Psych

A hospitalized client with a diagnosis of schizophrenia who is experiencing delusions says to the nurse, "I know that the doctor is talking to the top man in the mob to get rid of me." Which response should the nurse make to the client?

"I don't know anything about the top man in the mob. Do you feel afraid that people are trying to hurt you?" When delusional, a client truly believes what he or she thinks to be real is real. The client's thinking often reflects feelings of great fear and aloneness. It is most therapeutic for the nurse to empathize with the client's experience. Disagreeing with delusions may make the client more defensive, and the client may cling to the delusions even more. Encouraging discussion regarding the delusions is inappropriate.

A client who has been hospitalized with a paranoid disorder refuses to turn off the lights in the room at night and states, "My roommate will steal me blind." Which is the appropriate response by the nurse?

"I hear what you are saying, but I don't share your belief." Paranoid beliefs are coping mechanisms used by the client & therefore are not easily relinquished. It's important not to support the belief & not to ridicule, argue, or criticize it.

An older client says to the home care nurse, "I can't believe that my wife died yesterday. I keep expecting to see her everywhere I go in this house, ready to plan our activities for the day." Which is the therapeutic nursing response?

"It must be hard to accept that she has passed away." The therapeutic nursing response is the one that recognizes the difficulties of grieving the loss of a loved one and facilitates expression of feelings.

A 63-year-old woman whose husband died 2 months ago says to the visiting nurse, "My daughter came over yesterday to help me move my husband's things out of our bedroom, and I was so angry with her for moving his slippers from where he always kept them under his side of our bed. She doesn't know how much I'm hurting." Which statement by the nurse would be therapeutic?

"It's OK to grieve and be angry with your daughter and anyone else for a time." The therapeutic statement is the one that gives the client permission to grieve and acknowledges that anger is part of loss and that it may be aimed at the people who are trying most to help and are closest.

The mother of 6-year-old twins says to the nurse, "My mother-in-law doesn't think our children should come to the funeral service for their grandfather. What do you advise?" The nurse most appropriately responds by making which statement?

"What do you and your husband believe is the right thing for your children?" The most therapeutic response is the one that encourages open expression of feelings and empowers the grieving relative.

A client who has just received a diagnosis of asthma says to the nurse, "This condition is just another nail in my coffin." Which response by the nurse is therapeutic?

"You seem very distressed over learning you have asthma." Clients who have learned that they have a chronic illness may exhibit denial, anger, or sarcasm because of fear associated with the chronic illness. It is important for the nurse to convey an accepting attitude to enhance mutual respect and trust.

The parents of a young adult have expressed concerns about the cognitive and emotional changes they have noted in their child. The nurse recognizes which assessment and diagnostic data as associated with the diagnosis of schizophrenia? Select all that apply.

A late winter, early spring birthday (viral theory); apathy and anhedonia (the inability to experience pleasure from activities usually found enjoyable); suicidal ideations; and atrophy of brain tissue are all common to individuals exhibiting symptomatology of schizophrenia.

2nd generation psychotics

Abilify (aripiprazole), Clozaril (clozapine), Risperdal (risperidone), Zyprexa (olanzapine), Seroquel (quetiapine), Geodon (ziprasidone)

Bipolar meds

Lithium (metal salt) and anticonvulsants [Depakote (divalproex sodium), Tegretol (carbemazepine), Lamictal (lamotrigine), Topamax (topiramate)]

A nurse is monitoring a 7-year-old child who sustained a head injury in a motor vehicle crash for signs of increased intracranial pressure (ICP). The nurse should assess the child frequently for which early sign of increased ICP?

Nausea is an early sign of increased ICP. Late signs include a significant decrease in level of consciousness, Cushing's triad (increased systolic blood pressure and widened pulse pressure, bradycardia, and irregular respirations), and fixed and dilated pupils. Other late signs include decreased motor response to command, decreased sensory response to painful stimuli, posturing, Cheyne-Stokes respirations, and papilledema.

negative symptoms of schizophrenia

Negative symptoms are deficits of normal emotional responses or of other thought processes, and respond less well to medication. They commonly include apathy (flat expressions or little emotion), poverty of speech, anhedonia (inability to experience pleasure), social withdrawal (lack of desire to form relationships), and lack of motivation. Negative symptoms appear to contribute more to poor quality of life, functional ability, and the burden on others than do positive symptoms. People with greater negative symptoms often have a history of poor adjustment before the onset of illness, and response to medication is often limited.

positive symptoms of schizophrenia

Positive symptoms are those that most individuals do not normally experience but are present in people with schizophrenia. They can include delusions, disordered thoughts and speech, and tactile, auditory, visual, olfactory and gustatory hallucinations, typically regarded as manifestations of psychosis. Hallucinations are also typically related to the content of the delusional theme. Positive symptoms generally respond well to medication.

After a tonsillectomy, a child is brought to the pediatric unit. The nurse should appropriately place the child in which position?

Prone or side-lying position after tonsillectomy to facilitate drainage.

A client tentatively diagnosed with a borderline personality is admitted to the psychiatric unit for control of symptoms. Based on an understanding of personality disorders, the nurse should determine that which problem is the priority?

Risk of self harm; Clients with borderline personality disorder are most often hospitalized because of impulsive attempts at self-mutilation or suicide.

A nurse working in the day care center is told that a child with autism will be attending the center. The nurse collaborates with the staff of the day care center to plan activities that will meet the child's needs. Which should have the priority consideration in planning activities for the child?

Safety with all activities is a priority in planning activities with the child. The child with autism is unable to anticipate danger, has a tendency for self-mutilation, and has sensoriperceptual deficits. Although providing social interactions, verbal communications, and familiarity and orientation are also appropriate interventions, the priority is safety.

The client is a Jehovah's Witness and refuses to have a blood transfusion. The nurse should take which most appropriate action?

Support the client's decision not to receive a blood transfusion. A client's cultural and ethnic background influences the response to health, illness, surgery, and death. Awareness of cultural differences enhances the nurse's knowledge of how a health care experience may be perceived by the client or family. In the Jehovah's Witness religion, the administration of blood and blood products is forbidden; therefore the nurse would support the client's decision. Trying to convince the client of the need for the blood transfusion is inappropriate and does not respect the client's cultural beliefs.

Depression meds

Symbax [Prozac (fluoxetine) + Zyprexa (olanzapine)] treats depression w/o triggering mania, + 4 atypical drugs

OCD meds

TCAs and SSRIs

Phobic disorder meds

TCAs, MOAIs, beta-adrenergic receptor antagonists (e.g., propranolol; for palpitations)

Panic disorder meds

TCAs, SSRIs, MOAIs, benzodiazepines (for anticipatory anxiety), beta-adrenergic receptor antagonists (e.g., propranolol; for palpitations)

1st generation psychotics

Thorazine (chlorpromazine), Haldol (haloperidol) [low sedative effects], Prolixin (fluphenazine) [mild sedative; high side effects]

A client who is watching television in the dayroom shares with the nurse that he has begun seeing his mother being assaulted on the television screen. Which is the nurse's initial intervention?

Turn off the television. Environmental factors such as a reflective television screen are often the trigger for hallucinations. Eliminating the trigger when possible is the priority.

cognitive symptoms

attention deficits, memory lapses, poor abstract reasoning

PTSD meds [Depression meds]

atypical antipsychotics: [Risperdal (risperidone), Zyprexa (olanzepine), Seroquel (quetiapine), Geodon (ziprasidone), ] Abilify (aripipraxzole)

Anxiolytics

benzodiazepines (not for PRN; for use of < 4 months). Xanax (alprazolam) [short-acting, rebound anxiety, prescribed in multidose regimens. Valium (diazepam) [longer-acting, tends to accumulate leading to falls, memory loss, poor muscle coordination & intoxicated appearance]. Paxil (paraxetine) [an SSRI approved for Social Anxiety tx]. Buspar (buspirone) [structurally unrelated to benzos]

Mood Disorders

bipolar disorders and major depression

pseudoparkinsonism

flat affect, muscle rigidity, slowed body movements, shuffling gait

neuroleptic malignant syndrome

muscle rigidity, tachycardia, hyperthermia, altered consciousness, autonomic dysfunction, elevated CPK levels

akathisia

restlessness, pacing, psychomotor agitation, shifting from foot to foot

SSRIs

selective serotonin receptor inhibitors [compared to SDAs: less prone to sedation, less eye and mouth problems, less lethal, higher patient compliance]

SDAs

serotonin-dopamine antagonists

dystonia

severe distortion of face, neck and back muscles

mood symptoms

sudden swings in/out of emotional states: euphoria, apathy, grandiose ideas, belligerence, dysphoria (a state of mental discomfort or suffering; great anguish)

tardive dyskinesia

unusual movements resulting from long-term use of antipsychotics

dyskinesia

unusual movements, e.g., facial grimmacing, tongue protrusions (not cramping in nature)