N450 Mental Health Assessment
Isolation
-completely block out feelings, ideas, or impulse from thought process ex: oncology nurse completely isolating and separating emotions related to dying client
Interventions for anxiety
-listen -simple phrases/questions (4-5 words in sentence) -safe environment -establish trust
Schizotypical s/sx
-magical thinking -very odd -interpersonal deficits -socially isolated -odd in appearance and behavior
Risk factors of ADHD
-maternal substance abuse -impaired fetal nutrition -infection or damage to CNS -intra-ventricular bleeds -heavy metal exposure -stress (poverty, illness, family functioning, etc.)
How do you assess a child for depression?
preferably alone -if under 12, interview parent first -for mental healthcare in adolescents, parents are included in the circle of confidentiality -
Anxiety coping mechanisms
projection displacement sublimation repression
Antisocial defense mechanism
projection and manipulation; important to set rules and be consistent
Paranoid defense mechanism
projection: blame shifting
Cocaine defense mechanism
projections and very strong denial
What are some tools available to us as nurses to help us more accurately diagnose depression and anxiety in children?
-child depression rating scale -child depression inventory -state trait anxiety inventory for children
- symptoms of schizophrenia
-anergia: lack of energy -avolition: lack of motivation -poverty of speech: restricted amount of speech and word salad -thought blocking: stops talking in the middle of sentence -anhedonia: loss of pleasure and motivation to achieve things
What is Conduct Disorder?
-antisocial adults -focus on blame -conduct=physical disruptions/violence -"I throw a chair at you for telling me what to do" -harm animals -future serial killers
Generalized Anxiety
-anxiety w/o an identifiable cause resulting longer than 6 months -previously learned coping mechanisms become ineffective
Meds for alcoholism
-ativan: prevent seizures in withdrawal -camperal: reduces alcohol cravings -antibuse: gets them sick if they consume anything with alcohol
What are some non-pharm methods to manage symptoms of ADHD?
-behavioral therapy -routine -no caffeine -lifelong struggle (can decrease over time with increased coping ) -parent training -specialized day care
Failure to thrive
-below 5th percentile -drops weight more than two major percentile groups -help parents work through it
Somatic Symptom disorder
-mental illness presents are physical complaints- over a period of years -no physiologic explanation for symptoms -high level of anxiety about symptoms -peripheral -can lead to substance abuse
Complications of fragile x syndrome
-mitral valve prolapse -hypotonia -flat feet -arched palate
Cocaine withdrawal
-more sleep -huge appetites -body is "catching up" -irritable mood -seizures -hallucinations
Alcohol withdrawal s/sx
-n/v -increase in HR, RR -anxiety ****delirium tremens (related to alcohol withdrawal)- occurs 12-26 hours after they have had their last drink -sweating -hallucinations -seizures
TCAs
-narrow therapeutic index -can be lethal -highly sedative -anticholinergic
What are 2 common antipsychotic medications used for treatment of bipolar?
-olanzapine: successful in treating bipolar by itself -valproic acid: more commonly used
Psychogenic Amnesia
-one or more periods of memory loss of personal information -aware of amnesia -normally follows a traumatic event -localized, selective, generalized(forget entire life), systemized (loss of memory of occupation or family, etc)
What are three factors that can influence a nurse's ability to assess a child's mental health status?
-parents speak for kids -large normal range for kids -environment/strangers
Psychogenic Amnesia with Fugue
-wanders away from normal surroundings -because they forget who they are and what their surroundings are -associated with excessive alcohol consumption -F U im outta here
What are some symptoms of depression demonstrated in the adolescent population?
-weight changes -irritability -loss of interest in activities -sleep insomnia or excessive -more similar to adults - less coping mechanisms than adults
Failure to thrive s/sx
-weight decrease -hypotonia -decreased muscle mass -weakness -avoidance of eye contact and physical touch -repetitive self-stimulating behaviors (hitting head against the wall)
What makes pediatric anxiety different from adult anxiety? What are some symptoms?
-withdrawal -obsessive behaviors -isolation -demanding -excessively picky with food (varies from adults) -irritability -fatigue -insomnia/excessive sleep
Schizoid s/sx
-withdrawn -shy -introverted -lack of social skills like in autism
What are 3 types of psychotherapy
-cognitive-behavioral therapy: helps develop appropriate coping mechanisms and how they react to stressful situations -desensitization: gradually expose them to feared stimuli (porch, driveway, street) -flooding and response prevention: used with OCD and PTSD
Treatment of anxiety disorders
-benzos: safe in overdose; highly addictive; drunk-like symptoms -antihistamines: sedative use; used to treat side effects from antipsychotics -zolpidem/ambien: insomnia, hangover, don't give to elderly -ramelteon/rozerem: long term insomnia treatment; binds to melatonin receptors -buspar: anti-anxiety; short term use
Concerta
-better liked by children -more natural and steady release
Alcoholism s/sx
-blackouts -gastritis -family hx -incoordination -impulsively drink w/o even thinking about it
Involuntary Admission
-brought in -"chaptered" -harm to self or others -unable to care for self -doesn't include alcohol disorientation -retain civil rights unless declared incompetent
How do you converse with a schizophrenic?
-calm -don't argue with delusions
What is the difference between hospitalized and non-hospitalized mental health patients?
-ability to cope with stressors -ability to draw upon available resources and weather life's daily stressors
Avoidant
-afraid of being rejected -avoid relationships even though they want them -low self esteem
Dependent
-always in relationships -rely on others -their wishes and wants are unreasonable -whiny and demanding -like borderline but not as extreme -difficulty making everyday decisions by themselves
What is Oppositional Defiant Disorder?
-"can't tell me what to do" -primarily verbal -no physical disruptions -focus on blame -commonly occurs in ADHD patients
Dissociative Identity disorder
-2 or more distinct personality states within one individual -personalities emerge during stress -result of physical, sexual, or psychological child abuse
What is the average age for a child to receive a dx of ADHD?
-6 years old (when they go to school) -symptoms become more evident
How can ADHD be treated pharmacologically? What are some major concerns with these treatment options?
-Adderall and Ritalin : both stimulants -Ritalin: increases blood glucose -wean off during summer to allow growth (ie holiday) -constipation -SE: growth impaired, sleep issues, wt, appetite decreased -get baseline measurements and monitor -give meds after meals to increase appetite -second dose at lunch if unable to sleep
Four A's
-Affect: flat or blunt; inappropriate -associative looseness: confused thinking -autism: social aspect; not in reality -ambivalence: opposing emotions; difficult to make decisions
What are some physiological defects regarding failure to thrive?
-CNS abnormalities -heart defects -chromosomal disorders -metabolic disorders -infection -poor intrauterine environment
How do we classify Intellectual Disabilities?
-IQ level - less than or equal to 70 in WI -<30: severe learning disability
When do we use seclusion for psychiatric patients? What are some important considerations?
-In emergencies -last resort -must continuously monitor patient -occasionally patients will request it
What are some serious side effects of cocaine use?
-MI -stroke -it's hard on CV system
Interventions for fragile x
-PT/OT -behavioral therapy -medications: hyperactivity, attention span, aggressiveness
Bulimia
-Recurrent binge eating -awareness of abnormal eating pattern -fear of not being able to stop eating voluntarily -depressed mood following eating binges
Symptoms of NMS
-SNS in overdrive -high fever -increased HR -fluctuating BP -increased RR >25 -SOB -agitated -pale -muscle rigidity: arms and abdomen are board-like -increased WBC
Medical problems associated with down syndrome
-congenital heart defect -slowed GI motility -imperforate anus (monitor when they have their first BM) -renal agenesis: kidneys closed off -strabismus -tracheoesophogeal atresia -hypothyroidism -atlantoaxial instability: instability of the cervical spine
Interventions for mania
-decrease stimuli -finger foods -monitor for risk for injury -non-competitive activities
What are the two defining characteristics of Autism Spectrum Disorder?
-deficits in communication= lack of eye contact and aversion of touch -restrictive, repetitive behaviors -swaying, rocking, clapping -delayed, abnormal speech development
Alcoholism defense mechanism
-denial -projection -rationalization -manipulation
When can Trisomy 21 be diagnosed and how? What are some considerations we need to think about as nurses?
-diagnosed at prenatal visit: amniocentesis -otherwise at birth -vaginal birth: facial signs may not appear right away; they have no palmar crease -nurses need to support patients
Coping mechanisms of dissociative disorders
-dissociation: detach from reality -can spontaneously return to consciousness
Interventions for cluster B
-don't feed into it -set boundaries and limits -provide simple choices to empower them because underneath it all their self esteem is poor
What is fagile x syndrome? What is the population most affected by fragile x syndrome? what are some manifestations and characteristics?
-dysfunction w/ x chromosome -long face and eyelids -large testicles -most common issue: mitral valve prolapse -look older than their age -mom is carrier -only in males -ADHD like symptoms -aggression
Panic disorder
-dyspnea -chest discomfort -dizziness -hot or cold flashes -tingling -palpitations -diaphoresis ***peaks at 10 minutes; can last up to 30 minutes
Extrapyramidal symptoms
-dystonia (continuous spasms and muscle contractions), -akathisia (motor restlessness), -parkinsonism (characteristic symptoms such as rigidity), -bradykinesia (slowness of movement), and tremor, and -tardive dyskinesia (irregular, jerky movements).
+ symptoms of schizophrenia
-easier to treat -respond well to meds -hallucinations, delusions, illusions
Interventions for cluster A
-establish trust -be truthful and honest -help them to figure out what causes anxiety
What are some symptoms of anxiety demonstrated in the adolescent population?
-expressions of control (varies from adults) -intentional misbehavior -somatic symptoms -diminished concentration -excessive dependence or isolation
Anorexia Nervosa
-fear of becoming fat -weight decrease by at least 25% original body weight -no known physical illness
Depersonalization including derealization
-feeling detached from surround or surroundings aren't real -temporary loss of ones reality and ability to feel and express emotions -experiences others as unreal, or visually distorted
Describe mania
-feelings of euphoria -impulsive -irrational -spend lots of $$$$$$ -don't want to sit
Panic Attack
-feelings of impending doom -pale -diaphoretic -cool skin
What are some diagnostic characteristics and manifestations?
-flat face -square head -short and lowset ears -slanting eyes -epicanthal folds -excess neck skin -hypotonic muscles: extremely flexible -cryptorchidism: only one teste drops
Alcohol related illnesses
-gastritis -cirrhosis -Korasakoff syndrome (memory loss d/t thiamine deficiency) -wernicke syndrome (encephalopathy) -malnutrition -pancreatitis -neuropathy -electrolyte imbalances
How does IQ factor into the the diagnosis? Does IQ have an effect on nursing care?
-gives an idea of their level of function -functional behaviors effects nursing care (if they can do it for themselves or not)
Ecstasy treatment
-haldol -decanowade is liquid form
Rationalization
-having an acceptable explanation for unacceptable feelings and behaviors ex: a student who did poor on a test blames the instructor for not teaching well
How do you treat it?
-identify triggers -desensitization
Describe ADHD
-impulsiveness -lack of concentration -hyperactivity -misbehavior -can't sit still in class
Side effects of ASD
-increased appetite -weight gain -sedation -hypersalivation -nasal congestions -vomiting
Passive-aggression
-indirectly expressing aggression towards others ex: a nurse is reminded 15 times of the staff meeting and to be on time, but intentionally comes in late
Treatment of childhood depression
-individual family therapy -supportive environment -structure -praise socially positive behaviors -combination of psychotherapy and meds is most effective
Cocaine s/sx
-it's a stimulant -dilated pupils -nosebleeds -nasal congestion -tachycardia -seizures -elevated bp, resp, temp -agitation -hallucinations -anorexia
What is La Belle indifference? What is "primary gain" and "secondary gain"?
-la belle: sick role doesn't bother them -primary: responsibilities are gone -secondary: what they get from the sick role -> attention
Who is outside the circle?
-lawyers -outside therapists -uninvolved students and faculty -law enforcement -family
Cocaine therapy?
-learn triggers -don't put them down
Treatment of NMS
-levadopa carbidopa: increase dopamine -muscle relaxant to prevent muscle injury -bromocytptine: antiparkinsons -lorazepam: sedative/anxiolytic
Neuroleptic Malignant Syndrome (NMS)
-life threatening -caused by anti psychotic adverse reaction because they block the dopamine receptors
Side Effects of antipsychotics
-parkinsonism: 1-4 weeks after treatment initiation: tremors, muscle spasms, rigidity, restlessness -wean off after 3 mo of use -orthostatic hypotension -photosensitivity: skin turns blue with exposure and disappears 6 months after stopping treatment -tardive dyskinesia: lip smacking, tongue movement, pill rolling
Who is inside the circle of trust?
-patient -treatment team -staff supervisors -students and faculty -involved healthcare consultants
Voluntary admission
-patient asks for help -can request discharge but may not be granted if they are a danger to themselves or others -can't leave AMA
When can HIPPA be violated?
-patient is dangerous to self or others -pt is dangerous d/t mental illness -the danger is imminent -danger is targeted at an identifiable individual
Obsessive-Compulsive
-perfectionism -expression of control -obsessions=thoughts -compulsion=acts -inattentive to new viewpoints and facts
PICA
-persistent eating of non-nutritive substances -infants: paint, plaster, cloth -older children: bugs, rocks, sand -adults: chalk, starch, paper -pregnancy: clay, dirt, laundry detergent, baking soda
Treatment of shizophrenia
-phenothiazines (thorazine/vesprin): low potency, less risk of EPS, more sedation, more anti-cholinergic effects -haldol/navane: high potency, high risk of eps, less sedation, more anti-cholinergic effects -oxoindoles (moban): medium potency, elongated QT, less weight gain
Bipolar II
-primarily depression -less severe than type 1 -no impairment in reality
Antisocial
-primarily in males **physically aggressive w/o remorse -manipulative -refuse to conform to social norms -do whatever it takes to get what they want -lie, cheat, steal
Bipolar I
-primarily mania -impairs ability to function in society
Schizophrenia
-profound withdrawal -psychotic disorder -treat with antipsychotics
What is anorexia nervosa? What do nurses need to remember when caring for a patient with anorexia nervosa? What physcial care need to be done for a patient with it?
-provide support through meals -NG tubes if they refuse to eat -Sitter during eating and after -skin integrity -hair falls out
Countertransference
-redirected feelings and behaviors of a psychotherapist toward a client -transference: client directing feeling/attitudes towards psychotherapist
Depersonalization
-see themselves at detached from their own body
Alcoholism tx
-seizure precautions -antianxiety meds -treat the symptoms
Withdrawal symptoms of cocaine
-seizures -impaired movement -hallucinations -anxiety
Narcissistic
-self-centered -self-love -inability to be empathetic -want attention -talks about self -exploit others
Borderline Personality Disorder
-self-harm for attention -because they have a problem with their self identity -demanding -instability in relationships -fears of abandonment -primarily in females -difficulty regulating emotions -impulsive
What can we do to help children with Disruptive Behavior Disorders?
-set limits -rewards and consequences -positive feedback for acceptable behaviors -do not reinforce manipulative behaviors and don't let them get away with it
Interventions for cluster C
-set limits on behaviors -allow independence -encourage socialization -maintain safety -establish trust
Histrionic
-sexual, seductive -dramatic -appearance (dress seductively) to get attention -loud and over-reactive
What makes pediatric depression different from adult depression? What are some symptoms?
-somatic complaints: stomach aches, headaches -withdrawal, separation anxiety
Conversion disorder
-somatic symptom disorder related to **anxiety -nervous about something so it causes paralysis but no physical etiology -common complaints: pain (back, chest, head, pelvis), palpitations, dizziness
Difference between conversion and somatic?
-somatic: physcial -conversion: loss of function
How do we support the families of children with ASD?
-support groups -routines -self care techniques -self injury: biting, head banging, scratching -in hospitalization= allow parent to do as much care as possible to keep routines
Paranoid s/sx
-suspicious -distrustful -project blame -not in touch with reality *can be verbally offensive
SSRIs
-take in the morning -could develop insomnia if take them at night -suppose to increase energy -don't take with st. john's wort
Suicide
-talk about suicide plans a week before, give away possessions, and become happy -most at risk are those who start antidepressants
What can nurses do to help families with children with Disruptive Behavior Disorders?
-teach coping skills -respite care -family therapy -teach them how to discipline
Treatment for conversion disorder
-thought stopping
MAOIs
-tyramine (wine, cheese, beer) -risk for hypertensive crisis if consumed **don't take within 14 days of TCAs or SSRIs
Denial
-unconscious failure to recognize an event, thought or feeling -too painful to recognize -ex. alcoholic pt
What is lithium used for?
-used for mania -normal diet and Na intake -no diuretics -blood monitoring 1300-5,000 mL water
Risperidone
-used to treat schizophrenia, bipolar, and irritability caused by autism -low risk of EPS -weight gain -treats positive AND negative symptoms
What are 8 common manifestations of Schizophrenia? *know these
-word salad : meaningless phrases, made-up and real words -clanging: rhyming words -loose associations: skip from topic to topic (their thought process -neologsms: made up words -echolalia: repeating someone else's words -echopraxia: repeating someone else's movements -depersonalization: feel like they lost their identity; like watching their life as a movie -derealization: feel disconnected from surroundings
Lithium range
0.6-1.4
Lithium maintenance level?
0.8-1.0
The psychiatric nurse is greeted by a neighbor in a local grocery store. The neighbor says to the nurse, "How is Carol doing? She is my best friend and is seen at your clinic every week." Which is the appropriate nursing response? 1. "I cannot discuss any client situation with you." 2. "I'm not supposed to discuss this, but since you are my neighbor, I can tell you that she is doing great!" 3. "You may want to know about Carol, so you need to ask her yourself so you can get the story firsthand." 4. "I'm not supposed to discuss this, but since you are my neighbor, I can tell you that she really has some problems!"
1. "I cannot discuss any client situation with you." The nurse is required to maintain confidentiality regarding clients and their care. Confidentiality is basic to the therapeutic relationship and is a client's right. Option 3 is correct in a sense, but it is a rather blunt statement. Both options 2 and 4 identify statements that do not maintain client confidentiality.
A client is admitted to a psychiatric unit for treatment of a psychotic disorder. The client is at the locked exit door and is shouting, "Let me out! There's nothing wrong with me! I don't belong here!" The nurse identifies this behavior as which? 1. Denial 2. Projection 3. Regression 4. Rationalization
1. Denial Denial is refusal to admit to a painful reality and is treated as if it does not exist. In projection, a person unconsciously rejects emotionally unacceptable features and attributes them to other people, objects, or situations. In regression, the client returns to an earlier, more comforting, although less mature, way of behaving. Rationalization is justifying the unacceptable attributes about oneself.
A young client diagnosed with paranoid schizophrenia is talking with the nurse. "You know, when I thought everyone was out to get me, I was staying in my apartment all the time. Now, I'd like to get out and do things again." What is the best initial response by the nurse? a. "With whom do you want to do things?" b. ""What kind of activities did you enjoy in the past?" c. What kind of transportation do you use?" d. "How much money can you spend?"
B
The nurse in the mental health unit reviews the therapeutic and nontherapeutic communication techniques with a nursing student. Which are therapeutic communication techniques? Select all that apply. 1. Restating 2. Listening 3. Asking the client, "Why?" 4. Maintaining neutral responses 5. Giving advice or approval or disapproval 6. Providing acknowledgment and feedback 6. Providing acknowledgment and feedback
1. Restating 2. Listening 4. Maintaining neutral responses 6. Providing acknowledgment and feedback Some of the therapeutic communication techniques include listening, maintaining silence, maintaining neutral responses, using broad openings and open-ended questions, focusing and refocusing, restating, clarifying and validating, sharing perceptions, reflecting, providing acknowledgment and feedback, giving information and presenting reality, encouraging formulation of a plan of action, providing nonverbal encouragement, and summarizing. Asking why, giving advice, and approving or disapproving are nontherapeutic
The nurse is assigned to care for a client experiencing disturbed thought processes. The nurse is told that the client believes that the food is being poisoned. Which communication technique should the nurse plan to use to encourage the client to eat? 1. Open-ended questions and silence 2. Focusing on self-disclosure regarding food preferences 3. Stating the reasons that the client may not want to eat 4. Offering opinions about the necessity of adequate nutrition
1. Open-ended questions and silence Open-ended questions and silence are strategies used to encourage clients to discuss their problem. Options 3 and 4 do not encourage the client to express feelings. The nurse should not offer opinions and should not state the reasons but should encourage the client to identify the reasons for the behavior. Option 2 is not a client-centered intervention.
Borderline defense mechanisms
1. splitting (views people as all good or all bad 2. displacement: transfer of emotions from past onto another person that triggered you
The client with diagnosed borderline personality disorder tells the nurse, "You're the best nurse here. I can talk to you and you listen. You're the only one here that can help me." Which of the following responses by the nurse is most therapeutic? a. "thank you, you're a good person" b. "All of the nurses here provide good care" c. "other clients have told me that too" d. "mary and sam are good nurses too"
B
A client is admitted to the psychiatric nursing unit. When collecting data from the client, the nurse notes that the client was admitted on an involuntary status. Based on this type of admission, the nurse expects which? 1. The client presents a harm to self. 2. The client requested the admission. 3. The client consented to the admission. 4. The client provided written application to the facility for admission.
1. The client presents a harm to self. Involuntary admission is made without the client's consent. Involuntary admission is necessary when a person is a danger to self or others or is in need of psychiatric treatment or physical care. Options 2, 3, and 4 describe the process of voluntary admission.
Least to most restrictive
1. censorship 2. ability to use money and control resources 3. ability to make decisions of daily life 4. ability to move in space (seclusion) 5. physical restraints
What is required for diagnosis of ASD?
1. deficits in social interaction and communication 2. repetitive behaviors, interests, activities
What are the 3 ways that depression is caused?
1. genetics: dst test is an indirect marker of depression 2. biogenic: serotonin 3. exogenous reasons: death, relationships, stress
Explain the 4 S's 1. Safety 2. Support 3. Structure 4. Symptom management
1. move others away from patient and position yourself between patient's and the door 2. therapeutic communication, normal eye contact, remain calm 3. following policies and protocols, routines, set limits on phone time and dress code 4. medications, therapies, calming techniques
Risk factors of childhood depression
1. parental depression (3-4 x more likely to develop it) 2. depressive symptoms 3. prior depression (many will experience relapse within 5 years of intial dx)
lithium level when treating someone in mania who doesn't have a hx?
1.0-1.4
At what age can you provide consent?
14 years old
How soon do effects of cocaine ware off?
15-20 minutes after taken -withdrawal immediately
Treatment of suicide
1:1 supervision at first; no more than an arms length away -treat the depression
The nurse is providing care to a client admitted to the hospital with a diagnosis of anxiety disorder. The nurse is talking with the client, and the client says, "I have a secret that I want to tell you. You won't tell anyone about it, will you?" Which is the appropriate nursing response? 1. "No, I won't tell anyone." 2. "I cannot promise to keep a secret." 3. "If you tell me the secret, I will tell it to your doctor." 4. "If you tell me the secret, I will need to document it in your record."
2. "I cannot promise to keep a secret." The nurse should never promise to keep a secret. Secrets are appropriate in a social relationship but not in a therapeutic one. The nurse needs to be honest with the client and tell the client that a promise cannot be made to keep the secret.
The nurse enters a client's room, and the client immediately demands to be released from the hospital. On review of the client's record, the nurse notes that the client was admitted 2 days ago for treatment of an anxiety disorder and that the admission was a voluntary admission. The nurse reports the findings to the registered nurse (RN) and expects that the RN will take which action? 1. Call the client's family. 2. Contact the health care provider (HCP). 3. Persuade the client to stay a few more days. 4. Tell the client that discharge is not possible at this time.
2. Contact the health care provider (HCP). Rationale: Generally, voluntary admission is sought by the client or client's guardian. Voluntary clients have the right to demand and obtain release. The best nursing action is to contact the HCP. Option 1 violates client confidentiality. Option 3 is not therapeutic or appropriate. Option 4 does not apply to a voluntary admission status.
A housekeeping staff member in a mental health unit reports to the nurse that food was found hidden in a client's room. Knowing that the client was admitted with a fluid and electrolyte imbalance because of anorexia nervosa, the nurse should ask housekeeping personnel to: 1. Point this out to the client and remove the food 2. Keep the nursing staff informed if this happens again 3. Disregard this because it is common behavior of clients with anorexia 4. Keep a record of when this happens and report to the nursing staff weekly
2. Keep the nursing staff informed if this happens again Keeping the nursing staff informed indicates that housekeeping members are part of the health team and their input is valued; this will help keep lines of communication open.
The nurse in a psychiatric unit is assigned to care for a client admitted to the unit 2 days ago. On review of the client's record, the nurse notes that the admission was a voluntary admission. Based on this type of admission, the nurse should expect which? 1. The client will be angry and will refuse care. 2. The client will participate in the treatment plan. 3. The client will be very resistant to treatment measures. 4. The client's family will be very resistant to treatment measures.
2. The client will participate in the treatment plan. Rationale: Generally, voluntary admission is sought by the client or client's guardian. If the client seeks voluntary admission, the most likely expectation is that the client will participate in the treatment program. Options 1 and 3 are not likely for a client seeking voluntary admission. Option 4 is not centered on the individual client.
Laboratory work is prescribed for a client who has been experiencing delusions. When the laboratory technician approaches the client to obtain a specimen of the client's blood, the client begins to shout, "You're all vampires. Let me out of here!" The nurse present at the time should respond by stating which? 1. "The technician will leave and come back later for your blood." 2. "What makes you think that the technician wants to hurt you?" 3. "Are you fearful and think that others may want to hurt you?" 4. "The technician is not going to hurt you but is going to help."
3. "Are you fearful and think that others may want to hurt you?" Option 3 is the only option that recognizes the client's need. This response helps the client focus on the emotion underlying the delusion but does not argue with it. If the nurse attempts to change the client's mind, the delusion may, in fact, be even more strongly held. Options 1, 2, and 4 do not focus on the client's feelings.
A client says to the nurse, "I'm going to die, and I wish my family would stop hoping for a 'cure'! I get so angry when they carry on like this! After all, I'm the one who's dying." Which therapeutic response should the nurse make to the client? 1. "Have you shared your feelings with your family?" 2. "I think we should talk more about your anger with your family." 3. "You're feeling angry that your family continues to hope for you to be 'cured'?" 4. "Well, it sounds like you're being pretty pessimistic. After all, years ago people died of pneumonia."
3. "You're feeling angry that your family continues to hope for you to be 'cured'?" Reflection is the therapeutic communication technique that redirects the client's feelings back to validate what the client is saying. In option 2, the nurse attempts to use focusing, but the attempt to discuss central issues is premature. In option 4, the nurse makes a judgment and is nontherapeutic in the one-on-one relationship. In option 1, the nurse is attempting to assess the client's ability to openly discuss feelings with family members. Although this may be appropriate, the timing is somewhat premature and closes off facilitation of the client's feelings.
The nurse is preparing a client for the termination phase of the nurse-client relationship. Which task should the nurse appropriately plan for this phase? 1. Plan short-term goals. 2. Identify expected outcomes. 3. Assist in making appropriate referrals. 4. Assist in developing realistic solutions.
3. Assist in making appropriate referrals. Tasks of the termination phase include evaluating client performance, evaluating achievement of expected outcomes, evaluating future needs, making appropriate referrals, and dealing with the common behaviors associated with termination. Options 1, 2, and 4 identify the tasks of the working phase of the relationship.
The nurse leading a group session for parents of children diagnosed with oppositional defiant disorder. The nurse should give which of the following recommendations for discipline? a. avoid limiting the child's use of the tv and computer for punishment b. be consistent with discipline while assiting with ways for the child to more positively express anger and frustration c. use primarily positive reinforcement for good behavior while ignoring any demonstrated bad behavior d. use time-out as the primary means of pounishment for the child regardless of what the child has done
B
The nurse is assigned to care for a client admitted to the hospital after sustaining an injury from a house fire. The client attempted to save a neighbor involved in the fire, but despite the client's efforts, the neighbor died. Which action should the nurse take to enable the client to work through the meaning of the crisis? 1. Identifying the client's ability to function 2. Identifying the client's potential for self-harm 3. Inquiring about the client's feelings that may affect coping 4. Inquiring about the client's perception of the cause of the neighbor's death
3. Inquiring about the client's feelings that may affect coping The client must first deal with feelings and negative responses before the client is able to work through the meaning of the crisis. Option 3 pertains directly to the client's feelings. Options 1, 2, and 4 do not directly address the client's feelings.
Which represents a primary characteristic of an autism spectrum disorder? 1. Normal social play 2. Consistent imitation of others' actions 3. Lack of social interaction and awareness 4. Normal verbal and nonverbal communication
3. Lack of social interaction and awareness A primary characteristic of an autism spectrum disorder is a lack of social interaction and awareness. Social behaviors include a lack of or an abnormal imitation of others' actions and a lack of or abnormal social play. Additional characteristics include a lack of or impaired verbal communication and markedly abnormal nonverbal communication.
An intoxicated client is brought to the emergency department by local police. The client is told that the health care provider (HCP) will be in to see the client in about 30 minutes. The client becomes very loud and offensive and wants to be seen by the HCP immediately. The nurse assisting to care for the client should plan for which appropriate nursing intervention? 1. Watch the behavior escalate before intervening. 2. Attempt to talk with the client to de-escalate the behavior. 3. Offer to take the client to an examination room until he or she can be treated. 4. Inform the client that he or she will be asked to leave if the behavior continues.
3. Offer to take the client to an examination room until he or she can be treated. Rationale: Safety of the client, other clients, and staff is of prime concern. Option 3 is in effect an isolation technique that allows for separation from others and provides a less stimulating environment where the client can maintain dignity. When dealing with an impaired individual, trying to talk may be out of the question. Waiting to intervene could cause the client to become even more agitated and a threat to others. Option 4 would only further aggravate an already agitated individual.
Sublimation
Negative ideas he will channel through more socially acceptable ways; aggressive kid becomes a boxer
Can patients in mental health facilities leave freely?
No
The nurse is assisting with the data collection on a client admitted to the psychiatric unit. After review of the data obtained, the nurse should identify which as a priority concern? 1. The client's report of not eating or sleeping 2. The presence of bruises on the client's body 3. The client's report of self-destructive thoughts 4. The family member is disapproving of the treatment
3. The client's report of self-destructive thoughts The client's thoughts are extremely important when verbalized. Self-destructive thoughts are the highest priority. Options 1, 2, and 4 will all affect the treatment of the client but are not of greatest importance at this time.
How soon can withdrawal begin?
4-6 hours after
Following a group therapy session, a client approaches the nurse and verbalizes a need for seclusion because of uncontrollable feelings. The nurse reports the findings to the registered nurse (RN) and expects that the RN will take which action? 1. Call the client's family. 2. Place the client in seclusion immediately. 3. Inform the client that seclusion has not been prescribed. 4. Get a written prescription from the health care provider (HCP) and obtain an informed consent.
4. Get a written prescription from the health care provider (HCP) and obtain an informed consent. Rationale: A client may request to be secluded or restrained. Federal laws require the consent of the client unless an emergency situation exists in which an immediate risk to the client or others can be documented. The use of seclusion and restraint is permitted only on the written prescription of the health care provider (HCP), which must be reviewed and renewed every 24 hours, depending on state law requirements. It must also specify the type of restraint to be used.
La Belle indifference
A condition in which the person is unconcerned with symptoms caused by a conversion disorder.
How long can a psychiatric Emergency hospitalization last?
72 hours -not including weekends or holidays
What blood alcohol levels indicate legal, intoxication, tolerance and dependence, and lethal?
>0.10% Intoxication legal 0.08-0.1% >0.21% but functioning = tolerance and dependence >0.35% lethal
The nurse meets with the mother of a child diagnosed with ADHD. The mother states, "I feel so guilty that he has this disease, like I did something wrong. I feel like I need to be with him constantly in order for him to get better. But still sometimes I feel like I'm going to lose control and hurt him." The nurse should suggest which of the following to the mother? a. arranging for respite care to watch her child and give herself a regular break b. taking a job to allow herself to feel some success because her child won't ever improve c. arranging to have coffee with friends daily as a way to begin a support group d. considering foster care if she feels that she can't handle her child's problems
A
When comparing the s/sx of depression found in children with those found in adults, which of the following should the nurse expect? a. adults commonly display sad behaviors, while children have more somatic complaints and possible acting-out behaviors b. adults have more problems performing in the work setting than children have in performing in the school setting c. adults typically will not be able to function at work and at home but children continue to succeed in school activities while depressed d. adults usually have few major problems while functioning with depression, while children usually cannot function at school or with tasks at home
A
Introjection
A type of identification in which the individual incorporates the traits or values of another into himself or herself ex: son talks to people the same way as his dad
What do patient's with conduct disorder likely also have?
ADHD
Repression
An unconscious process in which the client blocks undesirable and unacceptable thoughts from conscious expression
A client reports having thoughts of being followed by foreign agents who are after his secret papers. Which response by the nurse is most appropriate when responding to the client's disturbed thought process? a. "I don't see any foreign agents" b. "I think these thoughts are frightening to you" c. "I don't know what you mean" d. I'd like you to come to group with me right now"
B
When a client is about to lose control, the extra staff who come to help commonly stay at a distance from the client unless asked to move closer by the nurse who is talking to the client. Which of the following best explains the primary rationale for staying at a distance initially? a. the client is more likely to act out if there is an audience b. the nurse talking to the client makes the decisions about other staff actions c. the client is likely to perceive others as being closer than they are and feel threatened d. when the extra staff is visible, the client is less likely to regain self-control
C
Which of the following responses to anger from others should the nurse expect as common in clients? a. increased self-esteem b. feelings of invulnerability c. fear of harm d. powerlessness
C
Which chapter requires an annual review?
Chapter 55
Why is it important to treat ADHD?
Children are more likely to abuse substances later in life if their ADHD goes untreated
A client loses control and throws two chairs toward another client. What should the nurse do next? a. ask the client to go to the quiet area and talk about the behavior b. administer an oral tranquilizer and prepare for a show of determination c. process the incident with the client and discuss alternative behaviors d. use restraints and administer an IM tranquilizer
D
When planning the care of a client expressing aggression, the nurse incorporates the principle of "least restrictive alternative," meaning that less restrictive interventions must be tried before more restrictive measures are employed. Which of the following measures should the nurse consider to be the most restrictive? a. tension reduction strategies b. haloperidol given orally c. voluntary seclusion or time out d. haloperidol given IM
D
Sublimation
Replacement of an unacceptable need, attitude, or emotion with one more socially acceptable ex: an extremely self-conscious woman becomes a model
What do you always need in order to place a patient in restraints?
Doctor's order
How do you respond to them when they say someone is trying to hurt them?
Don't tell them they are wrong, but rather say " that must be really scary"
What is a more common name for trisomy 21?
Down Syndrome
Undoing
Engaging in behavior that is considered to be opposite of a previous unacceptable behavior, thought, or feeling ex: someone thinks about being violent towards someone, but in turn is overly nice to them
Intellectualization
Excessive reasoning to avoid feelings ex: understands in a very informative way the process of alcoholism but still calls in as being ill
Displacement
Feelings about one person are directed to another who is less threatening, thereby satisfying an impulse with a substitute object ex: coming home and kicking the dog
Fantasy
Fixation: Never advancing to the next level of emotional development and organization; the persistence in later life of interests and behavior patterns appropriate to an earlier age
Chapter 880
Governs guardianship of persons who are declared mentally incompetent
Explain the Tarasoff Decision and who does it affect?
It means that the nurse has a duty to warn a person if a threat is made against them; effects the intended victim
Battery
Physical
Compensation
Putting forth extra effort to achieve in areas where one has a real or imagined deficiency.
Conversion
Putting forth extra effort to achieve in areas where one has real or imagined deficiency.
What rights do mental health patients retain? What rights do they lose?
Retain all civil rights expect for the right to leave at any time (in patient) -Outpatient retain all rights
Regression
Returning to an earlier developmental stage to express an impulse to deal with anxiety
Disassociation
The blocking off of an anxiety-provoking event or period of time from the conscious mind -usually a result from traumatic/stressful events
Symbolization
The conscious use of an idea or object to represent another actual event or object; many times the meaning is not clear because the symbol may be representative of something unconscious
Suppression
The conscious, deliberate forgetting of unacceptable or painful thoughts, ideas, and feelings
Substitution
The replacement of a valued unacceptable object with an object that is more acceptable to the ego
Identification
The unconscious attempt to change oneself to resemble an admired person ex: a teenage girl dresses and acts like her favorite celebrity
Why is knowing a patient's history vital in promoting the least restrictive environment?
To avoid them becoming combative; could push them into illusions from past seclusion experiences
Projection
Transferring one's internal feelings, thoughts, and unacceptable ideas and traits to someone else ex: a patient finds a nurse very attractive, but in turn tells their family that the nurse is extremely into them
Assault
Verbal-threat of harm
Insulation
Withdrawing into passivity and becoming inaccessible to avoid further threatening situations
Can a patient who is hallucinating give informed consent?
Yes
Can patients in mental health facilities have visitors?
Yes
Can patients in mental health facilities vote?
Yes
Can patients in mental health facilities refuse treatment or medications?
Yes, unless it's court ordered
A 7 year old client is diagnosed with conduct disorder. After admission, the nurse identifies his problematic behaviors as cruelty to animals, stealing, truancy, aggression with peers, lying, and explosive angry outbursts resulting in destruction of property. The nurse is now talking with the client about his behavioral contract, which should include which crucial components? select all that apply a. taking all prescribed meds b. acceptable methods for expressing anger c. consequences for unacceptable behaviors d. rules for interacting with staff and other clients e. personal possessions allowed on the unit
a, b, c, d
A client is taking diazepam (valium) for generalized anxiety disorder. Which instruction should the nurse give to this client? Select all that apply a. To consult with his HCP before he stops taking the drug b. to avoid eating cheese and other tyramine-rich foods c. to take the medication on an empty stomach d. not to use alcohol when taking this drug e. to stop taking the drug if he experiences swelling of the lips and face and difficulty breathing
a, b, e tyramine is MAOIs
Who should you not restrain?
abuse/rape victims, circulatory or respiratory patients
Serotonin Syndrome, what is noticed first?
altered mental status noticed first; hyperactive reflexes
What do you also need to treat with when treating with lithium?
anticonvulsants
What other meds are used for treatment of bipolar?
antipsychotics and antidepressants
Cluster C
anxious and fearful -avoidant, dependent, OCD
Cluster B
associated with low self esteem
A client who is neatly dressed and clutching a leather briefcase tightly in his arms scans the adult inpatient unit on his arrival at the hospital and backs away from the window. The client requests that the nurse move away from the window. The nurse recognizes that doing as the client requested is contraindicated for which of the following reasons? a. the action will make the client feel that the nurse is humoring him b. the action indicates nonverbal agreement with the client's false ideas c. the client will then think that he will have his way when he wishes d. the nurse will be demonstrating a lack of composure over the situation
b
The physician refers a client diagnosed with somatization disorder to the outpatient client because of problems with nausea. The client's past symptoms involved back pain, chest pain, and problems with urination. The client tells the nurse that the nausea began when his wife asked him for a divorce. Which of the following is most appropriate? a. asking the client to describe his problem with nausea b. directing the client to describe his feelings about his impending divorce c. allowing the client to talk about the physciians he has seen and the meds he has taken d. informing the client about a different med for his nausea
b
Which bipolar disorder are people with high socioeconomic status more likely to have?
bipolar 1
The nurse is with the parents of a 16 year old boy who recently attempted suicide. The nurse cautions the parents to be especially alert for which of the following in their son? a. expression of a desire to date b. decision to try out for an extracurricular activity c. giving away valued personal items d. desire to spend more time with friends
c
Other treatment for panic attack
calm approach, role modeling, breathing
Example of shizoid
computer programmer who only has relationship with his computer
What type of therapy do you use for alcoholism?
confrontation; don't ignore it
S/Sx of thiamine deficiency
confused, bad balance
A client diagnosed with pain disorder is talking with the nurse about fishing when he suddenly reverts to talking about the pain in his arm. Which of the following should the nurse do next? a. allow the client to talk about his pain b. ask the client if he needs more pain meds c. get up and leave the client d. redirect the interaction back to fishing
d
Ego dystonic
doesn't match behaviors: OCD
What does ecstasy put you at risk for?
electrolyte imblance
How often do you check restraints?
every hour; remove every 2 hours
Cluster A
paranoid, schizoid, schizotypical
Emergency Detention
ex: suicide -law enforcement officer can take a person into custody whom they believe may be at harm to themselves or others -we have 24 hours to assess them -cannot be detained for more than 72 hours (not including weekend or holiday) -at least 3 people can petition for someone to be involuntarily admitted -if probable cause exits, hearing is scheduled within 14 days of ED -2 physicians, at least 1 psychiatrist, or 1 MD with one licensed psychologist needs to examine pt
What is melingering?
faking an illness or disability in order to get what they want -not go to work
delusions
false fixed beliefs (I'm Jesus)
Agoraphobia
fear of public places -scared to have another panic attack in public
down's syndrome
hair: sparse eyes: inner epicanthal folds with short sparse lashes mouth: protruding tongue and arched palate muslces: hypotonic hands: short, stubby fingers; simian crease head: small face: flat nose: small with depressed bridge (saddle nose) ears: small, low set neck: broad and short abdomen: protruding genitalia: small penis and cryptorchidism
CAFE
initial assessment for alcohol dependence
Define therapeutic milieu
interactions and environmental (nurse with pt, art therapy, group discussions, and an environment with natural light and soothing colors)
Reaction Formation
laughing at a funeral; opposite of what you would expect
What is tardive dyskinesia?
lip smacking and pill rolling
Define the main objective of the Wisconsin Chapter 55
long-term protective services applicable populations: elderly, mentally disabled -may be voluntary or involuntary
Interroseptive conditioning
lowering dizziness response from anxiety by teaching to spin in a circle
CIWA
measures severity of withdrawal -if CIWA hits 15, give prn meds
illusion
misinterpretation of existing stimuli
Side effects of lithium
n/v diarrhea thirst polyuria seizures coma
Define the main objective of the Wisconsin Chapter 51
no loss of civil rights; to pull people into psychiatric institutions that are a danger to themselves or others
What kind of therapy do you want along with medications for depression?
psychotherapy
Redirecting or scolding/discipline to use when somebody has bipolar?
redirecting
Echopraxia
repetition of another person's movement
Medications for ASD
risperidone (nasal decongestant) aripiprazole (vomiting) antipsychotics
Mental Retardation
routine, repetition, reinforcement
Hallucinations
sensory w/o stimuli
What can alcohol lead to?
substance abuse
What is the 3rd leading cause of death in adolescents?
suicide *more common in females; most commonly use pills
Alcoholism leads to encephalopathy because:
thiamine deficiency
Ego syntonic
thoughts and self perception match behaviors (antisocial personality disorder)
OCD defense mechanism
undoing: attempt to feel better, less anxious, and more in control
Dilectical Behavior Therapy
used to identify negative thinking patterns and turn them positive
Treatment of tardive dyskinesia
vitamin E and anticholinergics
What races are at higher risk of getting ADHD?
white and black children
Is seclusion a restraint?
yes
