NCLEX Mental Health

Conduct Disorder

✓ Conduct disorder (CD) is often a precursor to antisocial personality disorder (ASPD), which can be diagnosed at age 18. ✓ CD symptoms are typically more severe than oppositional defiant disorder (ODD) directed towards others and involve theft or deceit, potentially leading to criminality. ✓ Clinical features of CD include an individual who fails to adhere to societal norms, engages in harmful acts towards others, or damages property. The individual is often deceptive and may be truant from school and steal items or money. ✓ Nursing care involves setting limits, providing positive reinforcement, supervising clients who may harm others, establishing a behavioral contract, and ignoring attention-seeking behavior. ✓ No medication is available to treat CD to ASPD; psychotherapy is the primary treatment.

Grandeur Delusions

✓Delusions of grandeur involve believing that one possesses exceptional abilities, wealth, knowledge, or importance far beyond reality. ✓Delusions of grandeur can vary in content and nature. Some may believe they are a famous person, a deity, or have connections to influential individuals or secret societies. Others may think they have extraordinary talents or abilities that surpass those of others. ✓Delusions of grandeur can be a symptom of various mental health conditions, including schizophrenia, bipolar disorder (during manic episodes), and other psychotic disorders. ✓Delusions of grandeur can significantly impact a person's daily life, relationships, and overall functioning. These beliefs may lead to difficulties in social interactions, strained relationships, and impaired judgment in decision-making. ✓Treatment for delusions of grandeur typically involves a combination of pharmacotherapy and psychotherapy. Antipsychotic medications may be prescribed to manage underlying psychotic symptoms. ✓Psychotherapy, such as cognitive-behavioral therapy (CBT), can help individuals challenge and modify their distorted beliefs, improve coping strategies, and enhance overall functioning.

A nurse in a substance abuse treatment facility is admitting a client who is experiencing acute alcohol withdrawal. Which of the following findings should the nurse expect? A. Hand tremors B. Slurred speech C. Bradycardia D. Hypotension

Correct Answer: A. Hand tremors Course tremors of the hands is an expected finding of alcohol withdrawal. Incorrect Answers: B. Slurred speech is an expected finding of alcohol intoxication, not alcohol withdrawal. C. Tachycardia, not bradycardia, is an expected finding of alcohol withdrawal. D. Hypertension, not hypotension, is an expected finding of alcohol withdrawal.

Milieu Therapy

✓ Hildegard Peplau referred to the therapeutic milieu as an all-inclusive term that recognizes the people (clients and staff), the setting, the structure, and the emotional climate as essential to healing. ✓ Whether the setting involves treating children with psychotic disorders, adult clients in a psychiatric hospital, clients with substance use disorder in a residential treatment center, or clients in a day treatment program. The milieu therapy aims to offer clients a sense of security and promote healing. ✓ The nurse can help maintain the therapeutic milieu by Minimizing disruptions in the unit through appropriate client placement Rendering culturally sensitive care Selecting appropriate activities that meet both the physical and mental needs Using the least restrictive environment

Medications for Opioid Disorder

✓ Treatment for opioid use disorder includes naltrexone, methadone, or buprenorphine ✓ These medications have proven efficacy in this disorder, and when combined with counseling and appropriate monitoring, they may assist a client in attaining opioid abstinence ✓ Approach the client with empathy and a non-judgmental attitude. Show support for their commitment to recovery and encourage open communication.

A client with newly diagnosed end-stage renal disease was transferred to the behavioral health unit after being found in the bathroom attempting suicide using hospital gown ties. What action by the nurse is priority at this time? 1.Assign the client a private room near the nurses' station 2.Explore the client's feelings about the diagnosis 3.Initiate continuous one-to-one observation 4.Perform a mental status examination

A client who has attempted suicide is at significantly high risk for another attempt. The priority nursing action is to create an environment of safety by initiating one-to-one observation until the client is stabilized. Continuous observation allows for a trained staff member to monitor and document the client's mood, behavior, and location, all of which will greatly reduce the risk for self-harm behaviors. Closely observing the client will also convey a sense of empathy and concern and allow the client to express feelings (Option 3). Additional nursing interventions for clients at high risk for suicide include: 1. Removing harmful objects from the client's environment (eg, belts, ties, blankets). Meal trays should be free of metal utensils and glass because these items can be used for self-harm behaviors. 2. Performing mouth checks to ensure the client swallows medications completely because clients may hoard medications and attempt to overdose on them later.

Vital Concept: Bowlby's Grief Stages

A client who is grieving might not go through these stages of grief smoothly; there is commonly back-and-forth behavior between the stages. One day, a client might begin to accept the loss, and the next day, the client might experience a feeling of disorganization. It is necessary for the nurse to be aware of these stages and use effective interventions based on the client's needs, including when to listen, when to provide hands-on care, and when to offer guidance.

Family Dynamics: Coalition

A coalition is a secret or semi-secret alliance between two family members against another family member. Nothing in the observation indicates that the involved child is in an alliance (or coalition) with another, as this child was invited into this conflict by one of the parents in an attempt to triangulate the other.

Anorexia Nervosa

Anorexia nervosa can be a life-threatening eating disorder. This eating disorder is characterized by an intense fear of weight gain, restriction of food take that causes a significantly low weight, and a distorted self-perception. Anorexia nervosa may also feature binging and purging. The key distinguishing factor between anorexia nervosa and bulimia nervosa is the abnormally low BMI in anorexia. The primary treatment of anorexia nervosa is psychotherapy with potential augmentation with olanzapine.

Family Dynamics: Triangulation

This inappropriate family dynamic is when a parent involves a child in a conflict with one another, and the child either acts as a mediator or is asked to take sides. Another example is when one parent does not communicate with another and asks the child to send messages through the child.

The nurse is reinforcing teaching about oral hydrocortisone for a client with newly diagnosed primary adrenal insufficiency (ie, Addison disease). Which of the following information should the nurse reinforce? Select all that apply. 1."Discontinue hydrocortisone if you have mood changes or disruptions in behavior." 2."Report even a low-grade fever to the health care provider immediately." 3."Report signs of hyperglycemia, including increased urine, hunger, and thirst." 4."The dose of hydrocortisone may need to be increased during times of illness or injury." 5."This medication should be taken on an empty stomach to enhance absorption."

Adrenal glands are responsible for producing hormones that regulate the body's stress response, metabolism, fluid and electrolyte balance, and immune system. Damage or destruction to the adrenal glands leads to chronic adrenal insufficiency (ie, Addison disease) and the hypofunction of hormones, including mineralocorticoids (eg, aldosterone) and glucocorticoids (eg, cortisol). Clinical manifestations include hypotension, hypoglycemia, weight loss, and muscle weakness. Management of primary adrenal insufficiency includes long-term oral glucocorticoid replacement (eg, prednisone, hydrocortisone). Medication teaching reinforcement by the nurse should include: 1. Reporting signs and symptoms of infection (eg, fever) immediately. Oral corticosteroids can cause immunosuppression, placing the client at risk for infection (Option 2). 2. Contacting the health care provider if increased urination, hunger, and thirst occur which would indicate rising blood glucose, because corticosteroids may cause glucose intolerance (Option 3). 3. Increasing the dose of hydrocortisone as prescribed during times of stress (eg, illness, injury) and before surgery (Option 4).

Defense Mechanism: Projection

Attributing one's feelings, thoughts, or actions to other

Borderline Personality Disorder

BPD has a defense mechanism of splitting where they may view an individual(s) as all good or all bad. Devaluation, splitting, denial, and projection are common defense mechanisms used in this disorder. Suicide is a priority assessment for any client ✓ A borderline personality disorder is about five times more common in first-degree biological relatives with the same disorder compared with the general population ✓ This disorder is characterized by the individual having an unstable self-image, fear of rejection, impulsivity, and emotional dysregulation ✓ A key intervention for a client with BPD is to assess for suicidality ✓ Parasuicide is common with this personality disorder; however, it is essential to keep this client safe ✓ Defense mechanisms commonly seen in this personality disorder include splitting, projective identification, and denial ✓ Treatment is therapy, specifically dialectal behavioral therapy, which focuses on emotional regulation and strategies to respond to stressors in a mature way ✓ No medication is approved to treat any personality disorder

The nurse has reinforced teaching with a client who has anxiety and a new prescription for alprazolam. Which of the following statements by the client would indicate a correct understanding of the teaching? 1."I can continue to take my prescribed muscle relaxant as needed." 2."I can omit the medication on days when I do not feel anxious." 3."I should eliminate aged cheese and processed meats from my diet." 4."I will discontinue the medication and notify my health care provider if I become pregnant."

Benzodiazepines (eg, alprazolam, clonazepam) are central nervous system (CNS) depressants that work by potentiating the effect of gamma-aminobutyric acid (GABA). GABA is a powerful inhibitory neurotransmitter in the brain that decreases the excitability of neurons, producing a sedative effect. As a result, benzodiazepines are effective in treating anxiety, insomnia, and seizure disorders. If pregnant or trying to become pregnant, the client should stop taking benzodiazepines because these medications can cause birth defects (eg, floppy baby syndrome) (Option 4).

Vital Concept: Bipolar I Disorder

Bipolar disorder type 1 is characterized by alternating periods of depression and mania. Mania is characterized by periods of time where the client's mood is abnormally and persistently elevated, expansive, or irritable PLUS impairment in social or occupational relationships; need for hospitalization to prevent harm; or psychosis. The symptoms cannot be due to substance use or another medical condition. Symptoms of mania include Inflated self esteem, decreased need for sleep, pressured speech, "flight of ideas," distractibility, need to fulfill goal oriented activities; psychomotor agitation; and excessive involvement in pleasurable activities with the potential for harm. Activities appropriate for clients experiencing an acute manic episode include those that provide an outlet for excess physical energy and activities that require a short amount of time and minimal concentration, attention to detail, and adherence to rules. Inappropriate activities for a client with mania include activities that require the use of social skills, teamwork, or cooperation with others.

Bulimia Nervosa

Bulimia nervosa is an eating disorder characterized by an individual binging and purging. An individual usually consumes a large number of calories and may experience a sense of revulsion, triggering them to purge. An individual may also abuse laxatives and diuretics and engage in excessive exercise. Fluoxetine is the only approved medication indicated in the treatment of this eating disorder.

The nurse has reinforced medication instruction to a client who has been prescribed methadone for opioid use disorder. Which of the following statements, if made by the client, would indicate a correct understanding of the instructions? Select all that apply. "I will need counseling while taking this medication." "I will need periodic blood tests while on this medication." "This medication may lower my risk for Hepatitis C." "This medication will send me into opioid withdrawals." "I may get drowsy while taking this medication." Submit Answer

Choices A, B, C, and E are correct. Methadone is an efficacious medication used in the treatment of opioid use disorder, chronic pain, and in the treatment of neonatal abstinence syndrome. This medication requires close monitoring and counseling for opioid use disorder. Periodic blood tests are required as this medication may be hepatotoxic. This medication has been shown to decrease the transmission of blood-borne pathogens such as HIV and Hepatitis C. This is because the reduction of intravenous drug use decreases the risk of the transmission of these pathogens. Drowsiness is a common side effect of this medication as it is an opioid agonist.

Defense Mechanism: Sublimination

Channeling negative energy or emotions into more productive, positive, or acceptable behaviors

The nurse is caring for assigned clients. The nurse should initially A. administer prescribed antibiotics to a client with bacterial meningitis. B. reposition a client with chronic back pain who reports pain rated 6/10 on the Numerical Rating Scale. C. remove a nitroglycerin transdermal patch for a client with chronic angina. D. collect data on a client who had a coronary artery bypass grafting (CABG) three days ago and has a serum glucose of 135 mg/dL [70-110 mg/d].

Choice A is correct. Bacterial meningitis has a high mortality rate and requires aggressive and prompt antibiotic treatment. The nurse should prioritize this client because this is a serious, acute concern that may result in death. Prescribed ceftriaxone and vancomycin are the preferred antibiotics in treating this pathogen. Choice B is incorrect. This client is not a priority because the client's concern is chronic. The nurse must prioritize acute, life-threatening problems over tasks such as repositioning for a chronic illness. Choice C is incorrect. Removing a nitroglycerin patch for a client with chronic angina is routine. The client receiving transdermal nitroglycerin needs a nitro-free period to avoid developing a tolerance. Again, this task is for a client with a chronic condition. Choice D is incorrect. Following a CABG, the client has a target glucose between 110-180 mg/dL. If the client should exceed 180 mg/dL, this has been shown to decrease healing time and compromise outcomes. This client's glucose level is acceptable, considering the standard after this surgery is to have a glucose level of less than 180 mg/dL. The stress of this surgery increases glucose levels which causes the client to receive prescribed insulin for several days following the surgery.

The licensed practical/vocational nurse (LPN/VN) reviews the assigned tasks. Which tasks would be appropriate for the LPN/VN to complete? Select all that apply. Reinforcing the discharge instructions to the client Adjusting of a client's cervical traction as ordered by the provider Obtaining a fecal occult blood sample from a client with ulcerative colitis. Performing an admission assessment for a client newly admitted with sepsis Administering the prescribed influenza vaccine

Choice A is correct. Reinforcing teaching and validating a client's understanding is within the scope of an LPN/VN. Choice B is correct. LPNs can adjust cervical traction based on healthcare providers' orders. LPNs can also apply and remove cervical collars for stable spinal injury clients. Choice C is correct. Collecting a stool sample and other procedures (inserting an indwelling urinary catheter, administering enteral feedings, and performing tracheostomy care) is within the scope of an LPN/VN. Choice E is correct. LPNs often give immunizations, such as influenza, hepatitis B, or tetanus shots, as part of routine immunization programs or as needed based on a client's medical history and requirements.

The nurse supervises a novice nurse interviewing a client with a borderline personality disorder. Which client statement would demonstrate the client using transference? A. "You are just like my mother bothering me with these questions." B. "Instead of breaking objects, I have joined a kickboxing class." C. "I cannot be an alcoholic because I still go to work every day." D. "I told my boyfriend if he leaves me, I will kill myself."

Choice A is correct. This is an example of transference. In transference, the client's unconscious feelings toward a healthcare worker come to the surface that originally stems from someone else. For instance, if a client starts to have hostility towards the healthcare worker because they reminds them of a family member with whom they had (or have) a negative relationship. The client bringing up their mother and pinning it on the healthcare worker exemplifies transference. Choice B is incorrect. The client's choice to join a kickboxing class instead of engaging in destructive behavior reflects the use of sublimation, which is a positive defense mechanism. Sublimation involves channeling unacceptable impulses or emotions into more socially acceptable and constructive activities. Choice C is incorrect. The client's denial of alcoholism is a reflection of the defense mechanism of denial, where individuals refuse to acknowledge the reality of a situation as a way to cope with emotional conflicts or distress. Choice D is incorrect. This statement reflects a form of manipulation, a behavior that can be associated with borderline personality disorder. Individuals with this disorder may use manipulative tactics to control or influence others in their relationships.

The nurse is discussing time management with a new nurse. Which of the following nursing actions reflects effective time management? A. The nurse asks the client what their priority is to accomplish each day. B. The nurse includes a "nice to do" for every "need to do" task on the list. C. The nurse "front-loads" the schedule with "must-do" priorities. D. The nurse avoids helping other nurses if scheduling does not permit it.

Choice A is correct. This option involves a proactive approach to understanding the client's priorities. By seeking input from the client, the nurse can incorporate their preferences into the overall plan of care, potentially streamlining tasks and focusing on what matters most to the client and balancing that amongst medical necessity. This aligns with effective time management by tailoring the care plan to meet both the client's needs and the nurse's responsibilities.

The nurse is evaluating a client with a binge eating disorder. The nurse understands which other comorbidity is commonly found with this disorder? A. Disorganized behavior B. Depression C. Fear of abandonment D. Perfectionism

Choice B is correct. Individuals who binge eat are more likely to have depression (and/or anxiety) than those who do not. Therefore, following this client admitting to binge eating, the nurse should screen this client for depression and suicidal ideation. Depression associated with the binge-eating disorder could be linked to their body image; however, other causes may be evident. Choice A is incorrect. Disorganized behavior, specifically disorganized speech or thoughts, are symptoms associated with schizophrenia spectrum disorders, not binge eating. Binge eating disorder is more closely associated with patterns of overeating and loss of control during eating episodes rather than disorganized behavior. Choice C is incorrect. Fear of abandonment is not typically identified as a common comorbidity with binge eating disorder. This fear is more commonly associated with certain personality disorders, such as borderline personality disorder, rather than binge eating disorder. Choice D is incorrect. Perfectionism is a symptom typically associated with an obsessive-compulsive personality disorder or anorexia nervosa. Depression is more consistently recognized as a prevalent comorbidity in individuals with binge eating disorder.

The nurse is precepting a student nurse on the medical-surgical unit. The student collects a blood sample from a patient with TPN infusing. Which action by the student nurse would require immediate intervention by the nurse? A. The student flushes the port with saline prior to collecting blood. B. The student accesses the non-infusing port to obtain the blood sample. C. The student draws up 10 mL of blood, clamps the line, and discards the syringe. D. The student uses an alcohol swab to clean the port.

Choice B is correct. TPN solutions are administered via a central line in order to reduce the risk of phlebitis and allow for rapid dilution. Even if a second port is available, the student nurse should stop the infusion for at least one minute prior to obtaining a blood sample to avoid aspirating fluids such as glucose and electrolytes which will give inaccurate results if the sample is drawn while TPN is running. Choice A is incorrect. Flushing the line ensures any infusing solution is cleared from the line, this should be done before and after accessing the port. Saline flushes may be used alone or followed by a heparin solution. Choice C is incorrect. The student nurse should withdraw 5 mL of blood, clamp the line, discard the syringe containing the blood in a puncture-proof container, then obtain the blood sample with a new syringe. Drawing up 10 mL of blood would be more than necessary, but would not warrant immediate intervention and could be addressed after the procedure is completed. Choice D is incorrect. The student nurse should use an alcohol swab (70% isopropyl alcohol) to clean the port and allow it to air dry before using it. Some facilities may use an alcohol/chlorhexidine disinfectant, but without that information provided, this action would be appropriate.

The nurse is developing a plan of care for a child with severe conduct disorder. The nurse should plan to Select all that apply. anticipate a prescription for stimulant medications. set limits that change based on the nurse that is assigned to the client. construct a behavioral contract between the client and the nurse. have the child to apologize to any individuals harmed by their behavior. ignore any attention seeking behavior. supervise any physical activity with other children.

Choice C is correct. A behavioral contract between the child and the nurse (can be verbal or written) is an effective way of promoting agreement and limit setting. The contract should discuss behavioral expectations, consequences for undesired behavior, and rewards for good behavior. The contract should be updated as necessary. Choice D is correct. Having the child make simple restitution for their bad behavior is essential. This creates a self-awareness that others (or property) have suffered because of the child's poor conduct. This includes having the child fix the destroyed property and appropriately apologizing to individuals harmed by poor conduct. Creating self-awareness may assist with the individual recognizing the harm of their actions. Choice E is correct. Attention-seeking behavior should be ignored. As long as the behavior is attention-seeking, the nurse should ignore the behavior so the child does not get any additional gain from that particular behavior. This should be coupled with positive reinforcement for acceptable and improved behavior. Choice F is correct. Because this child's conduct disorder is severe, the child should be supervised while engaging with other children. A child with conduct disorder may engage in behavior that causes harm to others. The nurse should prioritize safety.

The licensed practical/vocational nurse (LPN/VN) has attended a staff development conference on milieu therapy. Which of the following statements would indicate effective understanding? A. This type of environment is established in inpatient treatment facilities, emphasizing physical well-being. B. This therapy primarily focuses on helping clients develop emotional connections with individuals in the community. C. An emphasis of this therapy is the setting, the structure, and the emotional climate as important to the client's healing. D. The approach to milieu therapy is unstructured and allows clients to self-regulate what they feel should be allowed.

Choice C is correct. The cornerstone of milieu therapy is to provide an all-inclusive (staff and clients) structured environment that fosters routine, safety, and acceptance. This environment enables healing and promotes positive outcomes. Choices A, B, and D are incorrect. This type of therapy is not limited to inpatient facilities. This therapy may be established and maintained both inpatient and outpatient. Additionally, milieu therapy is holistic and focuses not just on physical well-being. This therapy aims to provide a safe, structured environment that promotes client healing - not establishing emotional connections with individuals in the community. The approach of the therapeutic milieu is to have structure and consistency that regulates the environment. This allows the client to feel productive, gain self-esteem, and problem-solve.

The nursing student inserts an indwelling urinary catheter for a female client prior to surgery. Which of the following would require immediate intervention by the nurse? A. The client states that she feels the need to urinate. B. The patient reports a pinching sensation as the catheter is advanced. C. The student nurse notes resistance when inflating the balloon. D. The student separates the labia majora and labia minora with the non-dominant hand.

Choice C is correct. This may indicate the balloon is within the urethra, not the bladder. If inflated within the urethra, the balloon may cause significant damage. Any complaints or nonverbal signs of discomfort or resistance are noted by the nurse during balloon inflation and are indications to stop this procedure immediately.

The emergency department nurse (ED) prepares to care for a client with severe anxiety. The nurse anticipates that the client will demonstrate A. limited problem solving and decreased attentiveness. B. heightened perceptual field and is aware of the anxiety. C. a narrowed perceptual field and ability to discuss past coping mechanisms. D. the inability to problem solve and has a sense of impending doom.

Choice D is correct. Severe anxiety may lead to physical exhaustion if prompt intervention is not obtained. Severe anxiety is marked by - Greatly reduced and distorted perceptual field Focuses on details or one specific detail Attention is scattered Inability to problem solve The feeling of impending doom Choice A is incorrect. Mild anxiety allows for effective problem-solving, whereas severe anxiety, as described, is associated with the inability to problem-solve. The reduction in the perceptual field during severe anxiety goes beyond limited problem-solving, encompassing a state where learning and problem-solving become nearly impossible. Choice B is incorrect. This choice still describes characteristics more aligned with heightened anxiety or mild anxiety. In severe anxiety, the perceptual field is greatly reduced, and the person may not be fully aware of the environment or able to engage effectively in learning and problem-solving. Choice C is incorrect. While individuals with severe anxiety may have a narrowed perceptual field, the ability to discuss past coping mechanisms may be compromised at this level.

The nurse is triaging phone calls in the prenatal clinic. The nurse should initially follow-up on the client who is A. 16 weeks of gestation and reports a fluttering sensation B. 30 weeks of gestation and reports perianal itching and bright red blood in the stool C. 28 weeks of gestation and reports intermittent leg cramping with swelling in her feet D. 38 weeks of gestation and reports lower back pain that increases with walking

Choice D is correct. These manifestations indicate that the client may be beginning labor. True labor manifestations include contraction patterns of increasing frequency, duration, and intensity. The contractions tend to increase with walking and may start in the lower back and gradually sweep around to the lower abdomen. Considering the client's gestational age and manifestations, this client requires immediate follow-up. Choice A is incorrect. The fluttering sensation is quickening (when the client first experiences the sensation of the baby). Quickening tends to occur between 16-20 gestational weeks. This is an expected finding that does not require follow-up. Choice B is incorrect. Perianal itching and bright red blood in the stool are manifestations of hemorrhoids. Hemorrhoids are common in pregnancy, especially in the third trimester, because of increased venous congestion and pregnancy-related constipation. Choice C is incorrect. Intermittent leg cramping and foot swelling are common in pregnancy, especially at night. Having the client elevate her feet and have a magnesium, sodium, and calcium-rich diet may alleviate the cramping. At-home exercises may be helpful, such as instructing the client to stand and apply pressure on the affected leg with the knee straight.

The nurse is planning care for a client with a borderline personality disorder. The nurse recognizes that the client will likely demonstrate which defense mechanism? Select all that apply. Splitting Sublimation Altruism Projection Conversion

Choices A and D are correct. Severe impairments in functioning characterize borderline personality disorder. Its major features are marked instability, impulsivity, identity or self-image distortions, unstable mood, and unstable interpersonal relationships. Splitting is a hallmark manifestation of this disorder in which an inability to view both positive and negative aspects of others as part of a whole, results in viewing someone as either a wonderful person or a horrible person. Projection is also a cardinal defense mechanism for this disorder in which an individual unconsciously rejects emotionally unacceptable features and attributes them to others. Choice B is incorrect. Sublimation is a defense mechanism where unacceptable impulses are transformed into socially acceptable actions or behaviors. It is not typically associated with borderline personality disorder. Choice C is incorrect. Altruism involves meeting the needs of others, often to the detriment of one's own needs. This is not a characteristic defense mechanism of borderline personality disorder. Choice E is incorrect. Conversion involves the expression of psychological distress through physical symptoms without a clear organic cause.

The nurse is collecting data on a client with dependent personality disorder. Which of the following would be an expected finding? Select all that apply. Difficulty with decision-making Flamboyant behaviors Intense and unstable relationships Avoiding social relationships Feels helpless when alone

Choices A and E are correct. Individuals with this personality disorder manifest difficulty with decision-making and initiating projects. Choice B is incorrect. Flamboyant behaviors and provocative dressing are hallmark characteristics of histrionic personality disorder. Choice C is incorrect. Intense and unstable relationships are a cardinal manifestation of borderline personality disorder. Choice D is incorrect. Avoiding social relationships and situations is a finding with avoidant personality disorder.

Which of the following clients would be most appropriate to assign to the LPN? Select all that apply. A client receiving antibiotics for lower extremity cellulitis. A client newly admitted with an exacerbation of myasthenia gravis. A client with a chest tube receiving mechanical ventilation. A client requiring a referral for an outpatient support group. A client needing to receive intramuscular RhoGAM. A patient needing scheduled tube feedings and colostomy irrigations.

Choices A and F are correct. When making client assignments, the LPN should be assigned to the stable client with a predictable outcome. A client receiving antibiotics for lower extremity cellulitis is a low acuity illness and may be cared for by the LPN. Scheduled tube feedings and colostomy irrigations are within the scope of an LPN, and this can be delegated.

What should the nurse look for when evaluating a 2-year-old client for possible neglect? Select all that apply. Poor hygiene Frequent unexplained injuries Malnourishment or extreme hunger Developmental delays Frequent illnesses

Choices A, B, C, and D are correct. A is correct. Poor hygiene: Neglected children may exhibit poor personal hygiene, such as unwashed hair, dirty or soiled clothing, or strong body odor. This is a correct option because neglect can result in inadequate care and maintaining the child's cleanliness. B is correct. Frequent unexplained injuries: Neglected children may have a higher incidence of injuries, including bruises, cuts, or fractures. These injuries may be left untreated or unexplained. This is a correct option because neglect can result in a lack of supervision and protection, leading to increased risks of accidents and injuries. C is correct. Malnourishment or extreme hunger: Neglected children may display signs of malnourishment, such as being significantly underweight or having a distended belly. They may also exhibit extreme hunger, constantly seeking food or appearing excessively hungry during meals. This is a correct option because neglect can result in inadequate nutrition and lack of access to regular meals. D is correct. Developmental delays: Neglected children may experience physical, cognitive, or social-emotional developmental delays. They may have difficulties with speech, motor skills, or social interactions compared to children of the same age. This is a correct option because neglect can hinder a child's growth and development due to a lack of stimulation, attention, and appropriate caregiving. Choice E is incorrect. E is incorrect. Frequent illnesses: This is an incorrect option. While neglected children may be at a higher risk of health problems due to poor living conditions or lack of medical care, frequent illnesses alone may not be a reliable indicator of neglect. Other factors need to be considered, such as the child's overall health, exposure to germs, and access to healthcare.

The nurse is collecting data on a client with delirium. Which of the following would be an expected finding? Select all that apply. Impaired insight into illness Difficulty with executive functioning Altered level of consciousness Emotional lability Insidious onset of symptoms

Choices A, B, C, and D are correct. Delirium has an abrupt onset of symptoms that include - Impairments with attention that fluctuate in intensity Difficulty with insight, judgment and executive functioning Memory impairments Altered level of consciousness Emotional lability Causes of delirium include fluid and electrolyte imbalances, infection, medications, sensory alterations, or substance use (intoxication/withdrawal).

Which of the following are components of the definition of critical thinking? Select all that apply. Reasoned thinking Openness to alternatives Adherence to established guidelines Ability to reflect Loyalty to traditional approaches Desire to seek the truth

Choices A, B, D, and F are correct. Critical thinking is a combination of reasoned thought, openness to alternatives, the ability to reflect, and a desire to seek the truth. There are many definitions of critical thinking. It is a complex concept, and people think about it in different ways. Any situation that requires critical thinking is likely to have more than one "right" answer. You do not need critical thinking to add 2 + 2 and come up with the solution. However, you do need critical thinking for problem-solving essential decisions. A crucial aspect of critical thinking is the process of identifying and checking your assumption. This is also a necessary part of the research process. Critical thinking is a combination of reasoned thought, openness to alternatives, the ability to reflect, and a desire to seek the truth.

The LPN is reinforcing education regarding advance directives with the client. Which of the following statements are not true regarding advance directives? Select all that apply. Only one physician must determine when a client is unable to make medical decisions for himself. Advance directives must be reviewed and re-signed every ten years to remain valid. Emergency Medical Technicians (EMTs) cannot honor advance directives unless a doctor has signed them. An advance directive is legally valid in every state, no matter which state it was initially created. An advanced directive can be revoked at any time if the client changes their mind, just by verbally saying so

Choices A, B, and D are correct. These statements are not true and, therefore the correct answers to the question. Once a client arrives at a hospital, physicians will need to evaluate the client and implement the advance directive, if necessary. Two physicians, not one (Choice A), are required to determine whether a client cannot make decisions for themself. Advance directives do not expire and remain in effect until they are changed. It is not true that they need to be signed every ten years to stay valid (Choice B). Some states do not honor advance directives created in other states. So, if a client moves, he/she should check with his/her new state policies on the topic (Choice D).

The nurse is triaging a client who reports a sexual assault. Which actions should the nurse take? Select all that apply. Interview the client in a private room Refer the client to support groups Allow the client to be alone to promote problem-solving Record verbatim statements in the medical record Repeat questions previously answered

Choices A, B, and D are correct. When caring for a client who has been sexually assaulted, the nurse must maintain a private environment to allow for the client to be forthcoming with their answers. Support groups are quite influential in the recovery process, and it would be wise for the nurse to provide these at discharge. Accurate documentation is essential in cases of sexual assault. Recording verbatim statements in the medical record helps ensure that the client's account is documented accurately for legal and medical purposes.

The nurse is caring for a client experiencing a manic episode with delusions of grandeur. Which of the following nursing interventions is appropriate for this client? Select all that apply. Maintain a calm environment. Set clear, consistent limits. Limit the amount of finger food and snacks provided to the client. Ignore the client's behavior until the delusion passes. Promote safety measures.

Choices A, B, and E are correct. A is correct. Reducing stimuli can help decrease the client's hyperactivity and distractibility. B is correct. Due to impulsivity during manic episodes, the client may benefit from clear, consistent boundaries. This should be done respectfully and firmly. E is correct. Due to impulsive behaviors and poor judgment, the client may be at risk for harm. Ensure a safe environment to prevent injury.

The nurse is admitting a new client to an acute psychiatric facility and determines that they have suicidal ideations. Which of the following questions should the nurse ask this client? Select all that apply. "Do you have a plan?" "Does anyone know about your plan to kill yourself?" "What is your plan?" "Do you have the means or methods to carry out your plan?" "Have you attempted suicide previously?"

Choices A, C, D, and E are correct. A is correct. "Do you have a plan?" is one of the first questions a nurse should ask any suicidal client after confirming the client is having thoughts of killing themselves. Clients with concrete ideas are much more likely to attempt suicide than clients who do not have a plan. C is correct. "What is your plan?" is another critical question a nurse asks a suicidal client. D is correct. This question will depend on what the client tells you about their plan for committing suicide. For example, if they say they plan to shoot themselves, the appropriate question is, "Do you have a gun?" This is of the utmost importance for the client's safety. If they do have a gun or whatever item is needed to carry out their suicide plan, the nurse needs to have it confiscated immediately to keep them safe. E is correct. Asking about a client's previous suicide attempts is essential because previous suicide attempts may enhance the credibility of the client's current ideation. This is a pertinent question to ask the client.

The nurse is caring for a client with Borderline Personality Disorder. Which of the following actions should the nurse take? Select all that apply. Assess the patient for suicide Encourage independent decision-making Establish therapeutic boundaries Refer the patient for therapy Encourage social relationships

Choices A, C, and D are correct. Individuals with Borderline Personality Disorder (BPD) often engage in self-harm/parasuicide behaviors in which the intent is not death. These gestures may be superficial cutting, etc. All clients should be assessed for suicide regardless of their diagnosis. Therapeutic boundaries should be established as a characteristic of this personality disorder is polarizing individuals and splitting. Referring the client for therapy is one of the cornerstone treatments for BPD.

The nurse is caring for a client who is demonstrating signs of aggression. The nurse should plan to take which action? Select all that apply. Use therapeutic touch Use genuineness and empathy Use a calm, clear tone of voice Talk with the client in a closed private room Give several clear options Respond as early as possible

Choices B, C, E, and F are correct. For a client demonstrating aggression, the nurse should respond quickly and calmly approach the client. The nurse should limit inflections in their voice to decrease the perception of aggression. The nurse should also maintain personal distance between themselves because if this escalates, the nurse has an appropriate distance from themselves and the client. Providing the client with several options is helpful as it decreases the client's feeling of powerlessness.

The nurse in the mental health unit is collecting data on a client with moderate anxiety. The nurse would anticipate which signs and symptoms to support this finding? Select all that apply. increased pulse feeling of impending doom reports of headache narrowing of the perceptual field inability to problem-solve or learn hyperventilation

Choices A, C, and D are correct. Moderate anxiety is characterized by a client experiencing - Narrowing of the perceptual field Slightly scattered thought process The client can problem-solve and learn, although not at an optimal level Somatic symptoms such as headache, urinary urgency, and muscle tension Sympathetic symptoms such as an increased pulse, respiratory rate, palpitations, voice tremors, and shaking Choices B, E, and F are incorrect. These manifestations align with severe anxiety. In severe anxiety, the client cannot engage in any problem solving and the somatic symptoms, such as headache and muscle tension, intensify The perceptual field is grossly narrowed, and the client may require directions because they may be dazed The thought process is not linear and significantly impaired The client may report signs of impending doom or dread Hyperventilation and tachycardia are commonly present Nursing care for severe anxiety is to remain with the client and be prepared to provide short, simple directions. Performing breathing exercises and providing reassurance. Prescriptive treatments such as hydroxyzine or diazepam may be warranted.

The nurse is working with a client who suffers from obsessive-compulsive disorder (OCD). The client has an obsession with the dangers of germs and performs compulsive hand washing hundreds of times per day. Which of the following should the nurse include in this client's treatment plan? Select all that apply. Create a schedule for the hand washing ritual. Teach about the dangers of over washing their hands. Incorporate meditation into their daily schedule. Block the sink so the client is not tempted to wash their hands. Administer fluoxetine as ordered.

Choices A, C, and E are correct. A is correct. Creating a schedule is one of the most critical aspects of treatment for clients with OCD. In this schedule, it is essential to allow time for the ritual - not allowing time for the compulsive activity will dramatically increase anxiety. C is correct. Adding time for mediation into the daily schedule is an appropriate intervention. Meditation is an excellent coping mechanism and can be added to replace some of the handwashing. E is correct. Selective serotonin reuptake inhibitor (SSRI) medications are commonly used to help clients manage compulsive behaviors. Examples of SSRIs include fluoxetine, fluvoxamine, and sertraline.

The nurse is putting together a community health presentation about the signs and symptoms of depression to promote awareness of the disease and educate the public. Which of the following signs and symptoms should the nurse include? Select all that apply. Social withdrawal or isolation. Flight of ideas. Looseness of associations. Sleep disturbances Persistent sadness or low mood

Choices A, D, and E are correct. A is correct. Withdrawing from social activities, avoiding friends or family, or isolating oneself can be a symptom of depression. Anhedonia is a common symptom of depression. It is defined as the loss of pleasure in usually pleasurable things. D is correct. Sleep disturbances are a common symptom of depression. Clients can experience a range of sleep disturbances, such as disrupted sleep continuity, difficulty sleeping, or sleeping too much. Any change in sleep patterns can be a symptom of both mental and physical health problems, and symptoms of depression frequently manifest with sleep disruption of some kind. E is correct. Feeling down or hopeless most of the day, nearly every day, for an extended period is a joint presentation of depression.

The nurse is reinforcing teaching to a group of students about drug toxicity. The nurse is correct in stating which of the following options? Select all that apply. "Naloxone is the treatment for opioid toxicity." "Magnesium is the treatment for lead toxicity." "N-acetylcysteine is the treatment for naproxen toxicity." "Calcium gluconate is the treatment for magnesium toxicity." "Flumazenil is the treatment for benzodiazepine toxicity."

Choices A, D, and E are correct. The antidote for opioid toxicity is naloxone which may be given IV, IM, Intranasal, or SubQ. Magnesium toxicity is treated with calcium gluconate. Flumazenil is indicated for benzodiazepine toxicity.

The nurse is caring for a client experiencing an acute episode of severe anxiety. The nurse should plan to take which appropriate action? Select all that apply. Discuss previous coping skills Stay and observe the client Maintain an environment with low stimuli Plan to ambulate with the client in the hallway Instruct the client to identify what triggered the event Evaluate the client for possible hypoventilation Obtain a prescription for haloperidol

Choices B and C are correct. Severe anxiety causes an individual to experience a narrow perceptual field, an inability to problem-solve, and somatic symptoms such as dizziness, palpitations, diaphoresis, and a feeling of impending doom. Staying with the client provides assurance and enables the nurse to give the client simple and short directions, if necessary. Choice A is incorrect. Discussing previous coping skills is not an intervention appropriate for a client experiencing severe anxiety. Choice D is incorrect. This level of anxiety prevents a client from appropriately reflecting and conversing about what triggered the anxiety and previous coping skills. Choice E is incorrect. The environment should be a low stimulus and ambulating the client in the hallway would exacerbate the anxiety because of the sounds and stimuli. Choice F is incorrect. If a client is experiencing this level of anxiety, hyperventilation is more likely to occur, which could cause the client to develop dizziness. Choice G is incorrect. If prescriptive interventions are necessary, haloperidol would be inappropriate because it is an antipsychotic. Antipsychotics have no utility in the management of anxiety. For an acute episode of anxiety, medications such as benzodiazepines (alprazolam) or antihistamines (hydroxyzine) may be indicated.

Which of the following would the nurse consider to be a warning sign of the presence of physical abuse? Select all that apply. Upper respiratory infections Bruises and broken bones Unintended pregnancies Repetitive strain injuries Alcoholism Depression

Choices B, C, E, and F are correct. B: Health issues related to domestic violence include physical injuries from the assault, such as bruises and broken bones. C: Families experiencing domestic violence have more unintended pregnancies, miscarriages, abortions, and low-birth-weight babies. E & F: Families experiencing domestic violence have higher rates of substance abuse and depression. Domestic violence, including physical, emotional, and sexual abuse, occurs throughout society. It is present among all racial, social, and economic groups. Health issues related to domestic violence include physical injury from the assault and chronic health problems that may emerge as a complication of traumatic injury or as a physical response to ongoing stress from violence or neglect.

Which of the following activities can be delegated to unlicensed assistive personnel (UAPs)? Select all that apply. Performing initial client assessments Making client beds Giving clients a bed bath Administering a client's medications Ambulating clients Assisting clients with meals

Choices B, C, E, and F are correct. In most cases, client hygiene, bed-making, ambulating clients, and helping to feed clients can be delegated to a UAP. Due to the pressure to reduce healthcare costs and the increasing demand for nursing services amid a critical shortage of professional nurses, many employers of nurses have increased their use of unlicensed assistive personnel (UAP). UAPs are trained to function in an assistive role to the nurse in the provision of client activities as delegated by and under the nurse's supervision.

The licensed practical/vocational nurse (LPN/VN) is caring for a client with a factitious disorder who reports chest pain. The nurse should take which action? Select all that apply. Provide reassurance that this is part of the disorder Notify the primary healthcare physician (PHCP) Obtain a 12-lead electrocardiogram Disregard the symptom as it may be unreliable Assess vital signs

Choices B, C, and E are correct. Chest pain is a worrisome manifestation as it may be a clinical finding associated with myocardial infarction, pulmonary embolism, or other pathology. Despite the client having factitious disorder, characterized by the client feigning their symptoms, the nurse should intervene by notifying the PHCP, obtaining a 12-lead electrocardiogram, and assessing vital signs. This is the standard of care for clients reporting an acute change such as angina.

The nurse is caring for a 14-year-old scheduled for an appendectomy. What is the nurse's role in obtaining informed consent before surgery? Select all that apply. Informing the parents that only the surgeon may withdraw the surgical consent Review the risks and benefits of the surgery with the parents Validate that the parents are competent to provide consent for the client Witness the signature on the informed consent Make sure that the consent is witnessed by two healthcare professionals

Choices C and D are correct. Since the client is 14, they are a minor, and their parents will be responsible for signing informed consent. The nurse is accountable for validating that the parents are competent to provide consent for the client (Choice C). The nurse will serve as the witness for the informed consent. This is one of the primary responsibilities of the nurse when a client is getting a procedure and signing a consent. The other primary responsibility will be to serve as the client's advocate and ensure that the parents have received sufficient information to make an informed decision. If they have not, the nurse must call the surgeon to return and speak further with the parents (Choice D).

The nurse is caring for a pediatric client with conduct disorder. Which of the following client behaviors would be consistent with the condition? 1.shoplifts items from the local shopping mall 2.feels that the toes are misshapen and avoids wearing open-toed shoes 3.expresses fear of being outside of the home without others 4.argues with parents about established time limits for watching television

Conduct disorder (CD) is characterized by persistent behavior in childhood and adolescence that willfully violates rules, norms of society, and others' rights. Clients with CD often lack empathy and ignore consequences, and many develop antisocial personality disorder as adults. The cause of CD is likely a combination of factors, including genetics, neurobiology, and interpersonal relationships (eg, maladaptive family dynamics). Diagnostic criteria for CD include: 1. Serious rule-breaking (eg, running away from home, truancy from school) 2. Property damage (eg, arson, graffiti) 3. Deceiving others (eg, conning others to avoid obligations [eg, schoolwork, chores] and obtain goods) or theft (eg, shoplifting, forgery) (Option 1) 4. Causing harm to people or animals (eg, initiates physical fights, intimidation, animal cruelty, sexual coercion)

A nurse is reinforcing medication teaching with a client who has major depressive disorder and a new prescription for amitriptyline. Which of the following information should the nurse include? A. "You might experience constipation while taking this medication." B. "Your blood pressure might increase while taking this medication." C. "Weight loss is a common adverse effect of this medication." D. "Increased salivation is an expected adverse effect of this medication."

Correct Answer: A. "You might experience constipation while taking this medication." Rationale: Constipation is a common adverse effect of amitriptyline. The nurse should instruct the client to increase the daily intake of fluids and foods high in fiber. Incorrect Answers: B. Hypotension is a common adverse effect of amitriptyline. The nurse should instruct the client to change positions slowly to prevent orthostatic hypotension and syncope. C. Increased appetite and weight gain are expected adverse effects of amitriptyline. The nurse should instruct the client to monitor daily caloric intake and notify the provider if unintentional weight gain occurs. D. Dry mouth is an expected adverse effect of amitriptyline. The nurse should instruct the client to increase daily fluid intake and use sugarless gum or mints to treat dry mouth.

A nurse is discussing the routine follow-up needs with a client who has a new prescription for valproic acid to treat bipolar disorder. The nurse should provide written instructions to the client about the need for routine monitoring of which of the following? A. Liver function B. Thyroid function C. Red blood cell count D. Serum electrolytes

Correct Answer: A. Liver function Rationale: Valproic acid is an anti-epileptic medication that is used in the treatment of bipolar disorder to manage rapid cycling. Routine monitoring of liver function and ammonia levels is necessary due to the risk of hepatotoxicity while taking valproic acid. Incorrect Answers: B. Valproic acid can cause pancreatitis. However, it does not alter thyroid function. The nurse should provide instruction to the client regarding the manifestations of pancreatitis, such as intense abdominal pain, nausea, and vomiting, and instruct the client to contact the provider should these manifestations occur. C. Valproic acid can cause blood dyscrasias, such as leukopenia and thrombocytopenia. The nurse should instruct the client that monitoring of white blood cells and platelets will be performed periodically while the client is taking valproic acid; there is no need to monitor the red blood cell count. D. While baseline levels of electrolytes can be drawn, valproic acid does not impact electrolyte levels. Routine monitoring of electrolytes is not necessary while taking valproic acid.

A nurse is caring for a client who was admitted for treatment of major depression. Which of the following techniques is a barrier to therapeutic communication? A. Reflecting B. Focusing C. Providing false reassurance D. Touch

Correct Answer: C. Providing false reassurance Rationale: Providing false reassurance or offering personal opinions can be barriers to effective communication. Other barriers include minimizing the client's feelings, changing the topic, offering value judgments, approving or disapproving responses, changing topics, giving advice, and asking irrelevant personal questions or "why" questions. Incorrect Answers: A. Reflecting refers to a therapeutic technique that is used to direct the focus of communication to the client, allowing the client to examine feelings and concerns. B. Focusing is a therapeutic communication technique used to help the client attend to an important topic or message. D. Appropriate touch can be used in therapeutic communication to provide comfort and express caring.

A nurse is caring for a client with delusions who refuses to eat because he believes the food is poisoned. Which of the following is the most appropriate initial intervention by the nurse? A. Suggest to the client that if he does not eat soon, tube feedings will be initiated B. Suggest to the client's family that they bring food from home for the client. C. Simply state the food is not poisoned. D. Taste the food in the client's presence.

Correct Answer: C. Simply state the food is not poisoned. Rationale: A client's delusions are often dealt with most effectively initially with simple statements of the facts. The nurse should state the facts to reorient the client to reality. Incorrect Answers: A. Threats are never appropriate nursing interventions. B. This statement may reinforce the client's delusion. D. This statement is a form of entering into the delusion. It is unlikely to end the client's delusion. It enables the delusion.

A home health nurse is providing care to a frail elderly client in the client's home. Which of the following should the nurse report to her supervisor as a potential indication of abuse? A. The client states, "My son doesn't like me anymore. He yells at me all the time." B. The client has several brown spots on her arms. C. The client is frequently left in bed, at home alone, for several hours at a time. D. The client's son is trying to be declared the client's legal power of attorney.

Correct Answer: C. The client is frequently left in bed, at home alone, for several hours at a time. Rationale: Being left at home alone in bed for several hours at a time may be an indication of abuse or neglect and should be reported for further evaluation. Incorrect Answers: A. Before reporting this as potential abuse, the nurse should check into this complaint further, especially checking for hearing loss in the client. B. Brown spots are normal findings in the elderly and are not indications of abuse. D. Attempting to be named power of attorney for a frail, elderly parent is not indicative of abuse and does not need to be reported.

A nurse conducts the intake interview for a 43-year-old client. The client is in overall good health, but she points out two enlarged lumps near her neck (see image). The nurse asks the client how long these lumps have been there, and the client states they have been there for a while, but she did not mention it because she was worried it may be cancer. The nurse is aware that clients may display which of the following immediate physiological responses to stress if they are anxious about a possible cancer diagnosis? A. Constricted pupils B. Decreased heart rate C. Decreased blood glucose level D. Increased blood pressure

Correct Answer: D. Increased blood pressure Rationale: An initial physiological response to stress resulting from the fight-or-flight response would be a temporary increase in blood pressure due to vasoconstriction. Incorrect Answers: A. An initial stress response due to the fight-or-flight response might include pupillary dilation, not constriction. B. An initial stress response due to the fight-or-flight response might include an increased heart rate, not a decreased heart rate. C. As an initial stress response due to the fight-or-flight response might include an elevated blood glucose level, not a decreased blood glucose level.

A nurse is teaching a Laotian client who has hypertension about selecting low-sodium food choices. Which of the following actions by the nurse demonstrates cultural competency? A. Asks the client what she likes to eat B. Instructs the client to use a salt-substitute C. Incorporates Buddhist concepts of diet into the teaching D. Recommends selecting cured meats instead of fresh

Correct Answer: A. Asks the client what she likes to eat Rationale: Traditional Asian food preservation methods such as salting and drying as well as the choice of condiments (soy sauce or fish sauce) can result in high sodium intake. However, race or ethnicity is not synonymous with cultural practices. The nurse should ask the client about her dietary practices, including the consumption of traditional foods that can be high in sodium. Asking the client what she likes to eat demonstrates cultural competency by showing respect for the client's food preferences. Incorrect Answers: B. Although the use of salt substitutes, such as herbs or potassium chloride, can be used in the place of regular table salt, this does not demonstrate cultural competence by the nurse. The nurse should ask the client about seasonings typically used in the client's diet and determine if low-sodium versions or no-salt versions of the seasonings are available. C. Although religion can play a significant role in dietary practices, the assumption that a client practices Buddhism because she is Laotian is not a demonstration of cultural competency. The nurse should ask the client about any religious dietary practices that she might follow, and incorporate these into maintaining a healthy diet. D. The nurse should instruct a client who has hypertension to limit sodium intake. Cured and processed meats are high in sodium and should be avoided. The nurse should instruct the client to choose lean meats and fish and limit the amount of red meat consumed.

A client develops confusion and anxiety after withdrawal from alcohol. Which of the following medication may the nurse expect to administer the client to reduce the withdrawal symptoms? A. Lorazepam B. Naloxone C. Disulfiram D. Fentanyl

Correct Answer: A. Lorazepam Lorazepam is an acceptable treatment option for alcohol withdrawal.

A nurse is leading a group discussion about the risk factors of family and community violence. This nurse should include that which of the following clients has a risk factor for experiencing violence? A. A 7-year-old male who asserts his independence to his parents B. A 29-year-old female who works for a demanding and authoritative boss C. A 62-year old retired male who lives independently in a retirement community D. A 25-year-old female who is pregnant with her first child

Correct Answer: D. A 25-year-old female who is pregnant with her first child Rationale: The nurse should include pregnancy as a risk factor for partner violence. The patient's partner might resent the added responsibility of having a baby or be jealous of the relationship the mother has with the child. Incorrect Answers: A. This patient is not considered to be at risk of experiencing violence. Female children and children younger than 3 years of age are more likely to experience violence. B. This patient is not considered to be at risk of experiencing violence. C. This patient is not considered to be at risk of experiencing violence.

A nurse is caring for a client who has been experiencing persecutory delusions and is now trying to get out the door of the behavioral unit. The client states, "Please let me go. I trust you, but my family is going to come and shoot me tonight." Which of the following is the best response by the nurse? A. "You are frightened. Come with me to your room and we can talk about it." B. "No one here wants to harm you. You know that. I'll come with you to your room." C. "Come with me to your room. I'll lock the door and no one will get in to hurt you." D. "I'm glad you trust me. Maybe you can trust me when I tell you no one can hurt you while you're here."

Correct Answer: A. "You are frightened. Come with me to your room and we can talk about it." Rationale: This response recognizes the client's feelings and provides reassurance that the nurse will be present. Incorrect Answers: B. The client does not know that no one wants to harm him. Delusions are very real to the person experiencing the delusion. C. Locking the door would increase the client's anxiety. D. The client is not ready to accept this; he believes his life is in danger.

A nurse is teaching a group of newly licensed nurses about suicide precautions. Which of the following interventions should the nurse include in the teaching? A. Include metal utensils with the client's meal tray. B. Assign the client to a private room. C. Inspect the client's personal belongings. D. Keep the client's door closed at all times.

Correct Answer: C. Inspect the client's personal belongings. Rationale: Inspecting the client's personal belongings is an appropriate intervention to ensure that the client does not have access to potentially harmful objects. Incorrect Answers: A. Clients who are at risk for suicide should have plastic, not metal, utensils on the meal tray. B. A client who is at risk for suicide should be in a semi-private room with the door open at all times. D. The client's room door should be open at all times to ensure the client's safety. The client should closely be monitored with rounding at infrequent times to prevent the client from planning self-harm between staff visits.

When a schizophrenic client claims to see demons in the room, what is the best documentation the nurse should make for the record? A. Experiencing hallucinations B. Frightened by hallucinations C. States, Seeing demons in my room D. Having distorted sensory perceptions

Correct Answer: C. States, Seeing demons in my room Rationale: Charting must be clear and objective as possible. Quoting the client is always appropriate. Incorrect Answers: A. This provides a conclusion and is not in the client's own words. B. This is a judgment and should not be documented. D. This is a diagnostic statement and should not be documented.

A 29-year-old male client was seen in the emergency room for a panic attack. What assessment findings support this diagnosis? (Select all that apply). A. Low blood pressure B. Perspiration C. Dizziness D. Shakiness E. Tachycardia

Correct Answers: B. Perspiration is a finding often seen with panic attacks, as excessive sweating is part of the body's innate stress response. C. Dizziness is a finding often seen with panic attacks. Unsteadiness, lightheadedness, and feeling faint can also occur, and the client should be encouraged to sit or lie down, preferably somewhere quiet. D. Shakiness is a finding often seen with panic attacks as a result of the fight-or-flight response. E. Tachycardia is a finding often seen with panic attacks. Clients may also feel their heart pounding as a result of the fight-or-flight response. Simple deep breathing can help the heart rate decrease. Incorrect Answers: A. Hypotension generally does not occur with a panic attack; rather, hypertension would be more common due to the fight-or-flight response.

A nurse is collecting data from a client who has major depressive disorder. The nurse should identify which of the following client statements as a covert 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."

Correct Answers: B. "The stress in my life is too much to handle." D. "I don't feel like I can ever be happy again." Rationale: This statement is a covert comment in which the client identifies a problem but does not directly talk about suicide. The nurse should check the client further for suicidal ideation. This statement is a covert comment in which the client identifies a problem but does not directly talk about suicide. The nurse should check the client further for suicidal ideation. Incorrect Answers: A. This statement is an overt comment about suicide in which the client directly talks about his perception of an outcome of his death. The nurse should check the client further for a suicide plan. C. This statement is an overt comment about suicide in which the client directly talks about his wish to no longer be alive. The nurse should check the client further for a suicide plan. E. This statement is an overt comment about suicide in which the client directly talks about his perception of an outcome of his death. The nurse should check the client further for a suicide plan.

A nurse in the inpatient psychiatric unit is caring for a client who is experiencing an acute manic state. Which of the following activities might be appropriate for this client? (Select all that apply) A. Relaxation exercises B. Watching television C. Alternating aerobic exercise with scheduled periods of rest D. Listening to music

Correct Answers: B. Watching television C. Alternating aerobic exercise with scheduled periods of rest D. Listening to music Rationale: Watching television may help to engage the client's mind and would be appropriate. Exercise is an engaging activity for the client and would be an appropriate intervention. Listening to music helps to engage the client's mind and thoughts; this would be appropriate. Incorrect Answer: A. A client in an acute manic state has poor concentration and attention span and will typically not be able to quiet his mind or his body enough to participate in relaxation exercises. An activity that allows the client to move around or to engage the client's thoughts is more appropriate.

Family Dynamics: Differentiation

Differentiation is a positive finding because while the individual is still associated with the family, they have their own identity and can have goal-directed behavior. They are independent and do not need others to manage their conflict.

Vital Concept: Duloxetine

Duloxetine (Cymbalta) can affect multiple body systems, including the neurological, gastrointestinal, and integumentary. Common neurological side effects of duloxetine (Cymbalta) include fatigue, headache, and dizziness. The nurse must educate the client on energy-conserving techniques to combat fatigue and overexertion. Common gastrointestinal side effects of duloxetine (Cymbalta) include constipation and nausea. A common side effect of duloxetine (Cymbalta) is xerostomia, an unusually dry mouth. Frequent and adequate hydration should be reinforced as helpful to prevent/manage this adverse effect.

The home health nurse visits a 75-year-old client with mild Alzheimer dementia who recently moved in with a caregiver. Which observations would cause the nurse to suspect neglect? Select all that apply. 1.Client breaks eye contact when discussing caregiver 2.Client has lost 8 lb (3.63 kg) in the previous 4 weeks 3.Client is wearing clothing that is out of style 4.Client's eyeglasses have been visibly broken for 1 month 5.Client's prescription medication is expired

Elder abuse or neglect occurs when caregivers intentionally or unintentionally fail to meet the older adult client's physical, emotional, or social needs. Approximately 1 in 10 older adult clients are victims of physical, psychological, or sexual abuse by a caregiver. Commonly neglected necessities include water, food, medication, hygiene, and clothing. The client's living conditions may be unsafe or have inadequate access to public utilities. Objective findings consistent with abuse or neglect include: 1. Dehydration, malnutrition, and weight loss (Option 2) 2. Poor hygiene, soiled bedding or clothing, and pressure ulcers 3. Missing/broken assistive devices (eg, eyeglasses); medications withheld or expired (Options 4 and 5) Clients who have experienced abuse or neglect may find the situation difficult to discuss and display apprehension, restlessness, withdrawal, poor eye contact, shame, and despair (Option 1). The client may also deny or minimize the extent of the abuse out of fear or embarrassment.

Family Dynamics: Fusion

Fusion occurs when two undifferentiated people function as a single emotional system. This blurring of emotional lines by two undifferentiated individuals is unhealthy. Undifferentiated individuals possess little self-identity and have decreased goal-directed behavior. They are often dependent on each other and vulnerable to stress and conflict.

Histrionic personality disorder (HPD)

Histrionic personality disorder (HPD) is characterized by an intense need to be the center of attention, preoccupation with physical attractiveness, and dramatic emotional displays. Clients with HPD constantly seek approval or acceptance from others and are highly impressionable (ie, easily influenced by others) but have difficulty maintaining relationships. They become distressed (eg, anxious, upset) in situations in which they are not the center of attention. Additional characteristics of HPD include: 1. Overly dramatic and exaggerated expressions of emotion 2. Shallowness and emotional immaturity 3. Inappropriate, provocative, and seductive behavior; the use of physical appearance to attract attention 4. Frequent perception that personal relationships are more intimate than they really are

Vital Concept: Mania

In some clients, hospitalization is warranted during a manic episode. Symptoms of mania include elevated mood, racing thoughts, and engaging in risky behavior such as gambling, excessive spending, and drug use. Individuals experiencing mania or hypomania often exhibit an elevated mood and racing thoughts. Clients experiencing a manic or hypomanic episode speak loudly and rapidly when conversing with others or engage in excessive spending and gambling.

A nurse is caring for a client whose partner died following a motor vehicle accident. Identify the sequence of Bowlby's four stages of grief that the nurse should expect the client to experience.

Step 1: Numbness or protest is the first stage of Bowlby's four stages of grief. In this stage, the client cannot believe the loss has occurred. Step 2: Disequilibrium is the second stage in Bowlby's four stages of grief. The client wants to recover what has been lost. There is intense crying and anger toward self and others. Step 3: Disorganization and despair characterize the third stage of Bowlby's four stages of grief. Realization of the loss has occurred and there is disorganization of behavior, including an inability to complete ADLs. Step 4: Reorganization is the fourth stage of Bowlby's four stages of grief. The client accepts the loss and begins to rechannel energy into new relationships.

Depression Manifestation

Including these signs and symptoms in the presentation can help raise awareness and promote understanding of depression among the community, enabling early recognition and intervention. ✓Persistent sadness or low mood: Feeling down or hopeless most of the day, nearly every day, for an extended period. ✓Loss of interest or pleasure in activities: Losing interest in previously enjoyed activities or hobbies. ✓Significant changes in appetite or weight: Significant weight loss or gain without intentional dieting. ✓Sleep disturbances: Experiencing insomnia or sleeping excessively. ✓Fatigue or loss of energy: Feeling tired, lacking energy, or experiencing a general decrease in physical and mental stamina. ✓Feelings of worthlessness or excessive guilt: Having persistent negative thoughts about oneself, feeling worthless or excessively guilty. ✓Difficulty concentrating or making decisions: Experiencing difficulty focusing, making decisions, or remembering details. ✓Agitation or slowed movements: Being restless, agitated, or experiencing psychomotor retardation (slowed movements or speech). ✓Recurrent thoughts of death or suicide: Having recurrent thoughts of death, dying, or suicidal ideation. ✓Social withdrawal or isolation ✓Withdrawing from social activities, avoiding friends or family, or isolating oneself. ✓Physical symptoms without clear medical cause: Experiencing unexplained physical symptoms like headaches or stomachaches.

Vital Concept: Panic Disorders

Panic attacks are a type of anxiety disorder. They involve a sudden episode of intense fear that can trigger specific physical manifestations such as increased heart rate, sweating, dizziness, shakiness, choking, and unsteady gait. While panic attacks are not life-threatening, they can be frightening for the client.

Defense Mechanism: Displacement

Redirecting feelings or actions to safer, substitutive objects

Defense Mechanism: Denial

Refusing to acknowledge unacceptable realities

Defense Mechanism: Regression

Reverting behaviors to younger or earlier developmental stages in response to stress

Schizotypal Personality Disorder Example

SPD is characterized by --Social avoidance --Odd and eccentric behavior --Magical thinking (illusions, ideas of reference) --Eccentric attire --Some paranoia --Appropriate self-esteem (it is usually not impaired) Findings supporting the risk for SPD for this client include: the client's thought content is illogical and explains his social avoidance with magical reasoning. The client's reported ability to see into the future and use tarot cards is a classic finding, as some individuals with this condition may describe themselves as clairvoyant or psychic. Finally, the client reported an idea of reference regarding the quotes or lyrics he sees on social media as he states it pertains to him. The client's hair is bright green, and eccentric appearance/attire is a feature of this condition. The client's self-esteem was without impairment and is a key differential in avoidant personality disorder, where the client has feelings of negative self-worth. The client's job is also a supporting factor for SPD, as it is solitary and found in schizoid and schizotypal personality disorders. The preference to be alone is shared, but the magical and atypical thinking is exclusive to an individual with SPD. While the client does have a criminal history, a criminal record does not automatically qualify for antisocial personality disorder (APD). APD is characterized by deceptive behavior, lack of regard for others, and the inability to conform to societal norms. None of this is found in the H&P. The client has no indication of bipolar disorder, as bipolar disorder is commonly familial, and no family history of mental illness was provided. Additionally, the mental status exam did not suggest any significant alterations in speech, suggesting depression or mania.

The nurse is evaluating the plan of care for a client diagnosed with social anxiety disorder who has a fear of eating and drinking in public. Which of the following client statements demonstrate an improvement in coping? Select all that apply. 1."I plan dates involving outdoor activities, such as hiking, instead of going to dinner and a movie." 2."I sat in the pizza shop and drank a cola while watching people eat and then bought a slice to go." 3."I started having lunch with my coworkers even though I still become very anxious eating in public." 4."I went out of town on the day of the company picnic instead of making excuses for not eating." 5."I went to a coffee house with my boss and focused on an upcoming project while drinking a latte."

Social anxiety disorder (ie, social phobia) is characterized as intense anxiety or fear when exposed to a public or social situation (eg, public speaking, eating or drinking in front of others). Clients who have social anxiety disorder tend to avoid participating in social situations because of the heightened anxiety and insecurity they experience. Treatment of social phobias may include medication (eg, selective serotonin reuptake inhibitors, benzodiazepines) and psychotherapy (eg, cognitive-behavioral therapy, systematic desensitization) to assist in developing effective coping strategies. As part of systematic desensitization, the client is gradually exposed to the phobic trigger, which in turn decreases anxiety. Effective coping with social phobia is demonstrated by: 1. Experiencing increased comfort while engaging in phobic situations (eg, drinking a cola while watching people eat) (Option 2) 2. Developing insight and verbalizing feelings about the irrational fear (Option 3) 3. Distracting oneself by focusing on something other than the phobic situation (eg, preparing for a meeting while drinking a latte) (Option 5)

The nurse is caring for a client who reported having thoughts of self-injury yesterday. Which of the following statements by the client should the nurse recognize as risk factors for suicide? Select all that apply. 1."I am currently unemployed and looking for a job." 2."I have been married for five years with three children." 3."I have multiple firearms at home stored in a safe." 4."It has been about a year since I last overdosed." 5."My family and I attend weekly religious activities." 6."Sometimes I experience feelings of hopelessness."

Suicidal ideation is a preoccupation with thoughts of self-harm and death. Active suicidal ideation is recognized as the constant consideration of suicide that involves the formulation of a suicide plan. Ideation and suicide risk factors may fluctuate over time and may be time limited. The nursing priority when caring for a client with suicidal ideation is ensuring client safety. The following risk factors place the client at increased risk for death by suicide: 1. Significant life stressors (eg, unemployment, difficulty finding a new job) (Option 1) 2. Access to devices used for self-harm (eg, firearms) (Option 3) 3. Substance abuse and history of overdose (Option 4) 4. Feelings of hopelessness (ie, doubts that anything will improve) (Option 6)

The nurse is preparing to administer sumatriptan to a client with a migraine headache. Which of the following findings would require follow-up prior to administering the medication? Click the exhibit button for additional client information. 1.BMI of 34 kg/m2 recorded during today's examination 2.past medical history of uncontrolled hypertension 3.takes alprazolam as prescribed for anxiety 4.BUN of 12 mg/dL (4.28 mmol/L)

Sumatriptan is a selective serotonin agonist prescribed to treat migraine headaches, which are thought to be caused by dilated cranial blood vessels. Triptan drugs, like sumatriptan, work by constricting cranial blood vessels, and clients should be instructed to take a dose at the first sign of a migraine to help prevent and relieve symptoms. Sumatriptan is contraindicated in clients with coronary artery disease and uncontrolled hypertension because its vasoconstrictive properties increase the risk of angina, hypertensive urgency, decreased cardiac perfusion, and acute myocardial infarction. The nurse should question the client about a past medical history of uncontrolled hypertension and report this to the health care provider (Option 2).

Dystonic Reaction

Sustained or intermittent spasms of the facial muscles, neck, or shoulders are a classic dystonic reaction. This may occur within hours after administering a dopaminergic medication (antipsychotics, metoclopramide). The client received IM olanzapine which is the culprit of the dystonic reaction. The nurse should notify the physician of the dystonia and obtain a prescription for an anticholinergic such as diphenhydramine or benztropine. Considering the spasms are impacting the neck, the nurse should also make the client NPO to avoid aspiration. ✓ Acute dystonia is a sudden, sustained contraction of one or several muscle groups, usually of the head and neck ✓ Acute dystonias can be frightening and uncomfortable, but they are not dangerous unless they involve muscles affecting the airway, which is rare ✓ However, they cause significant anxiety and should be treated promptly with anticholinergics such as diphenhydramine ✓ Dystonia is caused by medications blocking dopamine ✓ Classically, this involves antipsychotic medications (especially the typicals) and metoclopramide ✓ Typical antipsychotics include fluphenazine, haloperidol, and chlorpromazine ✓ Atypical antipsychotics may also cause this adverse reaction

Vital Concept: Alcohol WD Medications

The alcohol withdrawal symptoms such as shakiness, anxiety, and confusion are treated with lorazepam, diazepam, oxazepam, chlordiazepoxide, etc.

Vital Concept: Flight-or-Fight Responses

The fight-or-flight or initial stress response increases the client's heart rate. Vasoconstriction leads to an increase in blood pressure. Blood glucose levels rise, supplying more readily available energy, and pupils dilate, not constrict.

Vital Concept: Therapeutic Communication

Therapeutic communication is a critical component of nursing care. Techniques to show acceptance, build trust, and encourage the client to explore feelings and concerns include reflecting, focusing, use of open-ended questions, and appropriate touch. Barriers include changing the topic, giving advice, making value judgments, and minimizing the client's concerns or feelings.

Vital Concept: Bipolar I Medications

The nurse should anticipate and identify medications the provider may order for a client with bipolar I. For example, the anti-epileptic valproic acid (Depakote) is used as a mood stabilizer in clients experiencing a manic episode when lithium (Eskalith) is ineffective. Atypical antipsychotics such as risperidone (Risperdal), olanzapine (Zyprexa), and aripiprazole (Abilify) are commonly used in conjunction with lithium (Eskalith) and valproic acid (Depakote) in clients that experience rapid cycling. A client experiencing a manic episode should not be prescribed antidepressants as these will exacerbate symptoms, possibly leading to psychosis and the need for inpatient treatment. Benzodiazepines are not a standard treatment for a client experiencing a manic episode

Vital Concept: Alcohol WD Manifestations

The nurse should identify that a client who is experiencing alcohol withdrawal can experience manifestations of weakness, nausea and vomiting, tachycardia, sweating, hypertension, headache, insomnia, tachycardia, depressed mood, anxiety, and tremors of the hands, tongue, or eyelids.

Vital Concept: Destressing Patients

The nurse should maintain a quiet, pleasant environment and should approach the client in a slow and calm manner. The client may respond with anxious or aggressive behaviors if startled or overstimulated. The nurse should also reorient the client to reality, by presenting reality briefly and clearly, avoiding vague or evasive statements.

Vital Concept: Amitriptyline

The nurse should provide both verbal and written instructions to a client who has a new prescription. Amitriptyline is a tricyclic antidepressant used to treat depressive disorders, anxiety disorders, and chronic pain syndromes. The nurse should instruct the client to notify the provider of worsening manifestations of depression or suicidal ideation.

Defense Mechanism: Repression

Unconscious suppression of unwanted thoughts or information from consciousness

The nurse has reinforced teaching for a client with atrial fibrillation who is receiving warfarin. Which of the following statements by the client would indicate a correct understanding of the teaching? Select all that apply. Click on the exhibit for additional client information. 1."Antibiotics can affect my INR value." 2."I am going to eat more leafy green vegetables." 3."I will take the medication at the same time every day." 4."I understand that my INR value should be between 4 and 5." 5."If I miss a dose of medication, I'll double my dose the next day."

Warfarin is an oral anticoagulant used for the prevention of thrombosis. By stopping vitamin K activation, warfarin reduces the production of vitamin K-dependent clotting factors within the body. Many antibiotics destroy intestinal bacteria that produce vitamin K. This can lead to vitamin K deficiency and an increased INR. An increased INR places the client at greater risk for bleeding (Option 1). It is important to take warfarin at the same time every day to maintain a consistent therapeutic medication level (Option 3).

Vital Concept: Suicidal Precautions

When caring for a client who is at risk for suicide, the nurse should place the client in a semi-private room with the door open at all times, select plastic utensils for the client's meal tray, and remove all harmful objects from the client's room and personal belongings. Levels of Client Monitoring • One-to-one contact. A staff member is present at all times for clients who are identified as being at high risk for suicide. • Constant visual observation. A client is monitored at all times through use of a televised monitoring system. This is used for clients who are at increased risk for suicide. • 15 min checks. A staff member checks in on the client at infrequent intervals but no longer than every 15 min for a client who has suicidal ideations.

Vital Concept: Valproic Acid and Diagnostics

When the nurse is talking with the client about monitoring the function of body systems while taking valproic acid, it is important the tests are both written down and explained to the client. Information should be given in proportion to the client's ability to understand the information. A client who has bipolar disorder and is taking anticonvulsant medication can develop hepatotoxicity. Therefore, it is important for the client to understand the need for monitoring liver function.

Dependent Personality Disorder

✓ A dependent personality disorder is characterized by difficulty with making decisions and problems with expressing disagreement, and the individual often feels helpless when alone. Many individuals who are around a person with this disorder, often feel burdened because of the difficulty with trivial decision-making. ✓ When caring for a client with dependent personality disorder the nurse should encourage decision-making but never make decisions for the client. ✓ Psychotherapy is the preferred treatment for all personality disorders.

Factitious Disorder

✓ Factitious disorder is characterized by an individual feigning their symptoms ✓ The individual falsifies medical or psychiatric symptoms. This disorder may be imposed on themselves or others (by proxy) ✓ Nursing care for a client with this disorder includes - Developing a therapeutic rapport with the client Avoid confrontation or power struggles Focus on the client's disorder - not symptoms Investigate any new physical symptoms appropriately without them dominating the conversation.

The Anxieties

✓ Mild Anxiety This type of anxiety occurs during everyday living and allows an individual to perceive reality in sharp focus. A person experiencing a mild level of anxiety sees, hears, and grasps more information, and problem-solving becomes more effective. Physical symptoms may include slight discomfort, restlessness, irritability, or mild tension-relieving behaviors (e.g., nail-biting, foot or finger tapping, fidgeting). ✓ Moderate Anxiety As anxiety increases, the perceptual field narrows, and some details are excluded from observation. The person experiencing moderate anxiety sees, hears, and grasps less information and may demonstrate selective inattention, inhibiting problem-solving. More intense physical symptoms may be present, which include increased pulse and respiratory rates, perspiration, and mild somatic symptoms (e.g., gastric discomfort, headache, urinary urgency). ✓ Severe/Panic Anxiety The perceptual field of a person experiencing severe anxiety is greatly reduced. A person with severe anxiety may focus on one particular detail or on many scattered details and have difficulty noticing what is going on in the environment, even when another person points it out. Learning and problem solving is not possible at this level, and the person may be dazed and confused. Significant physical symptoms may be event including hyperventilation, palpitations, and headache. Hospitalization may be required for this level of anxiety.

Nervosa: Bulimia vs. Anorexia

✓ Significant overlap occurs between bulimia nervosa and anorexia nervosa ✓ Physically, the client with anorexia nervosa is significantly underweight with a BMI < 18.5 ✓ Fluoxetine has proven efficacy in the treatment of bulimia nervosa ✓ Commonalities Between Anorexia Nervosa and Bulimia Nervosa: 1. Both eating disorders can cause binging and purging behaviors, where individuals may engage in episodes of excessive eating followed by compensatory actions such as vomiting or excessive exercise. 2. Both eating disorders cause a client to have a distorted view of food and themselves. Individuals with these disorders often perceive themselves as overweight or have an intense fear of gaining weight, even when underweight. 3. Both eating disorders may have other psychiatric co-morbidities such as obsessive-compulsive personality disorder or depression. Individuals with anorexia nervosa and bulimia nervosa may experience additional mental health challenges, contributing to the complexity of their conditions.

Child Neglect

✓ Signs of neglect in children can be the following: 1. Poor personal hygiene (e.g., unwashed hair, dirty or soiled clothing, strong body odor) 2. Frequent unexplained injuries (e.g., bruises, cuts, fractures) 3. Malnourishment or extreme hunger (e.g., underweight, distended belly, constantly seeking food) 4. Developmental delays (e.g., speech, motor skills, social interactions) Inadequate supervision or lack of appropriate caregiving 5. Lack of necessary medical care or delayed medical treatment 6. Inconsistent attendance at school or chronic truancy 7. Lack of appropriate clothing or suitable living conditions 8. Emotional or behavioral issues (e.g., aggression, withdrawal, anxiety) 9. Abandonment or lack of supervision by a responsible adult ✓ Open and non-judgmental communication with parents or caregivers is essential. Nurses should gather information about the child's living conditions, daily routines, and access to healthcare. Establishing a trusting relationship can facilitate discussions about any concerns related to neglect. ✓ It is widely acknowledged that cases of infant neglect are likely underreported. Research suggests that many instances of neglect may go unnoticed or unreported, highlighting the need for increased awareness and education to encourage reporting by healthcare professionals, educators, and community members.

Obsessive Compulsive Disorder

✔︎Obsessive Compulsive Disorder (OCD) is a chronic condition involving recurrent, persistent, uncontrollable thoughts and/or compulsive behaviors which are used to suppress those thoughts. These repetitive behaviors are time consuming and cause impairment in daily functioning. ✔︎Therapies used to treat OCD include Cognitive Behavioral Therapy (CBT), Exposure and response prevention (ERP), and flooding. ✔︎Pharmaceutical interventions for OCD include fluoxetine, fluvoxamine, paroxetine, and sertraline (SSRIs) and clomipramine (TCA). Other antipsychotic and antidepressant medications may also be used to manage extreme symptoms.