Nurs 441 Psych-Mental Health Final

Standardized Screening Tool for Anorexia and Bulimia

-Eating Disorder Inventory -Body attitude test -Diagnostic Survey for Eating Disorder -Eating Attitudes Test

Bipolar Client Care -Acute Phase:

-acute mania -hospitalization can be required -reduction of mania and client safety are the goals of treatment -risk of harm to self or others is determined -one-to-one supervision can be indicated for client safety

Anxiety Disorder Risk Factors

-most anxiety disorders are more likely to occur in women -OCD affects women more than men -clients can experience anxiety d/t an acute medical condition -adverse effects of many medications can mimic anxiety disorders -substance-induced anxiety is related to current use of a chemical substance or to withdrawal effects from a substance, such as alcohol

Bipolar Client Care -Continuation Phase:

-remission of manifestations -treatment is generally 4-9 months in duration -relapse prevention through education, medication adherence, and psychotherapy is the goal of treatment

The effectiveness of selective serotonin reuptake inhibitor (SSRIs) therapy, in a client with post traumatic stress disorder (PTSD), can be verified when the client states: -"I'm sleeping better now" -"I'm not losing my temper" -"I've lost my craving for alcohol" -"I've lost my phobia for water"

-"I'm sleeping better now"

A client is prescribed disulfiram (Antibuse) as part of his alcohol treatment program to prevent relapse. The client asks the nurse, "How will this drug help me?" Which response by a nurse would be most appropriate? -"It makes the withdrawal symptoms less troublesome." -"It will help to cure your alcoholism." -"It helps to clear the alcohol out of your body." -"It can help to prevent you from drinking."

-"It can help to prevent you from drinking."

A client has started taking haloperidol. What is the most important instruction for the nurse to give the client? -"You should report feelings of restlessness or agitation at once." -"Use a sunscreen outdoors on a year-round basis." -"Be aware you will feel increased energy taking this drug." -"This drug will help control high blood pressure."

-"You should report feelings of restlessness or agitation at once."

A nurse is caring for a client who has experienced frontal lobe damage in a car accident. Which psychosocial behaviors are indications of the damage? -A change in personality -Overt sexual behavior -Difficulty controlling temper -Fewer facial expressions -Inability to go out in public settings -A disinterest in family relationships

-A change in personality -Overt sexual behavior -Difficulty controlling temper -Fewer facial expressions

A nurse is employed at an outpatient rehabilitation facility caring for the client with opioid addiction who is in withdrawal. When assessing clients who present for their counseling session, which findings would be commonly observed? -Abdominal cramps -Dry, warm skin -Rhinorrhea -Dilated pupils -Hypersomnia -Feelings of hunger

-Abdominal cramps -Rhinorrhea -Dilated pupils

When teaching a group of nursing students about the use of antipsychotic medications, the nurse advises them that certain symptoms can occur within the first few weeks of treatment. Which symptoms are likely to occur? -Acute dystonia reactions -Akathisia -Tardive dyskinesia -Neuroleptic malignant syndrome -Hearing loss -Orthostatic hypotension

-Acute dystonia reactions -Akathisia -Neuroleptic malignant syndrome -Orthostatic hypotension

A nurse is working in the emergency room when a police officer walks in with a rape victim to be examined. If the nursing goal is to reduce client anxiety, which interventions would be appropriate? -Admit the client to the treatment room right away. -Encourage the client to undergo an examination immediately in order to get it behind her. -Assure the client of safety in the examination room. -Touch the client early to show the nurse is supportive. -Allow a third party to be present if the client requests it. -Ask factual questions to determine the type of assault.

-Admit the client to the treatment room right away. -Assure the client of safety in the examination room. -Allow a third party to be present if the client requests it. -Ask factual questions to determine the type of assault.

A nurse is preparing discharge instructions for a client with resistant depression who was prescribed a new medication regimen that includes phenelzine, a monoamine oxidase inhibitor (MAO inhibitor). If the teaching was successful, what foods would the client state that they need to avoid? -Aged cheese -Cottage cheese -Milk -Wine -Salami -Fruit

-Aged cheese -Wine -Salami

The nurse is teaching a client who has been prescribed thiothixene. Which adverse reaction is most important for the nurse to discuss with the client? -Akinesia -Hypotension -Sedation -Weight gain

-Akinesia

A client, brought to the emergency department by the police, is found wandering the streets of town and appears to be disoriented. When approached by the nurse, the client begins to laugh inappropriately and states feeling dizzy. Which client behaviors suggest the client is symptomatic for huffing aerosols? -An unsteady gait -An elevated temperature -Multiple bruises on the skin -Impaired memory of where they had been -A slurred speech during conversation -Hallucinations of spiders crawling on the bed

-An unsteady gait -Impaired memory of where they had been -A slurred speech during conversation -Hallucinations of spiders crawling on the bed

Types of Personality Disorders -Cluster B

-Antisocial: disregard for others with exploitation, lack of empathy, repeated unlawful actions, deceit, and failure to accept personal responsibility -Borderline: instability of affect, identity, and relationships as well as splitting behaviors, manipulation, impulsiveness, and fear of abandonment -Histrionic: emotional attention seeking behavior, in which the person needs to be the center of attention -Narcissistic: arrogance, grandiose views of self-importance, the need for consistent admiration, and a lack of empathy for others that strains most relationships

A nurse is conducting a group session for children and adolescents who have been diagnosed with depression. Which behaviors would a nurse anticipate in this group? -Delusions -Anxiety -Mania -Irritability -Somatic symptoms, such as headache and stomach ache -Suicidal thoughts

-Anxiety -Irritability -Somatic symptoms, such as headache and stomach ache -Suicidal thoughts

A child with a tic disorder is prescribed an antipsychotic agent as part of his treatment plan. Which of the following would the nurse expect to be prescribed? -Ariprazole (Abilify) -Haloperidol (Haldol) -Clonidine -Guanfacine (Intuniv)

-Ariprazole (Abilify)

A nurse is working with a schizophrenic client who suddenly begins experiencing auditory hallucinations. Which interactions are appropriate at this time? -Ask the client, "What are you experiencing right now?" -Encourage the client to relate the history of the hallucinations. -Tell the client, "I'd like to spend time with you to discuss your hallucinations. Is that okay with you?" -Ask the client if he/she has recently taken any drugs or alcohol. -State, "Do you understand the side effects of your medication?" -Question if the client is faking the symptoms for attention

-Ask the client, "What are you experiencing right now?" -Encourage the client to relate the history of the hallucinations. -Tell the client, "I'd like to spend time with you to discuss your hallucinations. Is that okay with you?" -Ask the client if he/she has recently taken any drugs or alcohol.

The nurse is caring for a client who is receiving paroxetine for a major depressive disorder. What is the nurse's most important intervention? -Monitor thyroid function -Determine ECG changes -Assess for sleeping difficulties -Observe for extrapyramidal symptoms (EPS)

-Assess for sleeping difficulties

Cultural Beliefs and Practices

-Assess the client's cultural health care beliefs, practices, and values. -Assess for cultural factors that can impact a clients care. -The nurse's awareness of culture alleviates stereotyping and stigmatizing -use a trained interpreter when needed

The history of a child newly diagnosed with attention deficit hyperactivity disorder reveals that the child is experiencing sleeping difficulties. Which agent would the nurse most likely use? -Methylphendate -Atomoxetine -Bupropion -Clonidine

-Atomoxetine

Types of Personality Disorders -Cluster C

-Avoidant: social inhibition and avoidance of all situations that require interpersonal contact, despite wanting close relationships, d/t extreme fear of rejection -Dependent: extreme dependency in a close relationship with an urgent search to find a replacement when one relationship ends -Obsessive- compulsive: perfectionism with a focus on orderliness and control to the extent that the individual might not be able to accomplish a given task

When a client with obsessive-compulsive disorder has developed self-harming thoughts and actions, the emergency department nurse should expect to administer which medication to assist with the client's anxiety/panic? -Benzodiazepines such as lorazepam (Ativan) -Antipsychotics such as lithium carbonate -Analgesics such as morphine sulfate -Tricyclic antidepressants such as amoxapine (Asendin)

-Benzodiazepines such as lorazepam (Ativan)

The nurse notes that a client taking antipsychotic medications becomes agitated, fearful, and panicky when his neck twists to one side and his eyes forcefully draw upward toward the ceiling. Which medication should be administered to the client? -Benzotropine -Haloperidol -Paliperidone -Diazepam

-Benzotropine

An adolescent client tells a nurse that he or she occasionally "sniffs airplane glue". When discussing the effects of long-term use of inhalants, which of the following would the nurse most likely include? -Enhanced attention on focus and memory -Tremors and central nervous system arousal -Brain damage and cognitive abnormalities -Enhanced normal heart rhythms

-Brain damage and cognitive abnormalities

An 8 year old child, diagnosed with obsessive compulsive disorder, is admitted by the nurse to a psychiatric facility. During the admission assessment, which behaviors would be characterized as compulsary? -Checking and rechecking that the television is turned off before going to school. -Repeatedly washing the hands. -Brushing teeth three times a day. -Routinely climbing up and down a flight of stairs three times before leaving the house. -Feeding the dog the same meal every day. -Wanting to play the same video game each night.

-Checking and rechecking that the television is turned off before going to school. -Repeatedly washing the hands. -Routinely climbing up and down a flight of stairs three times before leaving the house.

A nurse interviews the family of a client hospitalized with severe depression and suicidal ideation. What family assessment information is essential to know when formulating an effective plan of care? -Physical Pain -Personal responsibilities -Employment skills -Communication patterns -Role expectations -Current family stressors

-Communication patterns -Role expectations -Current family stressors

A delusional client says to the nurse "I am the Easter bunny," and insists that the nurse refer to them as such. The belief appears to be fixed and unchanging. Which nursing interventions would the nurse implement when working with this client? -Consistently use the client's name in interactions. -Smile at the humor of the situation. -Agree that the client is the Easter bunny. -Logically point out why the client could not be the Easter bunny. -Provide an as-needed medication. -Provide the client with structured activities.

-Consistently use the client's name in interactions. -Provide the client with structured activities.

During the nurse's shift in the emergency department, a nurse assess a client who is suspected of being under the influence of amphetamines. Which symptoms are indicative of amphetamine use? -Depressed affect -Diaphoresis -Shallow Respirations -Hypotension -Tremors -Dilated pupils

-Diaphoresis -Shallow respirations -Tremors -Dilated pupils

The nurse is teaching a client with a generalized anxiety disorder how to effectively cope with severe distress. Which interventions would the nurse use to promote effective coping with anxiety? -Discuss previous methods that were effective in handling stress. -Encourage the client to limit to a mutually decided amount of time spent on worrying. -Help the client to establish a goal and develop a plan to meet the goal. -Teach the client how to label feelings and how to express them. -Discuss ways to examine the reality of fears. -Assist the client to acknowledge the major consequences of blaming others.

-Discuss previous methods that were effective in handling stress. -Encourage the client to limit to a mutually decided amount of time spent on worrying. -Help the client to establish a goal and develop a plan to meet the goal. -Teach the client how to label feelings and how to express them.

A group of nursing students is reviewing the various theories related to the etiology of schizophrenia. The students demonstrate understanding of the information when they identify which neurotransmitter as being responsible for hallucinations and delusions? -Dopamine -Serotonin -Norepinephrine -Gamma-aminobutyric acid (GABA)

-Dopamine

The client had been taking digoxin, furosemide, and diazepam. The nurse suspects that this client's impairment may be the result of: -Opportunistic infection -Metabolic acidosis -Drug intoxication -Hepatic encephalopathy

-Drug intoxication

A client diagnosed with Alzheimer's disease, is a new resident in a long-term care facility. The client has difficulty finding their room and is seen wandering into the room of others. When discussing the situation at a multidisciplinary conference, which client-centered actions would the nurse suggest? -Restrict the client to the client's room and hallway until they can recognize the area. -Ensure that the client has prescribed hearing aids and glasses on throughout the day. -Place a box with familiar items outside the client's door for visual recognition. -Assign the client to a room close to the nursing station for closer monitoring. -Provide a sedative medication to decrease the client's ability to wander. -Alzheimer's disease is a chronic, organic, mental disorder that involves a progressive, irreversible loss of memory. Safety is priority. Client-centered actions would focus on interventions to promote the identification of the client room and reduce the instances of wandering.

-Ensure that the client has prescribed hearing aids and glasses on throughout the day. -Place a box with familiar items outside the client's door for visual recognition. -Assign the client to a room close to the nursing station for closer monitoring.

A decrease in which of the following neuotransmitters has been implicated in seizure disorders? -Epinephrine -Serotonin -Dopamine -GABA

-GABA

During the nurse's assessment of a client who has been diagnosed with bulimia nervosa, the nurse evaluates certain assessment findings that accompany binge eating. Which are most applicable? -Guilt -Dental caries -Self-induced vomiting -Weight loss -Normal weight -Introverted behavior

-Guilt -Dental caries -Self-induced vomiting -Normal weight

A client is taaking medication to control schizophrenia asks the nurse to explain the causes of the disorder. The nurse knows that an overactive dopamine system in the rain is one of the leading causes of schizophrenia and tells the client that excessive dopamine activity is responsible for symptoms. Which symptoms is the nurse referring to? -Hallucinations -Withdrawn behavior -Grandiosity -Delusional thinking -Excessive tearfulness -Hypotension

-Hallucinations -Grandiosity -Delusional thinking

A nurse is caring for a client diagnosed with persistent depressive disorder. Which defining characteristics are associated with this disorder? -Insomnia or hypersomnia -Delusions or hallucinations -Suicidal thoughts -Onset of symptoms within a 2-week period -Symptoms that occur in the winter and resolve in the spring -Appetite disturbance

-Insomnia or hypersomnia -Suicidal thoughts -Appetite disturbance

Substance Use

-Involves repeated use of chemical substances, leading to clinically significant impairment during a 12 month period. -characterized by loss of control d/t substance use participation that continues despite problems, and a tendency to relapse back into the substance use disorder

A group of nursing students is reviewing the various drug classes used to treat psychiatric disorders. The students demonstrate understanding when they identify which as examples of antianxiety medications? Select all that apply. -Lorazepam -Selegiline -Buspirone -Methylphenidate -Zolpidem

-Lorazepam -Buspirone

A patient is experiencing panic-level anxiety. Of these medications listed on the patient's prn medication administration record, which should be given? -Buspirone (Buspar) -Fluoxetine (Prozac) -Phenytoin (Dilantin) -Lorazepam (Ativan)

-Lorazepam (Ativan)

A nurse is caring for a client recently diagnosed with cancer and experiencing situational anxiety. Which interventions would the nurse include in the care plan? -Maintain a calm, nonthreatening environment. -Explain relevant aspects of chemotherapy. -Encourage the client to verbalize concerns regarding the diagnosis. -Encourage the client to use deep breathing exercises and other relaxation techniques during periods of increased stress. -Provide distractions for the client during periods of stress. -Teach the stages of grieving to the client.

-Maintain a calm, nonthreatening environment. -Encourage the client to verbalize concerns regarding the diagnosis. -Encourage the client to use deep breathing exercises and other relaxation techniques during periods of increased stress.

A nurse is administering haloperidol to a client experiencing psychosis. What are the most appropriate nursing interventions to manage potential adverse effects. Select all that apply: -Review subcutaneous drug administration with the client -Monitor vital signs, especially temperature. -Provide the client an opportunity to pace. -Monitor blood glucose levels -Provide the client with hard candy -Monitor for urticaria.

-Monitor vital signs, especially temperature. -Provide the client an opportunity to pace. -Monitor blood glucose levels -Provide the client with hard candy

A man 20 years of age arrives at the emergency department by ambulance. He is unconscious, with slow respirations and pinpoint pupils. There are "tracks" visible on his arms. The friend who came with him reports that the client had just "shot up" heroin when he became unconscious. Which medication would the nurse most likely expect to administer? -Varenicline -Bupropion -Naltrexone -Naloxone

-Naloxone

A nurse is teaching a medication class to a group of psychiatric clients. One of them asks, "Why am I having so much more trouble learning now that I am 60 than I did when I was younger?" Which of the following concepts would the nurse integrate into the response? -The amygdala -Psychoneuroimmunology -The extrapyramidal motor system -Neuroplasticity

-Neuroplasticity

PTSD-depression

-PTSD --> the exposure to traumatic events causes anxiety, detachment, and other manifestations about the event for longer than 1 month following the event -the client who has PTSD is also at risk for other disorders, including dissociative disorders, anxiety, depression, and substance use disorders

A client is being seen in the clinic after returning from military service abroad. The nurse documents restlessness at night with nightmares leaving the veteran irritable and fatigued during the day. When discussing the possibility of post traumatic stress disorder (PTSD), which statements about PTSD are accurate? -PTSD is a syndrome that affects only those who have experienced traumatic episodes during war. -PTSD is characterized by nightmares and flashbacks. -Hypervigilance is characteristic of clients with PTSD. -Substance abuse is a common coping mechanism used by clients with PTSD. -Psychotic episodes can occur in clients with PTSD. -Clients with PTSD may complain of feeling empty inside.

-PTSD is characterized by nightmares and flashbacks. -Hypervigilance is characteristic of clients with PTSD. -Substance abuse is a common coping mechanism used by clients with PTSD. -Psychotic episodes can occur in clients with PTSD. -Clients with PTSD may complain of feeling empty inside.

A is caring for a client with agoraphobia. Which signs and symptoms would the nurse anticipate? -Hallucinations -Panic attacks -Inability to leave home -Eating disorders -Alcohol consumption -Tobacco use

-Panic attacks -Inability to leave home

Types of Personality Disorders -Cluster A

-Paranoid: distrust and suspiciousness toward others based on unfounded beliefs that others want to harm, exploit, or deceive the person -Schizoid: emotional detachment, disinterest in close relationships, and indifference to praise or criticism; often uncooperative -schizotypical: odd beliefs leading to interpersonal difficulties, an eccentric appearance, and magical thinking or perceptual distortions that are not clear delusions or hallucinations

A client with posttraumatic stress disorder (PTSD) who is having recurring nightmares may be prescribed which of the following medications (as an off-label use) to treat the nightmares and improve sleep? -Metoprolol, a beta-adrenergic blocking agent -Zolpidem, a sedative -Prazosin, an alpha 1 inhibitor -Lorazepam, a benzodiazepine

-Prazosin, an alpha 1 inhibitor

A client with a diagnosis of undifferentiated schizophrenia is admitted to the inpatient unit after developing water intoxication. Which nursing interventions are appropriate? -Medicate the client at night. -Provide gum for the client. -Lock the unit's kitchen and bathroom. -Weigh the client every day. -Monitor the client's intake and output. -Maintain a structured environment.

-Provide gum for the client. -Weigh the client every day. -Monitor the client's intake and output. -Maintain a structured environment.

A group of nurses is reviewing medications used to treat attention deficit hyperactivity disorder. The students demonstrate understanding of the information when they identify methylphenidate as which of the following? -Selective serotonin reuptake inhibitor -Psychostimulant -Alpha agonist -Noradrenergic reuptake inhibitor

-Psychostimulant

A client has been prescribed naltrexone for treatment of alcohol dependence. The nurse has explained the drug's purpose to the client. The nurse determines that the client has understood the instructions when the client identifies which of the following about the drug? -Improves appetite and nutritional status -Produces the euphoria of alcohol -Causes itching if alcohol is consumed -Reduces the appeal of alcohol

-Reduces the appeal of alcohol

The nurse is assessing a client who is poly-substance abuser, with cocaine being one of the drugs most frequently used. Which physiological symptom is suggestive of early (phase 1) cocaine intoxication? -Respiratory depression -Psychomotor agitation -Cardiac arrythmias -Dilated pupils -Flaccid paralysis -Slurred speech

-Respiratory depression -Psychomotor agitation -Cardiac arrythmias -Dilated pupils

A nurse is explaining client rights for psychiatric patients to a client who has voluntarily sought admission to an inpatient psychiatric facility. Which rights would the nurse include in the discussion? -Right to select health care team members -Right to refuse treatment -Right to written treatment plan -Right to obtain disability benefits -Right to confidentiality -Right to personal mail

-Right to refuse treatment -Right to written treatment plan -Right to confidentiality -Right to personal mail

The nurse is providing information to a client who is taking chlorpromazine. What is the most important information for the nurse to provide? -Reduce the dosage if feeling better. -Stop taking medication when sunbathing -Stop taking the drug if adverse reactions develop -Schedule routine medication checks

-Schedule routine medication checks

A nurse is assessing a new client and notices clang associations in the speech pattern. From this assessment finding, the nurse begins to evaluate for the potential of which psychiatric conditions? -Dissociative identity disorder -Schizophrenia -Narcolepsy -Mania -Organic disorders -Intermittent explosive disorder

-Schizophrenia -Mania -Organic disorders

Psychotic disorders

-Schizophrenia -Schizotypal personality disorder -Delusional disorder -Brief psychotic disorder -Schizophreniform disorder -Schizoaffective disorder -Substance-induced psychotic disorder -Psychotic or Catatonic disorder not otherwise specified

A client with somatic symptom disorder (SSD) also has anxiety. Which of the following would the nurse expect to be prescribed? -Atypical antipsychotic -Monoamine oxidase inhibitor (MAOI) -Tricyclic antidepressant (TCA) -Selective serotonin reuptake inhibitor (SSRI)

-Selective serotonin reuptake inhibitor (SSRI)

A client with depression is prescribed fluoxetine (Prozac). On a return visit to the clinic, the client tells the nurse that he also just started taking St. John's Wart to feel better. The nurse assesses the client for which of the following? -Increased depressive symptoms -Hypertensive crisis -Water intoxication -Serotonin syndrome

-Serotonin syndrome

A nurse is preparing a continuing education presentation about various psychopharmacologic agents for a group of psychiatric-mental health nurses. The nurse is planning to discuss selective serotonin reuptake inhibitors. Which agents would the nurse include in this group? Select all that apply: -Sertraline (Zoloft) -Bupropion (Wellbutrin) -Venlafaxine (Effexor) -Fluoxetine (Prozac)

-Sertraline (Zoloft) -Fluoxetine (Prozac)

The nurse monitoring a client with schizophrenia who is prescribed clozapine. During a multidisciplinary mental healt team meeting, which signs and symptoms would be brought to the psychiatrist's attention? -Sore throat -Pill-rolling movements -Polyuria -Fever -Polydipsia -Orthostatic hypotension

-Sore throat -Fever -Orthostatic hypotension

A client with schizophrenia is taking clonazepine. Which adverse effects would the nurse anticipate from this medicine? Select all that apply. -Sore throat -Pill-rolling movements -Polyuria -Fever -Polydipsia -Orthostatic hypotension

-Sore throat -Fever and -orthostatic hypotension

When describing neuronal transmission, an instructor describes the area where the electrical intracellular signal becomes a chemical one. The instructor is describing which of the following? -Terminal -Synaptic cleft -Soma -Receptor site

-Synaptic cleft

A client is prescribed chlodiazepoxide as needed to control the symptoms of alcohol withdrawal. Which symptoms may indicate the need for an additional dose of this medication? -Tachycardia -Mood swings -Elevated blood pressure and temperature -Piloerection -Tremors -Increasing anxiety

-Tachycardia -Elevated blood pressure and temperature -Tremors -Increasing anxiety

The nurse is caring for a mental health client who exhibits passive-aggressive behavior when interacting with the nursing staff. When reporting client behaviors to the next shift, which actions are consistent with this assessment? -The client states that problems are not his/her fault. -The client agrees with the staff but then complains to others. -The client pouts when he/she does not get his/her way. -The client feels angry about the group session so he/she scatters papers in the lunchroom. -The client attacks the nurse and later cries felling remorse. -None of the above

-The client agrees with the staff but then complains to others. -The client feels angry about the group session so he/she scatters papers in the lunchroom.

A nurse has developed a therapeutic relationship with a client who has an addiction problem. Which client behaviors would indicate that the therapeutic interaction is in the working phase? -The client discusses how the addiction has contributed to family distress. -The client reluctantly shares the family history of addiction. -The client verbalizes difficulty identifying personal strengths -The client discusses the financial problems to the addiction. -The client expresses uncertainty about what topic to discuss. -The client acknowledges the addiction's effects on his children.

-The client discusses how the addiction has contributed to family distress. -The client verbalizes difficulty identifying personal strengths -The client discusses the financial problems to the addiction. -The client acknowledges the addiction's effects on his children.

A nurse is assessing a client for dementia. What history findings would the nurse anticipate while talking with the client and family? -The progression of symptoms has been slow. -The client admits to feelings of sadness. -The client acts apathetic and pessimistic. -The family cannot determine when the symptoms first appeared. -The client has been exhibiting basic personality changes. -The client has great difficulty paying attention to others.

-The progression of symptoms has been slow. -The family cannot determine when the symptoms first appeared. -The client has been exhibiting basic personality changes. -The client has great difficulty paying attention to others.

A nurse is caring for a client who has been taking clozapine (Clozaril) for 2 weeks. The client tells the nurse, "My throat is sore, and I feel weak. " The nurse assesses the client's vital signs and finds that the client has a fever. The nurse notifies the physician, expecting an order to obtain which laboratory test? -White blood cell count -Liver function studies -Serum potassium concentration -Serum sodium concentration

-White blood cell count

Risk factors for Alzheimer's Disease

-advanced age -prior head trauma -life style factors -family hx -strong genetic link

Anorexia- Characteristics

-client preoccupied with food and the rituals of the eating, along with a voluntary refusal to eat -occurs most often in females -onset can be associated with a stressful life event -restricting type vs. binge-eating/purging type

Bulima Nervosa- Characteristics

-eat large quantities of food over a short period of time, which can be followed by inappropriate compensatory behaviors, such as purging, to rid the body of the excess calories -occurs once per week for 3 months -maintain a weight within normal range or slightly higher -onset is late adolescence or early adulthood -most commonly in females -between binges, clients typically restrict caloric intake and select low-calorie diet foods

Alterations in behavior-psychotic disorders

-extreme agitation -stereotyped behaviors -automatic obedience -waxy flexibility -stupor -negativism -echopraxia

Alteration of Thought (delusions)

-false fixed beliefs that cannot be corrected by reasoning and are usually bizarre -ideas of reference -persecution -grandeur (they believe they are all powerful and important) -somatic delusions (body is changing in an unusual way--> growing a 3rd arm) -jealousy -being controlled -thought broadcasting -thought insertion -thought withdrawal -religiosity -magical thinking

Bipolar Client Care -Maintenance Phase:

-increased ability to function -treatment generally continues throughout the client's lifetime -prevention of future manic episodes is the goal of treatment

Risk factors for Anorexia and Bulimia

-individual hx of being a picky eater in childhood -participation in athletics -a hx of obesity -parental pressure and the need to succeed -anxiety or obsessional traits in childhood

Suicide prevention

-long term therapy

Relaxation Techniques

-meditation -guided imagery -breathing exercises -progressive muscle relaxation -physical exercise (yoga, walking, biking)

When the nurse has tried all other less restrictive means to prevent a client from harming self or others, the following must occur in order to use seclusion or restraint:

-prescription for seclusion or restraint in writing -time limits for seclusion or restraints -complete documentation every 15 to 30 minutes - nurse can use seclusion or restraints without first obtaining a provider's written prescription if it is an emergency situation

Patient Centered Care- Substance

-safety is the primary focus -education -therapy (cognitive behavior therapy, relapse prevention therapy, group therapy, family therapy)

Seclusion and restraints

-seclusion rooms and/or restraints can be warranted and authorized for clients in some cases -restraints are either physical or chemical, such as neuroleptic mediation to calm the client -the provider should prescribe seclusion and/or restraint for the shortest duration necessary, and only if less restrictive measures are not sufficient

Psychological Suicidal Risk Factors

-sense of hopelessness -intense emotions, such as rage, anger, or guilt -poor interpersonal relationships at home, school and work -developmental stressors, such as those experienced by adolescents

Alzheimer's disease

-subtype of NCD that is neurodegenerative, resulting in the gradual impairment of cognitive function -most common type of major NCD -stages 1-3

After educating a group of nursing students about the neurobiologic theories of depression, the instructor determines the need for additional education when the students identify which neurotransmitter as playing a role? -Gamma-aminobutyric acid (GABA) -Norepinephrine -Serotonin -Dopamine

-Gamma-aminobutyric acid (GABA)

The nurse has taught the family about the medication donepezil for Alzheimer's disease. The nurse determines education has been successful when the family states: -"We'll need to figure out a schedule to get dad's weekly blood work done." -"When dad's Alzheimer's disease worsens, he will need to stop this drug." -"This drug may slow dad's pulse, since he has pre-existing heart disease." -"Donepezil acts like a diuretic, so dad should take it in the morning."

-"This drug may slow dad's pulse, since he has pre-existing heart disease."

A nurse is caring for a client displaying extreme mood swings with suicidal tendencies. A physician prescribes lithium and diagnoses the client with bipolar disorder. When teaching the client, which statements, verbalized by the client, indicate a good understanding of the teaching of medication management? -"I understand that there is a potential for addiction." -"I need to watch for signs and symptoms of drug toxicity including blurred vision and ringing ears." -"I will adjust my medication depending upon my symptoms." -"I will need to be on a low-tyramine diet." -"I will need to consistently monitor blood levels." -"The therapeutic effect of the medication takes time to occur."

-"I need to watch for signs and symptoms of drug toxicity including blurred vision and ringing ears." -"I will need to consistently monitor blood levels." -"The therapeutic effect of the medication takes time to occur."

Affect:

A client's affect is an objective expression of mood, such as a flat affect or a lack of facial expression.

Mood:

A client's mood provides information about the emotion that she is feeling

Justice:

Fair and equal treatment for all

Veracity:

Honesty when dealing with client

Fidelity:

Loyalty and faithfulness to the client and to one's duty

Positive and Negative symptoms of Schizophrenia

Positive: -hallucinations -delusions -alterations in speech -bizzarre behavior Negative: -Affect -Alogia -Anergia -Anhedonia -Avolition

Autonomy:

The client's right to make her own decisions. But the client must accept the consequences of those decisions. The client must also respect the decisions of others.

Beneficence:

The quality of doing good; can be described as charity

Timing/relevance:

knowing when to communicate allows the receiver to be more attentive to the message

Pacing:

the rate of speech can communicate a meaning to the receiver

Clarity/brevity:

the shortest, simplest communication is usually most effective

Hamilton Depression Scale

the standardized screening tool for depressive disorders

Intonation:

the tone of voice can communicate a variety of feelings

Vocabulary:

the words that are used to communicate either a written or spoken message

Denotative/connotative meaning:

when communicating, participants must share meanings