Psych - Ch 10, 11, 12, 13, 14, 15

A veteran of the was in Afghanistan tells the nurse, "Everyday, something happens that makes me feel like I'm still there. My family has grown impatient with me. They say it's time for me to move on from that time in my life but I can't." What is the nurses first priority? A. Assess the veteran for suicide risk. B. Refer the veteran for specialized mental health services. C. Assess the veteran for evidence of traumatic brain injury. D. Refer the veteran's family to a posttraumatic stress disorder group.

A. Assess the veteran for suicide risk. The veteran had high risk for posttraumatic stress disorder (PTSD). When PTSD is untreated or undertreated, painful repercussions often occur, particularly marital problems, unemployment, heavy substance abuse, and suicide. The highest priority is an assessment of suicide risk.

A nurse plans care for a patient diagnosed with borderline personality disorder. Which nursing diagnosis is most likely to apply to this patient? A. Ineffective relationships r/t frequent splitting B. Social isolation r/t fear of embarrassment or rejection C. Ineffective impulse control r/t violence as evidenced by cruelty to animals D. Disturbed thought processes r/t recurrent suspiciousness of people and situations

A. Ineffective relationships r/t frequent splitting People diagnosed with borderline personality disorder frequently use the defense of splitting, which strains personal relationships. Splitting is the inability to integrate both the positive and negative qualities of an individual into one person.

A college student has been experiencing significant stress associated with academic demands. Last month, the student began attending yoga sessions 3 times a week. Which outcome indicates this activity has been successful? A. The student reports improved feelings of well-being. B. The student increases use of caffeine to enhance concentration. C. The student reports, "Now I am sleeping about 10 hours every day." D. The student says, "I withdrew from 2 courses to reduce my academic load."

A. The student reports improved feelings of well-being. Yoga and other physical activities can be effective ways to manage stress. These activities deepen breathing, relieve muscle tension, and can elevate levels of the body's own endorphins, which induces a sense of well-being.

A nurse in an outpatient medical clinic talks to a patient with a long history of malingering and doctor-shopping. The patient continues to express complaints of multiple problems. Select the nurse's best comment to the patient. A. "The treatment team believes you would benefit more from seeing a mental health professional." B. "The treatment team discussed your case and wants to begin a special case management program for you." C. "Because you have a number of medications, it would be safer to have them all filled at the same pharmacy." D. "Diagnostic testing has shown no medical problems and you are using your fare share of health care services."

B. "The treatment team discussed your case and wants to begin a special case management program for you." It's important for the nurse to convey compassion and support to the patient but without reinforcing the symptoms. Case management can help to limit health care costs. Seeing the patient at regular intervals can instill security and avoid frantic and frequent demands. The patient who establishes a relationship with the case manager often feels less anxiety bc he or she has an advocate and feels that someone is managing and aware of his or her care.

The school nurse assesses four adolescents, all of whom outwardly appear healthy. Which adolescent meets one criterion for anorexia nervosa with mild severity? A. 5'2" tall; weight 104 lbs B. 5'7" tall; weight 110 lbs C. 5'5" tall; weight 114 lbs D. 5'8" tall; weight 127 lbs

B. 5'7" tall; weight 110 lbs BMI is used to gauge the level of severity, degree of functional disability, and need for supervision for persons diagnosed with anorexia nervosa. BMI is calculated as weight in kg divided by height in meters squared. Ideal BMIs are between 19 and 25. A person whose BMI is over or equal to 17 kg/m2 meets one criterion for anorexia nervosa with mild serverity. The BMI for the correct response is 17.2

A mental health nurse assesses a patient diagnosed with an antisocial personality disorder. Which comorbid problem is most important for the nurse to include in the assessment? A. Generalized anxiety B. Alcohol use and abuse C. Compulsions and phobias D. Dysfunctional sleep patterns

B. Alcohol use and abuse Alcohol abuse is a commonly occurring problem in persons diagnosed with antisocial personality disorder.

A mature, professional couple plans a large wedding in a city 100 miles away from their home. Which response is most likely to be associated with this experience? A. Distress B. Eustress C. Acute stress D. Depersonalization

B. Eustress - beneficial stress that will help the couple focus, problem solve, and successfully plan their wedding.

A patient in the emergency department was seen for the third time in a month with complaints of tremors and paresthesia in the lower extremities. Conversion disorder was diagnosed. While preparing for discharge, the patient says, "Now I'm having chest pain but it's probably nothing." How should the nurse respond? A. Assess the patient's most current lab values. B. Interrupt the discharge and arrange additional medical evaluation of the patient. C. Remind the patient, "The diagnostic tests showed you did not have a medical problem." D. Tell the patient, "Being in the ER a long time can be very distressing.

B. Interrupt the discharge and arrange additional medical evaluation of the patient. A paresthesia is a tingling or pricking sensation. Conversion disorder (functional neurobiological symptom disorder) usually involves weakness or paralysis, abnormal movement, swallowing or speech difficulties, seizures or attacks, and sensory problems. Patients may be distressed or show la belle indifference (a lack of emotional concern). Despite the diagnosis, the patient's complaint's must be taken seriously. Further evaluation is needed.

Friends invite an adult diagnosed with type 2 diabetes to go on a mountain hike next week. The adult replies, "I can't go bc I don't have any hiking shoes." In actuality, this adult fears difficulty with blood glucose management during strenuous activity. Which defense mechanism is evident? A. Displacement B. Rationalization C. Passive aggression D. Reaction formation

B. Rationalization Rationalization refers to justifying an action to satisfy the listener.

An individual lives in a community adjacent to a military base. Loud jets fly overhead multiple times daily. The person tells the nurse, "They're so loud I can't hear myself think." What is the nurse's best first action? A. Direct the individual to report the jet noise to local authorities. B. Teach relaxation and stress reduction techniques to the individual. C. Assess the individual for sensory impairments, particularly auditory. D. Encourage the individual to form a community action group to oppose noise pollution.

B. Teach relaxation and stress reduction techniques to the individual. Stress can by psychological (e.g., anxiety, guilt, or joy) or physical (e.g., stressful environment, such as loud noises, extreme heat or cold, or other disturbing physical condition). Stress is part of everyday life for everyone. Skills in stress reduction will assist the individual to cope with the jet noise. Later, the individual may consider the other options.

Parasympathetic

BP decreases when doing yoga

Dependent personality

Believe they are incapable of surviving if left alone and have an excess need to receive care. 35 y/o man lives in parents basement, doesn't work, uses public transportation

Med that can help with social anxiety and decreases HR?

Beta blocker - propanolol

A patient diagnosed with dissociative identity disorder is hospitalized on an acute care psychiatric unit after a suicide attempt. During a team meeting, which staff nurse's comment should prompt the nursing supervisor to intervene? A. "I have never taken care of a patient with this disorder." B. "I think this patient was misdiagnosed and probably has schizophrenia." C. "I find myself more fascinated and engaged with this patient than others." D. "I recently read an autobiographical book about someone with this problem."

C. "I find myself more fascinated and engaged with this patient than others." Working with people who have somatic symptom disorders can be frustrating as well as fascinating. The correct response presents a comment indicating that the nurse may have lost objectivity regarding the patient. Guidance from the nursing supervisor is needed.

A nurse analyzes reports from four adult patients of frightening events they encountered. Which patient's report most clearly indicates that the resulting fear was mentally healthy? A. "I saw a spider crawling along my kitchen wall." B. "I was at the mall when a gunman began firing an assault weapon." C. "I was at home when a storm with heavy thunder and lightening lasted over an hour." D. I was trapped on an elevator that stopped between floors when the power went out."

C. "I was at home when a storm with heavy thunder and lightening lasted over an hour." While all of these may produce some level of fear or anxiety, the correct response presents a scenario of imminent, specific danger.

A nurse assesses four adolescents diagnosed with various eating disorders. Which comment would the nurse expect from the adolescent diagnosed with anorexia nervosa? A. "I look good bc whenever I overeat, I purge myself." B. "I love sweets. I make myself throw up so I can eat more." C. "I've lost 60 lbs. but I'm still a size 2. I want to be a size 0." D. "I've hidden my eating disorder from everyone, even my parents."

C. "I've lost 60 lbs. but I'm still a size 2. I want to be a size 0." Thought processes that accompany anorexia nervosa include a terror of gaining weight, viewing oneself as fat even when emaciated, and judging one's self-worth by one's weight or size.

The nurse assesses a new patient suspected of having a schizotypal personality disorder. Which assessment question is this patient most likely to answer affirmatively? A. "Do some types of situations frighten you?" B. "Do you often have episodes of prolonged crying?" C. "Is anyone in your family diagnosed with a mental illness? D. "Is it ever very important for you to do everything correctly?"

C. "Is anyone in your family diagnosed with a mental illness? Genetics seem to play a significant role in the development of schizotypal personality disorder, which is more common in families with a history of schizophrenia.

A patient experiencing depression says to the nurse, "My health care provider said I need to 'talk' therapy but I think I need a prescription for an antidepressant medication. What should I do?" Select the nurses best response. A. "Which antidepressant medication do you think would be helpful?" B. "There are different types of talk therapy. Most patients find it beneficial." C. "Let's consider some ways to address your concerns with your HCP." D. "Are you willing to give 'talk therapy' a try before starting an antidepressant medication?"

C. "Let's consider some ways to address your concerns with your HCP." Helplessness is sometimes a finding in major depressive disorder. The nurse has a responsibility for patient advocacy. Helping the patient to advocate for self is empowering.

Shortly after hospitalization, an adolescent diagnosed with anorexia nervosa says to the nurse, "Being fat is the worst thing in the world. I hope it never happens to me." Which response by the nurse is appropriate? A. "You need to gain weight to become healthier." B. "Your world would not change if you gained a few pounds." C. "Tell me how your world would be different if you were fat." D. "Your attractiveness is not defined by a number on the scales."

C. "Tell me how your world would be different if you were fat." Cognitive distortions with underlying emotions of anxiety, dysphoria, low self-esteem, and feeling lack of control are often present in persons suffering with eating disorders. In this instance, the adolescent is catastrophizing. The nurse should first help the patient to identify the fears. Cognitive distortions are consistently confronted by all members of the interdisciplinary team in preparation for carefully planned challenges to the patient later in treatment.

After a power outage, a facility must serve a dinner of sandwiches and fruit to patients. Which comment is most likely from a patient diagnosed with narcissistic personality disorder? A. "These sandwiches are probably contaminated with bacteria." B. "I suppose it's the best we can hope for under these circumstances." C. "You should have ordered a to-go meal from a local restaurant for me." D. "I would rather wait to eat until the dietary department can prepare a meal."

C. "You should have ordered a to-go meal from a local restaurant for me." People diagnosed with narcissistic personlaity disorder consider themselves special and expect special treatment. Their demeanor is arrogant and haughty. They have a sense of entitlement.

A 28 y/o 2nd grade teacher is diagnosed with major depressive disorder. She grew up in Texas but moved to Alaska 10 years ago to separate from an abusive mother. Her father died by suicide when she was 12 y/o. Which combination of factors in this scenario best demonstrates the stress-diathesis model? A. Cold climate coupled with history of abuse B. Current age of 28 couple with family history of depression C. Family history of mental illness coupled with history of abuse D. Female gender coupled with the stressful profession of teaching

C. Family history of mental illness coupled with history of abuse The stress-diathesis model explains depression from an environmental, interpersonal, and life events perspective combined with biological vulnerability or prediposition (diathesis). Pschosocial stressors and interpersonal events, such as abuse, trigger certain neurophysical and neurochemical changes in the brain. Early life trauma is a significant component in the stress reaction

The nurse cares for a hospitalized adolescent diagnosed with major depressive disorder. the health care provider prescribes a low-dose antidepressant. In consideration of published warnings about use of antidepressant medications in younger patients, which action should the nurse employ? A. Notify the facility's patient advocate about the new prescription. B. Teach the adolescent about Black Box warnings associated with antidepressant medications. C. Monitor the adolescent closely for evidence of adverse effects, particularly suicidal thinking or behavior. D. Remind the health care provider about warnings associated with the use of antidepressants in children and adolescents.

C. Monitor the adolescent closely for evidence of adverse effects, particularly suicidal thinking or behavior. Use of SSRIs shows a strong association with a reduction in suicide.

antisocial personality disorder

Characterized by persistent disregard for and violation of the rights of others with no remorse - NO GUILT.

Example of acute anxiety

Charlie is 19 years old with an ileostomy caused by rectal surgery for cancer, which has rendered him sexually impotent. He is admitted to the psychiatric unit and is unable to state his name.

Suppression

Conscious denial of a disturbing situation or feeling. Example: A student has been studying for the state board exam says, "I can't worry about paying my rent until after my exam tomorrow."

An adult required a heart transplant 5 years ago. Multiple medical complications followed, resulting is persistent irritability, depression, and insomnia. The adult's spouse says, "I've walked on eggshells for 5 years, never knowing when something else will go wrong." What is the nurse's priority intervention regarding the spouse? A. Explore the spouses feelings, showing care and compassion. B. Encourage the spouse to attend a community support group. C. Teach stress reduction and relaxation techniques to the spouse. D. Refer the spouse to the primary care provider for health assessment.

D. Refer the spouse to the primary care provider for health assessment. The scenario suggests that the spouse has experienced the effects of long-term stress. When stress is prolonged, the body stays alert. Chemicals produced by the stress response can have damaging effects on the body, causing physical diseases. While all of the actions may be indicated, obtaining a health assessment from the primary care provider has the first priority.

A patient tells the nurse, "no matter what I do, I feel like there's always this dark cloud following me." Select the nurse's initial action. A. Assess the patient's current sleep and eating pattern. B. Explain to the patient, " Everyone feels down from time to time." C. Suggest alternative activities for times when the patient feels depressed. D. Say to the patient, "Tell me more about what you mean by 'a dark cloud'."

D. Say to the patient, "Tell me more about what you mean by 'a dark cloud'." The correct response accomplishes two results; the nurse can further assess the patient's complaint and the nurse uses clarification, a therapeutic communication.

An outpatient psychiatric nurse assesses a patient diagnosed with hoarding disorder. The patient has lost 12 pounds in the past two months, appears disheveled, and is wearing dirty clothing with poor hygiene. What is the nurse's priority action? A. Review the patient's medication regime. B. Ask the patient, "What types of foods have you been eating?" C. Refer the patient to a psychologist for cognitive behavioral therapy (CBT). D. Schedule a home visit to assess the safety of the patient's living condition.

D. Schedule a home visit to assess the safety of the patient's living condition. Safety is the nurse's 1st priority. Individuals diagnosed with hoarding disorder often live in unsafe conditions. A home visit will help to identify whether safety is the primary concern.

A nursing student arrives late for a clinical experience and is not wearing the correct attire. When the instructor privately criticizes the behavior, the student responds, "I'm always the one who gets caught. You're going to cause me to fail." Select the instructors best response. A. "Other students get caught as well." B. "I am not trying to cause you to fail. I am here to help you." C. I am sorry you feel that way. I try to treat all of my students equally." D. The requirements for this experience were discussed during our orientation."

D. The requirements for this experience were discussed during our orientation." The student is demonstrating projection, as evidenced by not taking responsibility for his or her own behavior and blaming the instructor for a perception of failing. In the correct answer, the instructor avoids defensive response and reinforces that responsibility belongs to the student.

What is the SSRI escitalopram (Lexapro) used for?

Depression, anxiety, panic disorder, aggression, anorexia nervosa, OCD

What is the MAOI phenelzine (Nardil) taken for?

Depression, phobias, and anxiety

What do you do after an ECT?

Lay them on their side so they don't choke

What is the best way to treat someone that has antisocial personality disorder?

Maintain consistent staff with the patient (one person), so you are not having to explain the patient over and over.

A with PTSD will normally also have ___________________.

Major depression

Example of chronic anxiety

Mr. Jones has not left the house for 3 months. He tells his family, "I know this is not normal, but I just can't go outside." His wife died 3 years earlier.

Will a person with depression talk a lot?

No

Buspar (buspirone)

Non-Benzo, non-addictive, can be used long term for anxiety

Conversion disorder

One or more symptoms of impaired motor or sensory functions. increased risk may be associated with early physical or sexual abuse. Symptoms: weakness or paralysis, abnormal movement, swallowing or speech difficulties, seizures, or attacks, sensory loss or anesthesia or symptoms involving the senses (blindness, loss of smell) Example: Mom goes blind after watching son get run over.

Somatic

Patient acting as though they had been shot and are having pains like they had been shot. These patients experience and communicate physical symptoms but nothing is actually wrong with them.

Denial

Patient diagnosed with lung cancer but says that there is nothing wrong.

Staff splitting

Patient turns nurses against eachother, making nurses feel like they have to watch eachother. *Best thing nurses can do is communicate with eachother.*

Severe anxiety

Perceptual field greatly reduced, may focus on one particular detail or many scatter details, learning and problem solving not possible, may be dazed and confused. Somatic symptoms (headache, nausea, dizziness, insomnia) trembling, and pounding heart. Most classic experiences are hyperventilation and sense of impending doom or dread.

Moderate anxiety

Person sees, hears, and grasps less information. Only certain things in the environment are seen or heard. (tension, pounding heart, increased HR and RR, perspiration, and mild somatic symptoms (GI discomfort, headache, urinary urgency)) Voice tremors and shaking may be noticed.

What SSRI is FDA approved for adolescents?

Prozac

What can a patient do to help problems to not be so overwhelming?

Saying problems out loud

Benzodiazepines (Ativan, Xanax, etc.)

Should be given PRN bc it can be habit forming. Should NOT drink beer or wine while taking this.

Jon an ER nurse, has just worked an 8 hour shift. After a 5 car wreck during his midshaft, 5 patients have been transported to the hospital with multiple injuries and one fatality. Jon looks exhausted, and his hands are tremulous. He insists that he is scheduled to work another 6 hours. As the nurse manager, what is your best action?

Tell him he needs to end his shift right away. Your role as nurse manager of patient care includes deciding who is safe to work, and Jon is not safe.

What do you do if someone is having a panic attack?

Tell them to breathe and tell them they will be okay

Heights can trigger __________________________________.

The autonomic nervous system.

A person shoplifts merchandise from a community cancer thrift shop. When confronted, the thief replies, "All this stuff was donated, so I can take it." This comment suggests features of which personality disorder? a. Antisocial b. Histrionic c. Borderline d. Schizotypal

a. Antisocial Shows callousness, entitlement, lack of remorse, and disregard for the rights of others. These characteristics are common in persons diagnosed with antisocial personality disorder

Passive aggression

aggression towards others expressed through procratination, failure, inefficiency, passivity, and illnesses that affect others more than one-self.

Compensation

although I am fat, I am beautiful

Agoraphobia

an intense, excessive anxiety about or fear of being in places or situations where help might not be available and escape might be difficult or embarrassing. Example: being alone outside the home, public transportation (car, bus, airplane), being in open spaces (bridges, marketplaces, parking lot), being in an enclosed space (elevators, churches, theatres), being in a crowd

While weighing patients on an eating disorders unit, the nurse overhears a psychiatric technician say, " I wish I had an eating disorder, maybe I'd lose a little weight." What is the nurse's best action? a. report the clinical observation to the nursing supervisor b. ask the psychiatric technician, "What did you mean by that comment?" c. privately discuss the importance of sensitivity with the psychiatric technician d. immediately interrupt the interaction between the patient and psychiatric technician

c. privately discuss the importance of sensitivity with the psychiatric technician The comment by the psychiatric technician trivializes the patients' problems. Low self-esteem and self-doubts about personal worth are characteristic features of persons who have eating disorders. The comment contributes to these aspects of self-perception.

Social phobia

characterized by severe anxiety or fear provoked by exposure to a social situation or a performance situation, resulting in humiliation or embarassment. Example: fear of saying something that sounds foolish in public, fear of being unable to answer questions in a classroom, fear of eating in the prescence of others, fear of performing on stage.

Dissociation (DID)

characterized by varying degrees of mental detachment from conscious awareness. Range from feeling unreal through actually creating more than one personality to cope to disperse psychological effects of severe abuse memories. Have lapses of memory, think you'd been asleep and wake up wearing different clothes.

childhood conduct disorder

cutting - grow up to have antisocial personality disorder

Over the past 2 months a patient made eight suicide attempts with increasing lethality. The health care provider informs the patient and family that electroconvulsive therapy (ECT) is needed. The family whispers to the nurse, "Isn't this a dangerous treatment?" How should the nurse reply? a. "Our facility has an excellent record of safety associated with use of electroconvulsive therapy." b. "Your family member will eventually be successful with suicide if aggressive measures are not promptly taken." c. "Yes, there are hazards with electroconvulsive therapy. You should discuss these concerns with the health care provider." d. "Electroconvulsive therapy is very effective when urgent help is needed. Your family member was carefully evaluated for possible risks."

d. "Electroconvulsive therapy is very effective when urgent help is needed. Your family member was carefully evaluated for possible risks." Electroconvulsive therapy (ECT) is safe and effective and can achieve a 70% to 90% remission rate in depressed patients within 1 to 2 weeks. ECT is especially indicated when there is a need for a rapid, definitive response when a patient is suicidal or homicidal as well as in selected other circumstances.

Select the best example of altruism a. After recovering from a gunshot wound, a police officer attends a local support group. b. After recovering from open heart surgery, an individual plays tennis three times a week. c. An individual who received a liver transplant volunteers at a local organ procurement agency. d. An individual with a long standing fear of animals volunteers at a community animal shelter.

d. An individual with a long standing fear of animals volunteers at a community animal shelter. Altruism is a health defense mechanism in which emotional conflicts and stressors are addressed by meeting the needs of others. With altruism, the person receives gratification with vicariously or from the response of others.

Idealization

emotional conflicts or stressors are addressed by attributing exaggerated positive qualities to others.

Hypochondriasis

exhibit high level of anxiety and alarm about their health lasting at least 6 months and may either excessively check for problems or avoid medical care.

Acute stress disorder

experiencing a violent event or repeatedly witnessing a violent or traumatic event. (e.g., first responders at the scene of a mass casualty incident, police officers repeatedly exposed to details of child abuse.)

What may set off a patient with PTSD?

loud noises

An elderly patient that is having depressive thoughts. What test do you give to rule out dementia?

mini mental status exam

Mild anxiety

occurs in the normal experience of every day living. Person sees, hears, and grasps for information, and problem solving becomes more effective. May display physical symptoms such as nail biting, foot or finger tapping, fidgeting

Projection

person unconsciously rejects emotionally unacceptable personal features and attirbutes them to other people, objects, or situations. The hallmark of blaming, scapegoating, prejudicial thinking, and stigmatization. Example: "The problem is Tommy." "The problem is the nurses' aides... the students... the new salesman... the Democrats/Republicans who are to blame for the situation we are in today."

Sympathetic

pulse rate increases in a car wreck

If you walk into the unit and see a patient that was depressed and started taking Lexapro that is now acting like they are happy, what do you need to do?

stay one on one with that patient bc their is a risk for suicide

Borderline personality disorder

the highest risk for attempted suicide but do not complete or follow through. They crave attention. -"I hate you--please don't leave me." -very needy -do things to get your attention

Displacement

transer of emotions associated w/a particular person, object, or situation that is non-threatening. Example: Boss yells at man, the man yells a this wife, the wife yells at the child, the child kicks the cat

What should not be included in your diet if you are taking an MAOI (pheneizine, Nardil)?

tyramine - aged cheese, beer, pork, yeast, yogurt, red wine, soy sauce, chocolate, bananas, chicken liver

Reaction formation (AKA: overcompensation)

unacceptable feelings or behaviors are kept out of awareness by developing the opposite behavior or emotion. Example: A person who harbors hostility toward children becomes a Boy Scout leader.

How long does it take for escitalopram (Lexapro) to become effective?

2-4 weeks

Narcissistic personality disorders

maladaptive social response characterized by a person's grandiose sense of personal acheivements. They lack empathy, exploit others to meet their own needs, attention seeking, often envy others successes or possessions. Always blame others

A patient at a general medical clinic tells the nurse, " I have so many ailments that I need to see six different doctors. None of them has discovered what is really wrong with me." Which comment should the nurse offer next? A. "Let's review all of the medications you currently take." B. "Tell me about allergic reactions you've had to medications." C. "Selecting one primary care provider would be better for you." D. "I'm not sure I understand how you can afford these expenses."

A. "Let's review all of the medications you currently take." Safety is the nurse's first concern. One serious risk associated with doctor-shopping is medication interactions and duplicate medications.

A patient has somatic disease, you know they are hurting, what do you do?

Acknowledge their pain. "I know you are having pain. However, labs/tests.....(show the patient the results)."

Example of normal anxiety

Alex has a chemistry test this morning. She "crammed" for the test the previous night but did not study before that. She has an upset stomach and headache.

What does the parasympathetic branch of the autonomic nervous system do?

As the threat passes it helps maintain homeostasis and relaxation takes over.

Wellbutrin (bupropion)

Atypical antidepressant Norepinephrine Dopamine Reuptake Inhibitor - 2nd line of antidepressant when SSRI and SNRI are not effective. Can be used for anxiety and sleep disturbances

A patient is hospitalized with a diagnosis of anorexia nervosa. The nurse reviews the patient's lab results below. Sodium 143 mEq/L Potassium 3.1 mEq/L Chloride 102 mEq/L Magnesium 2.2 mEq/L Calcium 8.4 mg/dL Phosphate 3.0 mg/dL The nurse should take which action next? A. Measure the patient's body temperature B. Inspect the patient's skin and sclera for jaundice C. Assess the patient's mucous membranes for erosion D. Auscultate the patient's heart rate, rhythm, and sounds.

D. Auscultate the patient's heart rate, rhythm, and sounds. The lab results should hypokalemia and hypocalcemia, which is likely to affect cardiac function, producing bradycardia, arrhythmias, and/or murmurs.

A combat veteran from two tours of the war in Afghanistan tells the nurse, "Some guys in my unit have PTSD, but I never had any problems other than my hearing is not as good as it once was." Which explanation for this comment should the nurse consider? A. The veteran wants to demonstrate toughness and strength. B. The veteran shows indicators of derealization and depersonalization. C. The veteran may be rationalizing this reaction to the memories of combat. D. The veteran may have amnesia associated with the combat experience.

D. The veteran may have amnesia associated with the combat experience. War is a traumatic experience for anyone. The veteran's comments about his peers and hearing deficit clearly indicate that he was exposed to explosives. Some studies show that between 5% and 20% of veterans are amnesic for their combat experiences.

What is secondary to another medical condition/a lot of psychiatric disorders?

Depression

What is the consequence if patient eats tyramine while taking an MAOI?

Hypertensive crisis (severe hypertension, severe headache, chest pain, fever, sweating, nausea, and vomiting)

Rationalization

Justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller as well as the listener. Example: "If i had Lynn's brain, I'd get good grades too." "Everybody cheats so why shouldn't I?"

If a patient refuses to eat solid food, what is the nest liquid you can give them?

milk

How does the body react in times of stress?

The sympathetic nervous system assumes control (fight or flight response) and sends signals to the adrenal glands, releasing epinephrine (or adrenaline). The circulating adrenaline increases HR, elevates BP, increases blood flow tot he skeletal muscles, and increases muscle tension. Respirations also increase, bringing more oxygen to the lungs, which is then sent to the brain, increasing alertness.

Why do people cut themselves?

They feel that it is a way to release pain that they are feeling.

A patient w/bulimia nervosa has become dehydrated from self-induced vomiting. The is most likely to result in:

hypokalemia

What class is Amitriptyline HCL (Elavil) and what is it used for?

Tricyclic -taken for depression -clients with morbid fantasies do not respond well to these drugs

What functions as the command-and-control center when receiving stressful signals?

hypothalamus

Splitting

inability to integrate the positive and negative qualities of oneself or others into a cohesive image. Aspects of the self and others tend to alternate between opposite poles; for example, either good, loving, worthy, and nurturing; or bad hateful, destructive, rejecting, and worthless