Nurs 343 Exam 3

What statement by a client would indicate that goals for treatment of her somatization disorder are being achieved? A. "I feel less anxiety that before." B. "My memory is better than it was a month ago." C. "I take my medications just as the physician prescribed." D. "I don't find myself thinking about my symptoms all the time as I used to."

"I don't find myself thinking about my symptoms all the time as I used to."

Which statement is *least* likely to be made by a client with bulimia nervosa during the assessment interview? A. "I eat three meals each day and purge every evening." B. "I'm concerned about what others think about my binging and purging." C. "I feel as though my eating and purging are out of my control." D. "When I eat I feel calm, but then I realize I have to make myself vomit or gain weight."

"I eat three meals each day and purge every evening."

The nurse would expect the chief complaint of the client with hypochondriasis to be A. "I feel confused and disoriented." B. "I feel spaced out, as though I'm outside my body watching what is happening." C. "I know I have cancer, but the doctors just cannot find it." D. "I woke up one morning and my left leg was paralyzed from the knee down."

"I know I have cancer, but the doctors just cannot find it."

A client with obsessive-compulsive personality disorder takes the nurse aside and mentions "I've observed you interacting with Mr. D. You are not approaching him properly. You should be more forceful with him." The *best* response for the nurse would be A. "I will be continuing to follow the care plan for Mr. D." B. "I see you are trying to control Mr. D's therapy as well as your own." C. "Your eye for perfection extends even to my nursing interventions." D. "Mr. D's care is really of no concern to you or to other clients."

"I will be continuing to follow the care plan for Mr. D."

What are some signs of alcohol withdrawal delirium

*medical emergency* Tachycardia diaphoresis hypertension disorientation hallucinations change in LOC paranoid delusions, agitation fever

alcohol withdrawal delirium

*medical emergency* Usually die of sepsis, MI,fat embolism,electrolyte imbalance, suicide, aspiration pneumonia, or peripheral vascular collapse -delirium state usually peaks 2-3 days after last drink and lasts 2-3 days

severe memory loss

*not a normal part of growing older!!* slight forgetfulness is common of aging, but not memory loss that interferes with ones ADL's.

Brain abnormalities (Anger)

- such as brain tumors, Alzheimer's temporal lobe epilepsy, and traumatic injury to certain parts of the brain result in changes to personality that includes increased violence.

clonidine (Catapres)

-*NON-addicting* suppressor of opioid withdrawal symptoms -effective somatic treatment when combines with naltrexone (ReVia) - old medication for blood pressure

buprenorphine (Subutex)

-blocks signs/symptoms of opioid withdrawal - partial opioid agnoist

disulfiram (Antabuse)

-causes adverse reactions when person drinks -last dose will last up to 2 weeks - must know about and stay away from "hidden" alcohol in food, medicines, and preparations that are applied to the skin

Nursing Interventions for eating disorders

-ensure safe, nonthreatening enviornment -prevent self harm -therapeutic alliance -behavioral program to restore weight, nutrition -----contracts, eat 50% or 3/4 of meal, tube feeding, TPN -structured enviornment w/ clear limits ------weigh 3x a week, stay one hr after meal in dining room -monitor labs--eletrolytes, CBC -monitor VS -I&O -behavioral plan to reward compliance --------increase choices of food -encourage expression of feelings -help increase client understanding of body image distortion -emphasize client capability to eat small portions w/o binging -maintain clear boundaries -avoid power struggles -intervene in anxiety -give positive feedback for adheerence to plan -engage in group therapy -assist in identity issues -teach adaptive strategies -collaborate w/ dietician to teach nutrition -collaborate w/ interdicciplinary staff

LAAM (l-a-acetylmethadol)

-for opioid (heroin) addiction -Only need every 3 days *Addictive* narcotic, similar to morphine

methadone (Dolophine)

-synthetic opiate that blocks the craving for and effects of heroin -*Highly Addictive* and produces withdrawal symptoms when stopped -Is the only approved treatment for pregnant opioid addicts

acamprosate (Campral)

-treat alcoholism; maintain abstinence *long term* -works to reduce the intake of alcohol by suppressing excitatory neurotransmission and enhancing inhibitory transmission (suppresses the food feeling you get by using the substances)

naltrexone (ReVia)

-used for narcotic addition and alcoholism -blocks opiate receptors reducing or eliminating the craving -low toxicity, with very few side effects -*Not* addictive -*Only need to take every 3 days*

topiramate (Topamax)

-works to decrease alcohol cravings by inhibiting the release of dopamine -reduces the pleasurable effects of substance

Nursing Guidelines for Schizotypal PD

1. Respect patient's need for social isolation. 2. Be aware of patient's suspiciousness, and employ appropriate interventions. 3. As with schizoid patient, perform careful diagnostic assessment as needed to uncover any other medical or psychological symptoms that may need intervention (e.g., suicidal thoughts).

Nursing Guidelines for Borderline PD

1. Set realistic goals, use clear action words. 2. Be aware of manipulative behaviors (flattery, seductiveness, instilling of guilt). 3. Provide clear and consistent boundaries and limits. 4. Use clear and straightforward communication. 5. When behavioral problems emerge, calmly review the therapeutic goals and boundaries of treatment. 6. Avoid rejecting or rescuing. 7. Assess for suicidal and self-mutilating behaviors, especially during times of stress.

Nursing Guidelines for Antisocial PD

1. Try to prevent or reduce untoward effects of manipulation (flattery, seductiveness, instilling of guilt): • Set clear and realistic limits on specific behavior. • Ensure that limits are adhered to by all staff. • Carefully document signs of manipulation or aggression. • Document behaviors (give times, dates, circumstances). Provide clear boundaries and consequences. 2. Be aware that antisocial patients can instill guilt when they are not getting what they want. Guard against being manipulated through feelings of guilt. 3. Substance abuse is best handled through a well-organized treatment program before counseling and other forms of therapy are started.

Nursing Guidelines for histrionic PD

1. Understand seductive behavior as a response to distress. 2. Keep communication and interactions professional, despite temptation to collude with the patient in a flirtatious and misleading manner. 3. Encourage and model the use of concrete and descriptive rather than vague and impressionistic language. 4. Teach and role-model assertiveness.

Anorexia peaks at what age?

11-18 yrs old

Describe the concept of substance-abuse intervention

Addiction is a progressive illness and rarely goes into remission w/out outside help

Assure your safety from violence by:

Avoid wearing dangling jewelry Have enough staff for backup Always know the layout of the area Do not stand directly in front of client or in front of doorway If escalating provide feedback "you seem upset." Avoid confrontation with the client either through verbal means or a show of force.

An unconscious client is admitted to the emergency department. The admitting diagnosis is "rule out opiate overdose." Which item of assessment data would be most consistent with opiate overdose? A. Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min B. Blood pressure, 120/80 mm Hg; pulse, 84 beats/min; respirations, 20 breaths/min C. Blood pressure, 140/90 mm Hg; pulse, 76 beats/min; respirations, 24 breaths/min D. Blood pressure, 180/100 mm Hg; pulse, 72 beats/min; respirations, 28 breaths/min

Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min

Psychiological Symptoms Of Bulimia

Body Image Disturbance Perisistent over concern w/ weight, shape.proportions Mood swings, irritability Self-concept unduly influenced by weight Depression Problems w/ interpersonal relationships and self concept

Causes of anger and aggression

Brain abnormalities Serotonin levels Genetic and environmental factors

Depression and substance abuse is more common with_____________

Bulimia

Why do you slowly refeed a patient?

Can kill the patient

SSRI's

Celexa, Lexapro, Prozac, Paxil, Zoloft. Blocks reuptake of serotoniin making more available and improving mood. useful w/ depression, irritability, sleep disturbances, and anxiety. S/e: agitation, insomnia, headache, N/V, sexual dysfuntion and hyponatremia. Do not abruptly withdraw, taper slowly.

What do you assess for when refeeding a patient?

Check electrolytes (esp. potassium!!!) and for edema

Evaluation for eating disorders

Clients ability to consumer adequate calories to maintain a minimum normal weight Achieve minimum normal weight as determined by the tx team Demonstrate ability to follow the tx regimen recommeneded for post d/c

Which statement about somatoform and dissociative disorders is true? A. An organic basis exists for each group of disorders. B. Nurses perceive clients with these disorders as easy to care for. C. No relation exists between these disorders and early childhood loss or trauma. D. Clients lack awareness of the relations among symptoms, anxiety, and conflicts.

Clients lack awareness of the relations among symptoms, anxiety, and conflicts.

What are the general strategies for relapse prevention?

Cognitive and behavioral: -recognize and learn how to avoid or cope with threats to recovery -changing lifestyle -learn how to participate in society w/out drugs - secure help from others/social support

Durable Power of attorney

Differs from living wills and directives to physicians in that a person other than a physician is appointed to act as the patient's agent.

Advance Directive

Directions provided by a patient for clinician to follow in the event of serious illness.

What information should the nurse give to the family of a client who has had a dissociative episode? A. Dissociation is a method for coping with severe stress. B. Dissociation suggests the possibility of early dementia. C. Alert family that brief periods of psychotic behavior may occur. D. How to intervene to prevent self-mutilation and suicide attempts.

Dissociation is a method for coping with severe stress.

Cluster B Personality Disorders

Dramatic, emotional, erratic behavior; problems with impulse control and emotional processing, and relationships; manipulations and acting out; Antisocial PD, Borderline PD, Histrionic PD, and Narcissistic PD

Schizoid PD

Emotionally detached! Does not seek out or enjoy close relationships. this individual may be able to function in a solitary occupation but shows indifference to praise or criticism from others. Depersonalization may occur.

Which drug is most apt to have been ingested by a young woman who comes to the emergency department with the report that although she has no recollection of the incident, she believes she was sexually assaulted at a party? A. LAAM B. GHB C. ReVia D. Clonidine

GHB

Which neurotransmitter imbalance has been shown to have a relation to impulsive aggression? A. Low levels of γ-aminobutyric acid B. Low levels of serotonin C. High levels of dopamine D. High levels of acetylcholine

Low levels of serotonin

What are some comorbid diagnosis that are common with BDD?

MDD, OCD, social phobia

Do not resuscitate- Comfor care only *DNR- CCO*

Medical care is focused on providing pain-free quality of life and comfort free of invasive procedures and intubation.

Fact or myth? As individuals age, they become more rigid in their thinking and set in their ways.

Myth

Fact or myth? Most Adults past the age of 65 are demented.

Myth

Fact or myth? Most older adults are infirm and require help with daily activities.

Myth

Fact or myth? Most older adults are socially isolated and lonely.

Myth

Fact or myth? Older adults are unable to learn new tasks.

Myth

Fact or myth? Sexual interest declines with age.

Myth

Fact or myth? The aged are well off and no longer impoverished.

Myth

In DID, is the host aware of the alters?

No, but the alters can be aware of each

Delirium

Occurs secondary to a general medical condition. It causes fluctuations in consciousness and changes in cognition which develop over a short period of time *hours to days*. There is usually evidence from history, examination, or diagnostic testing that the disturbance is caused by physiological changes due to underlying pathology.

What's the DSM criteria for substance abuse?

Pattern of drug use leading to clinically significant impairment or distress 1) inability to fulfill major role @ home/work/school 2) participating in physically hazardous situations while impaired 3) recurrent legal/interpersonal problems 4) keep using even though having problems

Which behavior by a client would not support a diagnosis of somatoform disorder? A. Attention seeking from significant others B. Acquiring financial gain from a disability plan C. Avoidance of certain unpleasant activities D. Performing activities of daily living unassisted

Performing activities of daily living unassisted

Common secondary condition causing Delirium in the elderly?

Polypharm

What symptom characterizes body dysmorphic disorder? A. Severe pain with psychological origins B. Fear of having a life-threatening illness C. Multiple physical symptoms spanning many years D. Preoccupation with an imagined defect in appearance

Preoccupation with an imagined defect in appearance

What is the usual course of Alzheimer's disease? A. A single short episode followed by years of normal function B. Reoccurring remissions and exacerbations C. Progressive deterioration D. No usual course exists

Progressive deterioration

Name some helpful techniques for interviewing older adults?

Provide empathetic understanding and active listening. Encouraging ventilation of feelings and normalizing emotional responses. Reestablishing emotional equilibrium when anxiety is moderate to severe. Providing health education and explaining alternative solutions. Assisting in the use of problem- solving approaches Allow adequate time to process information.

Late-life mental illness

Psychatric disorders not discovered earlier in life, but evident in older years. Depression medications: SSRI, SNRI, Tricyclics, MAOI

Supervision of Delirium Pt.

Pt in acute phase should never be left alone! family members can be encouraged to stay w/ pt.

Behavioral Symptoms of Bulimia

Recurrent episodes of binge eating Purging behavior to compensate -self induced vomiting, use of laxatives, diuretics, enemas, fasting, excessive exercise Increase levels of anxiety and compulsitivity Possible chemical dependency Possible impulsivity

A client with bulimia nervosa has several nursing diagnoses. Which diagnosis from the list below would be given priority? A. Disturbed body image B. Chronic low self-esteem C. Risk for injury: electrolyte imbalance D. Ineffective coping: impulsive responses to problems

Risk for injury: electrolyte imbalance

Pharamcologic Tx for eating disorders

SSRIs (bulimia) Atypical Antipsychotics for agitiation w/ weight gain, improving mood, OCD Thorazine for delusional pts NO wellbutrin or benzos May need specific drugs for medical s/e--reglan, stool softners, potassium

Which nursing diagnosis should be investigated for clients with somatoform disorders? A. Deficient fluid volume B. Self-care deficit C. Disturbed personal identity D. Delayed growth and development

Self-care deficit

What's the aim of treatment in substance abuse?

Self-responsibility, not compliance

Behavioral symptoms of Anorexia

Self-starvation Compulsive behaviors regarding food May use laxatives or diuretics, excessive exercise, vomitting Wearing baggy clothes

Which neurotransmitter has been implicated as a possible causative factor in both pain disorder and body dysmorphic disorder? A. Dopamine B. Serotonin C. Norepinephrine D. Acetylcholine

Serotonin

When analyzing assessment data to arrive at nursing diagnoses for a nonpsychotic client who displays much anger and occasional aggression, which nursing diagnosis would receive the *least* initial consideration? A. Social isolation B. Risk for other-directed violence C. Ineffective coping: overwhelmed D. Ineffective coping: maladaptive

Social isolation

Catastrophic reaction

Sometimes the client with a cognitive disorders experiences such severe agitation and aggression that it is referred to as a catastrophic reaction.adopts a calm and unhurried manner.

Cocaine exerts which of the following effects on a client? A. Stimulation after 15 to 20 minutes B. Stimulation and anesthetic effects C. Immediate imbalance of emotions D. Paranoia

Stimulation and anesthetic effects

What is a serious risk factor with pain disorder?

Suicide

A client was in an automobile accident. Although he has the odor of alcohol on his breath, his speech is clear and he is alert and answers questions posed to him. The law enforcement officer requests that the emergency department staff draw a blood sample for blood alcohol level determination. The level is determined to be 0.30 mg%. What conclusion can be drawn? A. The client has a high tolerance to alcohol. B. The client ate a high-fat meal before drinking. C. The client has a decreased tolerance to alcohol. D. No conclusions can be drawn from the data.

The client has a high tolerance to alcohol.

While helping an addicted individual plan for ongoing treatment, which of the following interventions is the first priority for a safe recovery? A. Securing ongoing support from at least two family members. B. The client needs to be employed. C. The client strives to maintain abstinence. D. A regular schedule of appointments with a primary care provider.

The client strives to maintain abstinence.

Which statement is descriptive of clients with personality disorders? A. They are resistant to behavioral change. B. They have an ability to tolerate frustration and pain. C. They usually seek help to change maladaptive behaviors. D. They have little difficulty forming satisfying and intimate relationships.

They are resistant to behavioral change.

Psychiatric advance directives

Those with serious mental illness can designate a health care agent to make treatment decisions during an illness relapse.

Under what conditions can the nurse seek an order to restrain an elderly resident of a health care facility? A. To ensure the physical safety of the resident or other residents. B. To prevent the client from injuring self by falling. C. To permit staff to provide routine care measures when the resident refuses. D. To facilitate care when the client is actively hallucinating.

To ensure the physical safety of the resident or other residents.

True or False: Avoid Benzodiazepine use with patients with delirium, because the medication will worsen the situation.

True.

Binge Eating Disorder

Variant of compulsive overeating No compensatory behaviors Frequently symptom of an affective disorder Cognitive-behavioral therapy, behavior therapy, dialextical behavior therapy and interpersonal therapy most affective

Which item of data routinely gathered during assessment of a client with dissociative disorder would be of least relevance to planning? A. Voluntary control of symptoms B. Ability to remember C. Level of anxiety D. Evidence of confusion and disorientation

Voluntary control of symptoms

Pseudodementia

a disorder that mimics dementia. Examples: drug toxicity, metabolic disorders, infections, and nutritional deficiencies.

The symptom the nurse can expect a client with depersonalization disorder to manifest is A. aimless wandering with confusion and disorientation. B. a feeling of detachment from one's body or mental processes. C. existence of two or more personalities that take control of behavior. D. worry about having a serious disease based on symptom misinterpretation.

a feeling of detachment from one's body or mental processes.

diathesis-stress model

a general theory that explains psychopathology using a systems approach. This theory helps us understand how personality disorders emerge from the multifaceted factors of biology and environment.

psychosomatic illness

a medical condition affected by stressor psychological factors

Anger can be defined as A. an unhealthy way of releasing anxiety. B. perpetrating intentional harm on others. C. an expression of conflict with others. D. a normal response to a perceived threat.

a normal response to a perceived threat.

depersonalization disorder

a persistent or recurrent alteration in the perception of self while reality testing *REMAINS* intact, may feel mechanical ,dreamy or detached form body

A client with histrionic personality disorder winks at an attractive nurse and states, "You and I should be able to turn those resident physicians into jelly if you'd wear your skirts about two inches shorter." The nurse's reply should be based on the understanding that the client's use of seductive behavior is A. a response to stress. B. based on a need to dominate. C. seated in primitive rage. D. callous disregard for others.

a response to stress.

An appropriate long-term goal/outcome for a recovering substance abuser would be that the client will A. discuss the addiction with significant others. B. state an intention to stop using illegal substances. C. abstain from the use of mood-altering substances. D. substitute a less-addicting drug for the present drug.

abstain from the use of mood-altering substances.

A client recently lost his wife for whom he had cared for several years. The community health nurse visits his apartment in the senior living complex and finds the house has not been cleaned and the client is wearing dirty clothing and appears disheveled and apathetic. She notes a vodka bottle in the trash. The client tells the nurse he has nothing to do with his time now that he is alone, so he has "several" cocktails daily. The intervention that would be most helpful would be to A. arrange for a mental health consultation to screen for alcoholism. B. remind the client to limit his drinking because alcoholism can develop insidiously. C. suggest that the client is unwise to drink alone, which will make him more depressed. D. accompany the client to a meeting for residents with drinking problems held at the community center.

accompany the client to a meeting for residents with drinking problems held at the community center.

A client has osteoarthritis and describes the inability to sleep because of aching in her hips and shoulders. An appropriate intervention the nurse could anticipate is administering a bedtime dose of A. aspirin. B. meperidine. C. acetaminophen. D. a sedative-hypnotic.

acetaminophen.

The nurse caring for a client with Alzheimer's disease can anticipate that the family will need information about therapy with A. antihypertensives. B. benzodiazepines. C. immunosuppressants. D. acetylcholinesterase inhibitors.

acetylcholinesterase inhibitors.

The physician mentions to the nurse that a client who is about to be admitted has "sundowning." The nurse can expect to assess nightly A. agitation. B. lethargy. C. depression. D. mania.

agitation.

A client with Alzheimer's disease looks confused when the phone rings and seems not to recognize what the stimulus is. He also cannot recall many common household objects by name, such as a pencil or glass. The nurse can document this as A. apraxia. B. agnosia. C. aphasia. D. anhedonia

agnosia.

For a client with pain disorder, the etiology statement most consistent with current theory would be "related to A. difficulty expressing emotions." B. altered perceptions of pain stimuli." C. lack of coping skills." D. unmet dependency needs."

altered perceptions of pain stimuli."

Cognitive based theory-

although threat is usually understood as an alert to physical danger, Beck noted that *perceived* assault on areas of personal domain, such as, values, moral code, and protective rules can also lead to anger.

*Dementia* cause or contributing factors

alzheimers disease, vascular disease, HIV, neurological disease, chronic alcoholism, head trauma

personality disorder

an enduring pattern of experience and behavior that deviates significantly from the expectations w/in the individuals culture.

A client has been diagnosed with delirium caused by a metabolic disorder. He begs the nurse to get someone to take away the huge snake in the hallway before it comes into his room. The nurse looks to where he is pointing and sees the hose of the vacuum cleaner being used by the housekeeping staff to clean the hall. The nurse can assess this symptom as A. a hallucination. B. an illusion. C. hypervigilence. D. agnosia.

an illusion.

Bupropion (Wellbutrin) while seemingly effective is contraindicated in patients who purge because of: A. historically poor patient compliance B. an increased risk in seizures C. long term effects on liver function D. the potential to cause gastric ulcers

an increased risk in seizures

personality

an individual's characteristic pattern of thinking, feeling, and acting.

The family of a client with Alzheimer's disease mentions to the nurse that seeing his loss of function when he was once such a competent individual has been very difficult. A nursing diagnosis that might be considered for such a family would be A. ineffective denial. B. anticipatory grieving. C. disabled family coping. D. ineffective family therapeutic regimen management.

anticipatory grieving.

A 16-year-old has stolen money from his invalid grandmother, uses drugs and alcohol, and frequently beats up acquaintances who disagree with him. Arrested for an assault in which he beat a classmate and caused brain damage, he stated in court "The guy deserved everything he got." The behaviors described are *most* consistent with the clinical picture of A. antisocial personality disorder. B. borderline personality disorder. C. schizotypal personality disorder. D. narcissistic personality disorder.

antisocial personality disorder.

Clients with cognitive deficits

are particularly at risk for acting aggressively. Can be from Alzheimer's or other dementia or brain injury.

Narcissistic PD

arrogance w/ grandiose view of self-importance. Has the need for constant admiration, along w/ a lack of empathy for others, which strains relationships. results in exploitation of others. Underneath this personality is a person w/ intense shame and fear of abandonment.

The *priority* nursing intervention for a client with borderline personality disorder is to A. protect other clients from manipulation. B. respect the client's need for social isolation. C. assess for suicidal and self-mutilating behaviors. D. provide clear, consistent limits and boundaries.

assess for suicidal and self-mutilating behaviors.

Impulse control training

assisting the pt to mediate impulsive behavior through application of problem-solving strategies to social and interpersonal situations

codependent behaviors

attempt to control other people's drug use think about drug user too much find excuses for person's drug abuse feeling responsible for person drug/alcohol use

A client is a widower who lives with his employed daughter and her busy family. He is quite self-sufficient but tells the community health nurse that he gets lonely being by himself so much of the time with only the television set for company. A suggestion the nurse might make is to A. have the neighborhood watch to visit once daily. B. attend a social day care three times a week. C. attend an adult day health program daily. D. attend a maintenance day care program daily.

attend a social day care three times a week.

delirium cognitive and perceptual disturbances

aware that something is very wrong. emotional response is often fear and anxiety and may be manifested by psychomotor agitation

Benzodiazepines are useful for treating alcohol withdrawal because they A. block cortisol secretion. B. increase dopamine release. C. decrease serotonin availability. D. bind to ã-aminobutyric acid-benzodiazepine receptors.

bind to ã-aminobutyric acid-benzodiazepine receptors

Blood transfusions are no longer the main cause for the spread of AIDS. Research shows that the risk for HIV-AIDS among elders is A. caused by failure to practice safer sex. B. not a high risk factor. C. usually only a factor for older men. D. an issue only among elders who are promiscuous.

caused by failure to practice safer sex.

Avoidant PD

characteristics are an extreme sensitivity to rejection and robust avoidance of interpersonal situations. These individuals demonstrate poor self-confidence and are prone to misinterpreting others' feedback because they are overly sensitive to rejection.

Cluster A personality disorders

characteristics of eccentric and odd behaviors, such as social isolation and detachment. may also be perception distortions, unusual levels of suspiciousness, Paranoid PD, Schizoid OD, & Schizotypal PD

obsessive-compulsive PD

characteristics of perfectionism w/ a focus on orderliness and control. These people become so preoccupied w/ details and rules that they may not be able to accomplish a given task.

Delirium

characterized by a disturbance of consciousness and a change in cognition that develop over a *short period of time*

paranoid PD

characterized by distrust and suspiciousness toward others based on the belief that others want to exploit, harm, or deceive the person. these people are hypervigilant, anticipate hostility, and may provoke hostile responses by initiating a "counterattack." demonstrate jealousy, controlling behaviors, and unwillingness to forgive

What may be associated with conversion disorder?

childhood physical or sexual abuse

AIDS Dementia Complex

cognitive impairment associated with HIV.

malingering

conscious process of intentionally producing symptoms of an obvious benefit

What is one of the most common somatoform disorder?

conversion disorder

An example of a somatoform disorder is A. depersonalization. B. dissociative fugue. C. conversion disorder. D. dissociative identity disorder

conversion disorder.

Therapeutic intervention for a client with a somatoform disorder would include A. steering conversation away from client feelings. B. conveying interest in the client rather than in symptoms. C. encouraging the client in liberal use of benzodiazepines. D. encouraging the client to refer to the nurse for meeting client needs.

conveying interest in the client rather than in symptoms.

A client is brought to the hospital by her daughter, who visited this morning and found her mother to be confused and disoriented. The client has difficulty answering the questions asked by the nurse. The daughter reports that her mother had been oriented and able to carry on a logical conversation the evening before. The nurse can suspect that the client is displaying symptoms associated with A. delirium. B. dementia. C. amnesic disorder. D. selective inattention.

delirium.

A coping mechanism used excessively by clients with anorexia nervosa is A. denial. B. humor. C. altruism. D. projection.

denial

Defense mechanisms for Alzheimers

denial, confabulation, perseveration and avoidance of questions

A client who is dependent on alcohol and drinks several six-packs of beer daily tells the nurse "Alcohol is no problem to me. I can quit anytime I want to." The nurse can assess this statement as indicating A. denial. B. projection. C. rationalization. D. reaction formation.

denial.

Dementia in an older adult is often a misdiagnosis for: A. depression B. cerebral emboli C. normal effects of aging D. poor nutritional statis

depression

What are some cormorbid conditions with hypochondriasis?

depression, ADs, PDs substance abuse

What are some common comorbid conditions with conversion disorder?

depression, anxiety, other somatoform disorders, and personality disorders

What are some comorbid conditions with pain disorder?

depression, substance abuse, PDs

Ageism is best explained as A. prominent personality disorganization after age 65 years. B. learned helplessness among elderly clients. C. discrimination against the elderly on the basis of age. D. behaviors of elderly persons that serve as barriers to health.

discrimination against the elderly on the basis of age.

dissociative disorder

disorder from conscious awareness of painful feelings, memories, thoughts or aspects of identity, unconscious defense mechanism to protect self

A client with bulimia nervosa uses enemas and laxatives to purge to maintain her weight. The imbalance for which the nurse should assess is A. an increase in red blood cell count. B. disruption in fluid and electrolyte balance C. elevated serum potassium. D. elevated serum sodium.

disruption in fluid and electrolyte balance

What is the difference between dissociative disorders and somatoform disorders?

dissociative disorders are unconscious

A person who covertly supports the substance-abusing behavior of another is called a(n) A. patsy. B. enabler. C. participant. D. minimizer.

enabler.

Illusions

errors in perception of sensory stimuli. the stimulus is a real object in the environment, however, it is misinterpreted and often becomes the object of pts projected fear.

Dependent PD

establish relationships in which they are submissive, self-doubting, and avoid self responsibility. find it difficult to sustain autonomy and often seek out relationships in which they can be taken care of.

limit-setting

establishing the parameters of desirable and acceptable pt behavior

dialectical behavior therapy

evidence-based theory to successfully treat chronically suicidal pts w/ borderline personality disorder. combines cognitive behavioral techniques with mindfulness, which emphasizes being aware of thoughts and actively shaping them.

Korsakoff's syndrome

example of secondary dementia cause by thiamine (Vitamin b1) deficiency, which may be associated with prolonged, heavy alcohol ingestion. marked by peripheral neuropathy, cerebellar ataxia, confabulation, and myopathy.

A terminally ill elderly client wishes to guarantee that his wishes about end-of-life care will be followed. The approach that will most closely guarantee this is for the client to A. remain in control of health care decision-making. B. write a living will. C. issue a directive to physician. D. execute a durable power of attorney for health care.

execute a durable power of attorney for health care.

A client tells the nurse that he prefers not to attend senior citizens meetings held in his apartment building because the members are "old fuddy duddies" who talk subjects to death but never take action. He states "They dodder around and never accomplish anything other than playing cards. I would rather go to a movie or a lecture." The nurse can hypothesize that the client may be A. exhibiting ageism. B. somewhat paranoid in his thinking. C. projecting his own weaknesses onto others. D. hypercritical of his peers' age-appropriate behaviors.

exhibiting ageism.

Delirium Risk Factors

existing cognitive impairment, low functional autonomy, polypharmacy (especially benzos, narcotics, and anticholinergics), and clinical severity of primary illness

The clinic waiting room is crowded and hot. The doctor seeing clients was late because of an emergency surgery and is quite behind schedule. A client is pacing and looking tense. The nurse estimates that he has at least a 45-minute wait. The nurse should A. tell the client that pacing will not help the rate at which clients are seen. B. adjust the appointment schedule to allow the client to be seen next. C. empathize with the long wait and ask the client if he would mind sitting down until his turn comes. D. explain to the client what caused the back-up and suggest that he has time to go to the coffee shop.

explain to the client what caused the back-up and suggest that he has time to go to the coffee shop.

schizotypal PD

expressed in strikingly odd characteristics, including magical thinking, derealization, perceptual distortions, and rigid, peculiar ideas. speech patterns may be distinctive and bizarre.

anger control assistance

facilitation of the expression of anger in an adaptive, nonviolent manner

Hallucinations

false sensory stimuli. Visual are common in delirium, and tactile(feel) may also be present.

Stage 4: Late Alzheimers disease (end stage)

family recognition disappears, does not recognize self in mirror. nonambulatory, shows little purposeful activity, often mute, may scream spontaneously. forgets how to eat, swallow, chew, commonly loses weight, emaciation common. has problems associated with immobility. incontinence common, seizures may develop. most certainly instituionalized at this point. return of primitive (infantile) reflexes. Agraphia (inability to read or write), hyperorality (the need to tase, chew, and put everything in ones mouth), bluntin of emotions, visual agnosia (loss of ability to recognize familiar objects), morphosis (manifested by touching of everything in sight). characterized by stupor and coma. death frequently is secondary to infection or choking.

A subjective symptom the nurse would expect to note during assessment of a client with anorexia nervosa is A. lanugo. B. hypotension. C. 25-lb weight loss. D. fear of gaining weight.

fear of gaining weight.

A client with delirium strikes out at staff. The nurse can most correctly hypothesize that this behavior is related to A. anger. B. fear. C. meanness. D. lack of social concern.

fear.

In contrast to the client with anorexia nervosa, the client with bulimia usually A. uses greater denial. B. is aware of the eating problem. C. fits more easily into the family. D. appraises his or her body more realistically.

fits more easily into the family.

Cognitive disorders interventions

focused on protecting patient dignity, preserving functional status and promoting well-being for cognitively impaired patients.

criteria for hypochondriasis

for at least 6 MONTHS; preoccupation with fears of having a serious disease, despite appropriate medication treatment and reassurance, causing significant impairment in social or occupational functioning or causes marked distress

Pre-assaultive stage:

frequently verbal interventions are sufficient during this stage.

A realistic short-term goal for the first week of hospitalization for a client with anorexia nervosa whose weight is 65% of normal weight would be: By end of week 1 the client will A. gain a maximum of 3 lb. B. develop a pattern of normal eating behavior. C. discuss fears and feelings about gaining weight. D. verbalize awareness of sensation of hunger.

gain a maximum of 3 lb.

what are the different types of amnesia?

generalized, localized, selective

Characteristic behaviors the nurse will assess in the narcissistic client are A. dramatic expression of emotion, being easily led. B. perfectionism and preoccupation with detail. C. grandiose, exploitive, and rage-filled behavior. D. angry, highly suspicious, aloof, withdrawn behavior

grandiose, exploitive, and rage-filled behavior.

early stages alzheimers assessment

person may be able to compensate for loss of memory. may have superior social graces and charm that give them ability to hide severe deficits in memory, even from experience health care professionals. form of denial, which is an unconscious protective defense against the terrifying reality of losing one's place in the world.

Dr. White writes the following order for restraint for a confused elderly resident who walks up to other residents and slaps them: "3/11/01 Restrain in chair or bed prn. William A. White, MD." The nurse transcribing the order should A. transcribe the order as written. B. point out that the order is premature. C. insert the type of restraint to be used. D. suggest the alternate use of an anxiolytic.

point out that the order is premature.

criteria for body dysmorphic disorder

preoccupied with imagine defect in appearance, causing significant impairment

The term "perceptual disturbance" refers to difficulty A. processing information about one's internal and external environment. B. changing one's way of thinking to accommodate new information. C. performing purposeful motor movements. D. formulating words appropriately.

processing information about one's internal and external environment.

Dementia

progressive deterioration of cognitive functioning and global impairment of intellect with no change in consciousness. manifested as difficulty w/ memory, thinking and comprehension. Irreversible.

stage 2: Moderate Alzheimers Disease (Confusion)

progressive memory loss, short term memory impaired, memory difficulties interfere with all abilities. withdrawn from social activities, shows decline in instrumental ADL's such as money management, legal affairs, transportation, cooking, housekeeping. denial commons; fears " losing their mind". Depression increasingly common; frighting b/c aware of deficits; covers up for memory through confabulation*** problems intensified when stressed, fatigued, out of own environment, ill. commonly needs day care or in home assistance. deterioration becomes evident. cannot remember address /date. memory gaps in persons hx may fluctuate. hygiene suffers and ability to dress appropriately is markedly affected (apraxia). has to be coaxed to bathe. mood becomes labile and individual may have bursts of paranoia, anger, jealousy, and apathy. activities such as driving are hazardous and families are faced with difficulty of taking away car keys. care and supervision become fulltime job for family. denial mercifully protects people from realization of losing control. people begin to withdraw from overwhelmed and frustration. may have moments of becoming tearful and sad. caretakers should realize that person still retains abilities that influence care.

A client has been placed in seclusion to control aggressive behavior. Care while the client is secluded should include A. observation every 30 minutes. B. releasing the client every 8 hours. C. increasing sensory stimulation. D. providing for nutrition and hydration.

providing for nutrition and hydration.

The intervention strategy least useful when addressing suicidal ideation in an elderly client is A. psychoanalytic psychotherapy. B. empathetic understanding. C. crisis intervention techniques. D. explaining alternative solutions.

psychoanalytic psychotherapy.

In performing quality assurance surveys of health education received by elderly clients, the nurse is most likely to find that the elderly A. receive considerably less information on available resources. B. receive maximal evaluation and treatment for acute illnesses. C. waste resources that are available for the population at large. D. are too pessimistic to seek out and use community resources.

receive considerably less information on available resources.

A nurse doing a survey about adequacy of pain management in the elderly will be most likely to find that the elderly A. receive less analgesia than younger adults, resulting in inadequate pain relief. B. need smaller doses of pain medication to achieve adequate pain relief. C. excrete analgesics more rapidly, thus needing more frequent doses. D. respond better to meperidine than to morphine sulfate when opiates are necessary.

receive less analgesia than younger adults, resulting in inadequate pain relief.

What's the DSM criteria for alcohol intoxication

recently drank behavior/mood changes slurred speech, unsteady gait, coma, impaired memory and/or incoordination not due to medical condition

Describe flashbacks

recurrences of perceptual disturbance caused by a person's earlier hallucinogenic drug use when in a drug free state

perseveration

repetition of phrases or behavior. eventually seen and is often intensified under stress.

A newly admitted client has an axis II diagnosis of schizoid personality disorder. The nursing intervention of *highest* priority will be to A. set firm limits on behavior. B. respect need for social isolation. C. encourage expression of feelings. D. involve in milieu and group activities.

respect need for social isolation.

Can BDD be successfully treated?

response to treatment is limited

The most helpful message to transmit about relapse to the recovering alcoholic client is that lapses A. are an indicator of treatment failure. B. are caused by physiological changes. C. result from lack of good situational support. D. can be learning situations to prolong sobriety.

result from lack of good situational support.

A client has had hypochondriasis for 2 years. His wife tells the nurse "It is so difficult! Whenever we make plans to get together with another couple or go on vacation or do anything pleasant, my husband throws a monkey wrench in the works, saying he is too ill, or he needs to make a doctor's appointment. I don't know how much longer I can take it." On the basis of this report, the nurse may wish to explore the nursing diagnosis of A. interrupted family processess. B. decisional conflict. C. risk for caregiver role strain. D. impaired home maintenance.

risk for caregiver role strain.

A nursing diagnosis appropriate for a client with Alzheimer's disease, regardless of the stage, would be A. risk for injury. B. acute confusion. C. imbalanced nutrition. D. impaired environmental interpretation syndrome.

risk for injury.

What is DID often misdiagnosed for?

schizophrenia

The most restrictive method for dealing with an aggressive client who is out of control is A. seclusion. B. a show of force. C. verbal intervention. D. antipsychotic medication.

seclusion.

Splitting is a process in which the client A. unconsciously represses undesirable aspects of self. B. places responsibility for his or her behavior outside the self. C. sees things as divided into "all good" or "all bad." D. evidences lack of personal boundaries.

sees things as divided into "all good" or "all bad."

Minnesota Multiphasic Personality Inventory (MMPI)

self-report inventory that is useful because they have built in validity and reliability scales for the clinician to refer to when interpreting test results. may give false positives if the pt is not totally honest.

Biological theorists suggest the cause of eating disorders may be A. normal weight phobia. B. body image disturbance. C. serotonin imbalance. D. dopamine excess.

serotonin imbalance.

Cholinesterase Inhibitors

tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne); prevents breakdown of acetylcholamine and thereby increases availability at synapse. improves cognition, behavior, function, slows disease progression. S/e: N/V, diarrhea, insomnia, fatigue, muscle cramps, incontinence, bradycardia, and syncope. Aricept better tolerated-dosage only 1/day (preferred). Exelon once daily patch. Razadyne used for 1 or 2 stage.

The nurse working with clients with eating disorders can help families develop effective coping mechanisms by A. teaching the family about the disorder and the client's behaviors. B. stressing the need to suppress overt conflict within the family. C. urging the family to demonstrate greater caring for the client. D. encouraging the family to use their usual social behaviors at meals.

teaching the family about the disorder and the client's behaviors.

An elderly client is moderately cognitively impaired and terminally ill with breast cancer. When asked if she is in pain, she usually denies it. She tells staff "My back aches a bit." The nurses note she lies rigidly in bed and grimaces when she turns from side to side. In an attempt to obtain a more accurate assessment the nurses might choose to use A. the Present Pain Intensity Rating Scale. B. the Visual Analog Scale. C. the FACES Scale. D. the Pain Assessment in Advanced Dementia (PAINAD) scale.

the Pain Assessment in Advanced Dementia (PAINAD) scale.

How is case management helpful with somatoform disorders

the case manager can recommend to the HCP to schedule appointments every 4-6 weeks and give the patient someone to contact, who is in charge.

confabulation

the creation of stories or answers in place of actual memories to maintain self esteem. (not the same as lying) lying they are aware of making up and answer, with this it is an unconscious attempt (this is according to the book; class notes state that this is conscious lying)

factitious disorder

the disorder that refer to deliberate fabrication of symptoms or self inflicted injury for the purpose of assuming the sick and receiving nurture, comfort and attention

Dissociative identity disorder is characterized by A. the inability to recall important information. B. sudden unexpected travel away from home and inability to remember the past. C. the existence of two or more subpersonalities, each with its own patterns of thinking. D. recurring feelings of detachment from one's body or mental processes.

the existence of two or more subpersonalities, each with its own patterns of thinking.

somatization

the expression of psychological stress through physical symptoms

Munchausen syndrome

the most severe and chronic form of factitious disorder, and results in self harm severe enough for hospitalization.

The term tolerance, as it relates to substance abuse, refers to A. use of a substance beyond acceptable societal norms. B. the additive effects achieved by taking two drugs with similar actions. C. the signs and symptoms that occur when an addictive substance is withheld. D. the need to take larger amounts of a substance to achieve the same effects.

the need to take larger amounts of a substance to achieve the same effects.

dissociative identity disorder (multiple personality disorder)

the presence of two or more distinct personality states (alters) that recurrently take control of behavior.

splitting

the primary defense or coping style used by persons w/ borderline PD, is the inability to incorporate + and - aspects of oneself or others into a whole image.

Antisocial PD

this disorder reflects constant disregard for others through exploitation and repeated unlawful actions. No remorse for others, neglect responsibilities, tell lies, and perform destructive or illegal acts w/o developing any insight into consequences. *Psychopaths/Sociopaths*

Munchausen syndrome by proxy

this is the disorder that manifested in a caregiver, injuring a child or dependent to get attention or sympathy

primary gains

this is when the patient wants to decrease actual symptoms and want relief from symptoms

Nursing assessment of an alcohol-dependent client 6 to 12 hours after the last drink would most likely reveal the presence of A. tremors. B. seizures. C. blackouts. D. hallucinations.

tremors.

localized amnesia

unable to recall information regarding certain event in a certain period

general amnesia

unable to recall information regarding the person's whole life

selective amnesia

unable to recall some but not all event in a certain period

Assaultive stage:

use of restraints, seclusion and medications. Throughout this time, the team leader continues to relate to the client in a calm, steady voice, communicating decisiveness, consistency, and control.

Nurses coping with angry clients may find it helpful to remember that anger and aggression begin as feelings of A. isolation. B. confidence. C. competence. D. vulnerability.

vulnerability.

A focus for the acute phase of treatment for anorexia nervosa would be A. weight restoration. B. improving interpersonal skills. C. learning effective coping methods. D. changing family interaction patterns.

weight restoration.

antagonist effects

when taken together, weaken or inhibit the effect of one of the drugs

secondary gains

when the patient will benefit from the symptoms alone

synergist effects

when two or more drugs are taken together it results in greater CNS depression -effects are intensified and prolonged

A syndrome that occurs after stopping use of a drug is A. amnesia. B. tolerance. C. enabling. D. withdrawal.

withdrawal.

s/s risk of escalating anger leading to aggressive behavior.

•Hyperactivity: most important predictor of imminent violence (e.g., pacing, restlessness) •Increasing anxiety and tension: clenched jaw or fist, rigid posture, fixed or tense facial expression, mumbling to self (patient may have shortness of breath, sweating, and rapid pulse) •Verbal abuse: profanity, argumentativeness •Loud voice, change of pitch; or very soft voice, forcing others to strain to hear •Intense eye contact or avoidance of eye contact

A client is experiencing manic hyperactivity. In the dining room she stands up and shouts "This food is garbage! I'll fight anyone who says it's not! I can fight all of you at one time and win with one hand tied behind my back!" She is flushed, her fists are clenched, and she glares challengingly at clients and staff. The nurse's most relevant assessment is that the client A. is upset with the quality of the food. B. is getting rid of tension in a harmless way. C. is frustrated by limits imposed by hospitalization. D. has a high potential for other-directed violence.

has a high potential for other-directed violence.

The nurse can determine that inpatient treatment for a client with an eating disorder would be warranted when the client A. weighs 10% below ideal body weight. B. has a serum potassium level of 3 mEq/L or greater. C. has a heart rate less than 60 beats/min. D. has systolic blood pressure less than 70 mm Hg.

has systolic blood pressure less than 70 mm Hg.

Opiates

have a greater analgesic effect than non-opiates. Avoid meperidine can cause confusion/ seizures. Morphine is safer option duration longer, for a smaller dose.

When working with an angry client it is best to A. encourage the client to fully explore and express his anger. B. help the client deny and repress the feelings of anger. C. help the client reframe the anger-producing situation. D. ignore the client's anger and change the subject.

help the client reframe the anger-producing situation.

During assessment of a client with anorexia nervosa it is *not* likely that the nurse would note indications of: A. introversion. B. social isolation. C. high self-esteem. D. obsessive-compulsive tendencies.

high self-esteem.

body dysmorphic disorder

highly distressing and impairing disorder, patient with normal appearance with minor defects, preoccupied wit image, resulting in obsessive thinking and compulsive behavior such as mirror checking and camouflaging. the feel great shame and hide or withdraw from others seek cosmetic surgery

What is the single best predictor of future violence?

history of violence

Amyloid vaccine (AN-1792)

hoped to clear brain of amyloid plaques. latest reports did not alleviate progression of alzheimers.

Anger and hostility are also risk factors for:

hypertension and cardiovascular disease. Hostility has been shown to increase adrenocorticotropin and cardiovascular responses to stress and to increase illness.

*Delirium* cause or contributing factors

hypoglycemia, fever, dehydration, hypotension, infection, other conditions that disrupt body's homestasis. Adverse drug reaction, head injury, change in environment, pain, emotional stress. nervous system disease, systemic disease, and intoxication or withdrawal from a chemical substance

A client reveals that she induces vomiting as many as a dozen times a day. The nurse would expect assessment findings to reveal A. tachycardia. B. hypokalemia. C. hypercalcemia. D. hypolipidemia.

hypokalemia

A short-term goal for a client who has demonstrated aggression while an inpatient would be that the client will A. strike objects rather than people. B. limit aggression to verbal outbursts. C. isolate in lieu of striking people. D. identify situations that precipitate hostility.

identify situations that precipitate hostility.

A nursing diagnosis for a client who is 16 years old, 5 foot 3 inches tall, and 80 pounds who eats one tiny meal daily and engages in a rigorous exercise program would be A. death anxiety. B. ineffective denial. C. disturbed sensory perception. D. imbalanced nutrition: less than body requirements.

imbalanced nutrition: less than body requirements.

*delirium* cognition

impaired memory, judgement, calculations, attention span can fluctuate through the day

*dementia* cognition

impaired memory, judgement, calculations, attention span does not fluctuate, problems with abstract thinking, agnosia

Clients with personality disorders have various self-defeating behaviors and interpersonal problems despite having near-normal ego functioning and intact reality testing. A nursing diagnosis that addresses this sort of interpersonal dysfunction is A. spiritual distress. B. defensive coping. C. impaired social interaction. D. disturbed sensory perception.

impaired social interaction.

Amnesia/ Memory Impairment Alzheimers assessment

initially has difficulty remembering recent events and gradually includes recent and remote memory.

Assessment of a client with suspected bulimia nervosa calls for the nurse to perform A. a range of motion assessment. B. inspection of body cavities. C. inspection of the oral cavity. D. body fat analysis.

inspection of the oral cavity.

A usually quiet resident in a long-term care facility has become confused and has shouted out a number of times during the night. The other residents in nearby rooms are upset by the noise and the interruptions to their sleep. The nurse in charge should A. obtain an order for an as-needed dose of Ativan for the client. B. give the other residents ear plugs and close their room doors. C. investigate the reason for the client's behavioral change. D. place the client in a geriatric chair near the nurse's station.

investigate the reason for the client's behavioral change.

Aggression

is a harsh physical or verbal action that reflects rage hostility, and potential for physical or verbal destructiveness.

An adolescent male is swearing and shouting at his physician, who refused to give him a pass to leave the unit. This behavior A. is acceptable if directed at staff but not when directed at other clients. B. may reduce tension and prevent the client from physically acting out. C. is a major indicator that the client may become physically aggressive. D. can be attributed to lack of parental controls applied at an early age.

is a major indicator that the client may become physically aggressive.

A physician describes a client as "malingering." The nurse knows this means the client A. is falsely claiming to have the symptoms. B. experiences symptoms that cannot be explained medically. C. experiences symptoms that have a physiological basis. D. is seeking medication to ease pain of psychological origin.

is falsely claiming to have the symptoms.

Primary dementia

is irreversible, progressive, and not secondary to any other disorder EX: alzheimers and vascular dementia

Anger

is the emotional response to frustration threats, or challenges and is a normal response. We should not feel guilty about becoming angry but how we respond to that anger may be a problem, venting anger may not be good in some cases.

One site known to be associated with aggression

is the limbic system which mediates primitive emotion and behaviors that are necessary for survival. The amygdala mediates anger experiences. The temporal lobe is associated with high violence.

A woman has to take her real estate examination tomorrow but suddenly finds she cannot see. She seems unconcerned about her symptom and tells her husband "Don't worry, dear. Things will all work out." Her attitude is an example of A. regression. B. depersonalization. C. la belle indifference. D. dissociative amnesia.

la belle indifference.

An initial intervention the nurse might suggest to the family members of a client with Alzheimer's disease who has begun to be incontinent for urine is to: A. label the bathroom door with a picture. B. provide toileting on an as-needed basis. C. apply disposable diapers. D. encourage hourly toileting.

label the bathroom door with a picture.

Research has indicated that antisocial personality may be characterized by: A. social isolation. B. lack of remorse. C. learning difficulties. D. difficulty with reality testing.

lack of remorse.

Symptoms that would signal opioid withdrawal include A. lacrimation, rhinorrhea, dilated pupils, and muscle aches. B. illusions, disorientation, tachycardia, and tremors. C. fatigue, lethargy, sleepiness, and convulsions. D. synesthesia, depersonalization, and hallucinations.

lacrimation, rhinorrhea, dilated pupils, and muscle aches.

Safe Return Program

launched by alzheimers association as the first nationwide program to help locate and return missing people with AD and other memory impairments.

A client has been a resident of the long-term care center for 6 weeks. She has been able to bathe with minimal assistance, feed herself, and ambulate short distances. Today, she tells the nurse "you bathe me." When the nurse inquires as to why the resident is making this request, she states "I don't do that anymore. The aides say it is faster to take care of me." The nurse can assess this as A. learned helplessness. B. lack of cooperation. C. continuing independence. D. striving for autonomy.

learned helplessness.

The more a nurse's intervention is prompted by emotion, the A. less likely it is to be therapeutic. B. less likely it is to be aggressive. C. more likely it is to be effective. D. more likely it is to be empathetic.

less likely it is to be therapeutic.

Validation therapy for cognitive deficits

lets you begin emotionally where the client is It grounds the client where he or she feels most secure It is often more helpful to reflect back to the client the feelings behind her demand and to show understanding and concern for her worry. As the nurse establishes himself or herself as a safe understanding person, the client becomes calmer and more open to redirection.

N-Methyl-D-Apartate (NMDA) Antagonist

memantine (Namenda). First drug to target symptoms during moderate to severe stages but not approved for mild. Normalizes levels of glutamate, which in excessive quantities contributes to neurodegeneration. Treatment of moderate to severe alzheimers. no evidence that it modifies underlying disease. S/e: dizziness, agitation, headache, constipation and confusion. clearance is reduced with renal impairment, use cautiously with moderate renal impairment and do not use with severe

mild delirium

memory deficits are noted only on careful questioning

severe delirium

memory problems usually take the form of obvious difficulty in processing and remembering recent events.

What are illusions?

misinterpretations, usually of a threatening nature, of objects in the environment

A nurse is assigned to work with a client with borderline personality disorder. The nurse will need to consider strategies for dealing with the client's A. mood shifts, impulsivity, and splitting. B. grief, anger, and social isolation. C. altered sensory perceptions and suspicion. D. perfectionism and preoccupation with detail.

mood shifts, impulsivity, and splitting.

Borderline PD

most common and dramatic, is characterized by severe impairments in functioning; instability in emotion regulation, interpersonal relationships, impulsivity, identity or self-image distortions, and unstable mood.

Alzheimer's disease (AD)

most common cause of dementia in older adults, progressive brain disorder marked by impaired memory and thinking skills.

A nurse attempts to intervene verbally when an angry client threatens to throw a chair. The client turns his wrath from the original unmet need to the nurse and begins to shout at her. Several staff members gather behind the nurse. In response to the direction to try to calm down, the client shouts "I will calm down when that bitch isn't in my face." The nurse should A. stand her ground. B. leave the room. C. move to the rear of the staff group. D. apologize for upsetting the client.

move to the rear of the staff group.

Does location of symptoms change with pain disorder?

no

A client has been using cocaine intranasally for 4 years. Two months ago she started freebasing. For the past week she has locked herself in her apartment and has used $8000 worth of cocaine. When brought to the hospital she was unconscious. Nursing measures should include A. induction of vomiting. B. administration of ammonium chloride. C. monitoring of opiate withdrawal symptoms. D. observation for hyperpyrexia and seizures.

observation for hyperpyrexia and seizures.

A client brought to the emergency department at the university hospital after PCP ingestion tries to run up and down the hallway. The nursing intervention that would be most therapeutic is A. taking him to the gym on the psychiatric unit. B. obtaining an order for seclusion and close observation. C. assigning a psychiatric technician to "talk him down." D. administering naltrexone as needed per hospital protocol.

obtaining an order for seclusion and close observation.

secondary dementia

occurs as a result of some other pathological process (metabolic, nutritional, or neuro) EX: AIDS. can result from viral encephalitis, pernicious anemia, folic acid deficiency and hypothryoidism.

codependence

often exhibit over-responsible behavior doing things for people they can do for themselves care for others @ exclusion of own needs

Postassaultive stage-

once seclusion is no longer needed the staff should review the incident with the client and with staff members. It can be a learning moment for all concerned. For the client their out of control behavior.

The only class of commonly abused drugs that has a specific antidote is A. opiates. B. hallucinogens. C. amphetamines. D. benzodiazepines.

opiates.

Temperament

our tendency to respond to challenges in predictable ways ex. "laid back" referring to calm or "uptight" referring to anxious

hypervigilance

patients are extraordinarily alert and their eyes constantly scan the room

Nursing Guidelines for Narcissistic PD

1. Remain neutral; avoid engaging in power struggles or becoming defensive in response to the patient's disparaging remarks. 2. Convey unassuming self-confidence.

Serotonin levels- (Anger)

studies have shown a relationship between impulsive aggression and low levels of serotonin.

Social learning theorists

such as Bandura, showed children learn by imitating others and that people repeat behavior that is rewarded. Also children who grow up in angry families learn to respond to frustration with anger and violence.

dissociative fugue

sudden, unexpected, unexplained travel away from the customary locale (home); inability to recall one's identity and some or all of the past; in this state they live a simple life not calling attention to self; may assume new identity; last from few minutes to several days. when remember former identity, usually become amnesic for time spent in fugue state

A client is brought to the hospital by her daughter, who visited this morning and found her mother to be confused and disoriented. The daughter remembered to bring her mother's medication to the hospital. They include digoxin, an antihypertensive, a tricyclic antidepressant, and an antiparkinson drug (benztropine mesylate) that the client has been taking for only 5 days. For planning purposes, the nurse should realize that the least likely action the physician will take is A. ordering benzodiazepine administration. B. withdrawing the antidepressant and antiparkinson drugs. C. having blood drawn for a serum digoxin level. D. suggesting the social worker talk to the family about institutionalization.

suggesting the social worker talk to the family about institutionalization.

A nurse planning continuing education programs for nursing staff at a multipurpose senior center will plan programs based on the knowledge that one of the most common mental health problems among the elderly is A. schizophrenia. B. agoraphobia. C. obsessive compulsive disorder. D. suicidal ideation.

suicidal ideation.

Sundowning

symptoms and problem behaviors become more pronounced in the evening, may occur in both delirium and dementia

Who is at highest risk for depression and suicide?

White males older than 75 years old (this is according to the book; according to class notes, the age is 65 years or older)

Which assessment question should be asked of a client suspected of having anorexia nervosa? A. "Do you find yourself feeling hungry?" B. "How would you describe your body?" C. "How often do you force yourself to vomit?" D. "Why do you choose to take laxatives?"

"How would you describe your body?"

A client is brought to the hospital by her daughter, who visited this morning and found her mother to be confused and disoriented. When the client is admitted, the daughter states "I'll take her glasses and hearing aid home so they don't get lost." The best reply for the nurse would be A. "That will be fine. I'll have you sign our hospital release form." B. "Because we do not have a copy of durable power of attorney we cannot release them to you." C. "Don't worry. You can leave them at her bedside. We are insured for losses of this sort." D. "I would like to have your mother wear them. It will help her to be less confused."

"I would like to have your mother wear them. It will help her to be less confused."

A client with dependent personality disorder who had been living with her newly married son was admitted a week ago for treatment of depression, which began after her son suggested that she move out. Which remark by the client would the nurse evaluate as showing *improvement* in the client's condition? A. "My son's suggestion hurt me greatly." B. "My son is less at fault than my daughter-in-law." C. "I'm going to need help to afford to rent an apartment." D. "How will I ever live alone with no one to look after my affairs?"

"I'm going to need help to afford to rent an apartment."

A teaching need is revealed when a client taking disulfiram states A. "I usually treat heartburn with antacids." B. "I take ibuprofen or acetaminophen for headache." C. "Most over-the-counter cough syrups are OK for me to use." D. "I have had to give up using aftershave lotion."

"Most over-the-counter cough syrups are OK for me to use."

A client wanders about the long-term care unit. She is unsteady and often falls, sustaining bruises and scrapes. The family is concerned about her falls and the potential for serious injury. They suggest that she be restrained. The best response for the nurse would be A. "You will need to make your request to the physician at the planning meeting." B. "The federal government forbids the use of restraints on elderly clients." C. "Using restraints puts the client at higher risk for serious injury, even death." D. "Immobilization will cause constipation and necessitate the use of enemas."

"Using restraints puts the client at higher risk for serious injury, even death."

Nursing Guidelines for Obsessive-Compulsive PD

1. Guard against power struggles with patient. Need for control is very high. 2. Intellectualization, rationalization, reaction formation, isolation, and undoing are the most common defense mechanisms.

Nursing Guidelines for Dependent PD

1. Identify and help address current stresses. 2. Try to satisfy patient's needs at the same time that limits are set up in such a manner that patient does not feel punished and withdraw. 3. Be aware that strong countertransference often develops in clinicians because of patient's excessive clinging (demands of extra time, nighttime calls, crisis before vacations); therefore, supervision is well advised. 4. Teach and role-model assertiveness.

Explain the assessment guidelines for chemically impaired patients

1) check for severe or major withdrawal syndrome 2) check for overdose to a drug or alcohol 3)check for suicidal thoughts/self-destructive behavior 4)check for physical complications related to drug abuse 5)does patient want to fix substance problem? 6)does patient/family know about community resources for drug/alcohol treatment

Describe the steps in substance-abuse intervention

1) concerned people gathered 2) specific evidence given by each person 3) right timing: person not high, current evidence available 4)privacy 5) don't react to defenses by person 6)genuine but firm concern is demonstrated 7)substance abuse seen as disease 8)treatment alternatives shown 9) response to possible outcomes ready -yes=go to treatment no=i gotta make some changes then

What's the DSM criteria for substance-induced delirium

1) impaired consciousness 2)change in cognition:memory, impairment, disorientation) 3)develops over short period of time and fluctuates over day 4)evidence of substance abuse and withdrawal

Which 2 questions can be asked to detect alcohol or drug problems?

1) in the last year, have you ever drunk or used more drugs than you meant to? 2) have you ever felt you wanted or needed to cut down on your drinking or drug use in the last year? ** red flags: rationalizations, automatic responses as if question were predicted, slow, prolonged response( thinking of what to say)

Explain the 3 basic concepts that are fundamental to 12 step programs

1) individuals with addictive disorders are powerless over their addiction, and their lives are unmanageable 2)although not responsible for disease, responsible for recovery 3)can no longer blame people, places, and things for addiction, must face problems and feelings

Describe some relapse prevention strategies

1) keep program simple=people are dumb 2) Cognitive-behavioral therapy to increase coping skills=strengths/weaknesses 3)become a member of a relapse prevention group 4)Therapy

How is addiction characterized

1) loss of control of substance consumption 2) substance use despite associated problems 3)tendency to relapse

Name 5 critical issues that arise in the first 6 months of sobriety

1) physical changes as body adapts to functioning w/out substances 2)Learning different responses to cues that would trigger substance abuse 3)Emotional responses now felt full strength 4) response of family/friends to new behavior 5)New coping skills must be developed to prevent relapse

What's the DSM criteria for alcohol withdrawal

1) quit drinking 2)Two or more of following: -nausea and vomiting -anxiety -hand tremor -hallucinations -seizures -sweating -insomnia -tachycardia -psychomotor agitation

What's the DSM criteria for substance dependence?

1) tolerance to drug 2)withdrawal syndrome 3)taken in larger amounts/for longer period than intended 4) unsuccessful or persistent desire to cut down or control use 5)^time in taking, getting, or recovering from substance 6)not showing up to important events 7)keep using even though you know its reason for problems

Nursing Guidelines for Avoidant PD

1. A friendly, accepting, reassuring approach is the best way to treat patients. 2. Being pushed into social situations can cause extreme and severe anxiety.

Nursing Guidelines for Schizoid PD

1. Avoid being too "nice" or "friendly." 2. Do not try to increase socialization. 3. Perform thorough diagnostic assessment as needed to identify symptoms or disorders the patient is reluctant to discuss.

Nursing Guidelines for Paranoid PD

1. Avoid being too "nice" or "friendly." 2. Give clear and straightforward explanations of tests and procedures beforehand. 3. Use simple, clear language; avoid ambiguity. 4. Project a neutral but kind affect. 5. Warn about any changes, side effects of medication, and reasons for delay. Such interventions may help allay anxiety and minimize suspiciousness. A written plan may help encourage cooperation.

Bulimia peaks at what age?

18 yrs old

Ageism

A bias against older people because of their age.

Dementia

A irreversible deterioration of cognitive and intellectual functions and memory, without impairment in consciousness.

Living Will

A personal statement of how and where one wishes to die.

Which item of assessment data is the best predictor of violence for a newly admitted client? A. A recent assault on a drinking companion. B. A family history of bipolar disorder. C. The nurse's subjective feeling that client is cooperative. D. A childhood history of being quick to anger.

A recent assault on a drinking companion.

When working with a patient with somatoform disorder the nurse should do which of the following: A. offer explanation and support during diagnostic testing B. imply that symptoms are not real C. assess the patient each time they complain about symptoms D. stay with patient when they are complaining about symptoms

A. offer explanation and support during diagnostic testing

Which cause of dementia has a clear genetic link? A. Dementia from advanced alcoholism B. Multiinfarct dementia C. Creutzfeldt-Jacob disease D. Alzheimer's disease

Alzheimer's disease

Types of Dementia

Alzheimers, vascular dementia, Lewy body disease, Pick's disease, Huntington's, alcohol related (Korsakoff's syndrome), creutzfeldt-jakob disease, Parkinson's, AIDS, and head trauma.

Explain incentive salience

Cue sensitive: presented w/a stimulus previously associated w/the drug, get overwhelming urge to use responsible for craving of a substance when not currently using it

Full Code

All life saving measures are initiated

Do not resuscitate- comfort care arrest *DNR-CCA*

All life saving measures are initiated, except in the case of a full cardiac arrest and intubation.

Guardianship

An involuntary trust relationship in which one party, the guardian, acts on behalf of an individual, the ward. The law regards the ward as incapable of managing his/ her own person and/ or affairs.

Interventions in pre-assaultive stage:

Analyze the client and situation Use verbal techniques Demonstrate respect for the client's personal space Interact with the client Invest time in the process Pay attention to the environment

Anxiety and OCD is more common with ___________

Anorexia

Which problem is not considered a causative agent in delirium? A. Elevated blood urea nitrogen levels B. Infection C. Anticholinergic drugs D. Antibiotic therapy

Antibiotic therapy

Cluster C Personality Disorders

Anxious or fearful behavior; rigid patterns of social shyness, hypersensitivity, need for orderliness, and relationship dependency; Avoidant PD, Dependent PD, Obsessive-Compulsive PD

A client has been diagnosed with dependent personality disorder. Which behavior descriptions can the nurse *expect* to assess? A. Anxious, fearful B. Odd, eccentric C. Dramatic, emotional, erratic D. Disoriented, disorganized

Anxious, fearful

Which of the drugs used by a polysubstance abuser is most likely to be responsible for withdrawal symptoms requiring both medical intervention and nursing support? A. Opiates B. Marijuana C. Barbiturates D. Hallucinogens

Barbiturates

Milieu characteristics conducive to violence:

Determine if environment is conducive to anger management Does the staff have the skills needed to handle angry aggressive clients Are staff numbers adequate

Which intervention strategy should be *avoided* by staff working with a client who is shouting and flailing his arms? A. Defusing the situation by laughing or making a joke of the challenge B. Saying "Let's go to your room to talk about this" C. Moving a few staff close together as a group to provide a show of force D. Allowing one staff person to speak to the client while others provide support

Defusing the situation by laughing or making a joke of the challenge

Psychological Symptoms of Anorexia

Denial of seriousness of low weight Body Image Disturbance Irrational fear of weight gain Cosntant striving for perfect body Self-concept unduly influenced by shape and weight Preoccupation w/ food and cooking Delayed psychosexual development (little interest in sex, relationships)

Which item of data should be routinely gathered during assessment of a client with a somatoform disorder? A. Potential for violence B. Level of confusion C. Dependence on medication D. Personal identity disturbance

Dependence on medication

Fact or myth? Musculare strength decreases with age. Muscle fibers atrophy with decreases in number.

Fact

Fact or myth? Older adults have a higher incidence of depression.

Fact

Fact or myth? Regular sexual expressions are important to maintain sexual capacity and effective sexual performance.

Fact

Fact or myth? The senses of vision, hearing, touch, taste, and smell decline with age.

Fact

Fact or myth? At least 50% of restorative sleep is lost as a result of the aging process.

Fact

True or False: Depression is a normal part of aging.

False. Depression is NOT a normal part of aging.

What are common concerns with health care and older adults?

Financial burden Caregiver burden Access to care Ageism Public policy Drug testing

Physical Symptoms for Bulimia

Fluid and Eletrolyte imbalances --*hypokalemia*, alkalosis, dehydration, idiopathic edema Cardiovasuclar --hypotension, arrhythmias, cardiomyopathy, MVP Endocrine --hypoglycemia, menstrual dyfunction GI --constipation, diarrhea, esophageal reflux, esophgitis, esophageal tears, dental enemel erosion, parotid gland enlargement (increased amylase)

Discharge criteria for eating disorders

Free from self harm Achieve minimal normal weight Consume adequate calories to maintain normal weight Demonstrate ability to comply w/ postdischarge regiment Verbalize understanding of underlying psycholohic issues Use improved coping strategies Exhibit more functional behaviors within family system Attend group therapy Interact w/ helpful peers Keep appointments to monitor behaviors and meds

What is the nurse's responsibility under the Patient Self-Determination Act of 1990 when a client is admitted to a long-term care facility? A. Explain advance directives and the agency expectation that the client will formulate such directives within 24 hours after admission. B. Give written materials concerning client rights to make decisions about medical care and formulate advance directives, and ask if the client has an advance directive. C. Offer to act as the client's health care proxy for as long as he or she is a resident at the facility. D. Ask the client to explain the end-of-life choices he or she has made and document these in the nursing progress notes.

Give written materials concerning client rights to make decisions about medical care and formulate advance directives, and ask if the client has an advance directive.

What's the goal of relapse prevention?

Help the individual learn from these situations so that periods of sobriety can be lengthened over time and relapses aren't viewed as total failure

Physical Criteria for Hospitalization

ICU Weight loss over 30% over 6 months Rapid decline in weight Inability to gain weight in outpt. tx Severe hypothermia HR > 40, SBP< 70 mmHg Hypokalemia EKG changes

Psychotherapeutic Tx Modalities for eating disorders

Individual psychotherapy Milieu Therapy --Cognitive distortions Behavioral --Contracts, exposure and response prevention Cognitive --reframing, cognitive restructing (work for bulimia) Family Therapy --decrease secondary gain, uncover family dysfunction Group Therapy --safe disclosure, minimize manipulation and secondary gain Expressive therapies

A nurse caring for a client who has been diagnosed with a personality disorder should expect that the client *will* exhibit which of the following characteristics? A. Frequent episodes of psychosis B. Constant involvement with the needs of significant others C. Inflexible and maladaptive responses to stress D. Abnormal ego functioning

Inflexible and maladaptive responses to stress

Ageism and Drug testing

Information about medications for the general population has to be generalized for older adults, and appropriate doses may not have been tested or available.

Which behavior would be *inconsistent* with defining characteristics for the nursing diagnosis of ineffective coping? A. Difficulty in relationships B. High levels of anxiety C. Manipulation D. Interdependence

Interdependence

Which of the following statements should be disregarded by a nurse planning care for elderly individuals? A. As a group, the elderly are major consumers of prescription drugs. B. As much as 50% of restorative sleep is lost as the result of aging. C. The senses of vision, hearing, touch, taste, and smell decline with age. D. Most adults past the age of 75 years have some form of cognitive disorder.

Most adults past the age of 75 years have some form of cognitive disorder.

Which client on the mental health unit is at *highest* risk for violence directed at others? A. Mr. A, who has a history of recurrent severe depression B. Mr. B, who is in an alcohol rehabilitation program C. Mr. C, who has delusions of persecution and has assaulted his brother D. Mr. D, who has somatic symptoms for which no organic basis is found

Mr. C, who has delusions of persecution and has assaulted his brother

During which client assessment interview should the nurse be particularly alert for the possibility of coexisting substance abuse disorder? A. Mrs. R, who has hypochondriasis B. Mrs. S, who has body dysmorphic disorder C. Mr. U, who has somatoform pain disorder D. Mr. V, who has been diagnosed as malingering

Mr. U, who has somatoform pain disorder

Which client would be most suitable for inclusion in a maintenance day care program? A. Ms. A, who is regressed and apathetic and sits staring out the window most of the day B. Mrs. B, who is slightly confused but interested in activities, including current events C. Mr. C, who is angry and hostile toward other clients and stays by himself to watch television D. Mr. D, who is alert and oriented, interested in others, but has right-sided paralysis

Ms. A, who is regressed and apathetic and sits staring out the window most of the day

Which client with a personality disorder is *most* likely to be admitted to a psychiatric unit? A. Mr. A, with paranoid personality disorder who is suspicious of his neighbors B. Mr. B, with narcissistic personality disorder who is highly self-important C. Ms. C, with borderline personality disorder who is impulsive D. Mrs. D, with dependent personality disorder who clings to her husband

Ms. C, with borderline personality disorder who is impulsive

What is the ethical obligation of the nurse who has seen a peer divert a narcotic compared with the ethical obligation when the nurse observes a peer to be under the influence of alcohol? A. The nurse should immediately report the peer who is diverting narcotics and should defer reporting the alcohol-using nurse until a second incident takes place. B. Neither should be reported until the nurse has collected factual evidence. C. No report should be made until suspicions are confirmed by a second staff member. D. Supervisory staff should be informed as soon as possible in both cases.

Supervisory staff should be informed as soon as possible in both cases.

Which intervention would be *removed* from the plan of care for a client with bulimia nervosa? A. Teach that fasting sets one up to binge eat B. Assist client to identify trigger foods C. Support importance of avoiding forbidden foods D. Teach client to plan and eat regularly scheduled meals

Support importance of avoiding forbidden foods

Assessment for eating disorders

Therapeutic alliance is vital Assess: willingness for tx tx hx patterns and perceptions regarding weight body dissatisfaction body image distortion dieting hx binge eating feelings regarding binge behaviors food cravings purging behaviors menstrual hx medical s/e of eating disorder co-morbidity factors

Which of the following would be the most appropriate response by the nurse to help a client who is demonstrating escalating anger? A. Walk the client to his room and help him practice stress-reduction techniques such as deep breathing or muscle relaxation. B. Suggest the client spend some time in the gym with a punching bag to relieve his stress. C. Suggest the client spend some time pacing rapidly in the hallway until he feels less stressed. D. Sit with the client in the day room so he can vent his anger and not isolate.

Walk the client to his room and help him practice stress-reduction techniques such as deep breathing or muscle relaxation.

Which intervention would be *least* useful for accurate assessment of the weight of a client with anorexia nervosa? A. Weigh two times daily, then three times weekly B. Weigh fully clothed before breakfast C. Do not reweigh client when client requests D. Permit no oral intake before weighing

Weigh fully clothed before breakfast

Physical Symptoms of Anorexia

Weight loss 15% below ideal Amenorrhea Bradycardia, subnormal body temp Cachexia, sunken eyes, dry skin Lanugo on face Constiptation Cold Sensitivity

In what culture is eating disorders most prominent?

Western Cultures- esp. Europe and US

Which event would a client with early (stage 1) Alzheimer's disease have greatest difficulty remembering? A. High school graduation B. The birth of one's children C. A story of a teenage escapade D. What was eaten for breakfast

What was eaten for breakfast

The nurse is expected to perform an assessment of a client suspected to be in the earliest stage of Alzheimer's disease. What finding would be out of character if the client truly has stage 1 Alzheimer's disease? A. Willingness to respond directly to questions posed by nurse B. Charming behavior designed to hide memory deficit C. Confabulation to compensate for forgotten information D. Avoidance of questions by subject changing

Willingness to respond directly to questions posed by nurse

An angry client has made a suicide attempt by shooting himself in the chest. He has a complicated dressing that is changed twice daily. He frequently loses patience with the nurses and shouts at them while they perform the dressing change. Which plan could they create to intervene effectively in this behavior? A. Tell him they will not change his dressing if he is going to abuse them. B. Wordlessly finish the dressing and leave when the shouting starts. Return in 20 minutes. C. Confront him with the fact that no dressing would be necessary if he had not shot himself. D. Explain that they are professionals and unused to being shouted at by people they are trying to help.

Wordlessly finish the dressing and leave when the shouting starts. Return in 20 minutes.

Does location of symptoms change with somatizaiton disorder?

Yes

gingko biloba

believed to improve memory and possibly prevent progression in dementia. found otherwise in recent study, but some improvements when adherence considered. pose risks for people who are taking warfarin, heparin, aspirin, or other anticoagulants

A danger of working with a client who idealizes the nurse is A. becoming over-involved and being protective and indulgent. B. becoming indecisive about planned interventions. C. developing a prejudicial, blaming orientation. D. stringent enforcement of boundaries and limits.

becoming over-involved and being protective and indulgent.

Behaviorists Theory-

believe anger was a learned response to environmental stimuli.

The family members of a client with stage 1 Alzheimer's disease have jobs and cannot provide adequate supervision for the client. A reasonable alternative for the nurse to explore with them would be A. day care. B. acute care hospitalization. C. long-term institutionalization. D. group home residency.

day care

Characteristics the nurse will assess in the client with antisocial personality disorder are A. deceitfulness, impulsiveness, and lack of empathy. B. perfectionism, preoccupation with detail, and verbosity. C. avoidance of interpersonal contact and preoccupation with being criticized. D. need for others to assume responsibility for decision-making and seeks nurture.

deceitfulness, impulsiveness, and lack of empathy.

Stage 1: Mild Alzheimer's Disease (forgetfulness)

loses energy, drive, and initiative and has difficulty learning new things. Personality and social behavior remain intact. Others tend to minimize and underestimate loss of individuals abilities. shows short term memory losses, loses things, forgets. memory aids compensate: lists, routines, organization. Aware of the problem; concerned about lost abilities. Depression common-worsens symptoms. Not diagnosable at this time. May still continue to work. activities such as shopping or managing finances are noticeably impaired during this phase. some in this stage decline quickly and may die within 3 yrs, may still function in community with support. other may remain at this level for 3 years or more.

Aphasia Alzheimers assessment

loss of language ability; initially difficulty finding right word, then reduced to few words and finally reduced to babbling or mutism.

dissociative amnesia

loss of memory sometimes concerning event that are traumatic or frightening

Apraxia alzheimers assessment

loss of purposeful movement in absense of motor or sensory impairment- unable to perform once familiar and purposeful tasks.

Agnosia alzheimers assessment

loss of sensory ability to recognize objects. may start out with familiar sounds, then familiar objects, and eventually loved ones or even parts of their own bodies

The client with bulimia differs from the client with anorexia nervosa by A. maintaining normal weight. B. holding a distorted body image. C. doing more rigorous exercising. D. purging to keep weight down

maintaining normal weight.

The primary goal of milieu therapy for clients with personality disorders is A. manage the affect behavior has on the entire group. B. one-on-one therapy. C. to help the client remain uninvolved with other patients. D. a laissez faire attitude.

manage the affect behavior has on the entire group.

histrionic PD

marked by emotional attention-seeking behavior in which the person needs to be the center of attention. -impulsive,melodramatic, flirtatious and provocative.

conversion disorder

marked by the presence of deficits in voluntary motor or sensory functions, including paralysis, blindness, movement disorder, gait disorder, numbness, paresthesia, loss of vision or hearing, or episodes resembling epilepsy; the most common somatoform disorder and is more common in females;Patients truly believe in the presence of the symptoms; they are not fabricated or under voluntary control.

Stage 3: moderate to Severe alzheimers disease (ambulatory dementia)

shows ADL losses (in order): willingness and ability to bathe, grooming, choosing clothing, dressing, gait and mobility, toileting, communication, reading, and writing skills. Shows loss of reasoning ability, safety planning, and verbal communication. Frustration common; becomes more withdrawn and self absorbed. depression resolves as awareness of losses diminishes. has difficulty communicating, shows increasing loss of language skills. shows evidence of reduced stress threshold, institutional care usually needed. often unable to identify familiar objects or people (agnosia). Person needs repeated instructions and direction to perform simplest tasks (advanced apraxia). Total care necessary at this point. often individual cannot remember where toilet is and becomes incontinent. world is very frighteningb/c nothing makes sense. agitation, violence, paranoia, and delusions common. wandering behavior.

Use of dissociation most closely resembles A. sitting in a lecture and "tuning out." B. developing a headache to avoid an unpleasant task. C. feeling angry with a co-worker who shirks work. D. finding a socially acceptable reason to meet a need.

sitting in a lecture and "tuning out."

An intervention of priority importance when a client with cognitive deficit is experiencing a catastrophic reaction is to A. decrease sensory stimuli. B. smile and call the client by name. C. take the client to the bathroom. D. calming asking the client what's wrong.

smile and call the client by name.

somatoform disorders include:

somatization disorder, hypochondriasis, pain disorder, body dysmorphic disorder, conversion disorder

criteria for pain disorder

somatoform disorder where pain is a major part of the clinical picture, significant impairment, psychological factor thought to cause onset severity or exacerbation; Pain associated with psychological or medical factors (onset severity or exacerbated by) medical condition may be present but plays minor role.

Playing one staff member against another is an example of A. devaluation. B. splitting. C. impulsiveness. D. social ineptitude.

splitting.

The factor most likely to contribute to a client's escalating anger is A. watching violence on television. B. another client's depressed mood. C. staff telling him he is "inappropriate." D. staff asking how to be helpful.

staff telling him he is "inappropriate."

A client with Alzheimer's disease can no longer perform hygiene and grooming. She often objects to being led to the shower and does not participate in washing herself. She puts her arms into the legs of her slacks, and so forth. She tests doors and walks through any door that will open. Sometimes she seems unable to find the bathroom and is incontinent. Communication with her is difficult because of the loss of language skills. The nurse would assess the client as being in the stage of Alzheimer's disease labeled A. stage 1, mild. B. stage 2, moderate. C. stage 3, moderate-severe. D. stage 4, end.

stage 3, moderate-severe.