpose of the group C. Discuss termination of the group D. Identify informal roles of members within the group E. Establish an expectation of confidentiality within the group
B, C, & E. During the initial phase, the nurse should identify the purpose of the group, discuss termination of the group, and set the tone of confidentiality. A & D take place during the working phase.
A nurse is planning care for a client who has bipolar disorder and is experiencing a manic episode. Which of the following interventions should the nurse include in the plan of care? (Select all that apply) A. Provide flexible client behavior expectations B. Offer concise explanations C. Establish consistent limits D. Disregard client complaints E. Use a firm approach with communication
B, C, & E. Offering concise explanations improves the client's ability to focus. Setting limits decreases the risk for client manipulation. Using a firm approach promotes structure.
A charge nurse is reviewing Kugler-Ross: Five Stages of Grief with a group of newly licensed nurses. Which of the following stages should the charge nurse include in the teaching? (Select all that apply) A. Disequilibrium B. Denial C. Bargaining D. Anger E. Depression
B, C, D, & E. Denial, bargaining, anger, and depression are stages of the Kulber-Ross five stages of grief. Disequilibrium is the second stage of Bowlby's four stages of grief.
A nurse is preparing to assess an infant who has shaken baby syndrome. Which of the following is an expected finding? (Select all that apply) A. Sunken fontanels B. Respiratory distress C. Retinal hemorrhage D. Altered LOC E. Increase in head circumference
B, C, D, & E. Respiratory distress, retinal hemorrhage, altered LOS, and increased head circumference are expected findings of shaken baby syndrome. Bulging, rather than sunken, fontanels are an expected finding of shaken baby syndrome.
A nurse is assessing a client in an inpatient mental health unit. Which of the following findings should the nurse expect if the client is in the preassaultive stage of violence? (Select all that apply) A. Lethargy B. Defensive responses to questions C. Disorientation D. Facial grimacing E. Agitation
B, D, & E. Defensive responses, facial grimacing, and agitation are assessment findings that indicate a client is in the preassaultive stage. A is more likely to be observed in a client who has depression. C is more likely to be assessed in a client who has a cognitive disorder.
A nurse is providing teaching to the family of a client who has a substance use disorder. Which of the following statements by a family member indicate an understanding of the teaching? (Select all that apply) A. "We need to understand that she is responsible for her disorder." B. "Eliminating any codependent behavior will promote her recovery." C. "She should participate in an Al-Anon group to help her recover." D. "The primary goal of her treatment is abstinence from substance use." E. "She needs to discuss her feelings about substance use to help her recover."
B, D, & E. Families should be aware of codependent behavior, such as enabling, that can promote substance use rather than recovery. Abstinence is the primary treatment goal for a client who has a substance use disorder. Clients must acknowledge their feelings about substance use as part of a substance use recovery program. Clients are responsible for their recovery not their disease. Al-Anon is for family members.
A nurse is assessing a client who has alcohol use disorder and is experiencing withdrawal. Which of the following findings should the nurse expect? (Select all that apply) A. Bradycardia B. Fine tremors of both hands C. Hypotension D. Vomiting E. Restlessness
B, D, & E. Fine tremors of both hands, vomiting, and restlessness are expected findings of alcohol withdrawal. Alcohol withdrawal would cause tachycardia rather than bradycardia and hypertension rather than hypotension.
A nurse is assessing a client 4 hr after receiving an initial dose of fluoxetine. Which of the following findings should the nurse report to the provider as indications of serotonin syndrome? (Select all that apply) A. Hypothermia B. Hallucinations C. Muscular flaccidity D. Diaphoresis E. Agitation
B, D, & E. Hallucinations, diaphoresis, and agitation are indications of serotonin syndrome. Fever and muscle tremors are indications of serotonin syndrome.
A nurse is planning a peer group discussion about the DSM-5. Which of the following information is appropriate to include in the discussion? (Select all that apply) A. The DSM-5 includes client education handouts for mental health disorders. B. The DSM-5 establishes diagnostic criteria for individual mental health disorders. C. The DSM-5 indicates recommended pharmacological treatment for mental health disorders. D. The DSM-5 assists nurses in planning care for client's who have mental health disorders. E. The DSM-5 indicates expected assessment findings of mental health disorders.
B, D, & E. The DSM-5 establishes diagnostic criteria, assists nurses in planning care, and identifies expected findings for mental health disorders. The DSM-5 does not contain client education handouts or recommended pharmacological treatment.
A nurse is providing teaching to an adolescent client who is to begin taking atomoxetine for ADHD. The nurse should instruct the client to monitor for which of the following adverse effects? (Select all that apply) A. Somnolence B. Yellowing skin C. Increased appetite D. Fever E. Malaise
B, D, & E. Yellowing skin, fever, and malaise are potential indications of hepatotoxicity that should be reported. Insomnia, rather than somnolence, is an adverse effect of atomoxetine. Decreased appetite is an adverse effect of atomoxetine.
A nurse is caring for a client on an acute mental health unit The client reports hearing voices that are telling her to "kill your doctor." Which of the following actions should the nurse take first? A. Use therapeutic communication to discuss the hallucination with the client B. Initiate one-to-one observation of the client C. Focus the client on reality D. Notify the provider of the client's statement
B. A client who is experiencing a command hallucination is at risk for injury to self or others and should be placed on one-to-one observation.
A community health nurse is leading a discussion about rape with a neighborhood task force. Which of the following statements by a neighborhood citizen indicates an understanding of the teaching? A. "Rape is a crime of passion." B. "Acquaintance rape often involves alcohol." C. "Young adults are the typical victims of sexual assault." D. "The majority of rapists are unknown to the victims."
B. Alcohol and other substances are often associated with date or acquaintance rape. Rape is a crime of violence, aggression, anger, and power. Individuals of all ages are affected by sexual assault and can be male or female. The majority of perpetrators are known to the vulnerable persons.
A nurse is caring for a group of clients. Which of the following clients should a nurse consider for referral to an assertive community treatment (ACT) group? A. A client in an cute care mental health facility who has fallen several times while running down the hallway B. A client who lives at home and keeps "forgetting" to come in for his monthly antipsychotic injection for schizophrenia C. A client in a day treatment program who says he is becoming more anxious during group therapy D. A client in a weekly grief support group who says she still misses her deceased husband who has been dead for 3 months
B. An ACT group works with clients who are nonadherent with traditional therapy, such as the client in a home setting who keeps "forgetting" his injection.
A nurse is caring for a client who is prescribed lithium therapy. The client states that he wants to take ibuprofen for osteoarthritis pain relief. Which of the following statements should the nurse make? A. "That is a good choice. Ibuprofen does not interact with lithium." B. "Regular aspirin would be a better choice than ibuprofen." C. "Lithium decreases the effectiveness of ibuprofen." D. "The ibuprofen will make your lithium level fall too low."
B. Aspirin is recommended as a mild analgesic rather than ibuprofen due to the risk for lithium toxicity.
A client says she is experiencing increased stress because her significant other is "pressuring me and my kids to go live with him. I love him, but I'm not ready to do that." Which of the following recommendations should the nurse make to promote a change in the client's situation? A. Learn to practice mindfulness B. Use assertiveness techniques C. Exercise regularly D. Rely on the support of a close friend
B. Assertive communication allows the client to assert her feelings and then make a change in the situation.
A nurse in an outpatient mental health clinic is preparing to conduct an initial client interview. When conducting the interview, which of the following actions should the nurse identify as the priority? A. Coordinate holistic care with social services. B. Identify the client's perception of her mental health status. C. Include the client's family in the interview. D. Teach the client about her current mental health disorder.
B. Assessment is the priority action. Identifying the client's perception of her mental health status provides important information about the client's psychosocial history.
A nurse is teaching a client who has an anxiety disorder and is scheduled to begin classical psychoanalysis. Which of the following client statements indicates an understanding of this form of therapy? A. "Even if my anxiety improves, I will need to continue this therapy for 6 weeks." B. "The therapist will focus on my past relationships during our sessions." C. "Psychoanalysis will help me reduce my anxiety by changing my behaviors." D. "This therapy will address my conscious feelings about stressful experiences."
B. Classical psychoanalysis places a common focus on past relationships to identify the cause of the anxiety disorder.
A nurse is evaluating a client's understanding of a new prescription for clonidine for the treatment or opioid use disorder. Which of the following statements by the client indicates an understanding of the teaching? A. "Taking this medication will help reduce my craving for heroin." B. "While taking this medication, I should keep a pack of sugarless gum." C. "I can expect some diarrhea from taking this medicine." D. "Each dose of this medication should be placed under my tongue to dissolve."
B. Clonidine commonly causes clients to experience dry mouth. Chewing sugarless gum is an effective method to address this adverse effect. Clonidine does not reduce cravings, but reduces diarrhea. Buprenorphine is administered sublingually.
. A nurse is caring for a client who has early stage Alzheimer's disease and a new prescription for donepezil. The nurse should include which of the following statements when teaching the client about the medication? A. "You should avoid taking over-the-counter acetaminophen while on donepezil." B. "You can expect the progression of cognitive decline to slow with donepezil." C. "You will be screened for underlying kidney disease prior to starting donepezil." D. "You should stop taking donepezil if you experience nausea or diarrhea."
B. Donepezil slows the cognitive deterioration of Alzheimer's disease. Clients should avoid NSAIDs, not acetaminophen. Clients should be screened for heart and pulmonary disease. The client should not abruptly stop the medication.
A nurse is conducting chart reviews of multiple clients at a community mental health facility. Which of the following events is an example of client experiencing a maturational crisis? A. Rape B. Marriage C. Severe physical illness D. Job loss
B. Marriage is an example of a maturational crisis, which is a naturally occurring event during the life span. Rape is an example of an adventitious crisis. Severe physical illness and job loss are examples of situational crises.
A nurse is providing preoperative teaching for a client who was just informed that she requires emergency surgery. The client has a respiratory rate 30/min and says, "This is difficult to comprehend. I feel shaky and nervous." The nurse should identify that the client is experiencing which of the following levels of anxiety? A. Mild B. Moderate C. Severe D. Panic
B. Moderate anxiety decreases problem-solving and may hamper the client's ability to understand information. Vital signs may increase somewhat, and the client is visibly anxious.
A nurse is preparing a community education seminar about family violence. When discussing types of violence, the nurse should include which of the following? A. Refusing to pay bills for a dependent, even when funds are available, is neglect. B. Intentionally causing an older adult to fall is an example of physical violence. C. Striking an intimate partner is an example of sexual violence. D. Failure to provide a stimulating environment for normal development is emotional abuse.
B. Physical violence occurs when physical pain or harm is directed toward another individual. A is economic maltreatment. C is physical violence. D is neglect.
A nurse is assessing a 4-year-old child for indications of autism spectrum disorder. For which of the following manifestations should the nurse assess? A. Impulsive behavior B. Repetitive counting C. Destructiveness D. Somatic problems
B. Repetitive actions and strict routine are an indication of autism spectrum disorder. Impulsive behavior is an indication of ADHD. Destructiveness is an indication of conduct disorder. Somatic problems are an indication of PTSD.
A nurse decides to put a client who has a psychotic disorder in seclusion overnight because the unit is very short-staffed, and the client frequently fights with other clients. The nurse's actions are an example of which of the following torts? A. Invasion of privacy B. False imprisonment C. Assault D. Battery
B. Secluding a client for the convenience of the staff is false imprisonment.
A nurse is caring for a client who is speaking in a loud voice with clenched fists. Which of the following actions should the nurse take? A. Insist that the client stop yelling B. Request that other staff members remain close by C. Move as close to the client as possible D. Walk away from the client
B. The nurse should request that other staff members remain close by to assist if necessary. The nurse should not make demands of the client or walk away from an angry client. Clients who are angry need large personal space.
A nurse is caring for a client who has schizoaffective disorder. Which of the following statements indicates the client is experiencing depersonalization? A. "I am a superhero and am immortal." B. "I am no one, and everyone is me." C. "I feel monsters pinching me all over." D. "I know that you are stealing my thoughts."
B. This indicates the client is experiencing loss of identity or depersonalization. A is a delusion of grandeur. C is a tactile hallucination. D is thought withdrawal.
A nurse is caring for a client who has bipolar disorder. The client states, "I am very rich, and I feel I must give my money to you." Which of the following responses should the nurse make? A. "Why do you think you feel the need to give money away?" B. "I am here to provide care and cannot accept this from you." C. "I can request that your case manager discuss appropriate charity options with you." D. "You should know that giving away your money is inappropriate."
B. This statement is matter of fact and concise and is a therapeutic response. A is a why question. C does not recognize the possibility of poor judgment. D offers disapproval.
A nurse is in the working phase of a therapeutic relationship with a client who has methamphetamine use disorder. Which of the following actions indicates transference behavior? A. The client asks the nurse whether she will go out to dinner with him. B. The client accuses the nurses of telling him what to do just like his ex-girlfriend. C. The client reminds the nurse of a friend who died from a substance overdose. D. The client becomes angry and threatens to harm himself.
B. When a client views the nurse as having characteristics of another person who has been significant to his personal life, such as his ex-girlfriend, this indicates transference.
A nurse working in an emergency department is caring for a client who has benzodiazepine toxicity due to an overdose. Which of the following actions is the nurse's priority? A. Administer flumazenil B. Identify the client's level of orientation C. Infuse IV fluids D. Prepare the client for gastric lavage
B. When taking the nursing process approach to client care, the initial step is assessment.
A nurse is assessing a client who has alcohol use disorder and is experiencing withdrawal. Which of the following findings should the nurse expect? (Select all that apply.) a. bradycardia b. fine tremors of both hands c. hypotension d. vomiting e. restlessness
BDE
A nurse is performing an admission assessment on an adolescent client who has depression. Which of the following manifestations should the nurse expect? (select all that apply.) A. fear of being alone B. substance use C. weight gain D. irritability E. aggressiveness
BDE
A nurse is providing teaching to the family of a client who has a substance use disorder. Which of the following statements by a family member indicate an understanding of the teaching? (Select all that apply.) a. "We need to understand that she is responsible for her disorder." b. "Eliminating any codependent behavior will promote her recovery." c. "She should participate in an al‑anon group to help her recover." d. "The primary goal of her treatment is abstinence from substance use." e. "She needs to discuss her feelings about substance use to help her recover."
BDE
A nurse working in an emergency department is assessing a preschool‑age child who reports abdominal pain. When conducting a head‑to‑toe assessment, which of the following findings should alert the nurse to possible abuse? (Select all that apply.) a. abrasions on knees b. round burn marks on forearms c. mismatched clothing d. abdominal rebound tenderness e. areas of ecchymosis on torso
BE
Systemic Desentization
Begins with mastering of relaxation techniques. Then a client is exposed to increasing levels of anxiety-producing stimulus.
Thought broadcasting
Believe that their thoughts are being heard by others
Grandeur
Believe that they are all powerful and important, like a god
Somatic delusions
Believes that his body is changing in an unusual way, such as growing a third arm
Bipolar grandeur delusions
Believes that she is all powerful and important, like a God
Grandeur
Believes that she is all powerful and important, like a god
MAO inhibitors expected pharmacological action
Block MAO in the brain, thereby increasing the amount of norepinephrine, dopamine, and serotonin available for transmission of impulses. An increased amount of those neurotransmitters at nerve endings intensifies responses and relieves depression
Atypical antidepressants
Bupropion, inhibits dopamine uptake; used to treat depression, alternative to SSRIs for those unable to tolerate the sexual dysfunction side effects, an aid to quit smoking, and prevent of SAD; should not be used with MAOIs or SSRIs; contraindicated in patients with anorexia or bulimia
A nurse is assisting with a court-ordered evaluation of a client who has antisocial personality disorder. Which of the following findings should the nurse expect? (Select all that apply) A. Demonstrates extreme anxiety when placed in a social situation B. Has difficulty making even simple decisions C. Attempts to convince other clients to give him their belongings D. Becomes agitated if his personal area is not neat and orderly E. Blames others for his past and current problems
C & E. Exploitation/manipulation and failure to accept personal responsibility are findings of antisocial personality disorder. A occurs in avoidant personality disorder. B occurs in narcissistic personality disorder. D occurs in OCD.
A charge nurse is discussing the characteristics of a nurse-client relationship with a newly licensed nurse. Which of the following characteristics should the nurse include in the discussion? (Select all that apply) A. The needs of both participants are met. B. An emotional commitment exists between the participants. C. It is goal-directed. D. Behavioral change is encouraged. E. A termination date is established.
C, D, & E. A therapeutic nurse-client relationship is goal-directed, encourages positive behavioral change, and has an established termination date. It should focus on the client only. An emotional commitment is a characteristic of an intimate or social relationship rather than a therapeutic relationship.
A nurse is caring for a client who takes ziprasidone. The client reports difficulty swallowing the oral medication and becomes extremely agitated with injectable administration. The nurse should contact the provider to discuss a change in which of the following medications? (Select all that apply) A. Olanzapine B. Quetiapine C. Aripiprazole D. Clozapine E. Asenapine
C, D, & E. Aripiprazole and clozapine are available in orally disintegrating tablets which are appropriate for clients who have difficulty swallowing tablets. Asenapine is available in a sublingual tablet which is appropriate for clients who have difficulty swallowing tablets.
A nurse is assisting in the discharge planning for a client following alcohol detoxification. The nurse should anticipate prescriptions for which of the following medications to promote long-term abstinence from alcohol? (Select all that apply) A. Lorazepam B. Diazepam C. Disulfiram D. Naltrexone E. Acamprosate
C, D, & E. Disulfiram promotes abstinence through aversion therapy. Naltrexone promotes abstinence by suppressing the craving and pleasurable effects. Acamprosate decreases the unpleasant effects resulting from abstinence. A & B are prescribed for short-term use during withdrawal.
A nurse is assisting the parents of a school-age child who has oppositional defiant disorder in identifying strategies to promote positive behavior. Which of the following is an appropriate strategy for the nurse to recommend? (Select all that apply) A. Allow the child to choose consequences for negative behavior B. Use role-playing to act out unacceptable behavior C. Develop a reward system for acceptable behavior D. Encourage the child to participate in school sports E. Be consistent when addressing unacceptable behavior
C, D, & E. The parents should have a method to reward the child for acceptable, encourage physical activity, and set clear limits on unacceptable behavior.
A nurse is counseling a client who has factitious disorder imposed on another. Which of the following client statements should the nurse expect? A. "I had to pretend I was injured in order to get disability benefits." B. "I know that my abdominal pain is caused by a malignant tumor." C. "I needed to make my son sick so that someone else would take care of him for a while." D. "I became deaf when I heard that my husband was having an affair with my best friend."
C. A client who has factitious disorder imposed on another often consciously injures another person or causes them to be sick due to a personal need for attention or relief of responsibility. A is malingering. B is found in illness anxiety disorder. D is found in conversion disorder.
A nurse is caring several clients who are attending community-based mental health programs. Which of the following clients should the nurse plan to visit first? A. A client who recently burned her arm while using a hot iron at home. B. A client who requests that her antipsychotic medication be changed due to some new adverse effects. C. A client who says he is hearing a voice that tells him he is not worth living anymore. D. A client who tells the nurse he experienced manifestations of severe anxiety before and during a job interview.
C. A client who hears a voice telling him he is not worthy is at greatest risk for self-harm, and the nurse should visit this client first.
A nurse in an emergency mental health facility is caring for a group of clients. The nurse should identify that which of the following clients requires a temporary emergency admission? A. A client who has schizophrenia with delusions of grandeur B. A client who has manifestations of depression and attempted suicide a year ago C. A client who has borderline personality disorder and assaulted a homeless man with a metal rod D. A client who has bipolar disorder and paces quickly around the room while talking to himself
C. A client who is a current danger to self or others is a candidate for a temporary emergency admission.
A nurse working in an outpatient clinic is providing teaching to a client who has a new diagnosis of premenstrual dysphoric disorder (PMDD). Which of the following statements by the client indicates understanding of the teaching? A. "I can expect my problems with PMDD to be worst when I'm menstruating." B. "I will use light therapy 30 min a day to prevent further recurrences of PMDD." C. "I am aware that my PMDD causes me to have rapid mood swings." D. "I should increase my caloric intake with a nutritional supplement when my PMDD is active."
C. A clinical finding of PMDD is emotional lability. Clinical findings of PMDD are present during the luteal phase of the menstrual cycle just prior to menses. Light therapy is best for SAD. PMDD increases the risk for weight gain due to overeating so the client should not increase her caloric intake.
A nurse in an acute mental health facility is assisting with discharge planning for a client who has a severe mental illness and requires supervision much of the time. The client's wife works all day but is home by late afternoon. Which of the following strategies should the nurse suggest as appropriate follow-up care? A. Receiving daily care from a home health aide B. Having a weekly visit from a nurse case worker C. Attending a partial hospitalization program D. Visiting a community mental health center on a daily basis
C. A partial hospitalization program can provide treatment during the day while allowing the client to spend nights at home, as long as a responsible family member is present. Daily care provided by a home health aide and weekly visits from a case worker will not provide adequate care and supervision. Visiting a community mental health center daily will not provide consistent supervision.
A nurse is working with an established group and identifies various member roles. Which of the following should the nurse identify as an individual role? A. A member who praises input from other members B. A member who follows the direction of other members C. A member who brags about accomplishments D. A member who evaluates the group's performance toward a standard
C. An individual who brags about accomplishments is acting in an individual role that does not promote the progression of the group toward meeting goals.
A nurse is providing discharge teaching for a client who has schizophrenia and a new prescription for iloperidone. Which of the following client statements indicates understanding of the teaching? A. "I will be able to stop taking this medication as soon as I feel better." B. "If I feel drowsy during the day, I will stop taking this medication and call my provider." C. "I will be careful not to gain too much weight while taking this medication." D. "This medication is highly addictive and must be withdrawn slowly."
C. Antipsychotic meds, such as iloperidone, have a high risk for significant weight gain. Antipsychotic meds are long term treatment. Drowsiness is not a reason to discontinue the med. Antipsychotic meds are not considered addictive.
A nurse is orienting a new client to a mental health unit. When explaining the unit's community meetings, which of the following statements should the nurse make? A. "You and a group of other clients will meet to discuss your treatment plans." B. "Community meetings have a specific agenda that is established by staff." C. "You and the other clients will meet with staff to discuss common problems." D. "Community meetings are an excellent opportunity to explore your personal mental health issues."
C. Community meetings are an opportunity for clients to discuss common problems or issues affecting all members of the unit.
A nurse wants to use democratic leadership with a group whose purpose is to learn appropriate conflict resolution techniques. The nurse is correct in implementing this form of group leadership when she demonstrates which of the following actions? A. Observes group techniques without interfering with the group process B. Discusses a technique and then directs members to practice the technique C. Asks for group suggestions of techniques and then support discussion D. Suggests techniques and asks group members to reflect on their use
C. Democratic leadership supports group interaction and decision making to solve problems. A is laissez-faire leadership. B & D are autocratic leadership.
A nurse is teaching a newly licensed nurse about the use of ECT for the treatment of bipolar disorder. Which of the following statements by the newly licensed nurse indicates understanding? A. "ECT is the recommended initial treatment for bipolar disorder." B. "ECT is contraindicated for clients who have suicidal ideation." C. "ECT is effective for client's who are experiencing severe mania." D. "ECT is prescribed to prevent relapse of bipolar behavior."
C. ECT is appropriate for the treatment of severe mania associated with bipolar disorder. Pharmacological intervention is the recommended initial treatment. ECT is effective in suicidal patients. ECT is prescribed for acute episodes of bipolar disorder rather than the prevention of relapse.
A nurse is interviewing a 25-year-old client who has a new diagnosis of dysthymic disorder. Which of the following findings should the nurse expect? A. Wide fluctuations of mood B. Report of a minimum of 5 clinical findings of depression C. Presence of manifestations for at least 2 years D. Inflated sense of self-esteem
C. Manifestations of dysthymic disorder last for at least 2 years in adults. A occurs in bipolar disorder. B occurs with MDD. Dysthymic disorder causes a decreased self-esteem.
A nurse is making a home visit to a client who is in the late stage of Alzheimer's disease. The client's partner, who is the primary caregiver, wishes to discuss concerns about the client's nutrition and the stress of providing care. Which of the following actions should the nurse take? A. Verify that a current power of attorney document is on file. B. Instruct the client's partner to offer finger foods to increase oral intake. C. Provide information on resources for respite care. D. Schedules the client for placement of an enteral feeding tube.
C. Providing information on resources for respite care is an appropriate action to provide the client's partner with a break from caregiver responsibilities.
A community mental health nurse is planning care to address the issue of depression among older adult clients in the community. Which of the following interventions should the nurse plan as a method of tertiary prevention? A. Educating clients on health promotion techniques to reduce the risk of depression B. Performing screenings for depression at community health programs C. Establishing rehabilitation programs to decrease the effects of depression D. Providing support groups for clients at risk for depression
C. Rehabilitation programs are an example of tertiary prevention, which deals with prevention of further problems in clients already diagnosed with mental illness. A & D are primary prevention. B is secondary prevention.
A nurse is planning a staff education program on substance use in older adults. Which of the following is appropriate for the nurse to include in the presentation? A. Older adults require higher doses of a substance to achieve a desired effect. B. Older adults commonly use rationalization to cope with a substance use disorder. C. Older adults are at an increased risk for substance use following retirement. D. Older adults develop substance use to mask manifestations of dementia.
C. Retirement and other life change stressors increase the risk for substance use in older adults.
A nurse is caring for a client in an inpatient mental health facility who gets up from a chair and throws it across the day room. Which of the following is the priority nursing action? A. Encourage the client to express her feelings B. Maintain eye contact with the client C. Move the client away from others D. Tell the client that the behavior is not acceptable
C. The client's behavior indicates that he is at greatest risk for harming others. The priority acton for the nurse is to move the client away from others.
A nurse is review the medical record of a client who has a new prescription for bupropion for depression. Which of the following findings is the priority for the nurse to report to the provider? A. The client has a family history of SAD. B. The client currently smokes 1.5 packs of cigarettes per day. C. The client had a motor vehicle crash last year and sustained a head injury. D. The client has a BMI of 25 and has gained 10 lb over the last year.
C. The greatest risk to the client is development of seizures. Bupropion can lower the seizure threshold and should be avoided by clients who have a history of a head injury. This is the highest priority.
A client tells a nurse, "Don't tell anyone but I hid a sharp knife under my mattress in order to protect myself from my roommate, who is always yelling at me and threatening me." Which of the following actions should the nurse take? A. Keep the client's communication confidential, but talk to the client daily, using therapeutic communication to convince him to admit to hiding the knife. B. Keep the client's communication confidential, but watch the client and his roommate closely. C. Tell the client that this must be reported to the health care team because it concerns the health and safety of the client and others. D. Report the incident to the health care team, but do not inform the client of the intention to do so.
C. The information presented by the client is a serious safety issue that the nurse must report to the health care team, using the ethical principle of veracity.
A nurse is caring for a client who has alcohol use disorder. The client is no longer experiencing withdrawal manifestations. Which of the following medications should the nurse anticipate administering to assist the client with maintaining abstinence from alcohol? A. Chlordiazepoxide B. Bupropion C. Disulfiram D. Carbamazepine
C. The nurse should expect the administer disulfiram to help the client maintain abstinence from alcohol. A & D are for alcohol withdrawal. B is for nicotine withdrawal.
A nurse is caring for a client who has bulimia nervosa and has stopped purging behavior. The client tells the nurse that she is afraid she is going to gain weight. Which of the following responses should the nurse make? A. "Many clients are concerned about their weight. However the dietitian will ensure that you don't get too many calories in your diet." B. "Instead of worrying about your weight, try to focus on other problems at this time." C. "I understand you have concerns about your weight, but first, let's talk about your recent accomplishments." D. "You are not overweight, and the staff will ensure that you do not gain weight while you are in the hospital. We know that is important to you."
C. This acknowledges the client's concern and then focuses the conversation on the client's accomplishments, which can promote client self-esteem and self-image. A, B, & D minimize and generalize the client's concern.
A nurse is caring for a client who was recently raped. The client states, "I never should have been out on the street alone at night." Which of the following responses should the nurse make? A. "Your actions had nothing to do with what happened." B. "You should focus on recovery rather than blaming yourself for what happened." C. "You believe this wouldn't have happened if you hadn't been out alone?" D. "Why do you feel that you should not have been alone on the street at night?"
C. This response uses the therapeutic communication technique restating, which promotes reflection and verbalization of feelings. A offers opinion. B indicates disapproval. D is a "why" question.
A nurse is talking with a client who is at risk for suicide following the death of his spouse. Which of the following statements should the nurse make? A. "I feel very sorry for the loneliness you must be experiencing." B. "Suicide is not the appropriate way to cope with loss." C. "Losing someone close to you must be very upsetting." D. "I know how difficult it is to lose a loved one."
C. This statement is an empathetic response that attempts to understand the client's feelings. A focuses on the nurse's feelings. B implies judgment. D focuses on the nurse's experiences.
A nurse manager is discussing the care of a client who has a personality disorder with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. "I can promote my client's sense of control by establishing a schedule." B. "I should encourage clients who have a schizoid personality disorder to increase socialization." C. "I should practice limit-setting to help prevent client manipulation." D. "I should implement assertiveness training with clients who have antisocial personality disorder."
C. When caring for a client who has a personality disorder, limit-setting is appropriate to help prevent client manipulation. The nurse should ask for the client's input instead of making a schedule, avoid trying to increase socialization for a client who has schizoid, and implement assertiveness training for clients who have dependent and histrionic personality disorders.
A nurse is caring for a client who is to begin taking fluoxetine for treatment of generalized anxiety disorder. Which of the following statements indicates the client understands the use of this medication? A. "I will take the medication at bedtime." B. "I will follow a low-sodium diet while taking this medication." C. "I will need to discontinue this medication slowly." D. "I will be at risk for weight loss with long term use of this medication."
C. When discontinuing fluoxetine, the client should taper the medication slowly to reduce the risk of withdrawal syndrome. Fluoxetine should be taken in the morning to minimize sleep disturbances. The client is at risk for hyponatremia and weight gain while taking fluoxetine.
Side effects of benzodiazepines
CNS depression (sedation, lightheadedness, ataxia, decreased cognitive function), anterograde amnesia, paradoxical response (insomnia, excitation, euphoria, anxiety, rage)
Side effects of antiepileptic drugs
Carbamazepine: nystagmus, double vision, vertigo, staggering gait, headache, leukopenia, anemia, thrombocytopenia, teratogenesis, hypoosmolarity, skin disorders Lamotrigine: double or blurred vision, dizziness, headache, nausea, vomiting, serious skin rashes Valproate: nausea, vomiting, indigestion, hepatotoxicity, pancreatitis, thrombocytopenia, teratogenesis, weight gain
Oppositional defiant disorder
Characterized by a recurrent pattern of the following antisocial behaviors: negativity, disobedience, hostility, defiant behaviors (especially toward authority figures), stubbornness, argumentativeness, limit testing, unwillingness to communicate, and refusal to accept responsibility for misbehavior
Separation anxiety disorder
Characterized by excessive anxiety when a child is separated from or anticipating separation from home or parents. Can develop into a school phobia or phobia of being left alone. Depression is also common
Panic level anxiety
Characterized by markedly disturbed behavior, cannot process what is occurring in the environment and can lose touch with reality, experiences extreme fight and horror
Shock and disbelief (Engel stage of grief)
Client experiences a sense of numbness and denial over the loss
Distorted or exaggerated grief response
Client experiences the feelings and somatic manifestations associated with normal grief but to an exaggerated level
Disorganization and despair (Bowlby stage of grief)
Client feels hopelessness which impacts the client's ability to carry out tasks of daily living
Disequilibrium (Bowlby stage of grief)
Client focuses on the loss and has an intense desire to regain what was lost
Cyclothymic bipolar d/o
Client has at least 2 years of repeated hypomanic manifestations that do not meet the criteria for hypomanic episodes alternating with minor depressive episodes.
Bipolar I
Client has at least one episode of mania alternating with major depression More severe
Bipolar 1 d/o
Client has at least one episode of mania alternating without major depression
Bipolar 2 d/o
Client has at least one or more hypomanic episodes alternating with major depressive episodes
Body dysmorphic disorder
Client has preoccupation with perceived flaws or defects in physical appearance
Stage 4 Alzheimers expected finding
Client is able to identify the names of family members
Numbness or protest (Bowlby stage of grief)
Client is in denial over the reality of the loss and experiences feelings of shock
Resolution of the loss (Engel stage of grief)
Client is preoccupied with the loss, over about a 12 month time period this preoccupation gradually decreases
Recovery (Engel stage of grief)
Client moves past the preoccupation and forward with life
Binge Eating Disorder
Client recurrently eat large quantities of food over a short period of time without the use of compensatory behaviors associated with bulimia nervosa Weight gain increases risk for: -diabetes -HTN -Cancer
Spitting
Client tends to characterize people or things as all good or all bad at any particular moment For example, client might say, "You are the worse person in the world!" Later that day, she might say, "You are best, but the nurse from the last shift is terrible!" Seen in borderline personality disorder
Transference
Client views a member of the team as having characteristics of another person who has been significant to the client's personal life.
Autonomy
Client's right to make her own decisions but also accepts the consequences of those decisions.
Dialectical behavior therapy
Cognitive-behavioral therapy for clients who have a personality disorder and exhibit self-injurious behaviors; focuses on gradual behavior changes and provides acceptance and validation for these clients
Secondary care of a crisis
Collaborate with client to identify interventions while in an acute crisis that promote safety
Primary care of a crisis
Collaborate with client to identify potential problems; instruct on coping mechanisms; and assist in lifestyle changes
Tertiary care of a crisis
Collaborate with client to provide support during recovery from a severe crisis that include outpatient clinics, rehab centers, and workshops
The client is unconscious and does not respond to painful stimuli. What is the level of consciousness?
Comatose
Effects of caffeine intoxication
Commonly occurs with ingestion of greater 250 mg (one 2 oz high energy drink can contain 215-240 mg caffeine); tachycardia and arrhythmias, flushed face, muscle twitching, restlessness, diuresis, GI disturbances, anxiety, insomnia
A nurse working in a mental health clinic is providing teaching to a client who has a new prescription for diazepam for generalized anxiety disorder. Which of the following information should the nurse provide?
Confusion is a potential indication of diazepam toxicity that the client should report to the provider
Identification
Conscious and unconscious assumption of the characteristics of another individual or group
Identification
Conscious or unconscious assumption of the characteristics of another individual or group
Empathy
Convey an objective awareness and understanding of the feelings, emotions, and behaviors of others, including trying to envision what it must be lik to be in the position of the client and their family.
A nurse is assessing a client who experienced sexual assault. Which of the following findings indicate the client is experiencing an emotional reaction of rape-trauma syndrome? (Select all that apply) A. Genitourinary soreness B. Difficulties with low self-esteem C. Sleep disturbances D. Emotional outburst E. Difficulty making decisions
D & E. Emotional outbursts indicate an expressed initial reaction of rape-trauma syndrome. Difficulty making decisions indicates a controlled initial reaction of rape-trauma syndrome. A and C are somatic reactions. B is a sustained and maladaptive emotional response beyond the initial reaction.
A nurse working on an acute mental health unit forms a group to focus on self-management of medications. At each of meetings, two of the members use the opportunity to discuss their common interest in gambling on sports. This is an example of which of the following concepts? A. Triangulation B. Group process C. Subgroup D. Hidden agenda
D. A hidden agenda is when some group members have a different goal than the stated group goals.
A nurse is admitting a client who has a new diagnosis of bipolar disorder and is scheduled to begin lithium therapy. When collecting a medical history from the client's adult daughter, which of the following statements is the priority to report to the provider? A. "My mother has diabetes that is controlled by her diet." B. "My mother recently completed a course of prednisone for acute bronchitis." C. "My mother received her flu vaccine last month." D. "My mother is currently on furosemide for her congestive heart failure."
D. Diuretics, such as furosemide, are contraindicated for use with lithium due to the risk for toxicity. This is the greatest risk for the client and is therefore the highest priority to report to the provider.
A nurse in an acute mental health facility is planning care for a client who has dissociative fugue. Which of the following interventions should the nurse add to the plan of care? A. Teach the client to recognize how stress brings on a personality change in the client B. Repeatedly present the client with information about past events C. Make decisions for the client regarding routine daily activities D. Work with the client on grounding techniques
D. Grounding techniques are useful for client who have a dissociate disorder and are experiencing manifestations of derealization. A is best for dissociative identity disorder. Flooding should be avoided to decrease anxiety. The nurse should encourage the client to make his own decisions.
A nurse in a long-term care facility is caring for a client who has major neurocognitive disorder and attempts to wander out of the building. The client states, "I have to get home." Which of the following statements should the nurse make? A. "You have forgotten that this is your home." B. "You cannot go outside without a staff member." C. "Why would you want to leave? Aren't you happy with your care?" D. "I am your nurse. Let's walk together to your room."
D. It is appropriate for the nurse to introduce herself with each new interaction and to promote reality in a calm, reassuring manner. A is argumentative. B is a negative statement. C is a why question.
A nurse is planning care for a client who has a mental health disorder. Which of the following actions should the nurse include as a psychobiological intervention? A. Assist the client with systematic desensitization therapy. B. Teach the client appropriate coping mechanisms. C. Assess the client for comorbid health conditions. D. Monitor the client for adverse effects of the medications.
D. Monitoring for adverse effects of medications is an example of a psychobiological intervention. Systematic desensitization is cognitive and behavioral. Teaching coping mechanisms is a counseling or health teaching. Assessing for comorbid conditions is health promotion and maintenance.
A nurse in an acute mental health facility is caring for a client who has bipolar disorder. Which of the following is the priority nursing action? A. Set consistent limits for expected client behavior B. Administer prescribed medications as scheduled C. Provide the client with step by step instructions during hygiene activities D. Monitor the client for escalating behavior
D. Monitoring for escalating behavior addresses the client's priority need for safety and is therefore the priority nursing action.
A charge nurse is leading a peer group discussion about family and community violence. Which of the following statements by a member of the group indicates an understanding of the teaching? A. "Children older than 3 are at greater risk for abuse." B. "Substance use disorder does not increase the risk for violence." C. "Entering an intimate relationship increases the risk for violence." D. "Pregnancy increases the risk for violence toward the intimate partner."
D. Pregnancy tends to increase the likelihood of violence toward the intimate partner. Children younger than 3 are at an increased risk for abuse. Substance use disorder increases the risk for violence. Vulnerable persons are at an increased risk for violence when they try to leave the relationship.
A charge nurse is discussing TMS with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. "TMS is indicated for clients who have schizophrenia spectrum disorders." B. "I will provide postanesthesia care following TMS." C. "TMS treatments usually last 5-10 minutes." D. "I will schedule the client for daily TMS treatments for the first several weeks."
D. TMS is commonly prescribed daily for a period of 4-6 weeks. TMS is not indicated for schizophrenic patients. Postanesthesia care is not necessary after TMS. The procedures lasts 30-40 min.
A nurse is collecting an admission history for a client who has acute stress disorder (ASD). Which of the following information should the nurse expect to collect? A. The client remembers many details about the traumatic incident B. The client expresses heightened elation about what is happening C. The client states he first noticed manifestations of the disorder 6 weeks after the traumatic incident occurred. D. The client expresses a sense of unreality about the traumatic event
D. The client who has ASD often expresses dissociative manifestations regarding the event, which includes a sense of unreality. Clients with ASD are usually unable to remember details about the incident and react with negative emotions and manifestations occur immediately to a few days following the event.
A nurse on an acute care unit is planning care for a client who has anorexia nervosa with binge-eating and purging behavior. Which of the following nursing actions should the nurse include in the client's plan of care? A. Allow the client to select preferred meal times. B. Establish consequences for purging behavior. C. Provide the client with a high-fat diet at the start of treatment. D. Implement one-to-one observation during meal times.
D. The nurse should closely monitor the client during and after meals to prevent purging. The nurse should provide structured milieu including meal times, a positive approach to client care, and should limit high-fat foods.
A nurse is developing a plan of care for a client who has conversion disorder. Which of the following actions should the nurse include? A. Encourage the client to spend time alone in his room B. Monitor the client for self-harm once per day C. Allow the client unlimited time to discuss physical manifestations D. Discuss alternative coping strategies with the client
D. The nurse should discuss alternative coping strategies with the client. The nurse should encourage communication with others, continuously monitor the client for risk of self-harm, and should set a time limit for discussion of physical manifestations.
A nurse is caring for a school age child who has conduct disorder and a new prescription for methylphenidate transdermal patches. Which of the following information should the nurse provide about the medication? A. Apply the patch once daily at bedtime B. Place the patch carefully in a trash can after removal C. Apply the transdermal patch to the anterior waist area D. Remove the patch each day after 9 hr
D. The transdermal patch is applied once daily in the morning and is removed after 9 hr. The patch should be folded and flushed down the toilet to discard. The patch should be applied to a clean, dry area on the hip, the waist area should be avoided.
A nurse is conducting a class for a group of newly licensed nurses on caring for clients who at risk for suicide. Which of the following information should the nurse include in the teaching? A. A client's verbal threat of suicide is attention-seeking behavior B. Interventions are ineffective for clients who really want to commit suicide C. Using the term suicide increases the client's risk for a suicide attempt D. A no-suicide contract decreases the client's risk for a suicide attempt
D. The use of a no-suicide contract decreases the client's risk for suicide by promoting and maintaining trust between the nurse and the client. However, it should not replace other suicide prevention strategies. A, B, & C are myths.
A nurse is caring for the parents of a child who has demonstrated changes in behavior and mood. When the mother of the child asks the nurse for reassurance about her son's condition, which of the following responses should the nurse make? A. "I think your son is getting better. What have you noticed." B. "I'm sure everything will be okay. It just takes time to heal." C. "I'm not sure whats wrong. Have you asked the doctor about your concerns?" D. "I understand you're concerned. Let's discuss what concerns you specifically."
D. This reflects upon and accepts the parents' feelings and allows them to clarify what they are feeling. A interjects the nurse's opinion. B provides false reassurance. C avoids addressing the parent's concerns directly and indicates disinterest.
A nurse is caring for a client who states, "I'm so stressed at work because of my coworker. He expects me to finish his work because he's too lazy!" When discussing effective communication, which of the following statements by the client to his coworker indicates client understanding? A. "You really should complete your own work. I don't think it's right to expect me to complete your responsibilities." B. "Why do you expect me to finish your work? You must realize that I have my own responsibilities." C. "It is not fair to expect me to complete your work. If you continue, then I will report your behavior to our supervisor." D. "When I have to pick up extra work, I feel very overwhelmed. I need to focus on my own responsibilities."
D. This response demonstrates assertive communication, which allows the client to state his feelings about the behavior and then promote a change. A can prompt a defensive reaction. B implies criticism. C is aggressive and threatening.
Disulfiram
Daily oral med used for alcohol aversion therapy; concurrent use with alcohol will cause acetaldehyde syndrome (nausea, vomiting, weakness, sweating, palpitations, hypotension); avoid any products that contain alcohol (cough syrup, aftershave lotion, mouthwash, hand sanitizer, vanilla extract)
A nurse in a provider's office is collecting a health history from the parent of a school-age child who had been taking atomoxetine. Which of the following adverse effects reported by the parent is the priority for the nurse to report to the provider?
Dark urine
A nurse in a provider's office is collecting a health history from the parent of a school-age child who has been taking atomoxetine. Which of the following adverse effects reported by the parent is the priority for the nurse to report to the provider
Dark urine R: greatest risk for a child is liver damage from atomoxetine, which can progress to failure and death.
A nurse in a provider's office is collecting a health history from the parent of a school-age child who has been taking atomoxetine. Which of the following adverse effects reported by the parent is the priority for the nurse to report to the provider a)reduced appetite b)fatigue c)dark urine d)sweating
Dark urine R: greatest risk for a child is liver damage from atomoxetine, which can progress to failure and death. *** read question dont have to know what effects it has just pick the worst for priority
Altruism
Dealing with anxiety by reaching out to others
Sublimation
Dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression
Intended effects of adjunct medications for alcohol withdrawal
Decrease in seizures (carbamazepine), decrease of autonomic response (clonidine, propranolol, atenolol), and decrease in craving (propranolol, atenolol)
Restricting type anorexia expected finding
Decreased caloric intake due to excessive fear of weight gain
Confabulation
Defense mechanism that a client makes up stories when questioned about events or activities that she does not remember.
Perseveration
Defense mechanism where client avoids answering questions by repeating phrases or behavior.
Sublimation
Defense mechanism where pt deals with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expressions
Altruism
Defense mechanism where the pt deals with anxiety by reaching out to others
Splitting
Demonstrating an inability to reconcile negative and positive attributes of self or others
Splitting
Demonstrating an inability to reconcile negative and positive attributes of self or others A client tells a nurse that she is the only one who cares about her, yet the following day, the same client refuses to talk to the nurse.
Reaction of Terminal Cancer Diagnosis
Denial
MAO inhibitors therapeutic uses
Depression Bulimia nervosa First‑line treatment for atypical depression
Cocaine withdrawal manifestations
Depression, fatigue, craving, excess sleeping or insomnia, dramatic unpleasant dreams, psychomotor retardation, agitation
tricyclic antidepressants therapeutic uses
Depressive disorders Neuropathic pain Fibromyalgia Anxiety disorders Insomnia Bipolar disorder
Medication that is given during alcohol detox
Diazepam
Chronic or prolonged grief
Difficult to identify due to varying lengths or time required by clients to work through the stages/tasks of grief; can remain in the denial stage and remain unable to accept the reality of the loss; can result in the client's inability to perform activities of daily living
Cocaine intoxication expected finding
Dilated pupils
A nurse is caring for a client who is receiving hospice care for an inoperable brain tumor. When completing a spiritual assessment as part of end-of-life care, which of the following interventions should the nurse implement
Discuss spiritual issues in a conversational manner
A nurse is caring for a client who is receiving hospice care for an inoperable brain tumor. When completing a spiritual assessment as part of end-of-life care, which of the following interventions should the nurse implement?
Discuss spiritual issues in a conversational manner
A nurse is caring for a client who is receiving hospice care for an inoperable brain tumor. When completing a spiritual assessment as part of end-of-life care, which of the following interventions should the nurse implement
Discuss spiritual issues in a conversational manner *do in a normal way not formal that would be with a pastor
A nurse is talking with a client who is beginning chemotherapy. The client tells the nurse that she is mourning the loss of her hair. Which of the following actions should the nurse take first?
Discuss the importance of hair with the client
A nurse is talking with a client who is beginning chemotherapy. The client tells the nurse that she is mourning the loss of her hair. Which of the following actions should the nurse take first
Discuss the importance of hair with the client R: 1st action for a nurse is to assess the pt, the experience of anticipatory grieving begins w the importance of the expected loss
Lithium interactions
Diuretics and NSAIDs can lead to toxicity; anticholinergics can cause abdominal discomfort due to urinary retention and polyuria
Effects of cocaine intoxication
Dizziness, irritability, tremor, blurred vision, hallucinations, seizures, extreme fever, tachycardia, hypertension, chest pain, possible cardiovascular collapse and death
A nurse is planning discharge teaching with a family member of a client who has a new diagnosis of depression. Which of the following information about relapse should the nurse include
Early identification of changes, such as decreased social involvement, is important R: decreased social involvement in a manifestation of depression, and early identification of findings can lead to early intervention
ECT
Electrical current to induce brief seizure activity while the client is anesthetized. Takes 2-3 x per week to equal 6-12 tx. Requires conscious sedation. Uses: MDD, Schizo, Acute manic episodes Contraindications: Cardiovascular d/o, cerebrovascular d/o. Comp: Memory loss, confusion, cardiac problems, reaction to anesthesia, headaches, muscle soreness, nausea, depression relapse
Vagus nerve stimulation
Electrical stimulation through the vagus nerve to the brain through a device that is surgically implanted under the skin on the client's chest. Delivers pulsations Q5min x 30 sec. Can be turned off by placing magnet over site of implant. Uses: Depression Comp: Voice changes, throat/neck pain, dysphagia, dyspnea.
Disruptive mood dysregulation disorder
Exhibit recurrent temper outbursts that are severe and do not correlate with situation. Temper outbursts are manifested verbally and/or physically and can include aggression. Temper outbursts are not appropriate for the client's developmental level. Temper outbursts are present three or more times per week and are observable by others, such as parents, peers, and teachers, in at least two settings, such as home and school. Onset of this disorder is between the ages of 6 and 18.
depressive disorders - risk factors
Family history of depression Physical or sexual abuse or neglect Homelessness Disputes among parents, conflicts with peers or family, and rejection by peers or family Bullying, either as the aggressor or victim, including traditional bullying and cyberbullying behavior Engaging in high‑risk behaviors Learning disabilities Chronic illness
expected findings of depressive disorders
Feelings of sadness Loss of appetite Nonspecific complaints related to health Engaging in solitary play or work Changes in appetite, resulting in weight changes Changes in sleeping patterns Crying Loss of energy Irritability Aggression High‑risk behavior Poor school performance and/or dropping out of school Feelings of hopelessness about the future Suicidal ideation or suicide attempts
Confabulation
Filling in gaps in memory bu fabrication
Expected findings of ASD and PTSD
Flashbacks, nightmares, avoidance of things that bring back memories of the trauma, trying to avoid thinking about the event, anxiety or depressive disorders, anger/irritability, decreased interest in current activities, guilt, negative self-beliefs, cognitive distortions, detachment from others, inability to experience positive emotional experiences, dissociative manifestations, aggression, hypervigilance with heightened startle response, inability to focus, sleep disturbances, destructive behavior (suicidal thoughts)
SSRI
Fluoxetine Citalopram Escitalopram Paroxetine Sertraline Vilazodone
Tertiary interventions for suicide
Focus on providing support and assistance to survivors of a client who completed suicide
Secondary interventions for suicide
Focus on suicide prevention for an individual client who is having an acute suicidal crisis; suicide precautions are included in this level
Primary interventions for suicide
Focus on suicide prevention through the use of community education and screenings to identify individuals at risk
Secondary prevention
Focuses on early detection of mental illness *screening*
Secondary prevention
Focuses on early detection of mental illness; screening older adults in the community for depression
Tertiary prevention
Focuses on rehab and prevention of further problems in clients who have previous diagnoses
Tertiary prevention
Focuses on rehabilitation and prevention of further problems in clients who have previous diagnoses; leading a support group for clients who have completed a substance use disorder program
Psychodynamic psychotherapy
Focuses on the client's present state rather than his early life
Rapid cycling
Four or more episodes of hypomania or acute mania within 1 year
Expected findings of a panic attack
Four or more of the following: palpitations, shortness of breath, choking or smothering sensation, chest pain, nausea, feelings of depersonalization, fear of dying or insanity, chills or hot flashes
A nurse in the emergency department is caring for a client who has alcohol toxicity and is unresponsive. Which of the following interventions should the nurse take?
Gather supplies for endotracheal intubation
A nurse in the emergency department is caring for a client who has alcohol toxicity and is unresponsive. Which of the following interventions should the nurse take
Gather supplies for endotracheal intubation R: the expected finding is resp depression
A nurse in the emergency department is caring for a client who has alcohol toxicity and is unresponsive. Which of the following interventions should the nurse take
Gather supplies for endotracheal intubation R: the expected finding is resp depression -NO beta blocker client already has hypotension no need to lower it more
The body's response to an increased demand. The first stage is initial adaptive response aka fight or flight mechanism. If it is prolonged maladaptive responses can occur
General adaptation syndrome
risk factors for substance use and addictive disorders disorders
Genetics: predisposition to developing a substance use disorder due to family history Chronic stress: socioeconomic factors History of trauma: abuse, combat experience Lowered self‑esteem Lowered tolerance for pain and frustration Few meaningful personal relationships Few life successes Risk‑taking tendencies
Hallucinogen withdrawal manifestations
Hallucinogen persisting perception disorder: visual disturbances or flashback hallucinations can occur intermittently for years
Standardized screening tools for anxiety disorders
Hamilton rating scale for anxiety, fear questionnaire (phobias), panic disorder severity scale, yale-brown obsessive compulsive scale, hoarding scale self-report
intellectual developmental disorder
Has intellectual deficits with mental abilities such as reasoning, abstract thinking, academic learning, and learning from prior experiences. Clients demonstrate impaired ability to maintain personal independence and social responsibility, including activities of daily living, social participation, and the need for ongoing support at school. Deficits in the disorder range from mild to severe
Side effects of SNRIs
Headache, nausea, agitation, anxiety, dry mouth, sleep disturbances, hyponatremia, anorexia/weight loss, hypertension, sexual dysfunction
Countertransference
Health care team member displaces characteristics of people in per past onto a pt.
Global Assessment of Functioning (GAF Scale)
Helps to determine a client's ability to perform ADLs and to function independently
Effects of nicotine intoxication
Hypertension, stroke, respiratory disease, irritation to oral mucous membranes, cancer
Electrolyte Imbalance: Bulimia
Hypokalemia Hyponatremia Hypochloremia
Benzo---finding that would indicate questioning the provider
Hypotension
A nurse is admitting a client who has alcohol use disorder. Which of the following statements by the client indicates that the client is using denial as a defense mechanism?
I am able to go to work every day, so I don't have a problem
A nurse is assessing a client who has a terminal illness adjust to progressive loss of independence. Which of the following statements by the client indicates acceptance of her illness?
I am going to order a wheelchair for when I'm unable to walk
A nurse is caring for a client who is in an abusive relationship and is assisting in the development of a safety plan. Which of the following actions is the first component of a safety plan
Identify signs of escalation of violence *greatest risk because it increases awareness of when danger is gonna come and it is time to leave
A nurse in an outpatient mental health clinic is preparing to conduct an initial client interview. When conducting the interview, which of the following actions should the nurse identify as the priority?
Identify the client's perception of her mental health status.
A nurse is updating the plan of care for a client who has bulimia nervosa and is 5% above his ideal body weight. Which of the following interventions should the nurse include in the plan
Identify the client's trigger foods R: to help=t understand the thoughts and behaviors that relate to the food of the patient. and identify what makes them initiate binge
Characteristic behaviors of ADHD
Inattention is evidenced by a difficulty in paying attention, listening, and focusing. Hyperactivity is evidenced by fidgeting, an inability to sit still, running and climbing inappropriately, difficulty with playing quietly, and talking excessively. Impulsivity is evidenced by difficulty waiting for turns, constantly interrupting others, and acting without the consideration of consequences Behaviors associated with ADHD must be present prior to age 12 and must be present in more than one setting to be diagnosed as ADHD. Behaviors associated with ADHD can receive negative attention from adults and peers
A nurse in a pediatric clinic is caring for a preschool‑age child who has a new diagnosis of ADHD. When teaching the parent about this disorder, which of the following statements should the nurse include in the teaching?
Inattentive or impulsive behavior increases the risk for injury in a child who has ADHD. you see this starting in 12 year olds
Extended families
Include children living with one biological or adoptive parent and a related adult who is not their parent (grandparent, aunt, uncle, etc.)
Cohabitating families
Include children who live with one biological parent and nonrelated adult who are cohabitating
Serious mental illness
Includes disorders classified as severe and persistent mental illnesses; clients often have difficulty with ADLs; can be chronic or recurrent
Assertive community treatment
Includes nontraditional case management and treatment by an inter professional team for clients who have severe mental illness and are noncompliant with traditional treatment; helps to reduce reoccurrences of hospitalizations and provides crisis intervention, assistance with independent living, and information regarding resources for necessary support services
A nurse is caring for a client who has alcoholic cardiomyopathy. Which of the following laboratory findings should the nurse expect a) Increased creatine phosphokinase (CPK) b) increased LDL c) decreased glucose d) decreased AST
Increased creatine phosphokinase (CPK) R: it is an enzyme released when muscle tissue is damaged *really look at what they mean has nothing to do with those things
Effects of benzodiazepine intoxication
Increased drowsiness and sedation, agitation, slurred speech, uncoordinated motor activity, nystagmus, disorientation, nausea/vomiting, respiratory depression, decreased LOC
A nurse is preforming an admission assessment on a client and notices that the client appears withdrawn and fearful. To establish a trusting nurse-client relationship, which of the following actions should the nurse take first?
Inform the client that her admission is confidential
Inhalants Use
Intoxication S/S: Dizziness, nystagmus, uncoordinated movements, slurred speech, drowsiness, hyporeflexia, muscle weakness, diplopia, stupor, resp depression, possible death
Amphetamine use
Intoxication S/S: Impaired judgment, psycho motor agitation, hyper vigilance, irritability, tachycardia, HTN Withdrawal S/S: Craving, depression, fatigue, sleeping, not life threatening.
Cannabis Use
Intoxication S/S: Lung cancer, chronic bronchitis, paranoia, delusions, hallucinations, increased appetite, dry mouth, tachycardia WIthdrawal S/S: irritability, aggression, anxiety, insomnia, lack of appetite, restlessness, depressed mood, abdominal pain, tremors, diaphoresis, fever, HA.
Sedatives, Hypnotics, and Anxiolytics Use
Intoxication S/S: Sedation, agitation, slurred speech, uncoordinated motor activity, nystagmus, disorientation, N&V, resp depression, decreased LOC Antidote: Flumazenil for benzo's. WIthdrawal s/s: Anxiety, insomnia, diaphoresis, HTN, psychotic reactions, hand tremors, N&V, hallucinations, illusions, psychomotor agitation, seizures
Hallucinogens Use
Intoxication S/S: anxiety, depression, paranoia, impaired judgment, panic attacks, incoordination, tremors, blurred vision, diaphoresis, palpitations, tachycardia, pupil dilation Withdrawals: Hallucinogen persisting perception d/o, visual disturbances, flashback hallucinations
Side effects of second and third gen antipsychotics
Metabolic syndrome, orthostatic hypotension, anticholinergic effects (urinary hesitancy or retention, dry mouth), agitation, dizziness, sedation, sleep disruption, mild EPS (tremor), elevated prolactin levels, sexual dysfunction
Dysthmyic d/o
Milder form of depression that may come more often in childhood or adolescence and lasts at least 2 yrs for adults and 1 year for children. Contains at least 3 s/s of depression that can become MDD.
Dysthymic disorder
Milder form of depression that usually has an early onset and lasts at least 2 years for adults and 1 year for children; contains at least 3 clinical findings of depression
mirtazapine
Mirtazapine provides relief from depression by increasing the release of serotonin and norepinephrine. can cause weight gain very sedations
Ideas of reference
Misconstrues trivial events and attaches personal significance to them, such as believing that others are talking about them
Bipolar ideas of reference delusions
Misconstrues trivial events and attaches personal significance to them, such as believing that others, who are discussing their next meal, are talking about him
A therapist or others serve as a role models for a client, who imitates this modeling to improve behavior
Modeling
A nurse is providing preoperative teaching for a client who was just informed that she requires emergency surgery. The client, has a respiratory rate 30/min, and says, "This is difficult to comprehend. I feel shaky and nervous." The nurse should identify that the client is experiencing which of the following levels of anxiety?
Moderate anxiety decreases problem‑solving and may hamper the client's ability to understand information. Vital signs may increase somewhat, and the client is visibly anxious.
Nicotine replacement therapy
Nicotine gum, patch, nasal spray, lozenges, or inhaler; substitute for the nicotine in cigarettes or chewing tobacco; doubles the rate of tobacco cessation
Varenicline
Nicotinic receptor agonist that promotes the release of dopamine simulate the pleasurable effects of nicotine; reduces cravings for nicotine as well as the severity of withdrawal manifestations; reduces incidence of relapse; take after a meal; can cause neuropsychiatric effects (unpredictable behavior, mood changes, thoughts of suicide); banned for use in clients who are commercial truck or bus drivers, air traffic controllers, or airplane pilots
A nurse is planning care for a client who constantly threatens other on the unit. Although the client does not want to leave the unit, the nurse requests the provider to transfer the client to a unit that is equipped to manage violent behavior. Which of the following ethical principles should the nurse apply in this situation?
Nonmaleficence
Depersonalization
Nonspecific feeling that a person has lose their identity, self is different or unreal
A client in a true manic state will...
Not stop moving, and does not eat or drink, or sleep. This can become a medical emergency
Seclusion Restraints
Nurse can use without first obtaining provider's order if it's an emergency. If then, the nurse must obtain written prescription within 15-30 min. Must reassess q 24 hrs.
Characterized by perfectionism with a focus on orderliness and control to the extent that the individual may not be able to accomplish a given task
Obsessive compulsive
Acute Phase of rape
Occurs immediately following the attack. Lasts for about 2 weeks and consists of initial emotional or impact reaction Emotional outbursts: crying, laughing, hysteria, anger, and incoherence
Intermittent explosive disorder - clinical manifestations
Occurs in clients 18 years and older Includes verbal or physical aggression Characterized by aggressive overreaction to normal events followed by feelings of shame and regret Prevents the client's ability to have healthy relationships and/or employment. Can lead to the development of chronic disease, such as hypertension or diabetes mellitus
Intermittent explosive disorder
Occurs in clients 18 years and older; clients who have this disorder exhibit recurrent episodic violent and aggressive behavior with the possibility of hurting people, property, or animals
Mild anxiety
Occurs in normal experience of everyday living, increases one's ability to perceive reality, has an identifiable cause
Somatic Reaction of rape
Occurs later and lasts about 2 weeks Bruising and soreness from attack Muscle tension, headaches, sleep disturbances, GI symptoms, genitourinary symptoms, a variety of emotional reactions: embarrassment, guilt, revenge, anger, anxiety, fear.
Countertransference
Occurs when a health care team member displaces characteristics of people in her past onto a client
Disruptive mood dysregulation disorder
Onset is between ages 6-28; clients who have this disorder exhibit recurrent temper outbursts that are severe and do not correlate with the situation; temper outbursts are manifested verbally and/or physically and can include aggression, are not appropriate for the client's developmental level, are present 3 or more times per week, and are observable by others
Methadone substitution
Oral opioid agonist that replaces the opioid to which the client has a physical dependence; prevents abstinence syndrome from occurring and removes the need to obtain illegal opioids; used for withdrawal and long term maintenance; must be slowly tapered; must be administered from an approved treatment center
A nurse is admitting a female client who has anorexia nervosa. Which of the following manifestations should the nurse expect during the admission assessment
Orthostatic hypotension R: low wt, electrolyte imbalance, starvation, and dehydration can cause this
A nurse is admitting a female client who has anorexia nervosa. Which of the following manifestations should the nurse expect during the admission assessment
Orthostatic hypotension Reason: Low weight, electrolyte imbalances, starvation and dehydration
Side effects of TCAs
Orthostatic hypotension, anticholinergic effects (dry mouth, blurred vision, photophobia, urinary hesitancy or retention, constipation, tachycardia), sedation, toxicity (dysrhythmias, mental confusion, agitation, seizures, coma), decreased seizure threshold, excessive sweating, increased appetite
Side effects of desipramine, imipramine, and clomipramine
Orthostatic hypotension, anticholinergic effects (dry mouth, blurred vision, photophobia, urinary hesitancy or retention, constipation, tachycardia), weight gain related to increased appetite, sedation, toxicity (dysrhythmias, mental confusion, agitation), decreased seizure threshold, excessive sweating
Reaction Formation
Overcompensating or demonstrating the opposite behavior of what is felt
Reaction formation
Overcompensating or demonstrating the opposite behavior of what is felt
Posttraumatic stress disorder
PTSD is precipitated by experiencing, witnessing, or learning of a traumatic event. Children and adolescents who have PTSD exhibit psychological indications of anxiety, depression, phobia, or conversion reactions. If the anxiety resulting from PTSD is displayed externally, it is often manifested as irritability and aggression with family and friends, poor academic performance, somatic reports, belief that life will be short, and difficulty sleeping.
Characterized by distrust and suspiciousness toward others based on unfounded beliefs that others want to harm, exploit, or deceive the person
Paranoid
Monoamine oxidase inhibitors (MAOIs)
Phenelzine, isocarboxazide, tranylcypromine, selegiline; used to treat depression, bulimia, and atypical depression; should not be taken with SSRIs, TCAs, or OTC meds; avoid caffeine and tyramine (aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein, some dietary supplements, some beers, and red wine)
Characteristics of abusers
Possible use of threats and intimidation to control the vulnerable person, usually an extreme disciplinarian who believes in physical punishment, poor impulse control, perceives the child as bad, violent outbursts, poor coping skills, low self-esteem, feelings of worthlessness, possible of history of substance use disorder, difficulty assuming typical adult roles, likely to have experienced family violence as a child
Refeeding Syndrome
Potentially fatal complication that can occur when fluids, electrolytes, and carbs are introduced to a severely malnourished client
Alogia
Poverty of thought or speech; the client may sit with a visitor but may only mumble or respond vaguely to questions
Denial
Pretending the truth is not reality to manage the anxiety of acknowledging what is real
Denial
Pretending the truth is not reality to manage the anxiety of acknowledging what is real.
Orientation phase of a group
Primary focus is defining the purpose and goals of the group
Termination phase of a group
Primary focus is marking the end of group sessions
Working phase of a group
Primary focus is promoting problem solving skills to facilitate behavioral changes
Levels of Suicide Nursing Interventions
Primary: prevention strategies that include providing information and education to at-risk populations Secondary: management of the suicide crisis Tertiary: interventions with the family or friends of a person who committed suicide
cognitive reframing technique
Priority restructuring monitoring thoughts journal keeping
Primary prevention
Promotes health and prevents mental health problems from occurring *teaching*
Primary prevention
Promotes health and prevents mental health problems from occurring; teaching a community education program on stress reduction techniques
A nurse is planning care for a newly admitted client who has bipolar disorder. Which of the following is the priority action by the nurse?
Provide frequent high-calorie snacks
Diet for individuals with eating disorders
Provide small, frequent meals which are better tolerated and will help prevent the client from feeling overwhelmed Provide a diet high in fiber to prevent constipation Provide a diet low in sodium to prevent fluid retention Limit high-fat, gassy foods during the start of treatment Administer a multivitamin and mineral supplement
Vagus nerve stimulation (VNS)
Provides electrical stimulation through the vagus nerve to the brain through a device that is surgically implanted under the skin on the client's chest; indicated for clients with depression that is resistant to pharmacological treatment and/or ECT
Delusional d/o
Pt experiences delusional thinking x 1 month minimum
Brief psychotic d/o
Pt has psychotic manifestations x 1 day - 1 month
Schizophreniform d/o
Pt has s/s similar to schizo but is from 1-6 months and social/occupational dysfunction may not be present
Naltrexone
Pure opioid antagonist that suppresses the craving and pleasurable effects of alcohol, also used for opioid withdrawal; concurrent use with opioids increases the risk for overdose of opiates; take with meals to decrease GI distress
What food type to avoid with Disulfram
Pure vanilla extract
how often should a restraints prescription be renewed?
Q 4 hrs offer toileting every 15-30 minutes
Beneficence
Quality of doing good; can be described as charity
Manifestations of generalized anxiety disorder
Restlessness, muscle tension, avoidance of stressful activities or events, increased time and effort required to prepare for stressful activities or events, procrastination in decision making, seeks repeated reassurance
A nurse is assessing a client who is experiencing opioid withdrawal. Which of the following manifestations should the nurse expect
Rhinorrhea R: rhinorrhea and flu like manifestions such as yawning, sneezing, and abd pain
A nurse is assessing a client who is experiencing opioid withdrawal. Which of the following manifestations should the nurse expect
Rhinorrhea R: rhinorrhea and flu like manifestions such as yawning, sneezing, and abd pain -hyperthermia, tachycardia, insomnia
positive and negative symptom med treatments
Risperidone ●● Olanzapine ●● Quetiapine ●● Ziprasidone ●● Clozapine
Second and third generation (atypical) antipsychotics
Risperidone, asenapine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, ziprasidone, aripiprazole (third gen); block serotonin and, to a lesser degree, dopamine receptors; treat positive and negative symptoms of schizophrenia; avoid alcohol and other CNS depressants and hazardous activities; should not be used with TCAs
Rigid boundaries
Rules and roles are completely inflexible, these families tend to have members that isolate themselves
Confusion develops......
SLOWLY with alzheimers
Atomoxetine
SNRI used to treat ADHD in children and adults; should not be used with MAOIs, OTC meds, or alcohol; use with caution if taken with SSRIs
Eating disorder medication
SSRI (Fluoxetine)
serotonin syndrome
SSRI or MAOI induced autonomic instability hyperthermia seizures coma or death hyperreflexia fever
Medications for anxiety disorders
SSRIs, SNRIs, benzodiazepines, buspirone, beta blockers, antihistamines, anticonvulsants (mood stabilizing)
Mileu
Safe, structured environment that decreases anxiety and distracts the client from constant thinking and hallucinations
the client has impairments of personality functioning. However impairment is no as severe as with schizophrenia
Schizotypal personality disorder
Severe to Panic level Anxiety
Severe S/S: Confusion, feelings of impending doom, hyperventilation, tachycardia, withdrawal, loud/rapid speech, aimless activity, not able to take direction from others. Panic-level S/S: Not able to process environment, lose touch with reality, has fright/horror, hyperactivity/flight, immobility, dysfunction in speech, dilated pupils, severe shakiness, severe withdrawal, inability to sleep, delusions, hallucinations. Nursing: Provide safe environment, remain with pt, quite environment, meds and restraints if needed, encourage gross motor activities, sets limits, short statements, repetition, direct pt to acknowledge reality, focus what is present in environment.
Effective communication skills
Silence Active listening Questions Clarifying Techniques Offering broad opening statements Showing acceptance and recognition Focusing Giving information Presenting reality Summarizing Offering self Touch
Moderate anxiety
Slightly reduced perception and processing of information occurs and selective inattention can occur, ability to think clearly is hampered but learning and problem solving can still occur, may show increased HR and RR
Schizo negative symptoms
Social withdrawal, lack of emotion, lack of energy, flattened affect, decreased motivation
A nurse is providing care for a client who has bipolar disorder and is experiencing acute mania. The client's morning lithium level is 1.5 mEq/L. Which of the following laboratory findings should the nurse report to the provider? (Click on the "Exhibit" button below for additional client information. There are three tabs that contain separate categories of data a) ESR 18mm/hr b)hgb 15 c) serum t45 d) na 125
Sodium level 125 mEq/l R: In the presence of low Na+ levels, renal excretion of Li is reduced and the pt is at risk for Li toxicity
Reattribution Treatment
Stage 1: Feeling Understood Stage 2: Broadening the Agenda Stage 3: Making the Link Stage 4: Negotiating Further Treatment
A nurse is caring for a client who has derealization disorder. Which of the following findings should the nurse identify as an indication of derealization?
Stating that one's surroundings are far away or unreal in some way is an example of derealization.
A nurse is caring for a client following the loss of her partner due to a terminal illness. Identify the sequence of Engel's five stages of grief that the nurse should expect the client to experience. (Select the stages of grief in the order of occurrence. All steps must be used.) A. Developing awareness B. Restitution C. Shock and disbelief D. Recovery E. Resolution of the loss
Step 1: C. Shock and disbelief Step 2: A. Developing awareness Step 3: B. Restitution Step 4: E. Resolution Step 5: D. Recovery
A nurse is caring for an older adult client who has dementia and has wandered into the day room looking for her deceased partner. Which of the following actions should the nurse take
Talk with the client about activities she enjoyed with her partner R: talking about + experiences can help distract her from disorientation
A nurse is caring for a client who had moderate Alzheimer's disease. Which of the following nursing interventions assists in orienting the client to reality?
Talk with the client about scheduled daily activities
A nurse is caring for a client who has moderate Alzheimer's disease. Which of the following nursing interventions assists in orienting the client to reality
Talk with the client about scheduled daily activities R: this can orient the pt to time and reality throughout the day
Depersonalization/derealization d/o
Temporary change in awareness. Depersonalization- Feeling that a person is observing one's own personality or body from a distance. Derealization- Feeling that outside events are unreal or part of a dream or that objects appear larger/smaller than they should.
A nurse is teaching a client who had bipolar disorder and a prescription for lithium. Which of the following instructions should the nurse include in the teaching?
That this medication with food
During a client's initial interview in a mental health inpatient setting, the nurse identifies that the client is maintaining eye contact and leaning forward. Which of the following assumptions should the nurse make based on the client's nonverbal behaviors
The client is interested in what the nurse is saying
During a client's initial interview in a mental health inpatient setting, the nurse identifies that the client is maintaining eye contact and leaning forward. Which of the following assumptions should the nurse make based on the client's nonverbal behaviors?
The client is interested in what the nurse is saying
Flight of ideas/loose association
The client might say sentence after sentence but each sentence can relate to a different topic
Operant conditioning
The client receives positive rewards for positive behavior (positive reinforcement)
A nurse in the emergency department is admitting a client who reports a headache along with heart palpitations after having a glass of wine with dinner a few hours ago. The client has a history of depression and has a blood pressure of 210/105 mm Hg. Which of the following questions should the nurse ask first
"What medications are you currently taking?" R: If the pt is taking MAOI to tx depression, they are at a greater risk for hypertensive crisis, it can also be precipitated by tyramine containing food
A nurse is teaching a client who has a depressive disorder about fluoxetine. Which of the following information should the nurse include in the teaching
"You may experience difficulties with sexual functioning while taking this medication R: SSRI can cause sexual dysfunction
Depression S/S
- Anergia (lack of energy) - Anhedonia - Anxiety - Sluggishness or unable to relax - Vegetative findings; change in appetite/bowel habits/sleep disturbances/sexual activity - Somatic; fatigue, pain, GI - Sad w/ blunted affect - Poor grooming - Slow physical movements, slump posture - Restlessness, packing, finger tapping - Socially isolated - Slowed speech, decreased verbalization, delayed response
PTSD and ASD Meds
- Antidepressants (Fluoxetine, Venlafaxine, Mirtazapine, Amitriptyline) - Prazosin - Propanolol
Alzheimer's Meds
- Cholinesterase Inhibitor (Donepezil, rivastigmine, galantamine) *Do not take w/ NSAIDs due to GI bleeding, Antihistamines, tricyclic antidepressants. - Memantine (blocks entry of calcium into nerve cells slowing death of brain cells)
Depression Risk Factors
- Family hx or previous personal hx - Females ages 15-40 y.o. - Clients over 65 y.o. (hard to recognize) - Neurotransmitter deficiencies (serotonin/norepinephrine) - Stressful life events, trauma - Medical illness - Postpartum period - Poor social support network - Comorbid substance use d/o - Being unmarried
A nurse who is working on a mental health unit should recognize that which of the following are indications for the use of electroconvulsive therapy (ECT)? (Select all that apply
- Pt who is suicidal and need rapid tx R: ECT is a rapid, definitive response for suicidal pt -pt w bipolar d/o w rapid cycling R: works best for these pt -pt w mania and not responding to med therapy
Behavior therapies
- Relaxation techniques - Modeling - Systematic desensitization - Flooding (exposing pt to increased undesirable stimulus) - Response prevention - Thought stopping
Depression Meds
- SSRI's (Citalopram, Fluoxetine, Sertraline) - Tricyclic (Amitriptyline) - MAOI (Phenelzine) - Atypical (Bupropion) - SNRI (Velafaxine, Duloxetine)
Anxiety disorders Meds
- SSRI's (Sertraline, paroxetine are 1st line) - SNRI (Venlafaxine, duloxetine) - Benzodiazepines (Diazepam for short term) - Buspirone for long term - Beta Blockers, Anti histamines, Anticonvulsants
Depression Therapies
- St. Johns wort - Light therapy - ECT - TMS - VNS
What client teaching is need with a depressive patient taking MAOI's
- avoid tyramine foods -avoid all medications including OTC talk to DR first
nursing history for eating disorder should include...
- client's perception of the issue - eating habits - hx of dieting - methods of weight control - value attached to specific weight and shape - interpersonal and social functioning - difficulty with impulsivity or compulsivity - family and interpersonal relationships
What are the fight or flight responses or adaptive responses?
-Apprehension -unhappiness or sorrow -decreased appetite -increased respiratory rate, HR, CO, BP -depressed immune system
Personality d/o Risk factors
-Comorbid substance use d/o -Hx violent/nonviolent crimes -Childhood abuse/trauma -Genetic, biochemical factors
What are the common pathological personality characteristics in a personality disorders
-Inflexibility/maladaptive responses to stress -compulsiveness and lack of social restraint -inability to emotionally connect in social and professional relationship -tendency to provoke interpersonal conflict -ability to merge personal boundaries with others.
Orientation phase of a therapeutic relationship includes what?
-Introduction to client and state purpose -Set the contract: meeting time, place, frequency, duration and date of termination -discuss confidentiality -build trust by establishing expectations and boundaries -set goals with the client -explore the clients ideas, issues, and needs -explore the meaning got testing behaviors -enforce limits on testing or other inappropriate behaviors
Bipolar manic s/s
-Labile mood w/ euphoria -Agitation / irritability -Restlessness -Dislike for interference and intolerance of criticism -Increase in talking/activity -Flight of ideas -Impulsivity; demanding behavior -Distractibility, decreased attention span -Poor judgement -Denial of illness -Delusions/hallucinations -Neglect of ADLs -Decreased sleep
Working phase of a therapeutic relationship includes what?
-maintain contract -perform ongoing assessment -facilitate the clients expression of needs and issues -encourage pt to problem solve -promote self esteem -foster positive behavioral change -explore and deal with resistance and other defense mechanisms -recognize transference and countertransference -reassess goals and plan -remind client of termination date
When patient is taking SSRI for depression what client teaching needs to be done?
-may cause nausea, headache and CNS stimulation (agitation, insomnia, anxiety) -sexual dysfunciton may occur -observe for serotonn syndrome -No st. Johns wort -watch diet
What are the stages of development according to Sigmund Freud? ATI Comprehensive NCLEX-RN Review: Mental Health
1. Oral: 0 - 1 year 2. Anal: 1 - 3 years 3. Phallic: 3 - 6 years 4. Latency: 6 - 12 years 5. Genital: 12 years to young adult ATI Comprehensive NCLEX-RN Review: Mental Health
lithium toxicity
>2 tremors, ataxia, muscle weakness, N/V, hypotension.polyuria Tx- may need dialysis.
A charge nurse is discussing mirtazapine with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates understanding? a. "this medication increases the release of serotonin and norepinephrine." b. "i will need to monitor the client for hyponatremia while taking this medication." c. "this medication is contraindicated for clients who have an eating disorder." d. "sexual dysfunction is a common adverse effect of this medication."
A
A nurse is caring for four clients in an inpatient mental health facility. Which of the following clients can give informed consent?
A 35- year- old who has major depressive disorder
A nurse in an acute mental health facility is receiving change-of-shift report for four clients. Which of the following clients should the nurse assess first?
A client who is experiencing delusions of persecution
autism spectrum disorder
A complex neurodevelopmental disorder thought to be of genetic origin with a wide spectrum of behaviors affecting an individual's ability to communicate and interact with others. Cognitive and language development are typically delayed. Characteristic behaviors include inability to maintain eye contact, repetitive actions, and strict observance of routines
B. "To whom do you talk when you feel overwhelmed?" By asking this question, the nurse is assessing the client's support systems, which is an important factor in the client's ability to cope with the situation.
A nurse is interviewing a client at a temporary shelter after surviving the destruction of her home by a tornado. When assessing the client, the nurse should ask which of the following questions to determine the client's ability to cope with this situation? A. "Don't you think you'll get through this in time?" B. "To whom do you talk when you feel overwhelmed?" C. "Have you thought about rebuilding your home on the same site?" D. "Would you like me to find a therapist for you to speak with?"
C. Interview the client in a private setting. The nurse should question clients in a private place when conducting interviews regarding client health.
A nurse is obtaining a mental health history from an older adult client. Which of the following actions should the nurse plan to take? A. Raise the pitch of the voice when speaking to the client. B. Begin the interview by explaining the plan of care. C. Interview the client in a private setting. D. Ask the client to complete a detailed questionnaire.
Mood Disorders Questionnaire
A standardized tool that places mood progression on a continuum from hypomania (euphoria) to acute mania (extreme irritability and hyperactivity) to delirious mania (completely out of touch with reality)
Adjustment disorders
A stressor triggers a reaction causing changes in mood and/or dysfunction in performing usual activities, less severe than ASD and PSTD
Suicide indicator
A sudden change in mood from sad/depressed to happy and peaceful
A nurse is obtaining a health history from the parents of a 12 year old client who has conduct disorder. Which of the following findings should the nurse expect? (Select all that apply) A. Bullying of others B. Threats of suicide C. Law-breaking activities D. Narcissistic behavior E. Flat affect
A, B, & C. Bullying behavior, suicidal ideation, and law and/or rule breaking are expected findings of conduct disorder. Low self-esteem and irritability/temper outbursts are expected findings of conduct disorder.
A nurse is assessing a client who has illness anxiety disorder. Which of the following findings should the nurse expect? (Select all that apply) A. Obsessive thoughts about disease B. History of childhood abuse C. Avoidance of health care providers D. Depressive disorder E. Narcissistic personality
A, B, C, & D. Obsessive thoughts about disease, a history of child abuse, avoidance of health care providers, and a depressive disorder are expected findings in a client who has illness anxiety disorder. Low self-esteem, rather than narcissism, is an expected finding in a client who has illness anxiety disorder.
A nurse is caring for a client who takes paroxetine to treat PTSD. The client states that he grinds his teeth during the night, which causes pain in his mouth. The nurse should identify which of the following interventions as possible measures to manage the client's bruxism? (Select all that apply) A. Concurrent administration of buspirone B. Administration of a different SSRI C. Use of a mouth guard D. Changing to a different class of antianxiety medication E. Increasing the dose of paroxetine
A, C, & D. Concurrent administration of buspirone, using a mouth guard, and changing to a different class are effective measures. Other SSRIs will have the same effect. Increasing the dose will worsen the bruxism.
A nurse working on an acute mental health unit is caring for a client who has PTSD. Which of the following findings should the nurse expect? (Select all that apply) A. Difficulty concentrating on tasks B. Obsessive need to talk about the traumatic event C. Negative self-image D. Recurring nightmares E. Diminished reflexes
A, C, & D. Manifestations of PTSD include the inability to concentrate, feeling guilty and having a negative self image, and recurring nightmares. Clients avoid talking about the event and are hypervigilant.
A charge nurse is discussing manifestations of schizophrenia with a newly licensed nurse. Which of the following manifestations should the charge nurse identify as being effectively treated by first generation antipsychotics? (Select all that apply) A. Auditory hallucinations B. Withdrawal from social situations C. Delusions of grandeur D. Severe agitation E. Anhedonia
A, C, & D. Positive symptoms of schizophrenia such as auditory hallucinations, delusions of grandeur, and severe agitation are treated with first gen antipsychotics. B & E are negative symptoms and are best treated with second gen antipsychotics.
A nurse is caring for a client who has substance-induced psychotic disorder and is experiencing auditory hallucinations. The client states, "The voices won't leave me alone!" Which of the following statements should the nurse make? (Select all that apply) A. "When did you start hearing the voices?" B. "The voices are not real, or else we would both hear them." C. "It must be scary to hear voices." D. "Are the voices telling you to hurt yourself?" E. "Why are the voices talking to only you?"
A, C, & D. The nurse should ask directly about the hallucination, focus on the client's feelings, and assess for command hallucinations and the client's risk for injury to self or others.
A charge nurse is preparing a staff education session on personality disorders. Which of the following personality characteristics associated with all of the personality disorders should the charge nurse include in the teaching? (Select all that apply) A. Difficulty in getting along with other members of a group B. Belief in the ability to become invisible during times of stress C. Display of defense mechanisms when routines are changed D. Claiming to be more important than other persons E. Difficulty understanding why it is inappropriate to have a personal relationship with staff
A, C, & E. Difficulty with social and professional relationships, maladaptive response to stress, difficulty understanding personal boundaries are characteristics seen in all personality disorders. B & D do not occur in all personality disorders.
A nurse is assessing a client who has major depressive disorder. The nurse should identify which of the following client statements as an overt comment about suicide? (Select all that apply) A. "My family will be better off if I'm dead." B. "The stress in my life is too much to handle." C. "I wish my life was over." D. "I don't feel like I can ever be happy again." E. "If I kill myself then my problems will go away."
A, C, & E. Overt statements talk directly about the client's perception of suicide and their wish to no longer be alive. B & D are covert statements.
A nurse is assisting with the development of protocols to address the increasing number of suicide attempts in the community. Which of the following interventions should the nurse include as a primary intervention? (Select all that apply) A. Conducting a suicide risk screening on all new clients B. Creating a support group for family members of clients who completed suicide C. Educating high school teens about suicide prevention D. Initiating one-on-one observation for a client who has suicidal ideation E. Teaching middle-school educators about warning indicators of suicide
A, C, & E. Primary interventions include suicide prevention through the use of screenings to identify individuals at risk and community education. B is tertiary intervention. D is secondary intervention.
A nurse is discussing silent rape reaction with a newly licensed nurse. The nurse should identify which of the following characteristics as expected for this type of reaction? (Select all that apply) A. Sudden development of phobias B. Development of substance use disorder C. Increased level of anxiety during interview D. Reactivation of a prior physical disorder E. Unwillingness to discuss the sexual assault
A, C, & E. Sudden onset of phobic reactions, increased anxiety during interview, and not verbalizing the sexual assault are characteristics of a silent rape reaction. B and D are characteristics of a compound rape reaction.
A nurse is teaching a client who has a new prescription for imipramine how to minimize anticholinergic effects. Which of the following instructions should the nurse include in the teaching? (Select all that apply) A. Void just before taking the medication B. Increase the dietary intake of potassium C. Wear sunglasses when outside D. Change positions slowly when getting up E. Chew sugarless gum
A, C, & E. Voiding just before taking the med will minimize urinary hesitancy and retention. Wearing sunglasses when outside will minimize photophobia. Chewing sugarless gum will minimize dry mouth.
A nurse is completing an admission assessment for a client who has schizophrenia. Which of the following findings should the nurse document as positive symptoms? (Select all that apply) A. Auditory hallucination B. Lack of motivation C. Use of clang association D. Delusion of persecution E. Constantly waving arms F. Flat affect
A, C, D, & E. Hallucinations, speech alterations, delusions, and bizarre movements are positive symptoms. Lack of motivation and flat affect are negative symptoms.
A nurse is assessing a client who has generalized anxiety disorder. Which of the following findings should the nurse expect? (Select all that apply) A. Excessive worry for 6 months B. Impulsive decision making C. Delayed reflexes D. Restlessness E. Need for reassurance
A, D, & E. Generalized anxiety disorder is characterized by uncontrollable, excessive worry for more than 3 months, restlessness, and the need for repeated reassurance. GAD is characterized by procrastination and muscle tension rather than impulsivity and delayed reflexes.
A nurse is planning care for a client following surgical implantation of a VNS device. The nurse should plan to monitor for which of the following adverse effects? (Select all that apply) A. Voice changes B. Seizure activity C. Disorientation D. Dysphagia E. Neck pain
A, D, & E. Voice changes, dysphagia, and neck pain are potential adverse effects of VNS. Seizure activity and disorientation are associated with ECT.
A nurse is caring for a client who has acute stress disorder and is experiencing severe anxiety. Which of the following statements should the nurse make? A. "Tell me about how you are feeling right now." B. "You should focus on the positive things in your life to decrease your anxiety." C. "Why do you believe you are experiencing this anxiety?" D. "Let's discuss the medications your provider is prescribing to decrease your anxiety."
A. Asking an open-ended question is therapeutic and assists the client in identifying anxiety. Offering advice and asking "why" questions are nontherapeutic. Clients experiencing severe anxiety are unable to concentrate or learn.
A charge nurse is discussing mirtazapine with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates understanding? A. "This medication increases the release of serotonin and norepinephrine." B. "I will need to monitor the client for hyponatremia while taking this medication." C. "This medication is contraindicated for clients who have an eating disorder." D. "Sexual dysfunction is a common adverse effect of this medication."
A. Mirtazapine provides relief from depression by increasing the release of serotonin and norepinephrine. Hyponatremia is an adverse effect of venlafaxine. Bupropion is contraindicated for clients who have an eating disorder. Sexual dysfunction is an adverse effect of SSRIs.
Conduct Disorder expected finding
Aggressive behavior toward others
Buprenorphine
Agonist-antagonist opioid used for both withdrawal and maintenance; decreases feelings of craving and can be effective in maintaining compliance; can be prescribed by a primary care provider
Side effects of first gen antipsychotics
Agranulocytosis, anticholinergic effects (dry mouth, blurred vision, photophobia, urinary hesitancy or retention, constipation, tachycardia), EPS, neuroendocrine effects (gynecomastia, weight gain, menstrual irregularities), neuroleptic malignant syndrome (sudden high fever, BP changes, diaphoresis, tachycardia, muscle rigidity, drooling, decreased LOC, coma, tachypnea), orthostatic hypotension, sedation, seizures, severe dysrhythmias, sexual dysfunction, skin effects, liver impairment
medications for substance use disorders
Alcohol withdrawal: Diazepam, carbamazepine, clonidine, chlordiazepoxide, phenobarbital, naltrexone Alcohol abstinence: Disulfiram, naltrexone, acamprosate Opioid withdrawal: Methadone substitution, clonidine, buprenorphine, naltrexone, levo‑alpha‑acetylmethadol Nicotine withdrawal from tobacco use: Bupropion, nicotine replacement therapy (nicotine gum and nicotine patch), varenicline, bupropion Nicotine abstinence: Varenicline, rimonabant
The client is responsive and able to fully respond by opening their eyes and attending to a normal tone of voice and speech. What is the level of consciousness?
Alert
mental health exam
Alert - The client is responsive and able to fully respond by opening her eyes and attending to a normal tone of voice and speech. The client answers questions spontaneously and appropriately. ■■ Lethargy - The client is able to open her eyes and respond but is drowsy and falls asleep readily. ■■ Stupor - The client requires vigorous or painful stimuli (pinching a tendon or rubbing the sternum) to elicit a brief response. She may not be able to respond verbally. ■■ Coma - No response can be achieved from repeated painful stimuli.
Modeling
Allows client to see a demonstration of appropriate behaviors in a stressful situation. The goal is that the client will imitate the behaviors
Benzodiazepines
Alprazolam, diazepam, lorazepam, chlordiazepoxide, clorazepate, oxazepam, clonazepam; used to treat anxiety disorders, seizure disorders, insomnia, muscle spasm, alcohol withdrawal (prevention and treatment of acute manifestations), induction of anesthesia, and amnesic prior to surgery or procedures
Cluster B personality disorders (dramatic, emotional, or erratic traits)
Antisocial (disregard for others), borderline (instability of affect, identity, and relationships as well as splitting behaviors, manipulation, impulsiveness, and fear of abandonment), histrionic (emotional attention-seeking behavior), and narcissistic (arrogance, grandiose views of self-importance, the need for consistent admiration, and lack of empathy)
Cluster B Personality Disorders (Dramatic, Emotional, or Erratic traits)
Antisocial: characterized by disregard for others with exploitation, repeated unlawful actions, deceit, and failure to accept personal responsibility Borderline: characterized by instability of affect, identity, and relationships as well as splitting behaviors, manipulation, impulsiveness, and fear of abandonment; often tries self-injury and may be suicidal Histrionic: characterized by emotional attention-seeking behavior, in which the person needs to be the center of attention; often seductive and flirtatious Narcissistic: characterized by arrogance, grandiose views of self-importance, the need for constant admiration
Side effects of atomoxetine
Appetite/growth suppression, weight loss, nausea, vomiting, upper abdominal pain, suicidal ideation, hepatotoxicity, headache, insomnia irritability
Expected findings of acute stress (fight or flight)
Apprehension, unhappiness or sorrow, decreased appetite, increased vital signs, increased metabolism and glucose use, depressed immune system
What medications would you give for a patient that has a neurocognitive disorder
Aricept Exelon Razadyne
A nurse in a mental health facility is planning discharge for a client who has a long history of alcohol use disorder. Which of the following postdischarge activities should the nurse plan to include
Attending a relapse prevention group several times each week R: most effective relapse prevention is a 12 step program such as AA
A nurse is communicating with a client in an inpatient mental health facility. Which of the following actions by the nurse demonstrates the use of active listening
Attention to body language R: active listening involves identifying verbal and nonverbal communication
Projection
Attributing one's unacceptable thoughts and feelings onto another
Projection
Attributing one's unacceptable thoughts and feelings onto another who does not have them
Mirtazapine
Atypical antidepressant, increases the release of serotonin and norepinephrine; therapeutic effects occur sooner with less sexual dysfunction than SSRIs; well tolerated but adverse effects include sleepiness, increased appetite and weight gain, and elevated cholesterol
Trazodone
Atypical antidepressant, moderate selective blockade of serotonin receptors; sedation may be an issue so it can be indicated in a client who has insomnia caused by an SSRI; may cause priapism
A nurse is caring for a client who has a new prescription for disulfiram for treatment of alcohol use disorder. The nurse informs the client that this medication can cause nausea and vomiting if he drinks alcohol. Which of the following types of treatment is this method an example?
Aversion therapy
Characterized by social inhibition and avoidance of all situations that rear interpersonal contact, despite wanting close relationships due to extreme fear of rejection;often very anxious in social situations
Avoidant
Cluster C personality disorders (anxious or fearful traits, insecurity and inadequacy)
Avoidant (social inhibition and avoidance of all situations that require interpersonal contact), dependent (extreme dependency in a close relationship), and obsessive-compulsive (perfectionism with a focus on orderliness and control)
Cluster C
Avoidant, Dependent, Obsessive-Compulsive they want others to make decisions for them
Cluster C Personality Disorders (Anxious, fearful, traits. Insecurity and inadequacy)
Avoidant: characterized by social inhibition and avoidance of all situations that require interpersonal contact, despite wanting close relationships, due to extreme fear of rejection; often very anxious in social situations. Fear of abandonment Dependent: characterized by extreme dependency in a close relationship with an urgent search to find a replacement when one relationship ends Obsessive-Compulsive: characterized by perfectionism with a focus on orderliness and control of the extent that the individual may not be able to accomplish a given task
A nurse is assessing a 4‑year‑old child for indications of autism spectrum disorder. for which of the following manifestations should the nurse assess? A. impulsive behavior B. repetitive counting C. destructiveness D. somatic problems
B
A nurse is preparing a community education seminar about family violence. When discussing types of violence, the nurse should include which of the following? A. Refusing to pay bills for a dependent, even when funds are available, is neglect. B. Intentionally causing an older adult to fall is an example of physical violence. C. Striking an intimate partner is an example of sexual violence. D. Failure to provide a stimulating environment for normal development is emotional abuse.
B
A nurse is providing teaching to a client who has a new prescription for amitriptyline. Which of the following statements by the client indicates an understanding of the teaching? a. "while taking this medication, i'll need to stay out of the sun to avoid a skin rash." b. "i may feel drowsy for a few weeks after starting this medication." c. "i cannot eat my favorite pizza with pepperoni while taking this medication." d. "this medication will help me lose the weight that i have gained over the last year."
B
A nurse is discussing the risk factors for somatic symptom disorder with a newly licensed nurse. Which of the following risk factors should the nurse include? (Select all that apply) A. Age older than 65 years B. Anxiety disorder C. Female gender D. Coronary artery disease E. Obesity
B & C. Anxiety disorder and female gender are risk factors for somatic symptom disorder. Age 16-25 years is a risk factor for somatic symptom disorder. Coronary artery disease and obesity are risk factors for somatic symptom disorders.
A nurse is performing an admission assessment of a client who has bulimia nervosa with purging behavior. Which of the following is an expected finding? (Select all that apply) A. Amenorrhea B. Hypokalemia C. Mottling of the skin D. Slightly elevated body weight E. Presence of lanugo on the face
B & D. Hypokalemia and a normal weight or slightly elevated weight are findings of bulimia. Amenorrhea, skin mottling, and lanugo are expected findings of anorexia.
A nurse is caring for a client who is taking phenelzine. For which of the following adverse effects should the nurse monitor? (Select all that apply) A. Elevated blood glucose level B. Orthostatic hypotension C. Priapism D. Headache E. Bruxism
B & D. Orthostatic hypotension and headache are adverse effects of phenelzine. Priapism is an adverse effect of trazodone. Bruxism is an adverse effect of SSRIs.
A nurse is discussing early indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. The nurse should include which of the following manifestations in the teaching? (Select all that apply) A. Constipation B. Polyuria C. Rash D. Muscle weakness E. Tinnitus
B & D. Polyuria and muscle weakness are early signs of lithium toxicity. Diarrhea is an early indication, not constipation. Tinnitus is an indication of severe toxicity. Lithium toxicity does not cause rash.
A nurse working in an emergency department is assessing a preschool-age child who reports abdominal pain. When conducting a head-to-toe assessment, which of the following findings should alert the nurse to possible abuse? A. Abrasions on knees B. Round burn marks on forearms C. Mismatched clothing D. Abdominal rebound tenderness E. Areas of ecchymosis on torso
B & E. Round burn marks anywhere on the child's body can indicate cigarette burns and should alert the nurse to possible abuse. Areas of ecchymosis on the torso, back, or buttocks should alert the nurse to possible abuse. Minor injuries on the arms and legs and mismatched clothing are common in this age group. Abdominal rebound tenderness is a possible indication or appendicitis rather than abuse.
A nurse is caring for a client who is experiencing a crisis. Which of the following medications might the provider prescribe? (Select all that apply) A. Lithium carbonate B. Paroxetine C. Risperidone D. Haloperidol E. Lorazepam
B & E. SSRIs and benzodiazepines may be prescribed to decrease the anxiety of a client experiencing a crisis. Mood stabilizers and antipsychotics are not useful in treating the anxiety of a client experiencing a crisis.
A nurse is involved in a serious and prolonged mass casualty incident in the emergency department. Which of the following strategies should the nurse use to help prevent developing a trauma-related disorder? (Select all that apply) A. Avoid thinking about the incident when it is over B. Take breaks during the incident for food and water C. Debrief with others following the incident D. Hold emotions in check in the days following the incident E. Take advantage of offered counseling
B, C, & E. Taking breaks for food and water, debriefing after the event, and taking advantage of counseling can help prevent development of a trauma-related disorder.
A nurse is performing an admission assessment for a client who has delirium related to an acute UTI. Which of the following findings should the nurse expect? (Select all that apply) A. History of gradual memory loss B. Family report of personality changes C. Hallucinations D. Unaltered level of consciousness E. Restlessness
B, C, & E. The client who has delirium can experience rapid personality changes, perceptual disturbances, and restlessness. Delirium is rapid and LOC is altered.
A nurse is conducting a family therapy session. The adolescent son tells the nurse that he plans ways to make his sister look bad so his parents will think he's the better sibling, which he believes will give him more privileges. The nurse should identify this dysfunctional behavior as which of the following? A. Placation B. Manipulation C. Blaming D. Distraction
B. Manipulation is the dysfunctional behavior of using dishonesty to support an individual agenda.
A nurse is providing teaching to a client who has a new prescription for amitriptyline. Which of the following statements by the client indicates an understanding of the teaching? A. "While taking this medication, I'll need to stay out of the sun to avoid a skin rash." B. "I may feel drowsy for a few weeks after starting this medication." C. "I cannot eat my favorite pizza with pepperoni while taking this medication." D. "This medication will help me lose the weight that I have gained over the last year."
B. Sedation is an adverse effect of amitriptyline during the first few weeks of therapy. Skin rash is associated with SSRIs. Foods such as pepperoni should be avoided if the client is taking an MAOI. TCAs cause weight gain not weight loss.
A nurse is caring for a client who has borderline personality disorder. The client says, "The nurse on the evening shift is always nice! You are the meanest nurse ever!" The nurse should recognize the client's statement as an example of which of the following defense mechanisms? A. Regression B. Splitting C. Undoing D. Identification
B. Splitting occurs when a person is unable to see both positive and negative qualities at the same time. The client who has BPD tends to see a person as all bad one time and all good another time.
A nurse is caring for a client who states, "I plan to commit suicide." Which of the following assessments should the nurse identify as the priority? A. Client's educational and economic background B. Lethality of the method and availability of means C. Quality of the client's social support D. Client's insight into the reasons for the decision
B. The greatest risk to the client is self-harm as a result of carrying out a suicide plan. The priority assessment is to determine how lethal the method is, how available the method is, and how detailed the plan is.
A nurse hears a newly licensed nurse discussing a client's hallucinations in the hallway with another nurse. Which of the following actions should the nurse take first? A. Notify the nurse manager. B. Tell the nurse to stop discussing the behavior. C. Provide an in-service program about confidentiality. D. Complete an incident report.
B. The greatest risk to this client is invasion of privacy through the sharing of confidential information in a public place. The first action the nurse should take is to tell the newly licensed nurse to stop discussing the client's hallucinations in a public location.
A nurse is speaking with a client who has schizophrenia when he suddenly seems to stop focusing on the nurse's questions and begins looking at the ceiling and talking to himself. Which of the following actions should the nurse take? A. Stop the interview at this point, and resume later when the client is better able to concentrate. B. Ask the client, "Are you seeing something on the ceiling?" C. Tell the client, "You seem to be looking at something on the ceiling. I see something there, too." D. Continue the interview without comment on the client's behavior.
B. The nurse should ask the client directly about the hallucination to identify client needs and assess for a potential risk for injury.
A nurse is caring for a client who smokes and has lung cancer. The client reports, "I'm coughing because I have that cold that everyone has been getting." The nurse should identify that the client is using which of the following defense mechanisms? A. Reaction formation B. Denial C. Displacement D. Sublimation
B. This is an example of denial, which is pretending the truth is not reality to manage the anxiety of acknowledging what is real.
a nurse is caring for a client who gave birth to a stillborn baby. Which of the following statements should the nurse make? a. you probably want to hold your baby b. i'll stay with you just in case you want to talk c. I know how you must be feeling d. It hurts now, but things will be better
B. indicates the nurse's interest and a desire to understand the client a is an assumption c minimizes feelings d minimizes feelings
A nurse is preparing to assess an infant who has shaken baby syndrome. Which of the following is an expected finding? (Select all that apply.) a. Sunken fontanels b. Respiratory distress c. Retinal hemorrhage d. Altered level of consciousness e. Increase in head circumference
BCDE
A nurse is caring for a client who is taking phenelzine for which of the following adverse effects should the nurse monitor? (select all that apply.) a. elevated blood glucose level b. orthostatic hypotension c. priapism d. headache e. bruxism
BD
A nurse is performing an admission assessment of a client who has bulimia nervosa with purging behavior. Which of the following is an expected finding? (select all that apply.) A. Amenorrhea B. Hypokalemia C. Mottling of the skin D. Slightly elevated body weight E. Presence of lanugo on the face
BD
When should Donapezil be taken?
Bedtime to reduce the risks for injury due to bradycardia and syncope
Medications for abstinence withdrawal
Benzodiazepines (chlordiazepoxide, diazepam, lorazepam, oxazepam) and adjunct medications (carbamazepine, clonidine, propranolol, atenolol)
the client has at least one episode of mania alternating with major depression
Bipolar I
The client has one or more hypomanic episodes alternating with major depressive episodes
Bipolar II
ECT is given for
Bipolar with rapid cycling
Nicotine Withdrawal med
Bupropion (Zyban)
A nurse is caring for a client who has bulimia nervosa and has stopped purging behavior. the client tells the nurse that she is afraid she is going to gain weight. Which of the following response should the nurse make? A. "Many clients are concerned about their weight. However, the dietitian will ensure that you don't get too many calories in your diet." B. "Instead of worrying about your weight, try to focus on other problems at this time." C. "I understand you have concerns about your weight, but first, let's talk about your recent accomplishments." D. "You are not overweight, and the staff will ensure that you do not gain weight while you are in the hospital. We know that is important to you."
C
A nurse is planning a staff education program on substance use in older adults. Which of the following is appropriate for the nurse to include in the presentation? a. older adults require higher doses of a substance to achieve a desired effect. b. older adults commonly use rationalization to cope with a substance use disorder. c. older adults are at an increased risk for substance use following retirement. d. older adults develop substance use to mask manifestations of dementia
C
A nurse is planning care for a client who is experiencing benzodiazepine withdrawal. Which of the following interventions should the nurse identify as the priority? a. orient the client frequently to time, place, and person. b. offer fluids and nourishing diet as tolerated. c. implement seizure precautions. d. encourage participation in group therapy sessions.
C
A nurse is reviewing the medical record of a client who has a new prescription for bupropion for depression. Which of the following findings is the priority for the nurse to report to the provider? a. the client has a family history of seasonal pattern depression. b. the client currently smokes 1.5 packs of cigarettes per day. c. the client had a motor vehicle crash last year and sustained a head injury. d. the client has a BMi of 25 and has gained 10 lb over the last year.
C
A nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and a flat affect. The nurse should anticipate a prescription of which of the following medications? A. Chlorpromazine B. Thiothixene C. Risperidone D. Haloperidol
C. Second gen antipsychotics, such as risperidone, are effective in treating negative symptoms of schizophrenia, such as lack of grooming and flat affect. A, B, & D are first gen antipsychotics that are used mainly to control positive symptoms of schizophrenia.
A nurse is caring for a client who has derealization disorder. Which of the following findings should the nurse identify as an indication of derealization? A. The client explains that her body seems to be floating above the ground B. The client has the idea that someone is trying to kill her and steal her money C. The client states that the furniture in the room seems to be small and far away D. The client cannot recall anything that happened during the past 2 weeks
C. Stating that one's surroundings are far away or unreal in some way is an example of derealization. A is depersonalization. B is a paranoid delusion. D is amnesia.
A nurse is assisting with systematic desensitization for a client who has an extreme fear of elevators. Which of the following actions should the nurse implement with this form of therapy? A. Demonstrate riding in an elevator, and then ask the client to imitate the behavior. B. Advise the client to say "stop" out loud every time he begins to feel an anxiety response related to an elevator. C. Gradually expose the client to an elevator while practicing relaxation techniques. D. Stay with the client in an elevator until his anxiety response diminishes.
C. Systematic desensitization is the planned, progressive exposure to anxiety-provoking stimuli. During this exposure, relaxation techniques suppress the anxiety response. A is modeling. B is thought stopping. D is flooding.
A charge nurse is discussing the care of a client who has MDD with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. "Care during the continuation phase focuses on treating continued manifestations of MDD." B. "The treatment of MDD during the maintenance phase lasts for 6-12 weeks." C. "The client is at greatest risk for suicide during the first weeks of an MDD episode." D. "Medication and psychotherapy are most effective during the acute phase of MDD."
C. The client is at greatest risk for suicide during the acute phase of MDD. Care in the continuation phase focuses on relapse prevention. The maintenance phase of treatment can last for a year or more. Med therapy and psychotherapy are used during the continuation phase.
A nurse is teaching a client who has tobacco use disorder about the use of nicotine gum. Which of the following information should the nurse include in the teaching? A. Chew the gm for no more than 10 min. B. Rinse out the mouth immediately before chewing the gum. C. Avoid eating 15 min prior to chewing the gum. D. Use of the gum is limited to 90 days.
C. The client should avoid eating or drinking 15 min prior to and while chewing the gum. The gum should be chewed gradually over 30 min. Use of the gum is not recommended for longer than 6 months.
A nurse is planning care for a client who is experiencing benzodiazepine withdrawal. Which of the following interventions should the nurse identify as the priority? A. Orient the client frequently to time, place, and person. B. Offer fluids and nourishing diet as tolerated. C. Implement seizure precautions. D. Encourage participation in group therapy sessions.
C. The greatest risk to the client is injury. Implementing seizure precautions is the priority intervention.
A nurse on an acute care unit is planning care for a client who has anorexia nervosa with binge‑eating and purging behavior. Which of the following nursing actions should the nurse include in the client's plan of care? A. Allow the client to select preferred meal times. B. Establish consequences for purging behavior. C. Provide the client with a high‑fat diet at the start of treatment. D. Implement one‑to‑one observation during meal times.
D
A nurse is providing teaching for a client who is scheduled to receive ECT for the treatment of major depressive disorder. Which of the following client statements indicates understanding of the teaching? A. "It is common to treat depression with ECT before trying medications." B. "I can have my depression cured if I receive a series of ECT treatments." C. "I should receive ECT once a week for 6 weeks." D. "I will receive a muscle relaxant to protect me from injury during ECT."
D. A muscle relaxant, such as succinylcholine, is administered to reduce the risk for injury during induced seizure activity. ECT should be used when meds are ineffective. ECT does not cure depression. ECT treatment is typically 2-3 times a week for a total of 6-12 treatments.
A nurse working in a mental health clinic is providing teaching to a client who has a new prescription for diazepam for generalized anxiety disorder. Which of the following information should the nurse provide? A. Three to six weeks of treatment is required to achieve therapeutic benefit B. Combining alcohol with diazepam will produce a paradoxical response C. Diazepam has a lower risk for dependence than other antianxiety medications D. Report confusion as a potential indication of toxicity
D. Confusion is a potential indication of diazepam toxicity that the client should report. Buspirone, rather than diazepam, requires 3-6 weeks to achieve therapeutic benefit. Combining alcohol with diazepam would cause CNS and respiratory depression. Diazepam is highly addictive and should be used short term.
A nurse is caring for a client who is on suicide precautions. Which of the following interventions should the nurse include in the plan of care? A. Assign the client to a private room B. Document the client's behavior every hour C. Allow the client to keep perfume in her room D. Ensure that the client swallows medication
D. Ensure that the client swallows medication to prevent hoarding of medication for an attempted overdose. Clients who are suicidal should not be assigned to a private room. Their behavior should be documented every 15 min. Perfume should be removed from the client's room.
A nurse is discussing free association as a therapeutic tool with a client who has major depressive disorder. Which of the following client statements indicates understanding of this technique? A. "I will write down my dreams as soon as I wake up." B. "I may begin to associate my therapist with important people in my life." C. "I can learn to express myself in a nonaggressive manner." D. "I should say the first thing that comes to my mind."
D. Free association is the spontaneous, uncensored vernalization of whatever comes to a client's mind. A is dream analysis. B is transference. C is assertiveness training.
A nurse in a pediatric clinic is caring for a preschool-age child who has a new diagnosis of ADHD. When teaching the parent about this disorder, which of the following statements should the nurse include in the teaching? A. "Behaviors associated with ADHD are present prior to age 3." B. "This disorder is characterized by argumentativeness." C. "Below-average intellectual functioning is associated with ADHD." D. "Because of this disorder, your child is at increased risk for injury."
D. Inattentive or impulse behavior increases the risk for injury in a child who has ADHD. Behaviors associated with ADHD are present before the age of 12. Argumentativeness is associated with oppositional defiant disorder. Below-average intellectual functioning is associated with intellectual development disorder.
Alcohol Withdrawal Medication
Disulfram
A nurse is caring for a client who is experiencing a panic attack. Which of the following actions should the nurse take?
During a panic attack, the nurse should quietly remain with the client. This promotes safety and reassurance without additional stimuli.
C. Assess the client for evidence of a perceptual disturbance. The nurse should assess the situation to determine if the client is hallucinating or misperceiving external stimuli (experiencing illusions).
During the morning rouns, a nurse finds a client who has schizophrenia trembling and tearful in her bed. The client reports that a bomb was placed in her room by a family member during visiting hours. Which of the following actions should the nurse take? A. Ask the client to identify the bomb in the room. B. Initiate disaster protocols per facility policies and procedures. C. Assess the client for evidence of a perceptual disturbance. D. Convince the client that there is no bomb in her room.
Side effects of SSRIs
Early adverse effects: nausea, diaphoresis, tremor, fatigue, drowsiness Later adverse effects: sexual dysfunction, weight gain, headache GI bleeding, weight changes, hyponatremia, serotonin syndrome (agitation confusion, disorientation, difficulty concentrating, anxiety, hallucinations, hyperreflexia, fever, diaphoresis, incoordination, tremors), bruxism (teeth grinding), withdrawal syndrome (nausea, sensory disturbances, anxiety, tremor, malaise, unease)
Phase 1 of a crisis
Escalating anxiety from a threat activates increased defense responses
what is a hallmark sign of delirium?
Extreme distractibility
Delirium expected findings
Family report of personality changes Hallucinations Restlessness
Persecution
Feels singled out for harm by others (being hunted down by the FBI)
Bipolar persecution delusions
Feels singled out for harm by others; being hunted down by the FBI
Anorexia Skin, Hair & Nails
Fine, downy hair (lanugo) on the face and back; yellowish skin, mottled, cool extremities and poor skin turgor
Decorticate rigidity
Flexion and internal rotation of upper extremity joints and legs
Bipolar d/o risk factors
Genetics, stressful events, major life changes, neurobiological and neuroendocrine d/o, substance use
A nurse is preparing to participate in an interdisciplinary conference for a client who has bipolar disorder. Which of the following behaviors is the priority for the nurse to report to the treatment team
Giving away possession R: giving away possessions indicates that the pt is a greater risk for suicide.
A nurse is preparing to participate in an interdisciplinary conference for a client who has bipolar disorder. Which of the following behaviors is the priority for the nurse to report to the treatment team
Giving away possession R: giving away possessions indicates that the pt is a greater risk for suicide. *pick which is most dangerous!
A nurse is preparing to participate in an interdisciplinary conference for a client who has bipolar disorder. Which of the following behaviors is the priority for the nurse to report to the treatment team?
Giving away possessions
Neurocognitive disorder
Gradual deterioration over months or years; impairments in memory, judgment, speech (aphasia), ability to recognize familiar objects (agnosia), executive functioning, and movement (apraxia), do not change throughout the day; LOC unchanged, personality change is gradual, vital signs are stable; irreversible
Alpha2-adrenergic agonists
Guanfacine, clonidine; used to treat ADHD; extended release clonidine is contraindicated for children younger than 6 years old; should not be used with CNS depressants, alcohol, antihypertensives, or foods with high-fat content
POSITIVE psychotic symptoms
Hallucinations Delusions Alterations in speech Bizarre behavior
Positive Symptoms of Schizo (obvious)
Hallucinations Delusions Use of clang association Constantly waving arms (bizarre movements)
PTSD expected findings
Hallucinations Recurring nightmares
meds for positive psychotic symptoms
Haloperidol ●● Loxapine ●● Chlorpromazine ●● Fluphenazine
characterized by emotional attention-seeking behavior in which the person needs to be the center of attention often seductive and flirtations
Histrionic
A nurse is assessing a client who recently used cocaine. Which of the following findings should the nurse expect
Hypertension R: it is a stimulant that increase BP, HR, body temp, energy levels, and metabolism
A nurse is assessing a client who recently used cocaine. Which of the following findings should the nurse expect
Hypertension R: it is a stimulant that increase BP, HR, body temp, energy levels, and metabolism, decreases appetite
A nurse is providing teaching to the partner of a client who is in rehabilitation program for alcohol use disorder. The nurse should identify that which of the following statements by the client's partner indicated an understanding of the teaching?
I will not take charge of my partner's work responsibilities
A nurse is teaching coping strategies to a client who is experiencing depression related to intimate partner abuse. Which of the following statements by the client indicates an understanding of the teaching?
I will talk about my feelings with a close friend
Medication management during ECT
IM injection of atropine sulfate 30 min prior to decrease secretions that could cause aspiration, short acting anesthetic at the time of the procedure, muscle relaxant (succinylcholine) after the anesthetic to decrease the risk for injury
A nurse is caring for a client who is in an abusive relationship an is assisting the development of a safety plan. Which of the following actions is the first component of a safety plan?
Identify signs of escalation of violence
A nurse is caring for a client who is in an abusive relationship and is assisting in the development of a safety plan. Which of the following actions is the first component of a safety plan
Identify signs of escalation of violence
A nurse is updating the plan of care for a client who has bulimia nervosa and is 5% above his ideal body weight. Which of the following interventions should the nurse include in the plan?
Identify the client's trigger foods
A nurse is updating the plan of care for a client who has bulimia nervosa and is 5% above his ideal body weight. Which of the following interventions should the nurse include in the plan
Identify the client's trigger foods R: to help pt understand the thoughts and behaviors that relate to the food
ADHD teaching
Ignore child's attention seeking behaviors that are not dangerous
A nurse is planning care for a client who has anorexia nervosa with binge-eating and purging behaviors. What should be included in the plan of care?
Implement one-on-one observation during meal time
Bipolar I Bipolar II Cyclothymic disorder
In BI the client has at least one episode of mania alternating with major depression. In BII the client has one or more hypomanic episodes alternating with major depressive disorders. In cyclothymic disorder the client has at least 2 years of repeated hypomanic manifestations that do not meet the criteria for hypomanic episodes alternating with minor depressive episodes.
Dissociative amnesia
Inability to recall personal information regarding stressful events for a period of time
Dissociative amnesia
Inability to recall personal information regarding stressful events for a period of time.
A nurse is teaching the partner of a client who has bipolar disorders how to identify manifestations of acute mania. Which of the following findings should the client's partner report to the provider?
Inability to sleep
A nurse is teaching the partner of a client who has bipolar disorder how to identify manifestations of acute mania. Which of the following findings should the client's partner report to the provider
Inability to sleep R: pt is extremely active and doesn't sleep, which can lead to relapse.
Nuclear families
Include children who reside with married parents
Characteristics of personality disorders
Inflexibility/maladaptive responses to stress, compulsiveness and lack of of social restraint, inability to emotionally connect in social and professional relationships, tendency to provoke interpersonal conflict, ability to merge personal boundaries with others
A nurse is performing an admission assessment on a client and notices that the client appears withdrawn and fearful. To establish a trusting nurse-client relationship, which of the following actions should the nurse take first
Inform the client that her admission is confidential
A nurse is performing an admission assessment on a client and notices that the client appears withdrawn and fearful. To establish a trusting nurse-client relationship, which of the following actions should the nurse take first a) inform that admission is confidential b)introduce to other clients c)assist in behavioral change d) determine coping strategies that client has used in the past
Inform the client that her admission is confidential (best to establish relationship) all other choices are part of working phase
Alcohol withdrawal expected findings
Insomnia and restlessness
Side effects of CNS stimulants
Insomnia, restlessness, weight loss related to reduced appetite, growth suppression, cardiovascular effects, development of psychotic manifestations, withdrawal reaction, hypersensitivity skin reaction to transdermal methylphenidate (hives, papules)
A nurse is teaching the parents of a client about their daughter's diagnosis of bulimia nervosa. Which of the following statements made by the parents indicates an understanding of their daughter's illness?
It is important for our daughter to have regular dental checkups
Covert Statements in suicide
Its ok now, soon everything will be fine I won't be a problem much longer things will never work out How do I give my body to science?
Displacement
Kicking the dog when frustrated
Factitious d/o
Known as Munchausen syndrome. Pt causes injury or illness to a vulnerable person.
A school nurse is assessing a school- age child who is experienced the traumatic loss of a parent 8 months ago. Which of the following findings should the nurse identify as an indications that the child is experiencing post traumatic stress disorder?
Lack of interest in an upcoming holiday
A school nurse is assessing a school-age child who experienced the traumatic loss of a parent 8 months ago. Which of the following findings should the nurse identify as an indication that the child is experiencing post traumatic stress disorder (PTSD)
Lack of interest in an upcoming holiday R: pt w PTSD will have - moods, child can also have loss or lack of interest and participation in significant activities.
Avolition
Lack of motivation in activities and hygiene
A nurse is educating the parent of a child who has a new diagnosis of autism spectrum disorder. Which of the following manifestations of this disorder should the nurse include in the teaching?
Language delay
Bipolar Meds
Lithium=mood stabilizer Anticonvulsants such as Valproic Acid (Depakote), Clonazapam, Lamitcal, Gabapentin, and Topiramate Benzos such as Lorazepam used on a short term basis SSRIs such as Prozac
Benzos
Lorazepam (ativan) Clonazepam (Klonopin)
Maturational loss
Loss, usually of an aspect of self, resulting from the normal changes of growth and development.
Maturational loss
Losses normally expected due to the developmental processing of life
Eating Disorder Vitals
Low BP with possible orthostatic hypotension Decreased pulse and body temperature Hypertension may be present in clients who have binge eating disorder
Fidelity
Loyalty and faithfulness to the client and to one's duty
Effects of cannabis intoxication
Lung cancer, chronic bronchitis, occurrence of paranoia, increased appetite, dry mouth, tachycardia
What meds should be discontinued before ECT
MAOI Seizure med Lithium usually 2 weeks ahead of time
Neologisms
Made up words that have meaning only to the client
Neologisms
Made up words that have meaning only to the patient
Acute Main---Priority Goal
Maintain adequate hydration
Intended effects of benzodiazepines for alcohol withdrawal
Maintenance of vitals, decrease in the risk of seizures, decrease in the intensity of withdrawal manifestations, and substitution therapy during alcohol withdrawal
SSRI therapeutic uses
Major depression Obsessive compulsive disorder Bulimia nervosa Premenstrual dysphoric disorders Panic disorders Posttraumatic stress disorder (PTSD) Bipolar disorder
Family violence other name
Maltreatment
Positive symptoms of psychotic disorders
Manifestation of things that are not normally present. Hallucinations ●● Delusions ●● Alterations in speech ●● Bizarre behavior, such as walking backward constantly
Positive symptoms of psychotic disorders
Manifestation of things that are not normally present such as hallucinations, delusions, alterations in speech, and bizarre behavior
Clang association
Meaningless rhyming of words
Medication approved for moderate stages of alzheimers
Memantine (Namenda)
maintenance role
Members who take on these roles tend to help maintain the purpose and process of the group. For example, the harmonizer attempts to prevent conflict in the group.
ECT expected findings
Memory loss Nausea Tachycardia
CNS stimulants
Methylphenidate, amphetamine mixture, dextroamphetamine; used to treat ADHD in children and adults; should not be used with MAOIs, caffeine, alcohol, or OTC cold and decongestant meds; oral med should be taken 30-45 min before meals with the last dose given by 4 pm
Mild to Moderate Anxiety
Mild S/S: Restlessness, irritability, impatience, apprehension, finger/foot tapping, fidgeting, lip chewing Moderate S/S: Difficulty concentrating, tiredness, pacing, change in voice path, voice tremors, shakiness, increased HR/RR, HA, backache, urinary urgency/frequency, insomnia Nursing: Active listening, willingness to help, open ended questions, broad openings, exploring and clarification. Provide calm presence, evaluate prior coping mechanisms, encourage participation in activities.
Dysthymic Disorder
Mild form of depression that usually has an early onset, such as in childhood and lasts at least 2 years in length
Decerebrate rigidity
Neck and elbow extension, wrist and finger flexion
Nicotine replacement therapy client education
Chew nicotine slowly and intermittently over 30 min; avoid eating or drinking 15 min prior to and while chewing nicotine gum or lozenges; do not use nicotine gum longer than 6 months; avoid using any nicotine products while wearing the patch; remove patch prior to MRI; allow lozenges to slowly dissolve in the mouth (20-30 min)
First generation (conventional) antipsychotics
Chlorpromazine (low potency), haloperidol (high potency), fluphenazine (high potency), loxapine (medium potency), thioridazine (low potency), thiothixene (high potency), perphenazine (medium potency), trifluoperazine (high potency); block dopamine, acetylcholine, histamine, and norepinephrine receptors; avoid alcohol and other CNS depressants and hazardous activities
Expected findings of prolonged stress (maladaptive response)
Chronic anxiety or panic attacks, depression, chronic pain, sleep disturbances, weight gain or loss, increased risk for myocardial infarction and stroke, poor diabetes control, hypertension, fatigue, irritability, decreased ability to concentrate, increased risk for infection
countertransference
Circumstances in which a psychoanalyst develops personal feelings about a client because of perceived similarity of the client to significant people in the therapist's life. unconsciously attributes positive or negative feelings about another person or client
A nurse is admitting a client who has schizophrenia to an acute care setting. When the nurse questions the client regarding his admission, the client states, "I'm red, in the head, and I'm going to bed!" The nurse should document the client's speech pattern as which of the following?
Clang association
A nurse is admitting a client who has schizophrenia to an acute care setting. When the nurse questions the client regarding his admission, the client states, "I'm red, in the head, and I'm going to bed!" The nurse should document the client's speech pattern as which of the following
Clang association R: clang often rhymes or contains a string of words tha can have the same beginning sounds
Developing awareness (Engel stage of grief)
Client becomes aware of the reality of the loss resulting in intense feelings of grief, this begins within hours of the loss
Restitution (Engel stage of grief)
Client carries out cultural/religious rituals, such as funeral, following the loss
Conversion d/o
Neurological d/o where a pt exhibits neurologic symptoms in the absence of a neurologic diagnosis. Pt's transmit emotional/psychological stressors into physical symptoms. Risk factors: Female, adolescent/young adult, recent stressful event, comorbid, first degree relative, childhood abuse S/S: Paralysis, movement/gait d/o, seizure like movements, blindness, inability to speak/smell, numbness, deafness, false pregnancy
Transcranial magnetic stimulation
Noninvasive therapy that uses magnetic pulsations to stimulate the cerebral cortex of the brain. Prescribed x 4-6 wks. Uses: MDD Comp: Mild discomfort, tingling sensation at site, seizures, headaches, lightheadedness
A nurse is planning care for a client who constantly threatens others on the unit. Although the client does not want to leave the unit, the nurse requests the provider to transfer the client to a unit that is equipped to manage violent behavior. Which of the following ethical principles should the nurse apply in this situation
Nonmaleficence R: it is the responsibility of the nurse to not harm the pt.
A nurse is planning care for a client who constantly threatens others on the unit. Although the client does not want to leave the unit, the nurse requests the provider to transfer the client to a unit that is equipped to manage violent behavior. Which of the following ethical principles should the nurse apply in this situation
Nonmaleficence R: it is the responsibility of the nurse to not harm to clients . preventing injury to others
Nardil A/E
Orthostatic Hypotension Headache
St. John's Wort adverse effects
Photosensitivity Skin rash Rapid heart rate GI distress Abdominal pain
Dissociative identity disorder
Client displays more than one distinct personality with a stressful event precipitating the change from one personality to another
Bipolar II
Client has one or more hypomanic episodes alternating with MDD
Reorganization (Bowlby stage of grief)
Client reaches acceptance of the loss
Dissociative identity disorder
Pt displays more than one distinct personality with a stressful event precipitating the change from one personality to another. S/S: 2 or more personalities
A nurse is assessing a 4‑year‑old child for indications of autism spectrum disorder. For which of the following manifestations should the nurse assess?
Repetitive counting and strict routines
Rape-Trauma Syndrome finding
Report of intense guilt
Heroin Intoxication Expected Finding
Respiratory Depression
Steps to handle aggressive behavior
Respond quickly, remain calm and in control, encourage the client to express feelings verbally, allow the client as much personal space as possible, maintain eye contact, sit or stand at the same level of the client, avoid accusatory or threatening statements, describe options clearly and offer choices, reassure the client that staff members are present to help prevent loss of control, set limits for the client
countertransference
Tendency of the nurse to displace feelings related to people in his or her past onto a patient
Confabulation
The client can make up stories when questioned about events or activities that she does not remember; this can seem like lying, but it is actually an unconscious attempt to save self-esteem and prevent admitting that she does not remember the occasion
Delusional disorder
The client experiences delusional thinking for at least 1 month but self or interpersonal functioning are not markedly impaired
Phase 4 of a crisis
The client experiences overwhelming anxiety that can lead to anguish and apprehension, feelings of powerlessness and being overwhelmed, dissociative symptoms (depersonalization, detachment from reality), depression, confusion, and/or violence against others or self
Schizotypal personality disorder:
The client has impairments of personality (self and interpersonal) functioning. However, impairment is not as severe as with schizophrenia.
Autonomy
The client's right to make their own decisions
What are healthy defense mechanisms?
alturism and sublimation
marijuana signs
bloodshot eyes
Characterized by instability of affect, identity, and relationships, as well as splitting behaviors, manipulations, impulsiveness, and fear of abandonment; often tries self injury
borderline
behaviors of transference
client expects exclusive services (i.e. more sessions) client demonstrates jealous of the nurse's time / attention client compares nurse to previous authority figure
paradoxical response
insomnia, excitation, urgency
echolalia
repeats the words of another person
what are intermediate defenses
repression reaction formation displacement rationalization undoing
GAD manifestations
restlessness muscle tension avoidance of stressful activities or events increased time and effort required to prepare for stressful activites procrastination in decision making seeks repeated reassurance
a member of the family with little power is blamed for problems within the family
scapegoating
quetiapine
schizo med, monitor glucose
the clients disorder meets both the criteria for schizophrenia and depressive or bipolar disorder
schizoeffective disorder
The client has psychotic thinking or behavior present for atlas 6 months. Areas of functions including school or work, self care, and interpersonal realties are significantly impaired
schizophrenia
The client has manifestation similar to those of schizophrenia, the but duration is from 1 to 6 months and social occupation dysfunction may or may not be present
schizophrenifrom disorder
What is dialectical behavior therapy used on what type of patient
self injurious
At what age is Erikson's Identity vs. Role Confusion ATI Comprehensive NCLEX-RN Review: Mental Health
• 12 - 20 years ATI Comprehensive NCLEX-RN Review: Mental Health
At what age does the Genital stage of Sigmund Freud's theory occur? ATI Comprehensive NCLEX-RN Review: Mental Health
• 12 years to young adult ATI Comprehensive NCLEX-RN Review: Mental Health
At what age is Erikson's Intimacy vs. Isolation ATI Comprehensive NCLEX-RN Review: Mental Health
• 20 - 35 years ATI Comprehensive NCLEX-RN Review: Mental Health
At what age is Erikson's Initiative vs. Guilt? ATI Comprehensive NCLEX-RN Review: Mental Health
• 3 - 6 years ATI Comprehensive NCLEX-RN Review: Mental Health
What is the defense mechanism of denial? ATI Comprehensive NCLEX-RN Review: Mental Health
• An attempt to escape unpleasant realities. ATI Comprehensive NCLEX-RN Review: Mental Health
What is the defense mechanism of projection? ATI Comprehensive NCLEX-RN Review: Mental Health
• An unconscious rejection of emotionally unacceptable features and attributing them to others. ATI Comprehensive NCLEX-RN Review: Mental Health
What is Buspirone used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• Antianxiety ATI Comprehensive NCLEX-RN Review: Mental Health
What is Diazepam used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• Antianxiety ATI Comprehensive NCLEX-RN Review: Mental Health
What is Clonazepam used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• Antianxiety • Bipolar Disorder ATI Comprehensive NCLEX-RN Review: Mental Health
What is Amitriptyline used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• Antidepressant ATI Comprehensive NCLEX-RN Review: Mental Health
What types of medications are used for personality disorders? ATI Comprehensive NCLEX-RN Review: Mental Health
• Antidepressants • Antianxiety agents • Antipsychotics Depending on disorder. ATI Comprehensive NCLEX-RN Review: Mental Health
What is Loxapine used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• Antipsychotic . . . ○ for Positive symptoms ATI Comprehensive NCLEX-RN Review: Mental Health
What is Thioridazine used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• Antipsychotic . . . ○ for Positive symptoms ATI Comprehensive NCLEX-RN Review: Mental Health
What is Quetiapine used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• Antipsychotic . . . ○ for both Positive & Negative symptoms ATI Comprehensive NCLEX-RN Review: Mental Health
What is Haloperidol used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• Antipsychotics . . . ○ for Positive symptoms ATI Comprehensive NCLEX-RN Review: Mental Health
What is Olanzapine used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• Antipsychotics . . . ○ for both Positive & Negative symptoms ATI Comprehensive NCLEX-RN Review: Mental Health
What are nursing interventions for Tourette's Disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Antipsychotics • Behavioral techniques. ATI Comprehensive NCLEX-RN Review: Mental Health
What types of personality disorders are Cluster B? ATI Comprehensive NCLEX-RN Review: Mental Health
• Antisocial • Borderline • Narcissistic • Histrionic ATI Comprehensive NCLEX-RN Review: Mental Health
What describes Cluster C personality disorders? ATI Comprehensive NCLEX-RN Review: Mental Health
• Anxious/Fearful ATI Comprehensive NCLEX-RN Review: Mental Health
What are nursing interventions for Bipolar Disorders? ATI Comprehensive NCLEX-RN Review: Mental Health
• Assess whether client is a danger to self or others • Assess the need to protect client from uninhibited behaviors. • Asses for coexisting medical conditions such as substance use disorder. ATI Comprehensive NCLEX-RN Review: Mental Health
What describes a client with Histrionic personality disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Attention seeking • Frustrates easily • Often melodramatic and seductive. ATI Comprehensive NCLEX-RN Review: Mental Health
What is a defense mechanism? ATI Comprehensive NCLEX-RN Review: Mental Health
• Automatic coping styles that protect individuals from anxiety and maintain self-image. ATI Comprehensive NCLEX-RN Review: Mental Health
What nursing interventions are used for a client with Paranoid personality disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Avoid being too nice or too friendly • Give clear explanations • Warn about changes in treatment plan and explain reasons for delays. ATI Comprehensive NCLEX-RN Review: Mental Health
What are nursing interventions used for clients with Antisocial personality disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Be aware of and assess for substance abuse. • Set clear limits on specific behavior • Be cautious of manipulation through guilt when client doesn't get what he wants. ATI Comprehensive NCLEX-RN Review: Mental Health
What nursing interventions are used for clients with Dependent personality disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Be aware of countertransference that can occur due to the client's clinging behavior • Identify current stresses • Satisfy client's need when setting limits. ATI Comprehensive NCLEX-RN Review: Mental Health
What are types of antianxiety agents? ATI Comprehensive NCLEX-RN Review: Mental Health
• Benzodizepines • Nonbenzodiazepines ATI Comprehensive NCLEX-RN Review: Mental Health
What is Valproic Acid used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• Bipolar Disorder . . . ○ Anticonvulsant ATI Comprehensive NCLEX-RN Review: Mental Health
What is Lithium used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• Bipolar Disorder . . . ○ Mood stabilizer ATI Comprehensive NCLEX-RN Review: Mental Health
What is Aripiprazole used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• Bipolar Disorder . . . ○ Atypical Antipsychotic ATI Comprehensive NCLEX-RN Review: Mental Health
What Norepinephrine Dopamine Reuptake Inhibitor (NDRI) is used for MDD? ATI Comprehensive NCLEX-RN Review: Mental Health
• Bupropion ATI Comprehensive NCLEX-RN Review: Mental Health
What are examples of SSRIs used for anxiety disorders? ATI Comprehensive NCLEX-RN Review: Mental Health
• Citalopram • Fluoxetine • Sertraline ATI Comprehensive NCLEX-RN Review: Mental Health
What theoretical model did Ivan Pavlov develop? ATI Comprehensive NCLEX-RN Review: Mental Health
• Classical Conditioning ATI Comprehensive NCLEX-RN Review: Mental Health
What are 2 types of behavioral theoretical models? ATI Comprehensive NCLEX-RN Review: Mental Health
• Classical Conditioning • Operant Conditioning ATI Comprehensive NCLEX-RN Review: Mental Health
What is an antianxiety agent used for Bipolar Disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Clonazepam ATI Comprehensive NCLEX-RN Review: Mental Health
What medications are second-generation antipsychotics used in schizophrenia? ATI Comprehensive NCLEX-RN Review: Mental Health
• Clozapine • Olanzapine • Quetiapine • Risperidone ATI Comprehensive NCLEX-RN Review: Mental Health
What type of personality disorder is Paranoid? ATI Comprehensive NCLEX-RN Review: Mental Health
• Cluster A ATI Comprehensive NCLEX-RN Review: Mental Health
What type of personality disorder is Schizoid? ATI Comprehensive NCLEX-RN Review: Mental Health
• Cluster A ATI Comprehensive NCLEX-RN Review: Mental Health
What type of personality disorder is Schizotypal? ATI Comprehensive NCLEX-RN Review: Mental Health
• Cluster A ATI Comprehensive NCLEX-RN Review: Mental Health
What are the types of personality disorders? ATI Comprehensive NCLEX-RN Review: Mental Health
• Cluster A • Cluster B • Cluster C ATI Comprehensive NCLEX-RN Review: Mental Health
What type of personality disorder is Antisocial? ATI Comprehensive NCLEX-RN Review: Mental Health
• Cluster B ATI Comprehensive NCLEX-RN Review: Mental Health
What type of personality disorder is Borderline? ATI Comprehensive NCLEX-RN Review: Mental Health
• Cluster B ATI Comprehensive NCLEX-RN Review: Mental Health
What type of personality disorder is Histrionic? ATI Comprehensive NCLEX-RN Review: Mental Health
• Cluster B ATI Comprehensive NCLEX-RN Review: Mental Health
What type of personality disorder is Narcissistic? ATI Comprehensive NCLEX-RN Review: Mental Health
• Cluster B ATI Comprehensive NCLEX-RN Review: Mental Health
What type of personality disorder is Avoidant? ATI Comprehensive NCLEX-RN Review: Mental Health
• Cluster C ATI Comprehensive NCLEX-RN Review: Mental Health
What type of personality disorder is Dependent? ATI Comprehensive NCLEX-RN Review: Mental Health
• Cluster C ATI Comprehensive NCLEX-RN Review: Mental Health
What type of personality disorder is Obsessive-compulsive? ATI Comprehensive NCLEX-RN Review: Mental Health
• Cluster C ATI Comprehensive NCLEX-RN Review: Mental Health
What factors promote client growth? ATI Comprehensive NCLEX-RN Review: Mental Health
• Communicating genuineness • Expressing empathy • Having positive regard for client ATI Comprehensive NCLEX-RN Review: Mental Health
What is the definition of autism spectrum disorders (ASDs)? ATI Comprehensive NCLEX-RN Review: Mental Health
• Complex neurobiological and developmental disabilities that typically appear during the first 3 years of life. ATI Comprehensive NCLEX-RN Review: Mental Health
What are signs of Opiate intoxication? ATI Comprehensive NCLEX-RN Review: Mental Health
• Constricted pupils • Decreased respirations • Decreased heart rate • Decreased blood pressure • Initial euphoria followed by dysphoria ATI Comprehensive NCLEX-RN Review: Mental Health
What symptoms are associated with autism spectrum disorders (ASDs)? ATI Comprehensive NCLEX-RN Review: Mental Health
• Deficits in social relatedness . . . ○ communication . . . ○ nonverbal behavior . . . ○ interactions ATI Comprehensive NCLEX-RN Review: Mental Health
What types of personality disorders are in Cluster C? ATI Comprehensive NCLEX-RN Review: Mental Health
• Dependent • Obsessive-compulsive • Avoidant ATI Comprehensive NCLEX-RN Review: Mental Health
What is the defense mechanism of sublimation? ATI Comprehensive NCLEX-RN Review: Mental Health
• Directing unacceptable behaviors into a socially acceptable area. This is always adaptive. ATI Comprehensive NCLEX-RN Review: Mental Health
What is an intellectual development disorder (IDD)? ATI Comprehensive NCLEX-RN Review: Mental Health
• Disorder characterized by deficits in intellectual functioning, social functioning, and managing activities of daily living. • Impairments can range from mild to severe. ATI Comprehensive NCLEX-RN Review: Mental Health
What describes a client with Antisocial personality disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Disregard for the rights of others • Impulsive risk-taking behaviors common • Lacks empathy ATI Comprehensive NCLEX-RN Review: Mental Health
What describes a client with Paranoid personality disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Distrust • Suspiciousness of others • Hypervigilance ATI Comprehensive NCLEX-RN Review: Mental Health
What describes Cluster B personality disorders? ATI Comprehensive NCLEX-RN Review: Mental Health
• Dramatic/Emotional ATI Comprehensive NCLEX-RN Review: Mental Health
What nursing interventions are used for autism spectrum disorders (ASDs)? ATI Comprehensive NCLEX-RN Review: Mental Health
• Early within 2nd or 3rd year of life through specialized treatment programs. . . . ○ Assist with behavior modification program . . . ○ Promote positive reinforcement . . . ○ Structure opportunities for small successes . . . ○ Set clear rules . . . ○ Decrease environmental stimulation . . . ○ Introduce the child to new situations slowly. ATI Comprehensive NCLEX-RN Review: Mental Health
What describes a client with Dependent personality disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Excessive clinging • Need to be taken care of • Submissive. ATI Comprehensive NCLEX-RN Review: Mental Health
What describes a client with Borderline personality disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Extreme emotional lability • Impulsivity • Self-image distortions . . . ○ severely impair functioning ATI Comprehensive NCLEX-RN Review: Mental Health
What are symptoms of major depressive disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Fatigue • Anhedonia (inability to feel pleasure) • Changes in appetite • Insomnia or hypersomnia • Anergia • Feelings of worthlessness • Persistent thoughts of suicide ATI Comprehensive NCLEX-RN Review: Mental Health
What are signs of CNS Stimulant Withdrawal? ATI Comprehensive NCLEX-RN Review: Mental Health
• Fatigue • Depression • Agitation • Apathy • Anxiety • Craving • Increased appetite ATI Comprehensive NCLEX-RN Review: Mental Health
What are examples of nontherapeutic communication? ATI Comprehensive NCLEX-RN Review: Mental Health
• Giving premature advice • Minimizing feelings • False reassurance • Disapproval • Making value judgments ATI Comprehensive NCLEX-RN Review: Mental Health
What nursing interventions are used for clients with Obsessive-Compulsive personality disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Guard against power struggles with client as the need to control is high • Assess for client's use of intellectualization, rationalization, and reaction formation as defense mechanisms. • Be aware of client's critical nature toward self and others. ATI Comprehensive NCLEX-RN Review: Mental Health
What are examples of tricyclic medications used as antidepressants? ATI Comprehensive NCLEX-RN Review: Mental Health
• Imipramine • Amitriptyline ATI Comprehensive NCLEX-RN Review: Mental Health
What are the mania characteristics of Bipolar Disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Inflated sense of self-importance • Extreme energy • Excessive talking with pressured speech • Indiscriminate spending, reckless sexual encounters, risky investments. ATI Comprehensive NCLEX-RN Review: Mental Health
What are some characteristics shared among all personality disorders? ATI Comprehensive NCLEX-RN Review: Mental Health
• Inflexibility • Difficulties in interpersonal relationships . . . ○ impair social/occupational functioning. ATI Comprehensive NCLEX-RN Review: Mental Health
What describes a client with Narcissistic personality disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Lack of empathy: impairs relationships • May appear arrogant . . . ○ over-inflated sense of self • Difficulty with criticism. ATI Comprehensive NCLEX-RN Review: Mental Health
What is a mood stabilizer medication for Bipolar Disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Lithium ATI Comprehensive NCLEX-RN Review: Mental Health
What is the definition of Bipolar II Bipolar Disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Low-level mania alternates with profound depression. ATI Comprehensive NCLEX-RN Review: Mental Health
What is Bupropion used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• MDD ATI Comprehensive NCLEX-RN Review: Mental Health
What is Duloxetine used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• MDD ATI Comprehensive NCLEX-RN Review: Mental Health
What is Escitalopram used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• MDD ATI Comprehensive NCLEX-RN Review: Mental Health
What is Phenelzine used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• MDD ATI Comprehensive NCLEX-RN Review: Mental Health
What is Tranylvypromine used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• MDD ATI Comprehensive NCLEX-RN Review: Mental Health
What are nursing interventions for severe and panic levels of anxiety? ATI Comprehensive NCLEX-RN Review: Mental Health
• Maintain calm manner. • Remain with client. • Minimize environmental stimuli. • Use clear, simple statements. • Use low-pitched voice. • Listen for themes in communication. • Attend to physical and safety needs. ATI Comprehensive NCLEX-RN Review: Mental Health
What are levels of anxiety? ATI Comprehensive NCLEX-RN Review: Mental Health
• Mild • Moderate • Severe • Panic
What types of medications are used for Bipolar Disorders? ATI Comprehensive NCLEX-RN Review: Mental Health
• Mood Stabilizer • Atniconvulsants • Atypical Antipsychotics • Antianxiety agent ATI Comprehensive NCLEX-RN Review: Mental Health
What is the definition of Bipolar I Bipolar Disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Mood disorder characterized by at least one week-long manic episode. • Manic episodes may alternate with depression. ATI Comprehensive NCLEX-RN Review: Mental Health
What is the definition of Tourette's Disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Motor and verbal tics appearing between 2 - 7 years of age. • Symptoms cause marked distress and impairment in social and occupational functioning. • Usually permanent. ATI Comprehensive NCLEX-RN Review: Mental Health
What are symptoms of CNS Depressant Withdrawal? ATI Comprehensive NCLEX-RN Review: Mental Health
• N/V • Tachycarida • Diaphoresis • Tremors • Grand mal seizures • Restlessness • Irritability ATI Comprehensive NCLEX-RN Review: Mental Health
What environmental guidelines used for suicide prevention? ATI Comprehensive NCLEX-RN Review: Mental Health
• No glass or metal in meal trays and utensils. • Hands should be in full view while patient is sleeping. • Carefully observe patient swallow medication. • Screen all potentially harmful gifts (i.e., flowers in a glass vase). • Injury-proof rooms and bathrooms. • Remove all possessions from client that could lead to injury. • On-on-one constant supervision. ATI Comprehensive NCLEX-RN Review: Mental Health
What are the phases of the Nurse-Client relationship? ATI Comprehensive NCLEX-RN Review: Mental Health
• Orientation Phase • Working Phase • Termination Phase ATI Comprehensive NCLEX-RN Review: Mental Health
What are the types of personality disorders in Cluster A? ATI Comprehensive NCLEX-RN Review: Mental Health
• Paranoid • Schizoid • Schizotypal ATI Comprehensive NCLEX-RN Review: Mental Health
What is the definition of a major depressive disorder (MDD)? ATI Comprehensive NCLEX-RN Review: Mental Health
• Persistently depressed mood lasting for a minimum of 2 weeks. ATI Comprehensive NCLEX-RN Review: Mental Health
What monoamine oxidase inhibitors (MAOIs) are used for MDD? ATI Comprehensive NCLEX-RN Review: Mental Health
• Phenelzine • Tranylcypromine ATI Comprehensive NCLEX-RN Review: Mental Health
What are second-generation antipsychotics used to treat in schizophrenia? ATI Comprehensive NCLEX-RN Review: Mental Health
• Positive and negative symptoms ATI Comprehensive NCLEX-RN Review: Mental Health
What model of psychology did Sigmund Freud focus on? ATI Comprehensive NCLEX-RN Review: Mental Health
• Psychoanalytic ATI Comprehensive NCLEX-RN Review: Mental Health
physical violence
occurs when physical pain or harm is directed toward the following. An infant or child, as is the case with shaken baby syndrome (caused by violent shaking of young infants). An intimate partner, such as striking or strangling the partner. A vulnerable adult in the home, such as pushing an older adult parent and causing her to fall.
sexual violence
occurs when sexual contact takes place without consent, whether the vulnerable person is able or unable to give that consent
Cluster A
odd or eccentric paranoid, schizoid, schizotypal
placating
one member takes responsiblity for problems to keep peace at all costs
The client receives positive rewards for positive behavior positive reinforcement
operant conditioning
phases of a therapeutic relationship
orientation, working, termination
MAOI
phenelzine inhibits breakdown of amine neurotransmitters, increase BP, increased HR hypertensive crisis. avoid pseudonephrine. no tyramine like pickles, cheese, wine, avocados
Conversion
physical complaints not true
heroin signs
pinpoint eyes
one member takes responsibility for problems to keep peace at all costs
placating
operant conditioning
positive reinforcement
priority needs for a client with bipolar disorder experiencing acute mania
preventing physical exhaustion, maintaining health, and meet nutritional and rest needs consider Maslow's hierarchy of needs
Blaming others for unacceptable thoughts and feelings Ex: a young adult planes his substance use disorder on his parents refusal to buy him a new car
projection
What are immature defenses
projection dissociation splitting denial
Working phase of group development includes:
promote problem solving skills to facilitate behavior changes. Power and control issues may dominate in this phase. -group leader uses therapeutic communication to encourage group work toward meeting goals. -members take informal roles within the group, which may interfere with or favor group progress toward goals.
Performing an act to make up for prior behavior. Ex; An adolescent completes his chores without being prompted to after having an argument with his parents.
undoing
A nurse is caring for a client who was admitted following an overdose of amitriptyline. The nurse should monitor the client for which of the following adverse effects associated with this medication?
urinary retention
aversion therapy
use bad stimuli if patient does something bag like dog chewing on cord and you put bitter apple on the cord and the dog pulls away
Benztropine
used to treat parkinsonism manifestation s such as shuffling gait
At what age is Erikson's Autonomy vs. Shame and Doubt? ATI Comprehensive NCLEX-RN Review: Mental Health
• 1 - 3 years ATI Comprehensive NCLEX-RN Review: Mental Health
At what age does the Anal stage of Sigmund Freud's theory occur? ATI Comprehensive NCLEX-RN Review: Mental Health
• 1 - 3 years old ATI Comprehensive NCLEX-RN Review: Mental Health
At what age does the Phallic stage of Sigmund Freud's theory occur? ATI Comprehensive NCLEX-RN Review: Mental Health
• 3 - 6 years old ATI Comprehensive NCLEX-RN Review: Mental Health
At what age is Erikson's Generativity vs. Stagnation? ATI Comprehensive NCLEX-RN Review: Mental Health
• 35 - 65 years ATI Comprehensive NCLEX-RN Review: Mental Health
At what age is Erikson's Industry vs. Inferiority? ATI Comprehensive NCLEX-RN Review: Mental Health
• 6 - 12 years ATI Comprehensive NCLEX-RN Review: Mental Health
At what age does the Latency stage of Sigmund Freud's theory occur? ATI Comprehensive NCLEX-RN Review: Mental Health
• 6 - 12 years old ATI Comprehensive NCLEX-RN Review: Mental Health
At what age is Erikson's Integrity vs. Despair? ATI Comprehensive NCLEX-RN Review: Mental Health
• 65 years and older ATI Comprehensive NCLEX-RN Review: Mental Health
What is schizophrenia? ATI Comprehensive NCLEX-RN Review: Mental Health
• A complex brain disorder that affects thinking, language, emotions, social behavior, and the ability to perceive reality correctly. ATI Comprehensive NCLEX-RN Review: Mental Health
What is the definition of a stereotypic movement disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• A complex neurobiological and developmental disability that typically appears before 3 years of age. ATI Comprehensive NCLEX-RN Review: Mental Health
What is mental health? ATI Comprehensive NCLEX-RN Review: Mental Health
• A state of well-being in which each individual is able to realize his own potential, cope with the normal stresses of life, work productively and fruitfully, and contribute to the community. ATI Comprehensive NCLEX-RN Review: Mental Health
What are examples of negative symptoms in schizophrenia? ATI Comprehensive NCLEX-RN Review: Mental Health
• Absence of something that should be present: . . . ○ flat/blunted affect . . . ○ inappropriate emotional response. ATI Comprehensive NCLEX-RN Review: Mental Health
What is an example of a humanistic theoretical model? ATI Comprehensive NCLEX-RN Review: Mental Health
• Hierarchy of Needs ATI Comprehensive NCLEX-RN Review: Mental Health
What are the 3 aspects of the self according to Freud? ATI Comprehensive NCLEX-RN Review: Mental Health
• Id • Ego • Superego ATI Comprehensive NCLEX-RN Review: Mental Health
What Tricyclic Antidepressant (TCA) is used for MDD? ATI Comprehensive NCLEX-RN Review: Mental Health
• Imipramine ATI Comprehensive NCLEX-RN Review: Mental Health
What is Venlafaxine used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• MDD ATI Comprehensive NCLEX-RN Review: Mental Health
What is Vilazodone used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• MDD ATI Comprehensive NCLEX-RN Review: Mental Health
What is electroconvulsive therapy (ECT) used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• MDD ATI Comprehensive NCLEX-RN Review: Mental Health
What is transcranial magnetic stimulation (TMS) indicated for? ATI Comprehensive NCLEX-RN Review: Mental Health
• MDD ATI Comprehensive NCLEX-RN Review: Mental Health
What nursing interventions are associated with Avoidant personality disorder? ATI Comprehensive NCLEX-RN Review: Mental Health
• Maintain a friendly, accepting, reassuring approach. • Do not push client into social situations. ATI Comprehensive NCLEX-RN Review: Mental Health
What theoretical model did B. F. Skinner develop? ATI Comprehensive NCLEX-RN Review: Mental Health
• Operant Conditioning ATI Comprehensive NCLEX-RN Review: Mental Health
What are first-generation antipsychotics used to treat in schizophrenia? ATI Comprehensive NCLEX-RN Review: Mental Health
• Positive symptoms ATI Comprehensive NCLEX-RN Review: Mental Health
What are 3 clarifying techniques? ATI Comprehensive NCLEX-RN Review: Mental Health
• Restating • Reflecting • Exploring ATI Comprehensive NCLEX-RN Review: Mental Health
What are motor disorders in childhood? ATI Comprehensive NCLEX-RN Review: Mental Health
• Stereotypic Movement Disorder • Tourette's Disorder ATI Comprehensive NCLEX-RN Review: Mental Health
What medications are used for ADD and ADHD? ATI Comprehensive NCLEX-RN Review: Mental Health
• Stimulants . . . ○ Methylphenidate . . . ○ Amphetamine . . . ○ Dextroamphetamine ATI Comprehensive NCLEX-RN Review: Mental Health
risk factors for eating disorders
- occupational choices that encourage thinness such as modeling - individual history of being a "picky" eater in childhood - participation in athletics, especially at the elite level of competition or in a sport where lean body build is prized or where a specific weight is necessary
Atypical anxiolytic/nonbarbiturate anxiolytics
Buspirone; less potential for dependency than other antianxiety meds, does not result in sedation or potentiate effects of other CNS depressants; initial responses take 1 week and at least 2-6 weeks to reach full effects; should not be used with MAOIs or grapefruit juice
A nurse is caring for a client who has a history of substance use disorder and was involuntary admitted to a mental health facility. When the nurse attempts to administer oral lorazepam, the client refuses to take the medication and becomes physically aggressive. Which of the following actions should the nurse take?
Do not administer the lorazepam
A nurse is caring for a client who has a history of substance use disorder and was involuntarily admitted to a mental health facility. When the nurse attempts to administer oral lorazepam, the client refuses to take the medication and becomes physically aggressive. Which of the following actions should the nurse take
Do not administer the lorazepam R: pt who is involuntarily admitted have the right to refuse tx
Beneficence
Doing good or causing good to be done; kindly action A nurse helps a newly admitted client who has a psychotic disorder to feel safe in the environment of the mental health facility.
Cholinesterase inhibitors
Donepezil, rivastigmine, galantamine; slow cognitive deterioration of alzheimer's; contraindicated in patients who have asthma or other obstructive pulmonary disorders; start low dose and gradually increase; give once daily at bedtime
A nurse is planning discharge teaching with a family member of a client who has a new diagnosis of depression. Which of the following information about relapse should the nurse include?
Early identification of changes, such as decreased social involvement, is important
Cocaine use
Intoxication S/S: mild (dizziness, irritability, tremor, blurred vision). Severe (hallucinations, seizures, fever, tachycardia, HTN, chest pain, CV collapse) Withdrawal S/S: Depression, fatigue, craving, excess sleeping, insomnia, dramatic dreams, psychomotor retardation, agitation
Opiate Use
Intoxication S/S: slurred speech, impaired memory, pupillary changes, decreased resp and LOC, impaired judgment Antidote: Naloxone Withdrawal S/S: Sweating, rhinorrhea, piloerection (gooseflesh), tremors, irritability, diarrhea, fever, insomnia, pupil dilation, nausea, vomiting, muscle pain/spasms
Orientation Phase
Introducing yourself to the client set meeting times build trust by establishing expectations and boundaries explore clients ideas
Dysfunctional Grief
Involves difficult progression through the expected stages of the grieving process
Cannabis withdrawal manifestations
Irritability, aggression, anxiety, insomnia, lack of appetite, restlessness, depressed mood, abdominal pain, tremors, diaphoresis, fever, headache
A charge nurse is discussing the characteristics of a nurse‑client relationship with a newly licensed nurse. Which of the following characteristics should the nurse include in the discussion? (Select all that apply.)
It is goal-directed. Behavioral change is encouraged. A termination date is established.
Lithium carbonate
Mood stabilizer, produces neurochemical changes in the brain including serotonin receptor blockade, decreases atrophy and/or increases neuronal growth; used in the treatment of bipolar disorders to control episodes of acute mania, help prevent the return of mania or depression, and decrease the incidence of suicide
Factitious disorder
Munchausen syndrome conscious decision by the client to report physical or psychological manifestations. The falsification of manifestations is done in the absence of personal gain by the client other than possible fulfillment of an emotional need for attention. In some cases, clients inflict self‑injury.
Heroin withdrawal expected findings
Muscle aches
Cholinesterase interactions
NSAIDs cause GI bleeding; antihistamines, TCAs, and conventional antipsychotics reduce effectiveness
Alcohol withdrawal
Naltroxone. 2-3 days after can be a seizure risk, hand tremors will occur, monitor bp
Cholinesterase side effects
Nausea, vomiting, diarrhea, bradycardia, syncope
Oppositional defiant disorder
Negativity Disobedience Hostility Defiant behaviors (especially toward authority figures) Stubbornness Argumentativeness Limit testing Unwillingness to compromise Refusal to accept responsibility for misbehavior can exhibit low self‑esteem, mood lability, and a low frustration threshold can develop into conduct disorder
Cluster A personality disorders (odd or eccentric traits)
Paranoid (distrust and suspiciousness), schizoid (emotional detachment, disinterest in close relationships, indifference to praise or criticism), and schizotypal (interpersonal difficulties, eccentric appearance, magical thinking)
contributing factors to conduct disorder
Parental rejection and neglect Difficult infant temperament Inconsistent child‑rearing practices with harsh discipline Physical or sexual abuse Lack of supervision Early institutionalization Frequent changing of caregivers Large family size Association with delinquent peer groups Parent with a history of psychological illness
SSRI's
Paroxetine Sertraline Fluoxetine Citalopram Escitalopram Fluvoxamine
Selective serotonin reuptake inhibitors (SSRIs)
Paroxetine, sertraline, citalopram, escitalopram, fluoxetine, fluvoxamine; may take up to 4 weeks to produce therapeutic medication levels; used to treat depression, anxiety disorders, and trauma/stressor related disorders; should not be used with MAOIs or TCAs
Necessary loss
Part of the cycle of life, anticipated but can still be intensely felt
Severe anxiety
Perceptual field is greatly reduced with distorted perceptions, learning and problem solving do not occur, may cause increased HR and RR
Schizophreniform disorder
Periods of disturbed behavior lasting 1-6 months
A nurse is caring for an older adult client who is experiencing delirium. Which of the following interventions should the nurse include in the client's plan of care?
Permit the client to perform daily rituals to decrease anxiety
A nurse is caring for an older adult client who is experiencing delirium. Which of the following interventions should the nurse include in the client's plan of care
Permit the client to perform daily rituals to decrease anxiety R: allowing them to do so will decrease frustration and anxiety
With delirium pts
Permit the client to perform daily rituals to decrease anxiety R: allowing them to do so will decrease frustration and anxiety need -consistent caregivers -they get frustrated wuth too many decisions to make (like picking from a lot of food) -well lit area
Feels singled out for harm by others (being hunted down by FBI)
Persecution
MAOI's
Phenelzine
MAO inhibitors
Phenelzine Isocarboxazid Tranylcypromine Selegiline: transdermal patch
Dealing with unacceptable feelings or impulses by unconsciously substitute acceptable forms of expression. Ex: a person who has feelings of anger and hostility toward his work supervisor sublimates those feelings by working out vigorously a the gym during his lunch period
Sublimation
The client experiences psychosis within 1 month of substance intoxication or withdrawal. May be caused by medications intend for therapeutic use
Substance induced psychotic disorder
A community health nurse is planning an education program about depressive disorders. Which of the following factors should the nurse include as increasing the risk for depression
Substance use disorder
A community health nurse is planning an education program about depressive disorders. Which of the following factors should the nurse include as increasing the risk for depression?
Substance use disorder
A nurse is caring for a client who is undergoing ECT and will receive succinylcholine. The client asks the nurse about this medication. What is an appropriate response by the nurse?
Succinylcholine is given to reduce muscle movements during therapy
Regression
Sudden use of childlike or primitive behaviors that do not correlate with the person's current developmental level
Voluntarily denying unpleasant thoughts and feelings. Ex: A person who has lost his job states he will worry about paying his bills next week
Suppression
Rape trauma syndrome
Sustained and maladaptive response to a forced, violent sexual penetration against the individual's will and consent, similar to PTSD; expressed reaction is overt and consists of emotional outbursts (crying, laughing, hysteria, anger, incoherence); controlled reaction is ambiguous; somatic reaction can occur later
Acute Stress Disorder
Sx are the same as PTSD but last < 1 month and occur within one month of trauma
Desipramine, imipramine, clomipramine
TCAs used to treat depression, autism spectrum disorder, ADHD, panic disorder, separation anxiety disorder, social phobia, school phobia, and OCD in children; contraindicated in clients who have seizure disorders; should not be used with MAOIs, antihistamines, anticholinergic agents, alcohol, benzodiazepines, and opioids
Acamprosate
Taken orally 3x a day to reduce the unpleasant effects of alcohol abstinence (dysphoria, anxiety, restlessness); diarrhea may result, maintain adequate fluid intake; avoid use in pregnancy
A nurse is caring for an older adult client who has dementia and has wandered into the day room looking for her deceased partner. Which of the following actions should the nurse take?
Talk with the client about activates she enjoyed with her partner
Worden: Four Tasks of Mourning
Task I: accepting the reality of the loss Task II: processing the pain of grief Task III: adjusting to a world without the lost entity Task IV: finding an enduring connection with the lost entity in the midst of embarking on a new life
Valproic Acid Teaching
Teach the need to regularly monitor liver function levels due to the risk of hepatotoxicity
Thought Stopping
Teaches a client to say "stop" when a negative thought or compulsive behavior arises and substitute positive thought. The goal is that the client with time will use command silently
Setting limits with aggressive clients
Tell the client calmly and directly what he must do in a particular situation "I need you to stop yelling and walk with me outside where we can talk."
Schizophrenia
The client has psychotic thinking or behavior present for at least 6 months. Areas of functioning, including school or work, self‑care, and interpersonal relationships, are significantly impaired.
A nurse is caring for a client who is experiencing a situational crisis. Which of the following findings should the nurse expect?
The client recently lost a grandparent in a motor vehicle crash
A nurse is caring for a client who is experiencing a situational crisis. Which of the following findings should the nurse expect
The client recently lost a grandparent in a motor vehicle crash R: unexpected events
A nurse is caring for a client who is taking clozapine. For which of the following findings should the nurse withhold the medication?
The client reports a sore throat
A nurse is caring for a client who is taking clozapine. For which of the following findings should the nurse withhold the medication
The client reports a sore throat R: clozapine can lead to a fatal blood d/o, agranulocytosis. this is a severe drop in WBC which leaves them at risk for infection. Nurse should w/hold
A nurse is collecting an admission history for a client who has acute stress disorder (ASD). Which of the following information should the nurse expect to collect?
The client who has ASD often expresses dissociative manifestations regarding the event, which includes a sense of unreality.
A nurse is caring for a client who is borderline personality disorder. Which of the following goals is the priority when planning care for this client?
The client will refrain from self- mutilation
A nurse is caring for a client who has borderline personality disorder. Which of the following goals is the priority when planning care for this client
The client will refrain from self-mutilation R: greatest risk is injury to self or others
Echolalia
The clients repeat words spoken to them
Factitious disorder
The conscious decision by the client to report physical or psychological manifestations for atttention
atypical antidepressants therapeutic uses
Treatment of depression Alternative to SSRIs for clients unable to tolerate the sexual dysfunction side effects Aid to quit smoking Prevention of seasonal pattern depression
Phase 3 of a crisis
Trial-and-error methods of resolution fail, and the client's anxiety escalates to severe or panic levels, leading to flight or withdrawal behaviors
Dissociative fugue
Type of dissociative amnesia in which the client travels to a new area and is unable to remember one's own identity and at least some of one's past, can last weeks to months
Empathy
UNDERSTANDING of feelings
situational loss
Unanticipated loss caused by an external event
Can give____________with lithium
Valproic Acid Both treat bipolar
Serotonin norepinephrine reuptake inhibitors (SNRIs)
Venlafaxine, duloxetine, desvenlafaxine; used for major depression, panic disorders, and generalized anxiety disorder; should not be used with MAOIs, alcohol, opioids, antihistamines, or sedatives/hypnotics
Group process
Verbal and nonverbal communication that occurs during group sessions, including how the work progresses
Risk factors of family & community violence
Victims are the greatest risk of violence when they try to leave the relationship Pregnancy tends to increase the likelihood of violence toward the intimate partner Child under 3 years of age
Vagus Nerve Stimulation adverse effects
Voice changes Dysphagia Neck pain
Suppression
Voluntarily denying unpleasant thoughts and feelings
Anorexia
Voluntary refusal to eat Body weight less than 85% of expected normal weight for individual) Restricting Type: individual drastically restricts food intake and does not binge or purge Binge-eating/purging type: engages in binge-eating or purging behaviors
A nurse in the emergency department is admitting a client who reports a headache along with heart palpitations after having a glass of wine with dinner a few hours ago. The client has a history of depression and has blood pressure of 210/105 mmHg. Which of the following questions should the nurse ask first?
What medications are you currently taking?
Word salad
Words jumbled together with little meaning or significance to the listener
A nurse in an acute mental health facility is planning care for a client who has dissociative fugue. Which of the following interventions should the nurse add to the plan of care?
Work with the client on grounding techniques. stomp your feet, clap your hands
Delirium
a usually brief state of excitement and mental confusion often accompanied by hallucinations
Pairing of a maladaptive behavior with a punishment or unpleasant stimui such as a bitter taste or mild electric shock as punishment for behaviors such as alcohol use disorder violence self mutilation and thumb sucking
aversion therapy
neologism
consists of words that are made up by the client
The client has atlas 2 years of repeated hypomanic manifestations that do not meet the criteria for hypomania episodes alternating with minor depressive episodes.
cyclothymia
Intermittent explosive disorder
exhibit recurrent episodic violent and aggressive behavior with the possibility of hurting people, property, or animals
w bipolar disorder can have
extended periods of depression
Delusion
false fixed belief seen in schizos
separation anxiety
fear of abandonment
agoraphobia
fear of places or situations that might cause panic such as going outside
Lanugo
fine, downy, unpigmented hair
The client may say sentence after sentence but each sentence may relate to another topic and the listeniner is bale to follow the clients thoughts
flight of ideas
exposing a client while in the company of a therapist to a great deal of an undesirable stimulus in an attempt to turn off the anxiety response
flooding
antidote for benzo toxicity
flumazenil
Interpersonal therapy
focuses on social roles and relationships
donepezil (aricept)
for alzheimers prolong time and functioning of individual in early stages of disease
Buprenorphine
for heroin overdose
A charge nurse is discussing TMS with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?
for major depressive disorders TMS is commonly prescribed daily for a period of 4 to 6 weeks.
Bupropion
for quitting nicotine and for depression
Believes that she is all powerful and important like a god
grandeur
some group members or the leader may have goals different from the stated group goals that may disrupt group processes
hidden agenda
sumblimination
hidden feelings about someone and then goes to work out to release the anger
What are affective symptoms
hopelessness suicidal ideation
Affective symptoms of psychotic disorders
hopelessness suicidal ideation
Oppositional Defiant Disorder
hostile behavior
Persecution
hostility and ill-treatment, especially because of race or political or religious beliefs.
physical manifestations of alcohol withdrawal psychological symptoms
hypertension, tachycardia, fever agitation, insomnia, irritability
illness anxiety disorder
hypochondriasis
criteria for hospital anorexia nervosa
hypothermia <40 HR potassium <3 weight loss 30% of total body weight in 6 months
Covert Comment (Suicide)
"Everything is look pretty grim for me"
A nurse is caring for a client whose child has a terminal illness. The client requests information about how to deal with the upcoming loss. Which of the following statements should the nurse make
"It is not uncommon to feel angry toward yourself or others."
Catastrophizing
"My life is over if I gain weight"
Overt Comment (Suicide)
"There is just no reason for me to go on"
Personalization
"When I walk through the hallways, I know everyone is looking at me"
What are the personality disorders in cluster A
(Odd and eccentric traits) -Paranoid -Schizoid -Schizotypal
tort
(law) any wrongdoing for which an action for damages may be brought
Personality d/o Cluster C (anxious, fearful traits, insecurity, inadequacy)
-Avoidant -Dependent -Obsessive compulsive
What SNRI's are used for depression?
-Effexor -Cymbalta
Personality d/o s/s
-Inflexibility response to stress -Compulsiveness and lack of social restraint -Inability to emotionally connect -Provoke interpersonal conflict -Ability to merge personal boundaries
What medications are given for patients that have bipolar disorder?
-Mood stabilizers: Lithium -Anticonvulsants that act as mood stabilizers: Depakote, Klonopin, Lamictal, nuerontin, Topaz -Benzo's: Ativan, for sleep -Antidepressants such as Prozac to manage depression
working phase of a therapeutic relationship
-performing ongoing assessments -encourage problem-solving -recognize transference and countertransference -remind client of date of termination
What is included in cognitive reframing
-priority restructuring -journal keeping -assertiveness training -monitoring thoughts.
Termination phase of a therapeutic relationship includes what?
-provide pt tine to discuss thoughts and feelings about termination -discuss the clients experience with separation and loss summarize goals and achievements -review memories of work in the sessions -express own feelings -discuss ways to incorporate new healthy behaviors matinaing limits of final termination
High risk pt with ECT
-recent MI - hx of CVA -Cerebrovascular malformation -intracranial mass lesion -increased intracranial pressure
What atypical antipsychotics would be prescribed for patients with psychotic disorders?
-risperdal -zyprexa -seroquel -Geodon -Abilify -Clozaril These treat both negative and positive symptoms watch diet Report agitation, dizziness, sedation, and sleep disruption may occur.
complications of VNS
-voice changes -hoarsness -throat or neck pain -dysphagia -dyspnea with exertion
What are the medications for anxiety disorder (Benzo)
-xanax -Valium -Ativan -Librium -Tranxene -Serax -Kolonopin
Severity Scale for substance use disorder
0-1=no diagnosis of substance abuse 2-3=mild substance abuse 4-5=moderate substance abuse 6 or more= severe substance abuse
ETOH Use
0.08 (80g/dl) considered legally intoxicated. Death occurs in levels greater than 0.4 or 400g/dl. Effects of intoxication: slurred speech, nystagmus, memory impairment, altered judgment, decreased motor skills and LOC, resp arrest, liver damage, erosive gastritis, GI bleed, ED, pancreatitis. Withdrawals: Abdominal cramping, vomiting, tremors, restlessness, insomnia, increased HR/BP/temp, illusions/hallucinations, seizures. Delirium occurs 2-3 days after cessation.
alcohol level considered legally intoxication for adults operating automobiles
0.08% death can occur at 0.4%
Electrical stimulus time vs seizure time
0.2-0.8 for electrical stimulus 25-60 for seizure activity
Lithium levels range
0.5-1.4
ECT not for
1) client who has recently been diagnosed with severe depression R: ECT not appropriate as first line tx for recent diagnosis 2) client whose depression is secondary to situational difficulties R: ECT not effecrive for clients whose depression stems from situational or social problems
Kubler ross stages of grief
1. denial 2. anger 3. bargaining 4. depression 5. acceptance
Maslow's hierarcy of needs
1. sleep, food 2. safety 3. love and belonging 4. self actualization
A nurse is preparing to administer diazepam 7.5 mg IV bolus to a client for alcohol withdrawal. Available is diazepam injection 5 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero
1.5
Advanced lithium toxicity
1.5-2.0 mEq/L; manifestations: mental confusion, sedation, poor, coordination, coarse tremors, ongoing GI distress (nausea, vomiting, diarrhea)
A nurse is preparing to administer diazepam
1.5ml
Sodium
135-145
how long is ECT?
2-3 times a week for 6-12 treatments
Severe lithium toxicity
2.0-2.5 mEq/L; manifestations: extreme polyuria of dilute urine, tinnitus, giddiness, jerking movements, blurred vision, ataxia, seizures, severe hypotension and stupor leading to coma, possible death from respiratory complications; greater than 2.5 mEq/L can lead to coma and death
how long does buspirone take before its effective?
3-6 weeks
potassium
3.5-5
what medications are administered for ECT?
30 minutes before atropine sulfate or glycopyrrolate is administered to decrease secretions methohexital or propofol for anesthetic muscle relaxant such as succinylcholine
Rapid Cycling
4 or more episodes of acute mania within 1 year
how long is involuntary admission good until?
60 days
Lithium blood testing rules
8 hrs after last dose, 5 days after beginning dose, dosage changes, then testing for 6 months monthly
A nurse in an acute mental health facility is receiving change-of-shift report for four clients. Which of the following clients should the nurse assess first
A client who is experiencing delusions of persecution R: greatest risk due to the pt belief that a person in power is out to harm him.
C. Hand tremors Fine hand tremors are an expected adverse effect of lithium and can interfere with the client's ADLs, causing the client to stop taking the medication.
A nurse in a mental health clinic is caring for a client with bipolar disorder and reports that she stopped taking lithium 2 weeks ago. The nurse should recognize which of the following as an expected adverse effect that might have caused the client to stop taking the medication? A. Sore throat B. Photophobia C. Hand tremors D. Constipation
D. Easily distracted Extreme distractibility is a hallmark manifestation of delirium.
A nurse is performing a cognitive assessment to distinguish delirium from dementia in a client whose family reports episodes of confusion. Which of the following assessment findings supports the nurse's suspicion of delirium? A. Slow onset B. Aphasia C. Confabulation D. Easily distracted
D. Monitor the client's cardiac rhythm during the procedure. The seizure induced during ECT can stress that client's heart. Therefore, the nurse should plan to monitor the client's cardiac rhythm during ECT via an electrocardiogram.
A nurse is planning care for a client who is to undergo electroconvulsive therapy (ECT). Which of the following actions should the nurse include in the plan? A. Administer phenytoin 30 minutes prior to the procedure. B. Instruct the client to expect a headache following the procedure. C. Place the client in four point restraints prior to the procedure. D. Monitor the client's cardiac rhythm during the procedure.
Glasgow Coma Scale
A score of 7 or less indicates a come highest value is 15
A nurse is told during change of shift report that a client is stuporous. When assessing the client, which of the following findings should the nurse expect? A. The client arouses briefly in response to a sternal rub. B. The client has a glasgow coma scale score less than 7. C. The client exhibits decorticate rigidity. D. The client is alert but disoriented to time and place.
A. A client who is stuporous requires vigorous or painful stimuli to elicit a response. B & C occur with comatose patients.
A nurse is planning care for the termination phase of a nurse-client relationship. Which of the following actions should the nurse include in the plan of care? A. Discussing ways to use new behaviors B. Practicing new problem-solving skills C. Developing goals D. Establishing boundaries
A. Discussing ways for the client to incorporate new healthy behaviors into life is an appropriate task for the termination phase. B occurs in the working phase. C & D occur in the orientation phase.
Types of ADHD
ADHD predominantly inattentive ADHD predominantly hyperactive‑impulsive Combined type: Client exhibits both inattentive and hyperactive impulsive behaviors
Serotonin Syndrome
Agitation, confusion, disorientation, anxiety, hallucinations, fever, diaphoresis, tremors
Dementia
An abnormal condition marked by multiple cognitive defects that include memory impairment.
anorexia
An eating disorder characterized by an obstinate and willful refusal to eat, a distorted body image, and an intense fear of being fat. Appearance of lanugo, amenorrhea, intolerance to cold, bradycardia, dry skin, hypotension, occupied thoughts of food
Perceived loss
Any loss defined by a client that is not obvious to others
Actual loss
Any loss of a valued person or item
A nurse is communicating with a client is an impatient mental health facility. Which of the following actions by the nurse demonstrates the use of active listening?
Attention to body language
A nurse is performing an admission assessment on an adolescent client who has depression. Which of the following manifestations should the nurse expect (Select all that apply) A. Fear of being alone B. Substance use C. Weight gain D. Irritability E. Aggressiveness
B, D, & E. Substance, irritability, and aggressiveness are expected findings associated with depression. Solitary play and weight loss are expected findings of depression.
Somatic Delusionals
Believes that his body is changing in an unusual way, such as growing a third arm
A nurse is caring for a client who has alcohol use disorder. the client is no longer experiencing withdrawal manifestations. Which of the following medications should the nurse anticipate administering to assist the client with maintaining abstinence from alcohol? a. chlordiazepoxide b. bupropion c. disulfiram d. carbamazepine
C
A nurse is assessing a client immediately following an ECT procedure. Which of the following findings should the nurse expect? (Select all that apply) A. Hypotension B. Paralytic ileus C. Memory loss D. Nausea E. Confusion
C, D, & E. Transient short term memory loss, nausea, and confusion are expected findings immediately following ECT. BP usually elevates after ECT. Paralytic ileum is not a finding.
A nurse is leading a peer group discussion about the indications for ECT. Which of the following indications should the nurse include in the discussion? A. Borderline personality disorder B. Acute withdrawal related to a substance use disorder C. Bipolar disorder with rapid cycling D. Dysphoric disorder
C. ECT is indicated for the treatment of bipolar disorder with rapid cycling.
ECT Potential Complications
Cardiac arryhthmia
generalized anxiety disorder
Characterized by excessive anxiety or worry about numerous things, lasting for 6 months or longer.
A nurse is teaching a client who has an anxiety disorder and is scheduled to begin classical psychoanalysis. Which of the following client statements indicates an understanding of this form of therapy?
Classical psychoanalysis places a common focus on past relationships to identify the cause of the anxiety disorder.
Perseveration:
Client avoids answering questions by repeating phrases or behaviors (Grandpa Mose!)
Conduct disorder
Clients who have conduct disorder demonstrate a persistent pattern of behavior that violates the rights of others or rules and norms of society. Categories of conduct disorder include the following. -Aggression to people and animals -Destruction of property -Deceitfulness or theft -Serious violations of rules Childhood‑onset develops before the age of 10, with males being more prevalent. Adolescent‑onset occurs after the age of 10. The ratio of males‑to‑females is equal in the adolescent stage
Conduct disorder
Clients who have this disorder demonstrate a persistent pattern of behavior that violates the rights of others or rule and norms of society; categories of conduct disorder include aggression to people and animals, destruction of property, deceitfulness or theft, and serious violations of rules; child onset occurs before 10 years, adolescent onset occurs after 10 years
Indications for electroconvulsive therapy (ECT)
Clients with major depressive disorder whose manifestations are not responsive to pharmacological treatment, clients who are suicidal or homicidal and need rapid treatment, clients who are experiencing psychotic manifestations, clients who have schizophrenia with catatonic manifestations, clients who have schizoaffective disorder, clients who are pregnant and have a schizophrenia spectrum disorder, clients who have bipolar disorder with rapid cycling, clients who are unresponsive to treatment with lithium and antipsychotic medications
A nurse is caring for a client who takes PAROXETINE to treat posttraumatic stress disorder. The client states that he grinds his teeth during the night, which causes pain in his mouth. The nurse should identify which of the following interventions as possible measures to manage the client's bruxism? (Select all that apply.)
Concurrent administration of a low‑dose of buspirone is an effective measure to manage the adverse effect of paroxetine. use mouth guard change to different antianxiety med
False imprisonment
Confining a client to a specific area if the reason for such confinement is for the convenience of the staff
Amphetamine withdrawal manifestations
Craving, depression, fatigue, sleeping
Dissociation
Creating a temporary compartmentalization or lack of connection between the person's identity, memory, or how they perceive the environment
Rationalization
Creating reasonable and acceptable explanations for unacceptable behavior
A nurse in a pediatric clinic is caring for a preschool‑age child who has a new diagnosis of adHd. When teaching the parent about this disorder, which of the following statements should the nurse include in the teaching? A. "Behaviors associated with ADHD are present prior to age 3." B. "This disorder is characterized by argumentativeness." C. "Below‑average intellectual functioning is associated with adHd." D. "Because of this disorder, your child is at an increased risk for injury."
D
A nurse is caring for a client who is experiencing a panic attack. Which of the following actions should the nurse take? A. Discuss new relaxation techniques B. Show the client how to change his behavior C. Distract the client with a television show D. Stay with the client and remain quiet
D. During a panic attack, the nurse should quietly remain with the client. This promotes safety and reassurance without additional stimuli. During a panic attack, the client is unable to concentrate on learning new information and further stimuli should be avoided.
A nurse is conducting group therapy with a group of clients. Which of the following statements made by a client is an example of aggressive communication? A. "I wish you could not make me angry." B. "I feel angry when you leave me." C. "It makes me angry when you interrupt me." D. "You'd better listen to me."
D. This implies a threat and a lack of respect for another individual. A, B, & C do not imply threats or indicate a lack of respect.
Alturism
Dealing with anxiety by reaching out to others. Person who lost spouse in fire is a firefighter
Common defense mechanism with substance abuse
Denial
Benzodiazepine
Diazepam lorazepam A minor tranquilizer that controls minor symptoms of anxiety.
Anterograde Amnesia
Difficulty recalling events that occur after dosing
Justice
During a treatment team meeting, a nurse leads a discussion regarding whether or not two clients who broke the same facility rule were treated equally.
Phenelzine---Finding to report
Elevated BP: increases risk for hypertensive crisis This is an MAOI!
Compensation
Emphasizing strengths to make up for weaknesses
Effects of alcohol intoxication
Excess: slurred speech, nystagmus, memory impairment, altered judgment, decreased motor skills, decreased LOC, respiratory arrest, peripheral collapse, and death Chronic: direct cardiovascular damage, liver damage, erosive gastritis and GI bleeding, acute pancreatitis, sexual dysfunction
Gustatory hallucinations
Experiencing tastes
Justice
Fair and equal treatment for all
Behavioral relaxation techniques
Guided Imagery Breathing exercises Progressive muscle relaxation Physical exercise
Veracity
Honesty when dealing with a client
A nurse is assessing a client who recently used cocaine. Which of the following findings should the nurse expect?
Hypertension
Other families
Include children living with related or nonrelated adults who are neither biological nor adoptive parents (grandparents, adult siblings, foster parents)
Blended families
Include children who live with one biological or adoptive parent and a nonrelated stepparent who are married
May feel that her spouse is sexually involved with another individual
Jealousy
school nurse is assessing a school-age child who experienced the traumatic loss of a parent 8 months ago. Which of the following findings should the nurse identify as an indication that the child is experiencing post traumatic stress disorder (PTSD)
Lack of interest in an upcoming holiday R: pt w PTSD will have - moods, child can also have loss or lack of interest and participation in significant activities. negative mood and diff remembering parts of trauma. also diff sleeping, diff concentrating, distressing dreams, detachment and estrangement
Assault
Making a threat to a client's person
Illness anxiety disorder
Misinterprets physical manifestations as evidence of a serious disease process
Side effects of lithium
Nausea, diarrhea, abdominal pain, fine hand tremors, polyuria, mild thirst, weight gain, renal toxicity, goiter and hypothyroidism, bradydysrhythmias, hypotension, electrolyte imbalances, and toxicity
Small group communication
Occurs between two or more people in a small group.
Interpersonal communication
Occurs one-on-one with another individual.
Methadone is indicated for TX of....
Opiate use disorder
What antidepressants are prescribed for psychotic disorders
Paxil -monitor for SI -Notify for deepened depression -Do not stop abruptly
SSRI
Paxil Zoloft Lexapro Prozac Luvox
Psychosocial History
Perception of own health, beliefs about illness and wellness Activity/leisure activities, how the client passes time Use of substances/substance use disorder Stress level and coping abilities - usual coping strategies, support systems Cultural beliefs and practices Spiritual beliefs
Derealization
Perception that environment has changed
Undoing
Performing an act to make up for prior behavior
Schizophrenia
Psychotic thinking x 6 months minimum
A nurse is assessing a client who is experiencing opioid withdrawals. Which of the following manifestations should the nurse expect?
Rhinorrhea
Characterized by emotional detachment, disinterest in close relationships and indifference to praise or criticism; often uncooperative
Schizoid
Schizoaffective disorder
Schizophrenia plus mania or depression
Intellectualization
Separation of emotional and logical facts when analyzing or coping with a situation or event
Intellectualization
Separation of emotions and logical facts when analyzing or coping with a situation or event
Displacement
Shifting feelings related to an object, person, or situation to another less threatening object, person or situation.
Beneficence
The quality of doing good, can be described as charity
Group norm
The way the group behaves during sessions, and, over time, it provides structure for the group
Assault
Threat or attempt to injure
Antiepileptic drugs interactions
Use additional birth control; avoid grapefruit juice
disulfram
alcohol use disorder
Cocaine signs
dilated pupils
cognitive reframing
perceiving things differently
word salad
words are completely meaningless and disorganized
What is Alprazolam used for? ATI Comprehensive NCLEX-RN Review: Mental Health
• Antianxiety ATI Comprehensive NCLEX-RN Review: Mental Health
What SSRIs are used for MDD? ATI Comprehensive NCLEX-RN Review: Mental Health
• Citalopram • Escitalopram ATI Comprehensive NCLEX-RN Review: Mental Health
What is a medication used as an anticonvulsant? ATI Comprehensive NCLEX-RN Review: Mental Health
• Gabapentin ATI Comprehensive NCLEX-RN Review: Mental Health
What is an adaptive use of a defense mechanism? ATI Comprehensive NCLEX-RN Review: Mental Health
• One that allows anxiety to be lowered and goals to be achieved. ATI Comprehensive NCLEX-RN Review: Mental Health
What types of medications are used for major depressive disorder (MDD)? ATI Comprehensive NCLEX-RN Review: Mental Health
• SSRIs • Selective Serotonin Reuptake Inhibitor and Serotonin Receptor Agonist • SNRIs • Norepinephrine Dopamine Reuptake Inhibitor (NDRI) • Tricyclic Antidepressants (TCAs) • Monoamine Oxidase Inhibitors (MAOIs) ATI Comprehensive NCLEX-RN Review: Mental Health
What are types of antidepressants used for clients with anxiety disorders? ATI Comprehensive NCLEX-RN Review: Mental Health
• Selective serotonin reuptake inhibitors (SSRI) • Serotonin norepinephrine reuptake inhibitors (SNRI) • Venlafaxine • Duloxetine • Tricyclics ATI Comprehensive NCLEX-RN Review: Mental Health
Caffeine withdrawal manifestations
Can occur within 24 hr of last consumption; headache, nausea, vomiting, muscle pain, irritability, inability to focus, drowsiness
Mood-stabilizing antiepileptic drugs
Carbamazepine, valproate, lamotrigine; help treat and manage bipolar disorder and prevent relapse of manic and depressive episodes, particularly useful for clients who have mixed mania and rapid cycling bipolar disorders
Displacement
Shifting feelings related to an object, person, or situation to another less threatening object, person, or situation
The client requires vigorous or painful stimuli (pinching a tendon or rubbing the sternum) to elicit a brief response. They might not be able to respond verbally. What is the level of consciousness?
Stuporous
A nurse is caring for a client who is prescribed lithium therapy. The client states that he wants to take ibuprofen for osteoarthritis pain relief. Which of the following statements should the nurse make?
Take aspirin you cant use ibuprofen
A nurse in a mental health facility is planning discharge for a client who has a long history of alcohol use disorder. Which of the following postdischarge activities should the nurse plan to include?
Attending a relapse prevention group several times each week
What are the risk factors of personality disorders?
-comorbid substance use disorders -hx or nonviolent and violent crime -sex offenses -childhood abuse or trauma -development factors with a direct link to parenting -Genetic and Biochemical factors
Adjustment disorder
-depression directly related to stressor -onset with 2 months -lasts < 6 months
termination phase of therapeutic relationship
-discussion -summarize -discuss ways of incorporation of new healthy behaviors -maintain limits
Ris factors for neurocognitive disorder and Alzheimer's disease
-disorder of the neurological system -advanced age -prior head trauma -genetic factors -family history of Alzheimer's disease and or down syndrome
What are cognitive symptoms of psychotic disorders
-disordered thinking -inability to make decisions -poor problem solving ability -difficult concentrating to perform tasks -Memory deficits
Orientation phase of a therapeutic relationship includes what?
-introduction -contract -set goals -build trust -enforce limites
What MAOI's are used for depression
-Nardil
What Atypical antidepressants are used for depression?
-Wellbutrin
Delirium Meds
Antipsychotics or antianxiety meds may be used
Tricyclic Antidepressants
Amitriptyline Imipramine Clomipramine
Wernicke-Korsakoff Expected Finding
Confusion
Mematine is used to treat
Severe alzheimers
B. "It is easier to talk about my feelings now." When clients express their feelings, this indicates a positive treatment outcome.
The nurse is planning care for a client who has depression and has made frequent suicide attempts. Which of the following statements indicates the client has a decreased risk for suicide? A. "I'm relieved now that my financial affairs are in order." B. "It is easier to talk about my feelings now." C. "Suddenly I have enough energy to do anything I want." D. "Thank you for always taking such good care of me."
Adventitious crisis
The occurrence of natural disaster or crimes; people in communities with large scale psychological trauma caused by natural disasters
A nurse is assisting the parents of a school‑age child who has oppositional defiant disorder in identifying strategies to promote positive behavior. Which of the following is an appropriate strategy for the nurse to recommend? (Select all that apply.)
The parents should have a method to reward the child for acceptable behavior. The parents should encourage physical activity through which the child can use energy and obtain success. The parents should set clear limits on unacceptable behavior and should be consistent.
A charge nurse is planning a teaching session regarding the code of ethics for registered nurses. Which of the following information should the nurse include in the teaching?
The right to treatment ensures individualized care
A charge nurse is planning a teaching session regarding the code of ethics for registered nurses. Which of the following information should the nurse include in the teaching
The right to treatment ensures individualized care R: The Hospitalization of the Mentally Ill Act of 1964 requires that pt admitted to an inpatient mental health facility have a right to individualized tx
Silent rape reaction
The survivor does not report or tell anyone of the sexual assault; abrupt changes in relationships with partners, nightmares, increased anxiety during interview, marked changes in sexual behavior, sudden onset of phobic reactions, no verbalization of the occurrence of sexual assault
Acute Battering Phase
The tension becomes too much to bear and serious abuse takes place Victim may try to cover up injuries or may get help
Free association
Therapeutic tool that is the spontaneous, uncensored verbalization of whatever comes to a client's mind
A. The client needs excessive external input to make everyday decisions. Clients who have dependent personality disorder need excessive input from others to make everyday decisions.
While observing group therapy, a nurse recognizes that a client is behaving in a way suggestive of dependent personality disorder. Which of the following behaviors is consistent with this condition? A. The client needs excessive external input to make everyday decisions. B. The client demonstrates a dedication to his job that excludes time for leisure activities. C. The client adheres to a rigid set of rules. D. The client has difficulty starting new relationships unless he feels accepted.
Side effects of buspirone
Dizziness, nausea, headache, lightheadedness, agitation
borderline personality disorder
condition marked by extreme instability in mood, identity, and impulse control
a third party is drawn into the relationship with two members whose relationship is unstable
triangulation
Side effects of alpha agonists
Sedation, drowsiness, fatigue, hypotension, bradycardia, weight gain, nausea, vomiting, constipation, dry mouth
behaviors of countertransference
nurse overly identifies with client nurse competes with client nurse argues with client
Buprenorphine
think phine for opioids withdrawal treatment
believes that her thoughts are heard by others
thought broacasting
believes that others thoughts are being inserted into his mind
thought insertion
Overt Statements in suicide
"I can't take it anymore." "Life isn't worth living anymore." "I wish I were dead." "Everyone would be better off if I died."
Emotional Reasoning
"I know i look bad because I feel bloated"
A nurse is providing teaching to the partner of a client who is in a rehabilitation program for alcohol use disorder. The nurse should identify that which of the following statements by the client's partner indicates an understanding of the teaching
"I will not take charge of my partner's work responsibilities
A nurse is providing teaching for a client who is scheduled to receive ECT for the treatment of major depressive disorder. Which of the following client statements indicates understanding of the teaching?
"I will receive a muscle relaxant to protect me from injury during ECT."
Overgeneralization
"Other girls don't like me because I'm fat"
Personality d/o - Cluster B (dramatic/emotional/erratic)
- Antisocial (disregard for others w/exploitation, lack of empathy, sense of entitlement, manipulative, impulsive, nonadherence to traditional morals/values, charming, engaging - Borderline (instability of affect, identity and relationships) -Histrionic (Emotional attention seeking behavior, flirtatious, seductive) -Narcissistic (Arrogance, grandiose, views of self importance, constant admiration, lack of empathy)
who can ECT be used on?
- MDD - pt that has rapid cycling of acute manic episodes - schizophrenia spectrum disorders that are less responsive to neuroleptic meds such as schizoaffective disorder
Bipolar meds
- Mood stabilizers (Lithium) - Antianxiety (Lorazepam, clonazepam) - Second generation antipsychotic (aripiprazole, clozapine, ziprasidone) - Antidepressants (SSRI, fluoxetine)
disorders that can appear during childhood and adolescence
- depressive - anxiety - trauma/stressor related - substance use - feeding and eating - disruptive, impulse control, and conduct - neurodevelopmental - bipolar and related - schizophrenia spectrum and other psychotic - non-suicidal self-harm and suicidal behaviors - impulse control disorders
What TCA's are used for depression?
-Elavil
Psychotic medications
-First generation/conventional (Haloperidol, Loxapine, Chlorpromazine, Fluphenazine) -Second generation/atypical (Risperidone, Olanzapine, Quetiapine, Ziprasidone, Clozapine) -Third generation (Arpipriazole) -Antidepressants (Paroxetine) -Mood stabililizing/benzo's (Valproate, Lamotrigine, Lorazepam)
Bipolar depressive s/s
-Flat, blunted, labile affect -Tearfulness, crying -Lack of energy, Anhedonia -Pain -Difficulty concentrating/focusing -Self destructive behavior, possible S/I -Decrease in personal hygiene -Loss or increase in appetite
Alzheimer's Moderate Symptoms
-Forgetting events of one's own history -Difficulty performing tasks that require planning/organizing -Difficulty w/ complex mental arithmetic -Personality/behavioral changes -Changes in sleep patterns -Can wander or get lost -Can be incontinent
What is the first line of treatment for anxiety disorders?
-SSRI such as zoloft Then they can also benefit from antidepressants, sedative hypnotic anxiolytics such as valium, non barbiturate anxiolytics such as buspar, beta blockers, antihistamines.
What are the standardized screening tools for Bipolar disorders?
-The mood disorders questionnaire.
What client teaching is needed with a depressive patient that is taking SNRI's
-adverse effects include nausea, weight gain, and sexual dysfunction
cloazapine
-agranulocytosis fatal blood disorder -constipation -weight gain -ortho hypotension
What SSRI's are used for depression?
-celexa -prozac -zoloft
What are the prolonged stress or maladaptive responses?
-chronic anxiety -depression, chronic pain, sleep disturbances -weight gain or loss -increased risk for MI/ Stroke -poor diabetes control, hypertension, fatigue, irritability, decreased ability to concentrate -increased risk for infection
complications of TMS
-mild discomfort -tingling sensation at the site of the electromagnet -lightheadness -seizures are rare but a potential
restraints
-must be specific order (not prn) -one-to-one monitoring -document client behavior q 15 minutes -2 fingers to fit between the restraints
risk factors for cognitive disorders
-parkinson's disease -huntington's disease -hepatic or renal failure -fluid and elctrolyte imbalances -nutritional deficiencys -cardiovascular diseases -infections (HIV/AIDS) -Substance use or withdrawal *More communion older adult clients and clients in and intensive care unit.
A nurse in a mental health unit is admitting a client who is anxious because he often hears voices telling him what to do. Which of the following actions should the nurse take?
Ask the client what the voices are saying R: to determine if the pt or others are at risk for injury
Schizophreniform disorder
The client has manifestations similar to schizophrenia but the duration is 1-6 months and social/occupational dysfunction might not be present
A nurse who is working on a mental health unit should recognize that which of the following are indications for the use of electroconvulsive therapy (ECT)? (Select all that apply
1. Pt who is suicidal and need rapid tx R: ECT is a rapid, definitive response for suicidal pt 2. pt w bipolar d/o w rapid cycling R: works best for these pt 3. pt w mania and not responding to med therapy (ECT for clients with mania and have not responded to medication therapy)
Brief psychotic disorder
The client has psychotic manifestations that last 1 day to 1 month in duration
Transference
Occurs when the client views a member of the health care team as having characteristics of another person who has been significant to the client's personal life
Intrapersonal communication
Occurs within an individual, "Self-talk"
Public communication
Occurs within large groups of people.
A nurse is caring for four clients in an inpatient mental health facility. Which of the following clients can give informed consent a)17 yo who lives with friends b)50yo who has blood alcohol level of .08 c)35yo who has major depressive disorder d)65yo who just received a dose of morphine
35yo who has major depressive disorder (pt w major depressive d/o can make decisions unless legally incompetent) a)not 18 b)intoxicated legally cant d) opiod analgesic makes functionally incompetent due to medication effect on the CNS
Effects of inhalant intoxication
Behavioral or psychological changes, dizziness, nystagmus, uncoordinated movements or gait, slurred speech, drowsiness, hyporeflexia, muscle weakness, diplopia, stupor or coma, respiratory depression, and possible death; no withdrawal manifestations
A nurse is caring for an adult client who has injuries resulting from intimate partner abuse. the client does not wish to report the violence to law enforcement authorities. Which of the following nursing actions is the highest priority? A. advise the client about the location of women's shelters. B. encourage the client to participate in a support group for survivors of abuse. C. implement case management to coordinate community and social services. D. educate the client about the use of stress management techniques.
A
A nurse is caring for an adolescent client who has anorexia nervosa with recent rapid weight loss and a current weight of 90 lb. Which of the following statements indicates the client is experiencing the cognitive distortion of catastrophizing? A. "Life isn't worth living if I gain weight." B. "Don't pretend like you don't know how fat i am." C. "If i could be skinny, i know i'd be popular." D. "When i look in the mirror, I see myself as obese."
A
Ideas of reference
Belief that conversations or actions of others have reference to the client
A nurse who is working on a mental health unit should recognize that which of the following are indications for the use of ECT? SA
A client who is suicidal and in need of rapid treatment A client who had bipolar disorder with rapid cycling A client who had mania and has not responded to medication therapy
B. Determine if the client has been physically harmed. The greatesy risk to this client is injury. Therefore, the priority intervention the charge nurse should take is to determine id the client has injuries that need attention.
A charge nurse enters a client's room and observes an assistive personnel (AP) slapping an older adult client. After moving the client to safety, which of the following actions is the charge nurse's priority? A. Complete an incident report. B. Determine if the client has been physically harmed. C. Provide emotional support to the client. D. Discipline the AP.
A nurse who works with newborns is assessing the potential for abuse or neglect. Which of the following family groups should the nurse identify as the highest potential for future child abuse
A family where one or both parents witnessed intimate partner violence in the home as children R: They are more likely to become abused themselves.
A nurse who works with newborns is assessing the potential for abuse or neglect. Which of the following family groups should the nurse identify as the highest potential for future child abuse a) adolescent parents b)family in which both parents respond indifferently c)family where one or both parents witnessed intimate partner violence in the home as children\ d)family in which one or both parents has dev disability
A family where one or both parents witnessed intimate partner violence in the home as children R: They are more likely to become abused themselves. all risks tho!
A nurse is discussing normal grief with a client who recently lost a child. Which of the following statements made by the client indicates understanding? (Select all that apply) A. "I may experience feelings of resentment." B. "I will probably withdraw from others." C. "I can expect to experience changes in sleep." D. "It is possible that I will experience suicidal thoughts." E. "It is expected that I will have a loss of self-esteem."
A, B, & C. Resentment, withdrawal, and somatic manifestations are associated with normal grief. Suicidal ideations and loss of self-esteem are associated with maladaptive grief.
A nurse is preparing to implement cognitive reframing techniques for a client who has an anxiety disorder. Which of the following techniques should the nurse include in the plan of care? (Select all that apply) A. Priority restructuring B. Monitoring thoughts C. Diaphragmatic breathing D. Journal keeping E. Meditation
A, B, & D. Cognitive reframing utilizes priority restructuring, monitoring thoughts, and journal keeping. Diaphragmatic breathing and meditation are used in behavioral therapy.
A nurse is teaching the parents of a child who has autism spectrum disorder and a new prescription for imipramine about indications of toxicity. Which of the following should the nurse include in the teaching? (Select all that apply) A. Seizures B. Agitation C. Photophobia D. Dry mouth E. Irregular pulse
A, B, & E. Seizures, agitation, and irregular pulse are indications of TCA toxicity. Photophobia and dry mouth are anticholinergic effects.
A nurse is working with a client who has recently lost his mother. The nurse recognizes that which of the following factors influence a client's grief and coping ability? (Select all that apply) A. Interpersonal relationships B. Culture C. Birth order D. Religious beliefs E. Prior experience with loss
A, B, D, & E. Interpersonal relationships, culture, religious beliefs, and prior experience with loss influence a client's grief and coping ability. Birth order does not influence a client's grief and coping ability.
A nurse is preparing to obtain a nursing history from a client who has a new diagnosis of anorexia nervosa. Which of the following questions should the nurse include in the assessment? (Select all that apply) A. "What is your relationship like with your family." B. "Why do you want to lose weight?" C. "Would you describe your current eating habits?" D. "At what weight do you believe you will look better?" E. "Can you discuss your feelings about your appearance?"
A, C, & E. An anorexia assessment should include family and interpersonal relationships, current eating habits, and the client's perception of the issue. B is a "why" question and D promotes cognitive distortion.
A home health nurse is making a visit to a client who has Alzheimer's disease to assess the home for safety. Which of the following suggestions should the nurse make to decrease the client's risk for injury? (Select all that apply) A. Install childproof door locks. B. Place rugs over electrical cords. C. Mark cleaning supplies with colored tape. D. Place the client's mattress on the floor. E. Install light fixtures above stairs.
A, D, & E. Door locks that are difficult to open reduce the risk of the client wandering. Placing the client's mattress on the floor and installing lights above stairs reduce the risk for falls. Rugs are a fall hazard. Cleaning supplies should be in locked cupboards.
A nurse is obtaining a health history from the parents of a 12‑year‑old client who has conduct disorder. Which of the following findings should the nurse expect? (select all that apply.) a. bullying of others b. threats of suicide c. law‑breaking activities d. narcissistic behavior e. flat affect
ABC
A nurse is reviewing the medication administration record for a client who is experiencing the adverse effects of chlorpromazine. The nurse should administer benztropine to relieve which of the following adverse effects
Acute dystonia
A nurse is reviewing the medication administration record for a client who is experiencing the adverse effects of chlorpromazine. The nurse should administer benztropine to relieve which of the following adverse effects?
Acute dystonia
Extrapyramidal side effects
Acute dystonia (severe spasm of the tongue, neck, face, and back), pseudoparkinsonism (bradykinesia, rigidity, shuffling gait, drooling, tremors), akathisia (inability to sit or stand still), tardive dyskinesia (involuntary movements of the tongue and face, arms, legs, and trunk)
Dealing with anxiety by reaching out to others. Ex: a nurse who lost a family member in a fire is a volunteer firefighter
Altruism
Difference between alzheimers and dementia
Alzheimers is progressive forgetfullness and dementia is rapid
tricyclic antidepressants
Amitriptyline Imipramine Doxepin Nortriptyline Amoxapine Trimipramine
Tricyclic antidepressants (TCAs)
Amitriptyline, imipramine, doxepin, nortriptyline, amoxapine, trimipramine; used to treat depressive disorders, neuropathic pain, fibromyalgia, anxiety disorders, insomnia, and bipolar disorder; should not be used in clients who have seizure disorders; should not be used with MAOIs and antihistamines
Bulimia
An eating disorder characterized by episodes of overeating, usually of high-calorie foods, followed by vomiting, laxative use, fasting, or excessive exercise. tooth erosion, hand calluses, hypokalemia monitor patient 1 hour after eating
Panic disorder
An extreme anxiety that manifests itself in the form of panic attacks lasts 15-30 minutes
A nurse in the emergency department is caring for four clients. Which of the following clients is the nurse required to report as a potential victim of abuse?
An older adult client who is bedbound and has a huge stage IV pressure ulcer
A nurse in the emergency department is caring for four clients. Which of the following clients is the nurse required to report as a potential victim of abuse
An older adult client who is bedbound and has a stage IV pressure ulcer R: Stage 4 pressure ulcer in a pt who is bedbound can indicate physical neglect and warrants reporting
A nurse in the emergency department is caring for four clients. Which of the following clients is the nurse required to report as a potential victim of abuse
An older adult client who is bedbound and has a stage IV pressure ulcer R: Stage 4 pressure ulcer in a pt who is bedbound can indicate physical neglect and warrants reporting *any kind of abuse
Tricyclic Antidepressants
Sedation, urinary retention, they lower seizure threshold, uses include BAD, acute panic attacks, phobias, enuresis, and chronic pain and their overdose can be deadly
A nurse is planning care for a newly admitted client who has bipolar disorder. Which of the following is the priority action by the nurse
Provide frequent high-calorie snacks R: Maslow's requirement is for adequate nutrition
A nurse is teaching a client who has intermittent explosive disorder about a new prescription for fluoxetine. Which of the following information should the nurse provide? (Select all that apply) A. An adverse effect of this medication is CNS depression B. Administer the medication in the morning C. Monitor for weight loss while taking this medication D. Therapeutic effects of this medication will take 1-3 weeks to fully develop E. This medication blocks the synaptic reuptake of serotonin in the brain.
B, C, & E. Fluoxetine should be administered in the morning to avoid insomnia, can result in weight loss, and blocks the synaptic reuptake of serotonin. An adverse effect of fluoxetine is CNS stimulation rather than CNS depression. Fluoxetine takes 4 weeks to fully develop therapeutic effects.
A nurse is discussing relapse prevention with a client who has bipolar disorder. Which of the following information should the nurse include in the teaching? (Select all that apply) A. Use caffeine in moderation to prevent relapse B. Difficulty sleeping can indicate a relapse C. Begin taking your medications as soon as a relapse begins D. Participating in psychotherapy can help prevent a relapse E. Anhedonia is a clinical manifestation of a depressive relapse
B, D, & E. Sleep disturbances and anhedonia can indicate a relapse. Psychotherapy is helpful in preventing a relapse. The client should caffeine use and should take prescribed medications to prevent and minimize a relapse.
neglect
Includes the failure to provide the following: Physical care, such as feeding Emotional care, such as interacting with a child, or stimulation necessary for a child to develop normally Education, such as enrolling a young child in school Necessary health or dental care
Effects of opioid intoxication
Slurred speech, impaired memory, pupillary changes, decreased respirations and LOC, and maladaptive behavioral or psychological changes (impaired judgment or social functioning)
A nurse observes a client who has OCD repeatedly applying, removing, and then reapplying makeup. The nurse identifies that repetitive behavior in a client who has OCD is due to which of the following underlying reasons? A. Narcissistic behavior B. Fear of rejection from staff C. Attempt to reduce anxiety D. Adverse effect of antidepressant medication
C. Clients who have OCD demonstrate repetitive behaviors in an attempt to suppress persistent thoughts or urges that cause anxiety.
A nurse is assisting the parents of a school‑age child who has oppositional defiant disorder in identifying strategies to promote positive behavior. Which of the following is an appropriate strategy for the nurse to recommend? (select all that apply.) A. allow the child to choose consequences for negative behavior. B. use role‑playing to act out unacceptable behavior. C. develop a reward system for acceptable behavior.d.encourage the child to participate in school sports. E. be consistent when addressing unacceptable behavior.
CDE
Side effects of MAOIs
CNS stimulation (anxiety, agitation, hypomania, mania), orthostatic hypotension, hypertensive crisis, rash
specific learning disorder
Client demonstrates persistent difficulty in acquiring reading, writing, or mathematical skills. Performance in one or more academic areas is significantly lower than the expected range for the client's age, level of intelligence, or educational level. Clients who have specific learning disorder benefit from an individualized education program (IEP)
Dissociative identity disorder
Client displays more than one distinct personality, with a stressful event precipitating the change from one personality to another.
Delayed or inhibited grief
Client does not demonstrate the expected behaviors of the normal grief process
Conversion disorder
Client exhibits neurologic manifestations in the absence of a neurologic diagnosis
Generalized anxiety disorder
Client exhibits uncontrollable, excessive worry for at least 6 months; impairment in or more areas of functioning
Preassaultive Stage of Violence
Defensive responses to questions Rapid breathing Facial grimacing Agitation
a charge nurse is leading a peer group discussion about family and community violence. Which of the following statements by a member of the group indicates an understanding of teaching?a."Children older than 3 are at greater risk for abuse"B."Substance use disorder does not increase the risk for violence."C."entering an intimate relationship increases the risk for violence."d."Pregnancy increases the risk for violence toward the intimate partner."
D
Common adverse effect of Buspirone
Dizziness
Characterized by extreme dependency in a close relationship with a n urgent search to find a replacement when one relationship ends
Dependent
Benzo IV use include:
Diazepam Lorazepam
Disenfranchised Grief
Entails an experienced loss that cannot be publicly shared or is not socially acceptable, such as suicide
Milieu Therapy
Environment that is supportive, therapeutic, and safe. Pt will learn the tools necessary to cope.
Glasgow Coma Scale
Exam is used to obtain a baseline assessment of a client's LOC. 15= pt is awake and responding appropriately 7= Client is in a coma
A nurse is assessing a client who has generalized anxiety disorder. Which of the following findings should the nurse expect? (Select all that apply.)
Excessive worry for 6 months restlessness need for reassurance
Flooding
Exposing the client to a great deal of undesirable stimulus in an attempt to turn off anxiety response. Most useful for phobias
Acute stress disorder
Exposure to traumatic events causes anxiety, detachment, and other manifestations about the event for at least 3 days but for no more than 1 month following the event (becomes PTSD if it persists longer than 1 month)
Somatic symptom d/o
Expression of psychological stress through physical symptoms and cannot be explained. Risk factors: First degree relative, decreased levels of neurotransmitters, depression, personality d/o, anxiety d/o, childhood trauma, learned helplessness, female 16-25 Tools: PHQ-15 assessment Meds: Analgesis, antidepressants, anxiolytics
economic maltreatment
Failure to provide for the needs of a vulnerable person when adequate funds are available Unpaid bills, resulting in disconnection of heat or electricity
Risk factors for anxiety
Female, family history, acute medical condition, medication adverse effects, substance use/withdrawal
Side effects of bupropion
Headache, dry mouth, GI distress, constipation, increased HR, nausea, restlessness, insomnia, appetite suppression leading to weight loss, seizures at high doses
A nurse in a community health center is counseling a family of two parents and two children. Which of the following statements by a family member indicates manipulative behavior?
If you do my homework for me, I won't bother you for the rest of the day
Effects of amphetamine intoxication
Impaired judgment, psychomotor agitation, hypervigilance, extreme irritability, tachycardia, elevated BP
Schizotypal personality d/o
Impairments of personality functioning
A nurse is caring for a client who has alcoholic cardiomyopathy. Which of the following laboratory findings should the nurse expect
Increased creatine phosphokinase (CPK) R: it is an enzyme released when muscle tissue is damaged
A nurse is educating the parent of a child who has a new diagnosis of autism spectrum disorder. Which of the following manifestations of this disorder should the nurse include in the teaching
Language delay R: typical manifestation
Panic Disorder
Lasts 10-15min w/four or more symptoms present. S/S: Palpitations, SOB, choking, smothering sensation, chest pain, nausea, feelings of depersonalization, fear of dying or insanity, chills or hot flashes, behavior changes or persistent worries.
Early lithium toxicity
Less than 1.5 mEq/L; manifestations: diarrhea, nausea, vomiting, thirst, polyuria, muscle weakness, fine hand tremors, slurred speech, lethargy
A nurse is caring for an older client who begins to cry and states, "I knew God would punish me and I deserve this horrible sickness!" Which of the following responses should the nurse make?
Let's talk about what is upsetting you
The client is able to open their eyes and respond but is drowsy and falls asleep readily. What is the level of consciousness?
Lethargic
How is seasonal depression treated?
Light therapy
Shaken Baby Syndrome findings
May cause intercranial hemorrhage Assess for respiratory distress, bulging fontanelles, increase in head circumference
Neurocognitive Disorder Meds
Medications such as Donepezil (Aricept), Rivastigmine (Exelon) and Galantamine (Razadyne) increase actetylcholine at cholinergic synapses by inhbiting its breakdown by acetylcholinterase, which increases the availability of acteylcholine at neurotransmitter receptor sites in the CNS Adverse effects: nausea & diarrhea which in occur in about 10% of patients Bradycardia
Task role
Members take on various tasks within the group process. An example is the recorder, who takes notes and records what occurs during each session.
Transcranial magnetic stimulation (TMS)
Noninvasive therapy that uses magnetic pulsations to stimulate the cerebral cortex of the brain, indicated for clients with major depressive disorder who are not responsive to pharmacological treatment
Cluster A Disorders
Odd or eccentric traits Paranoid: characterized by distrust and suspiciousness toward others based on unfounded beliefs that others want to harm, exploit or deceive the person Schizoid: characterized by emotional detachment, disinterest in close relationships and indifference to praise or criticism; often uncooperative Schizotypal: characterized by odd beliefs lead to interpersonal difficulties, an eccentric appearance and magical thinking or perceptual distortions that are not clear delusions or hallucinations
Situational/external crisis
Often unanticipated loss or change experienced in every day, often unanticipated, life events
Medications for Anger Management
Olanzapine (Zyprexa) Ziprasidone (Geodon) These are atypical antipsychotics used to control aggressive behavior and impulsive behaviors. These are used more commonly than Haloperidol because of the severity of side effects of Haloperidol Haloperidol is often used...just not as often
Medications to control aggressive and impulsive behaviors
Olanzapine and ziprasidone (atypical antipsychotics; haloperidol (antipsychotic); may also use SSRIs, mood stabilizers, and benzodiazepines
A nurse is planning care for a newly admitted client who has bipolar disorder. Which of the following is the priority action by the nurse a) scheduele the client for group therapy sessions b)maintain consistent rules c)provide frequent high calorie foods d)avoid value judgement
Provide frequent high-calorie snacks R: Maslow's requirement is for adequate nutrition ***no matter what choices always pick whats most important like FOOD
Partial hospitalization programs
Provide intense short term treatment for clients who are well enough to go home every night and who have a responsible person at home to provide support and a safe environment
Requirements for restraining a patient
Provider must prescribe the restraint in writing; time limits are based on age, 4 hr for adults, 2 hr for ages 9-17, 1 hr for age 8 and younger; must be reviewed every 24 hr; documentation must be done every 15-30 min
Delirium
Rapid over a short period of time (hours or days), emergency; impairments in memory, judgment, ability to focus, and ability to calculate (can fluctuate at night); altered LOC, rapid personality changes, labile mood, unstable vital signs; cause unknown
Autonomy
Rather than giving advice to a client who has difficulty making decisions, a nurse helps the client explore all alternatives and arrive at a choice.
Autism expected finding
Repetitive counting
Putting unacceptable ideas, thoughts, and emotions out of conscious awareness. Ex: a person who has a fear of the dentist's drill continually "forgets" his dental appointments.
Repression
Conversion
Responding to stress through the unconscious development of physical manifestations not caused by a physical illness
anorexia nervosa types
Restricting type - drastically restricts food intake and does not binge or purge Binge-eating/purging type - engages in binge eating or purging behaviors
Confabulation
Seen with cognitive disorders Client may make up stories when questioned about events or activities that she does not remember
SSRI
Sertraline paroxetine citalopram first line of treatment for: anxiety OCD depression AE sweating nausea dry mouth drowsiness erectile dysfunction BRUXISM don't take st. johns wort
A nurse is establishing a therapeutic relationship with a client who has antisocial personality disorder. Which of the following strategies should the nurse use when communicating with this client?
Set realistic limits on the client's behavior
A nurse is establishing a therapeutic relationship with a client who has antisocial personality disorder. Which of the following strategies should the nurse use when communicating with this client
Set realistic limits on the client's behavior R: these pt can seem to be in control of their behavior, but are manipulative and impulsive and can suddenly become aggressive and assaultive.
Group Therapy Goals
Share common feelings and concerns Share stories and experiences Diminish feelings of isolation Create community healing/restoration Provide cost effective environment than that of individual therapy.
A nurse is providing care for a client who has bipolar disorder and is experiencing acute mania. The clients morning lithium level is 1.5 mEq/L. Which of the following laboratory findings should the nurse report to the provider?
Sodium level 125 mEq/L
A nurse is providing care for a client who has bipolar disorder and is experiencing acute mania. The client's morning lithium level is 1.5 mEq/L. Which of the following laboratory findings should the nurse report to the provider? (Click on the "Exhibit" button below for additional client information. There are three tabs that contain separate categories of data
Sodium level 125 mEq/l R: In the presence of low Na+ levels, renal excretion of Li is reduced and the pt is at risk for Li toxicity
Compound rape reaction
Some survivors of rape can experience additional disorders as a result of the sexual assault; mental health disorders (depression, substance use); physical disorders (manifestations of a prior physical illness)
Schizotypal personality disorder
The client has impairments of personality (self and interpersonal) functioning but is not as severe as schizophrenia
Termination phase of group development includes:
This makes the end of group sessions -group members discuss termination issues -the leader summarizes work of the group and individual contributions.
Mirtazaprine (Remeron)
This medication increases the release of serotonin and norepinephrine
A charge nurse is developing an educational program about schizophrenia. Which of the following manifestations should the nurse include as a negative symptom of schizophrenia?
Thought blocking
A charge nurse is developing an educational program about schizophrenia. Which of the following manifestations should the nurse include as a negative symptom of schizophrenia
Thought blocking R: thought block is a - symptom of schizo. It is a sudden interruption in pt thought processes usually due to internal stimuli
A charge nurse is developing an educational program about schizophrenia. Which of the following manifestations should the nurse include as a negative symptom of schizophrenia
Thought blocking R: thought block is a - symptom of schizo. It is a sudden interruption in pt thought processes usually due to internal stimuli. client may abruptly stop talking midsentance
Enmeshed boundaries
Thoughts, roles, and feelings blend so much that individual roles are unclear
Battery
Touching a client in a harmful or offensive way
Atypical Antipsychotics
Treat BOTH positive and negative symptoms of schizophrenia Abilify Geodon Zyprexa Seroquel Risperdal Clozaril (Clozapine)
Conventional Antipsychotics
Treat positive symptoms of schizo Haloperidol (Haldol) Loxapine Chlorpromazine (Thorazine) Fluphenazine
The leader completely controls the direction and structure of the group without allowing group interaction or decision making to solve problems
autocratic
positive signs of schizophrenia
concrete thinking (think in abstract terms) echolalia (repeats others words) posturing (client assumes an unusual or illogical position or facial expression. like grimacing
transference
act of projecting intense, unrealistic feelings and expectations from the past onto the therapist
A nurse is reviewing the medication administration record for a client who is experiencing the adverse effects of chlorpromazine. The nurse should administer benztropine to relieve which of the following adverse effects
acute dystonia *benztropine is an anticholinergic agent that relieve acute dystonia which is an extra pyramidal adverse effect of chlorpromazien
A nurse is assessing a school-aged child who has conduct disorder. Which of the following characteristics should the nurse expect the child to demonstrate?
aggression toward animals
A nurse is completing an admission assessment for a client who has schizophrenia. Which of the following findings should the nurse document as positive symptoms? (Select all that apply.)
alterations in speech delusions bizarre motor movements
Believes that a force outside his body is controlling him
being controlled
veracity
being truthful with client and others
reference delusion
belief that objects, events, or other people have particular significance to them
Bipolar somatic delusions
believes body is changing in an unusual way, such as growing a third arm
somatic delusions
believes that his body is changing in an unusual way, such as growing a third arm
what short acting anesthetic is used for ECT
brevital IV bolus
the client has psychotic manifestations that last between 1 day to 1 mont in duration
brief psychotic disorder
atypical antidepressants
buproprion - inhibits dopamine uptake
What are the atypical anxiolytic
buspar
flooding technique
clients put directly into phobic situation
Which of the following manifestations is a common adverse effect of buspirone? a. confusion b. bradycardia c. dizziness d. insomnia
c. dizziness. clients should be informed of this adverse effect and be instructed to avoid driving and operating heavy machinery until the presence of adverse effects is determined
a nurse is admitting a client who has major depressive disorder and a new prescription for tranylcypromine. Which of the following over the counter meds the client reports taking should alert the nurse to a potential adverse reaction? a. lansoprazole b. naproxen c. magnesium hydroxide d. phenylephrine
d. phenylephrine- tranylcypromine is an MAOI antidepressent and over-the-counter medications for sinus congestion, colds, or allergies should not be taken at the same time due to their actions on the SNS than can cause severe hypertension
displacement
psychoanalytic defense mechanism that shifts sexual or aggressive impulses toward a more acceptable or less threatening object or person, as when redirecting anger toward a safer outlet i.e. a client receiving a new terminal diagnosis then begins to yell at staff for not receiving care and that nobody cares about him here
Sublimination
putting bad urges into acceptable social ways (boxing/football)
How often should provider renew restraints perscription
q4 hrs and follow up withing 1st hour of prescribing
pcp signs
rapid eye movement
A nurse is assessing a client immediately following an ECT procedure. Which of the following findings should the nurse expect? (Select all that apply.)
short term memory loss nausea confusion BP elevated
believes that his body is changing in an unusual way, scubas growing a third arm
somatic delusions
