Pysch Hesi practice
What are the 4 A's of schizophrenia?
A. Autism 2. Affect (flat) 3. Associations (loose) 4. Ambivalence
What information is important to include in the nutritional counseling of a family with a member who has bipolar disorder? If sufficient roughage isn't eaten while taking lithium, bowel problems will occur. If the intake of carbohydrates increases, the lithium level increases. If the intake of calories is reduced, the lithium level will increase If the intake of sodium increases, the lithium level will decrease.
Any time the level of sodium increases, such as with a change in the dietary intake, the levels of lithium will decrease.
Which of the following nursing actions would be included in a care plan for a client with PTSD who states the experience was "bad luck"? Encourage the client to verbalize the experience Assist the client in defining the experience Work with the client to take steps to move on with his life Help the client accept positive and negative feelings
Assist the client in defining the experience; The client must define the experience as traumatic to realize the situation wasn't under his personal control. Encouraging the client to verbalize the experience without first addressing the denial isn't a useful strategy. The client can move on with life only after acknowledging the trauma and processing the experience. Acknowledgement of the actual trauma and verbalization of the event should come before the acceptance of feelings.
A hospitalized client with a history of alcohol abuse tells the nurse, "I am leaving now. I have to go. I don't want anymore treatment. I have things that I have to do right away." The client has not been discharged. In fact, the client is scheduled for an important diagnostic test to be performed in 1 hour. After the nurse discusses the client's concerns with the client, the client dresses and begins to walk out of the hospital room. The most important nursing action is to: Restrain the client until the physician can be reached Call security to block all areas Tell the client that the client cannot return to this hospital again if the client leaves now. Call the nursing supervisor.
Call the nursing supervisor.; A nurse can be charged with false imprisonment if a client is made to believe wrongfully that the client cannot leave the hospital. Most health care facilities have documents that the client is asked to sign that relate to the client's responsibilities when the client leaves against medical advice. The client should be asked to sign this document before leaving. The nurse should request that the client wait to speak to the physician before leaving, but if the client refuses to do so, the nurse cannot hold him against his will. Restraining the client and calling security to block exits constitutes false imprisonment. Any client has a right to health care and cannot be told otherwise.
Select all nursing interventions for a hospitalized client with mania who is exhibiting manipulative behavior. Communicate expected behaviors to the client Enforce rules and inform the client the he or she will not be allowed to attend group therapy sessions. Ensure that the client knows that he or she is not in charge of the nursing unit Be clear with the client regarding the consequences of exceeding limits set regarding behavior. Assist the client in testing out alternative behaviors for obtaining needs
Communicate expected behaviors to the client Be clear with the client regarding the consequences of exceeding limits set regarding behavior. Assist the client in testing out alternative behaviors for obtaining needs; Interventions for dealing with the client exhibiting manipulative behavior include setting clear, consistent, and enforceable limits on manipulative behaviors; being clear with the client regarding the consequences of exceeding limits set; following through with the consequences in a non-punishment manner; and assisting the client in identifying strengths and in testing out alternative behaviors for obtaining needs. Enforcing rules and informing the client that he or she will not be allowed to attend group therapy sessions is a violation of the client's rights. Ensuring the client knows that he or she is not in charge of the nursing unit is inappropriate, power struggles need to be avoided.
This disorder is characterized by the client's sudden flight from home or work with an inability to recall his or her own identity.
Dissociative fugue
A client with a diagnosis of major depression, recurrent with psychotic features is admitted to the mental health unit. To create a safe environment for the client, the nurse most importantly devises a plan of care that deals specifically with the client's: Disturbed thought processes Imbalanced nutrition Self-care deficit Deficient knowledge
Disturbed thought processes; major depression, recurrent, with psychotic features alerts the nurse that in addition to the criteria that designate the diagnosis of major depression, one also must deal with the client's psychosis. Psychosis is defined as a state in which a person's mental capacity to recognize reality and to communicate and relate to others is impaired, thus interfering with the person's capacity to deal with the demands of life. Altered thought processes generally indicate a state of increased anxiety in which hallucinations and delusions prevail. Although all of the nursing diagnoses may be appropriate because the client is experiencing psychosis, option 1 is correct.
A client with borderline personality disorder is admitted to the unit after slashing his wrist. Which of the following goals is most important after promoting safety? Establish a therapeutic relationship with the client Identify whether splitting is present in the client's thoughts Talk about the client's acting out and self-destructive tendencies. Encourage the client to understand why he blames others
Establish a therapeutic relationship with the client; After promoting safety, the nurse establishes a rapport with the client to facilitate appropriate expression of feelings. At this time, the client isn't ready to address unhealthy behavior. A therapeutic relationship must be established before the nurse can effectively work with the client on self-destructive tendencies and the issues of splitting.
Which of the following interventions is important for a client with paranoid personality disorder taking olanzapine (Zyprexa)? Explain effects of serotonin syndrome Teach the client to watch for extrapyramidal adverse reactions Explain that the drug is less effective if the client smokes Discuss the need to report paradoxical effects such as euphoria
Explain that the drug is less effective if the client smokes; Olanzapine (Zyprexa) is less effective for clients who smoke cigarettes. Olanzapine doesn't cause euphoria, and extrapyramidal side effects aren't a problem. However, the client should be aware of adverse effects such as tardive dyskinesia.
A client with schizotypal personality disorder is sitting in a puddle of urine. She's playing in it, smiling, and softly singing a child's song. Which action would be best? Admonish the client for not using the bathroom Firmly tell the client that her behavior is unacceptable Ask the client if she's ready to get cleaned up now Help the client to the shower, and change the bedclothes.
Help the client to the shower, and change the bedclothes; A client with schizotypal personality disorder can experience high levels of anxiety and regress to childlike behaviors. This client may require help meeting self-care needs. The client may not respond to the other options or those options may generate more anxiety.
Which of the following types of behavior is expected from a client diagnosed with a paranoid personality disorder? Eccentric exploitative Hypersensitive Seductive
Hypersensitive; People with paranoid personality disorders are hypersensitive to perceived threats. Schizotypal personalities appear eccentric and engage in activities others find perplexing. Clients with narcissistic personality disorder are interpersonally exploitative to enhance themselves or indulge in their own desires. A client with histrionic personality disorder can be extremely seductive when in search of stimulation and approval.
Which of the following characteristics or client histories substantiates a diagnosis of antisocial personality disorder? Delusional thinking Feelings of inferiority Disorganized thinking Multiple criminal charges
Multiple criminal charges; Clients with antisocial personality disorder are often sent for treatment by the court after multiple crimes or for the use of illegal substances.
Bupropion, Mirtzapine are both _?_ that treat _?_
NDRI's; used with another SSRI or SNRI when they are not effective alone
A woman comes into the ER in a severe state of anxiety following a car accident. The most appropriate nursing intervention is to: Remain with the client Put the client in a quiet room Teach the client deep breathing Encourage the client to talk about their feelings and concern
Remain with the client; If a client with severe anxiety is left alone; the client may feel abandoned and become overwhelmed. Placing the client in a quiet room is also important, but the nurse must stay with the client. Teaching the client deep breathing or relaxation is not possible until the anxiety decreases. Encouraging the client to discuss concerns and feelings would not take place until the anxiety has decreased.
When caring for a client with a diagnosis of schizotypal personality disorder, the nurse should: Set limits on manipulative behavior encourage participation in group therapy Respect the client's needs for social isolation Understand that seductive behavior is expected
Respect the client's needs for social isolation; These clients are withdrawn, aloof, and socially distant; allowing distance and providing support may encourage the eventual development of a therapeutic alliance. Group therapy would increase this client's anxiety; cognitive or behavioral therapy would be more appropriate
A client with a diagnosis of narcissistic personality disorder has been given a day pass from the psychiatric hospital. The client is due to return at 6pm. At 5pm the client telephones the nurse in charge of the unit and says "6 o'clock is too early. I feel like coming back at 7:30." The nurse would be most therapeutic by telling the client to: Return immediately, to demonstrate control Return on time or restrictions will be imposed come back at 6:45, as a compromise to set limits Come back as soon as possible or the police will be sent
Return on time or restrictions will be imposed; This sets limits, points out reality, and places responsibility for behavior on the client.
When working with the nurse during the orientation phase of the relationship, a client with a borderline personality disorder would probably have the most difficulty in: Controlling anxiety terminating the session on time Accepting the psychiatric diagnosis Setting mutual goals for the relationship
Setting mutual goals for the relationship; Clients with borderline personality disorders frequently demonstrate a pattern of unstable interpersonal relationships, impulsiveness, affective instability, and frantic efforts to avoid abandonment; these behaviors usually create great difficulty in establishing mutual goals
An adult client with a borderline personality disorder become nauseated and vomits immediately after drinking after drinking 2 ounces of shampoo as a suicide gesture. The most appropriate initial response by the nurse would be to: Promptly notify the attending physician Immediately initiate suicide precautions Sit quietly with the client until nausea and vomiting subsides Assess the client's vital signs and administer syrup of ipecac
Sit quietly with the client until nausea and vomiting subsides; This intervention demonstrates the nurse's caring presence which is vital for this client. (1) Although the treatment team does need to know about the event, notification is not the immediate concern. (2) This is premature and it reinforces the client's predisposition to manipulative behavior. (4) This medication is inappropriate in this situation; vomiting would be expected after the ingestion of shampoo
Five years ago, a man was involved in a motor vehicle accident that killed a friend who was a passenger in the car. Since that time, he has been unable to work because of severe back pain. The pain is unrelieved by prescribed medications. What type of disorder is this?
Somatization disorder
A client with a diagnosis of borderline personality disorder has negative feelings toward the other clients on the unit and considers them all to be "bad." The nurse understands this defense is known as: Splitting Ambivalence Passive aggression Reaction formation
Splitting; Splitting is the compartmentalization of opposite-affect states and failure to integrate the positive and negative aspects of self or others
A client with avoidant personality disorder says occupational therapy is boring and doesn't want to go. Which action would be best? State firmly that you'll escort him to OT. Arrange with OT for the client to do a project on the unit. Ask the client to talk about why OT is boring Arrange for the client not to attend OT until he is feeling better
State firmly that you'll escort him to OT; If given the chance, a client with avoidant personality disorder typically elects to remain immobilized. The nurse should insist that the client participate in OT. Arranging for the client to do a project on the unit validates and reinforces the client's desire to avoid getting to OT. Addressing an invalid issue such as the client's perceived boredom avoids the real issue: the client's need for therapy.
A nurse is orienting a new client to the unit when another client rushes down the hallway and asks the nurse to sit down and talk. The client requesting the nurse's attention is extremely manipulative and uses socially acting-out behaviors when demands are unmet. The nurse should: Suggest that the client requesting attention speak with another staff member Leave the new client and talk with the other client to avoid precipitating acting out behavior Tell the interrupting client to sit down and be patient, stating, "I'll be back as soon as possible." Introduce the two clients and suggest that the client join the new client and the nurse on the tour
Tell the interrupting client to sit down and be patient, stating, "I'll be back as soon as possible."; This sets realistic limits on behavior without rejecting the client
The nurse reviews the activity schedule for the day and plans which activity for the manic client? Brown-bag luncheon and book review Tetherball Paint-by-number activity Deep breathing and progressive relaxation group
Tetherball A person who is experiencing mania is overactive and full of energy, lacks concentration, and has poor impulse control. The client needs an activity that will allow use of excess energy yet not endanger others during the process. Options 1, 3, and 4 are relatively sedate activities that require concentration, a quality that is lacking in the manic state. Such activities lead to increased frustration and anxiety for the client. Tetherball is an exercise that uses the large muscle groups of the body and is a great way to expend the increased energy that the client is experiencing.
Which of the following behaviors by a client with dependent personality disorder shows the client has made progress toward the goal of increasing problem solving skills? The client is courteous The client asks questions The client stops acting out The client controls emotions
The client asks questions; The client with dependent personality disorder is passive and tries to please others. By asking questions, the client is beginning to gather information, the first step of decision making.
When assessing a client diagnosed with impulse control disorder, the nurse observes violent, aggressive, and assaultive behavior. Which of the following assessment data is the nurse also likely to find? Select all that apply. The client functions well in other areas of his life. The degree of aggressiveness is out of proportion to the stressor. The violent behavior is most often justified by the stressor. The client has a history of parental alcoholism and chaotic, abusive family life. The client has no remorse about the inability to control his anger.
The client functions well in other areas of his life. The degree of aggressiveness is out of proportion to the stressor. The client has a history of parental alcoholism and chaotic, abusive family life.; A client with an impulse control disorder who displays violent, aggressive, and assaultive behavior generally functions well in other areas of his life. The degree of aggressiveness is typically out of proportion with the stressor. Such a client commonly has a history of parental alcoholism and a chaotic family life, and often verbalizes sincere remorse and guilt for the aggressive behavior
Milieu therapy, behavior modification, family therapy, crisis intervention, cognitive therapy, group intervention and ECT are all types of _?_
Treatment modalities
Amitriptyline, Desipramine, Imipramine, Nortriptyline, Protriptyline and Maprotiline are all _?_ that treat _?_
Tricyclic antidepressants; depression
The manic client announces to everyone in the dayroom that a stripper is coming to perform this evening. When the nurse firmly states that this will not happen, the manic client becomes verbally abusive and threatens physical violence to the nurse. Based on the analysis of this situation, the nurse determines that the most appropriate action would be to: With assistance, escort the manic client to her room and administer Haldol as prescribed if needed Tell the client that smoking privileges are revoked for 24 hours Orient the client to time, person, and place Tell the client that the behavior is not appropriate
With assistance, escort the manic client to her room and administer Haldol as prescribed if needed; The client is at risk for injury to self and others and therefore should be escorted out of the dayroom. Antipsychotic medications are useful to manage the manic client. Hyperactive and agitated behavior usually responds to Haldol. Option 2 may increase the agitation that already exists in this client. Orientation will not halt the behavior. Telling the client that the behavior is not appropriate already has been attempted by the nurse.
The nurse is planning activities for a client who has bipolar disorder with aggressive social behavior. Which of the following activities would be most appropriate for this client? Ping pong Writing Chess Basketball
Writing; Solitary activities that require a short attention span with mild physical exertion are the most appropriate activities for a client who is exhibiting aggressive behavior. Writing, walks with staff, and finger painting are activities that minimize stimuli and provide a constructive release for tension. Competitive games can stimulate aggression and increase psychomotor activity.
Trazodone is a(n) _?_ that treats _?_
atypical antidepressant; depression, insomnia
Risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, clozapine are all _?_ that treat _?_
atypical antipsychotics; + and - symptoms of schizophrenia
The nurse should be aware that all _?_ has meaning
behavior
Chlordiazepoxide, Diazepam, Clorazepate dipotassium and Lorazepam are all _?_ that treat _?_
benzodiazepines; anxiety
If a client with bulimia uses Syrup of Ipecac to induce vomiting but does not vomit, _?_ may occur
cardiotoxicity
Denial, displacement, identification, intellectualization, introjection, isolation, passive-aggression, projection, rationalization, reaction formation, regression, repression, sublimation, suppression and undoing are all type of _?_
coping styles (defense mechanisms)
If a client with bulimia uses Syrup of Ipecac to induce vomiting but does not vomit, assess for _?_ and _?_
edema; wet lungs
Fluphenazine, haloperidol are _?_ that treat _?_
long-acting drugs; clients who require supervision with medication regimens
_?_ anxiety continues to motivate learning with assistance from others but it dulls perceptions of sensory stimuli and causes the client to become restless
moderate
Lithium, valproic acid, carbamazepine and lamotrigine are all _?_ drugs
mood-stabilizing
Haloperido, Thiothixene and Pimozide are all _?_ that treat _?_
non-phenothiazines; psychotic behavior
_?_ causes perceptions to be grossly distorted; the client is unable to differentiate real from unreal.
panic
Avoid giving clients diagnosed with dissociative disorders too much information about _?_ at one time
past events
A _?_ is a decrease in anxiety that results from some effort made to deal with stress
primary gain
_?_anxiety stimulates the fight-or-flight response. It may cause perceptions to be distorted and results in selective attention.
severe
The nurse knows that depressed clients are improving when they begin to take an interest in _?_
their appearance
The best intervention that you can provide for a depressed client is _?_
to sit quietly with the client and offer support with your presence
Which of the following statements is appropriate for a client who is depressed? "I noticed you combed your hair today" "You look nice today"
"I noticed you combed your hair today"
Which of the following statements is typical for a client diagnosed with paranoid personality disorder? "I understand you're the one to blame." "I must be seen first; it's not negotiable." "I see nothing humorous in this situation." "I wish someone would select the outfit for me."
"I see nothing humorous in this situation."; Clients with paranoid personality disorder tend to be extremely serious and lack a sense of humor.
Which of the following statements is expected from a client with borderline personality disorder with a history of dysfunctional relationships? "I won't get involved in another relationship." "I'm determined to look for the perfect partner." "I've decided to use better communication skills." "I'm going to be an equal partner in a relationship."
"I'm determined to look for the perfect partner."; Clients with borderline personality disorder would decide to look for a perfect partner. This characteristic is a result of the dichotomous manner in which these clients view the world. They go from relationship to relationship without taking responsibility for their behavior. It's unlikely that an unsuccessful relationship will cause clients to make a change. They tend to be demanding and impulsive in relationships. There's no thought given to what one wants or needs from a relationship. Because they tend to blame others for problems, it's unlikely they would express a desire to learn communication skills.
A hospitalized client is being considered for ECT. The client appears calm, but the family is anxious. The client's mother begins to cry and states "My son's brain will be destroyed. How can the doctor do this to him?" The nurses best response is: "It sounds as though you need to speak with the psychiatrist" "Your son has decided to have this treatment. You should be supportive to him." "Perhaps you'd like to see the ECT room and speak to the staff." "It sounds as though you have some concerns about the ECT procedure. Why don't we sit down together and discuss any concerns you may have."
"It sounds as though you have some concerns about the ECT procedure. Why don't we sit down together and discuss any concerns you may have."; The nurse encourages the client and the family to verbalize fears and concerns. The other options avoid dealing with concerns and are blocks to communication.
A depressed client is ready for discharge. The nurse feels comfortable that the client has a good understanding of the disease process when the client states: "I'll never let this happen to me again. I won't let my boss or my job or my family get to me!" "It's important for me to eat well, exercise, and to take my medication. If I begin to lose my appetite or not sleep well, I've got to get in to see my doctor." "I've learned that I'm a good person and that I am worthy of giving and receiving love. I don't need anyone; I have myself to rely on!" "I don't know what happened to me. I've always been able to make decisions for myself and for my business. I don't ever want to feel so weak or vulnerable again!
"It's important for me to eat well, exercise, and to take my medication. If I begin to lose my appetite or not sleep well, I've got to get in to see my doctor."; The exact cause of depression is not known but is believed to be related to biochemical disruption of neurotransmitters in the brain. Diet, exercise, and medication are recognized treatment for the disease process.
A nurse discusses job possibilities with a client with schizoid personality disorder. Which suggestion by the nurse would be helpful? "You can work in a family restaurant part-time on the weekend and holidays." "Maybe your friend could get you that customer service job where you work only on the weekends." "Your idea of applying for the position of filing and organizing records is worth pursuing." "Being an introvert limits the employment opportunities you can pursue."
"Your idea of applying for the position of filing and organizing records is worth pursuing."; Clients with schizoid personality disorder prefer solitary activities, such as filing, to working with others. Working as a cashier or in customer service would involve interacting with many people.
What are the 4 Category B personality disorders? What words describe these clients?
1. Anti-social 2. Borderline 3. narcissistic 4. histronic dramatic, emotional, erratic
What are the 4 Category C personality disorders? What words describe these clients?
1. Avoidant 2. Dependent 3. Obsessive-compulsive 4. passive-aggressive anxious, fearful
What are the 3 Category A personality disorders? What words describe these clients?
1. paranoid 2. schizoid 3. schizotypal odd, eccentric
A young, handsome man with a diagnosis of antisocial personality disorder is being discharged from the hospital next week. He asks the nurse for her phone number so that he can call her for a date. The nurse's best response would be: "We are not permitted to date clients." "No, you are a client and I am a nurse." "I like you, but our relationship is professional." "It's against my professional ethics to date clients."
"I like you, but our relationship is professional."; This accepts the client as a person of worth rather than being cold or implying rejection. However, the nurse maintains a professional rather than a social role.
The nurse determines that the wife of an alcoholic client is benefiting from attending Al-Anon group when she hears the wife say: "My attendance at the meetings has helped me to see that I provoke my husband's violence." "I no longer feel that I deserve the beatings my husband inflicts on me." "I can tolerate my husband's destructive behavior now that I know they are common with alcoholics." "I enjoy attending the meetings because they get me out of the house and away from my husband.
"I no longer feel that I deserve the beatings my husband inflicts on me."; Al-Anon support groups are protected, supportive opportunity for spouses and significant others to learn what to expect and to obtain excellent pointers about successful behavior changes. Option 2 is the most healthy response because is exemplifies and understanding that the alcoholic partner is responsible for his behavior and cannot be allowed to blame family members for loss of control.
The spouse of a client admitted to the mental health unit for alcohol withdrawal says to the nurse "I should get out of this bad situation." The most helpful response by the nurse would be: "I agree with you. You should get out of this situation." "What do you find difficult about this situation?" "Why don't you tell your husband about this?" "This is not the best time to make that decision."
"What do you find difficult about this situation?"; The most helpful response is one that encourages the client to problem solve. Giving advice implies that the nurse knows what is best and can foster dependency. The nurse should not agree with the client, nor should the nurse request that the client provide explanations.
A client with antisocial personality is trying to convince a nurse that he deserves special privileges and that an exception to the rules should be made for him. Which of the following responses is the most appropriate? "I believe we need to sit down and talk about this." "Don't you know better than to try to bend the rules?" "What you're asking me to do is unacceptable." "Why don't you bring this request to the community meeting?"
"What you're asking me to do is unacceptable.";These clients often try to manipulate the nurse to get special privileges or make exceptions to the rules on their behalf. By informing the client directly when actions are inappropriate, the nurse helps the client learn to control unacceptable behaviors by setting limits. By sitting down to talk about the request, the nurse is telling the client there's room for negotiating when there is none.
Which of the following assessment findings is seen in a client diagnosed with borderline personality disorder? Abrasions in various healing stages intermittent episodes of hypertension Alternating tachycardia and bradycardia Mild state of euphoria with disorientation
Abrasions in various healing stages; Clients with borderline personality disorder tend to self-mutilate and have abrasions in various stages of healing.
Which of the following information must be included for the family of a client diagnosed with dependent personality disorder? Address coping skills Explore panic attacks Promote exercise programs Decrease aggressive outbursts
Address coping skills; The family needs information about coping skills to help the client learn to handle stress. Clients with dependent personality disorder don't have aggressive outbursts; they tend to be passive and submit to others. They don't tend to have panic attacks. Exercise is a health promotion activity for all clients. Clients with dependent personality disorder wouldn't need exercise promoted more than other people.
A hospitalized client, diagnosed with a borderline personality disorder, consistently breaks the unit's rules. This behavior should be confronted because it will help the client: Control anger reduce anxiety Set realistic goals Become more self-aware
Become more self-aware; . Client's must first become aware of their behavior before they can change it. (3) Occurs after the client is aware of the behavior and has a desire to change the behavior
In planning care for a client with borderline personality disorder, a nurse must be aware that this client is prone to develop which of the following conditions? Binge eating Memory loss Cult membership Delusional thinking
Binge eating; Clients with borderline personality disorder are likely to develop dysfunctional coping and act out in self-destructive ways such as binge eating.
A client is admitted to the hospital with a diagnosis of major depression, severe, single episode. The nurse assesses the client and identifies a nursing diagnosis of imbalanced nutrition related to poor nutritional intake. The most appropriate nursing intervention related to this diagnosis is: Explain to the client the importance of a good nutritional intake Weight the client 3 times per week before breakfast Report the nutritional concern to the psychiatrist and obtain a nutritional consultation as soon as possible. Consult with the nutritionist, offer the client several small meals per day, and schedule brief nursing interactions with the client during these times.
Consult with the nutritionist, offer the client several small meals per day, and schedule brief nursing interactions with the client during these times.; Change in appetite is one of the major symptoms of depression. Reporting to the psychiatrist and nutritionist is to some degree correct but lacks the method as to how one would increase food intake.
Which of the following psychological symptoms would the nurse expect to find in a hospitalized client who is the only survivor of a train accident? Denial Indifference Perfectionism Trust
Denial can act as a protective response. The client tends to be overwhelmed and disorganized by the trauma, not indifferent to it. Perfectionism is more commonly seen in clients with eating disorders, not in clients with PTSD. Clients who have had a severe trauma often experience an inability to trust others.
Which of the following conditions is likely to coexist in clients with a diagnosis of borderline personality disorder? Avoidance Delirium Depression Disorientation
Depression; Chronic feelings of emptiness and sadness predispose a client to depression. About 40% of the clients with borderline struggle with depression.
Which of the following short term goals is most appropriate for a client with bipolar disorder who is having difficulty sleeping? Obtain medication for sleep Work on solving a problem Exercise before bedtime Develop a sleep ritual
Develop a sleep ritual; A sleep ritual or nighttime routine helps the client to relax and prepare for sleep. Obtaining sleep medication is a temporary solution. Working on problem solving may excite the client rather than tire him. Exercise before retiring is inappropriate.
A person with antisocial personality disorder has difficulty relating to others because of never having learned to: Count on others Empathize with others Be dependent on others Communicate with others socially
Empathize with others; The lack of superego control allows the ego and the id to control the behavior. Self-motivation and self-satisfaction are of paramount concern.
A psychiatrist prescribes an anti-obsessional agent for a client who is using ritualistic behavior. A common anti-anxiety medication used for this type of client would be: Fluvoxamine (Luvox) Benztropine (Cogentin) Amantadine (Symmetrel) Diphenhydramine (Benadryl)
Fluvoxamine (Luvox); . This drug blocks the uptake of serotonin
Which of the following communication guidelines should the nurse use when talking with a client experiencing mania? Address the client in a light and joking manner Focus and redirect the conversation as necessary Allow the client to talk about several different topic Ask only open ended questions to facilitate conversations
Focus and redirect the conversation as necessary; To decrease stimulation, the nurse should attempt to redirect and focus the client's communication, not allow the client to talk about different topics. By addressing the client in a light and joking manner, the conversation may contribute to the client's feeling out of control. For a manic client, it's best to ask closed questions because open-minded questions may enable the client to talk endlessly, again possibly contributing to the client's feeling out of control.
The nurse is monitoring a client who abuses alcohol for signs of alcohol withdrawal. Which of the following would alert the nurse to the potential for delirium tremors? Hypertension, changes in LOC, hallucinations Hypotension, ataxia, hunger Stupor, agitation, muscular rigidity Hypotension, coarse hand tremors, agitation
Hypertension, changes in LOC, hallucinations; Some of the symptoms associated with delirium tremors typically are anxiety, insomnia, anorexia, hypertension, disorientation, hallucinations, and changes in LOC, agitation, fever, and delusions.
The client has been hospitalized and is participating in a substance abuse therapy group sessions. On discharge, the client has consented to participate in AA community groups. The nurse is monitoring the client's response to the substance abuse sessions. Which statement by the client best indicates that the client has developed effective coping response styles and has processed information effectively for self use? "I know I'm ready to be discharged. I feel I can say 'no' and leave a group of friends if they are drinking... 'No Problem.'" "This group has really helped a lot. I know it will be different when I go home. But I'm sure that my family and friends will all help me like the people in this group have... They'll all help me... I know they will... They won't let me go back to my old ways." "I'm looking forward to leaving here. I know that I will miss all of you. So, I'm happy and I'm sad, I'm excited and I'm scared. I know that I have to work hard to be strong and that everyone isn't going to be as helpful as you people." "I'll keep all my appointments; go to all my AA groups; I'll do everything I'm supposed to... Nothing will go wrong that way."
I'm looking forward to leaving here. I know that I will miss all of you. So, I'm happy and I'm sad, I'm excited and I'm scared. I know that I have to work hard to be strong and that everyone isn't going to be as helpful as you people."; In the defense mechanism of denial the person denies reality. Option 1 identifies denial. In option 2 the client is relying heavily on others, and the client's focus of control is external. In option 4 the client is concrete and procedure oriented; again the client identifies that "Nothing will go wrong that way" if the client follows all the directions. In option 3 the client is expressing real concern and ambivalence about discharge from the hospital. The client also demonstrates reality in that statement.
When planning the discharge of a client with chronic anxiety, the nurse directs the goals at promoting a safe environment at home. The most appropriate maintenance goal should focus on which of the following? Continued contact with a crisis counselor Identifying anxiety-producing situations Ignoring feelings of anxiety Eliminating all anxiety from daily situations
Identifying anxiety-producing situations; Recognizing situations that produce anxiety allows the client to prepare to cope with anxiety or avoid a specific stimulus. Counselors will not be available for all anxiety-producing situations, and this option does not encourage the development of internal strengths. Ignoring feelings will not resolve anxiety. Elimination anxiety from life is impossible.
A 20-year old college student has been brought to the psychiatric hospital by her parents. Her admitting diagnosis is borderline personality disorder. When talking with the parents, which information would the nurse expect to be included in the client's history? Select all that apply. Impulsiveness Lability of mood Ritualistic behavior psychomotor retardation self-destructive behavior
Impulsiveness Lability of mood self-destructive behavior
The nursing diagnosis that would be most appropriate for a 22-year old client who uses ritualistic behavior would be: Ineffective coping Impaired adjustment personal identity disturbance Sensory/perceptual alterations
Ineffective coping; Ineffective coping is the impairment of a person's adaptive behaviors and problem-solving abilities in meeting life's demands; ritualistic behavior fits under this category as a defining characteristic.
In conferring with the treatment team, the nurse should make which of the following recommendations for a client who tells the nurse that everyday thoughts of suicide are present? A no-suicide contract Weekly outpatient therapy A second psychiatric opinion Intensive inpatient treatment
Intensive inpatient treatment; For a client thinking about suicide on a daily basis, inpatient care would be the best intervention. Although a no-suicide contract is an important strategy, this client needs additional care. The client needs a more intensive level of care than weekly outpatient therapy. Immediate intervention is paramount, not a second psychiatric opinion.
The client with antisocial personality disorder: Suffers from a great deal of anxiety Is generally unable to postpone gratification Rapidly learns by experience and punishment Has a great sense of responsibility toward others
Is generally unable to postpone gratification; Individuals with this disorder tend to be self-centered and impulsive. They lack judgment and self-control and do not profit from their mistakes.
_?_ is an herb that is believed to relieve anxiety and elevate mood. However, it may induce psychotic symptoms and cause liver damage.
Kava kava
A nurse notices other clients on the unit avoiding a client diagnosed with antisocial personality disorder. When discussing appropriate behavior in group therapy, which of the following comments is expected about this client by his peers? Lack of honesty Belief in superstitions Show of temper tantrums Constant need for attention
Lack of honesty; Clients with antisocial personality disorder tend to engage in acts of dishonesty, shown by lying.
Isocarboxazid, Phenelzine, Tranylcypromine and Selegiline are all _?_ that treat _?_
MAOI; depression/anxiety/phobias
Which of the following nursing interventions has priority for a client with borderline personality disorder? Maintain consistent and realistic limits Give instructions for meeting basic self-care needs Engage in daytime activities to stimulate wakefulness Have the client attend group therapy on a daily basis
Maintain consistent and realistic limits; Clients with borderline who are needy, dependent, and manipulative will benefit greatly from maintaining consistent and realistic limits. They don't tend to have difficulty meeting their self-care needs. They enjoy attending group therapy because they often attempt to use the opportunity to become the center of attention. They don't tend to have sleeping difficulties.
_?_ anxiety is associated with daily life and motivates learning.
Mild
Select the appropriate interventions for caring for the client in alcohol withdrawal. Monitor vital signs Provide stimulation in the environment Maintain NPO status Provide reality orientation as appropriate Address hallucinations therapeutically
Monitor vital signs Provide reality orientation as appropriate Address hallucinations therapeutically When the client is experiencing withdrawal of alcohol, the priority of care is to prevent the client from harming himself or others. The nurse would provide a low stimulating environment to maintain the client in as calm a state as possible. The nurse would monitor vital signs closely and report abnormal findings. The nurse would reorient the client to reality frequently and would address hallucinations therapeutically. Adequate nutritional and fluid intake needs to be maintained.
Buspirone, Zolpidem, Ramelteon are all _?_ that treat _?_
Non-benzodiazepines; anxiety
The nurse assesses a client with the admitting diagnosis of bipolar affective disorder, mania. The symptom presented by the client that requires the nurse's immediate intervention is the client's: Outlandish behaviors and inappropriate dress Grandiose delusions of being a royal descendent of King Arthur. Nonstop physical activity and poor nutritional intake Constant, incessant talking that includes sexual innuendoes and teasing the staff
Nonstop physical activity and poor nutritional intake; Mania is a mood characterized by excitement, euphoria, hyperactivity, excessive energy, decreased need for sleep, and impaired ability to concentrate or complete a single train of thought. Mania is a period when the mood is predominately elevated, expansive, or irritable. All options reflect a client's possible symptomatology. Option 3, however, clearly presents a problem that compromises one's physiological integrity and needs to be addressed immediately.
A nurse is assessing a client diagnosed with dependent personality disorder. Which of the following characteristics is a major component to this disorder? Abrasive to others Indifferent to others Manipulative of others Overreliance on others
Overreliance on others; Clients with dependent personality disorder are extremely overreliant on others; they aren't abrasive or assertive. They're clinging and demanding of others; they don't manipulate.
A nurse notices that a client is mistrustful and shows hostile behavior. Which of the following types of personality disorder is associated with these characteristics? Antisocial Avoidant Borderline Paranoid
Paranoid; Paranoid individuals have a need to constantly scan the environment for signs of betrayal, deception, and ridicule, appearing mistrustful and hostile. They expect to be tricked or deceived by others.
Chlorpromazine, Trifuoperazine, Thioidazine, Perphenazine, Triflupromazine, Fluphenazine, and Loxapine are _?_ that treat _?_
Phenothiazines' control psychotic behavior
In planning activities for the depressed client, especially during the early stages of hospitalization, which of the following plans is best? Provide an activity that is quiet and solitary to avoid increased fatigue, such as working on a puzzle or reading a book. Plan nothing until the client asks to participate in milieu. Offer the client a menu of daily activities and insist the client participate in all of them Provide a structured daily program of activities and encourage the client to participate
Provide a structured daily program of activities and encourage the client to participate; A depressed person experiences a depressed mood and is often withdrawn. The person also experiences difficulty concentrating, loss of interest or pleasure, low energy, fatigue, and feelings of worthlessness and poor self-esteem. The plan of care needs to provide successful experiences in a stimulating yet structured environment. Option 3 is a forceful and absolute approach.
Which of the following characteristics or situations is indicated when a client with borderline personality disorder has a crisis? Antisocial behavior Suspicious behavior Relationship problems Auditory hallucinations
Relationship problems; Relationship problems can precipitate a crisis because they bring up issues of abandonment. Clients with borderline personality disorder aren't usually suspicious; they're more likely to be depressed or highly anxious.
Duloxetine, Venlafaxine, Desvenlafaxine are all _?_ that treat _?_
SNRI's' depression/anxiety/panic/aggression
Fluoxetine, Paroxetine, Sertaline, Fluvoxamine, Citalopram, Escitalopram, Vilazodone, are all _?_ that treat _?_
SSRI's; depression/anxiety/panic/aggression, etc.
_?_ is an OTC treatment for depression. However, it may induce mania in bipolar clients and cause photosensitivity
St. John's Wort
Which of the following characteristics is expected for a client with paranoid personality disorder who receives bad news? The client is overly dramatic after hearing the facts The client focuses on self to not become over-anxious The client responds from a rational, objective point of view The client doesn't spend time thinking about the information.
The client responds from a rational, objective point of view; Clients with paranoid personality disorder are affectively restricted, appear unemotional, and appear rational and objective.
The depressed client verbalizes feelings of low self-esteem and self-worth typified by statements such as "I'm such a failure... I can't do anything right!" The best nursing response would be: To tell the client this is not true; that we all have a purpose in life. To remain with the client and sit in silence; this will encourage the client to verbalize feelings To reassure the client that you know how the client is feeling and that things will get better To identify recent behaviors or accomplishments that demonstrates skill ability
To identify recent behaviors or accomplishments that demonstrates skill ability; Feelings of low self-esteem and worthlessness are common symptoms of the depressed client. An effective plan of care to enhance the client's personal self-esteem is to provide experiences for the client that are challenging but will not be met with failure. Reminders of the client's past accomplishments or personal successes are ways to interrupt the client's negative self talk and distorted cognitive view of self. Silence may be interpreted as agreement. Options 1 and 3 give advice and devalue the client's feelings.
_?_ is a Complementary and Alternative Medicine (CAM) that may alleviate insomnia. However it may cause headaches and uneasiness.
Valerian
Do not allow clients diagnosed with _?_ plan or prepare food for unit-based activities. They gain pleasure from this and it reinforces their perception of self-control
anorexia
Shortness of breath, heart palpitations, dizziness, diaphoresis and frequent urination are all autonomic responses to _?_
anxiety
Dissociative amnesia, dissociate identity disorder (formerly called multiple personality disorder) and depersonalization disorder are all types of _?_
dissociative disorders
A _?_ is the advantage, other than reduced anxiety, that occurs as as a result of a client with somatic symptom disorder displaying the "sick role"
secondary gain