The nurse provides preoperative teaching to a client for a permanent colostomy. The client does not make eye contact with the nurse and interrupts the nurse constantly. Which is the most appropriate statement for the nurse to make to the client?
“It seems like it is hard for you to listen to this information”
An older adult. client diagnosed with terminal cancer has difficulty providing self care due to fatigue and dyspnea. When the nurse comes to assist the client, the client says, “What’s the use. I might as well just die.” Which interpretation of the client’s behavior is most justifiable?
The client is depressed and is physically and emotionally exhausted
The nurse provides care for a preschooler client in the pediatrics clinic who is involved in play therapy. The nurse understands which is a desired goals of play therapy?
To allow the client to express feeling and resolve conflict
The nurse provides care for a client diagnosed with paranoid schizophrenia. the client is alone in the hall, muttering and gesturing angrily. What is the most appropriate action for the nurse to take?
Calmly ask if the client is having a hallucination
The nurse admits a client who has a diagnosis of alcoholism and admits to drinking a pint of vodka a day. The client is scheduled for surgical repair of a fractured femur following a motor vehicle accident. the nurse includes which intervention in the client’c plan of care?
Ensure seizure precautions are in place
The nurse counsels a client with a diagnosis of depression. During the second therapy session, the client wits with arms folded, speaks very little, and looks at the floor. Which statement by the nurse is most appropriate?
“Where would you like to talk about during out time today?
The nurse provides care for a client who is disoriented to time and place. Which nursing action is most appropriate when caring for the client?
Allow the client to use own clothing and personal care items
The nurse provides care for clients in the pediatrics clinic. The nurse understands that according to Erikson’s stages of psychosocial development, developing a sense of personal control and a sense of independence occurs during which time period?
18months to 3 years
A client is brought to the emergency department with a diagnosis of myocardial and respiratory arrest. The client expires and the client’s spouse comes to the client’s bedside. Which is the best initial action for the nurse to take?
Allow the spouse to spend time with the client and provide privacy
A client talks with the nurse about feeling overwhelmed since the client was terminated from employment. The client states, “I feel like I can barely get out of bed in the morning.” The nurse recognizes the client is in which stage of crisis?
Disorganized
A client with a diagnosis of antisocial personality disorder is being treated in an inpatient psychiatric facility. The client has signed a behavior contract which states that if the client uses inappropriate language in the dining room, the client will be restricted to the hospital room to eat meals. The nurse observes the client berate and curse another cellist in the dining room. Which response by the nurse is best?
“You agreed to the behavior thats acceptable here. You will need to eat in your room today.”
The UAP states with a critical tone, “The client’s family worries about the cellist but the client does not seem to care how anybody feels.” Which response by the nurse to the UAP is best?
“Sometimes it’s difficult to see how anxious the cellists really are”
The nurse provides care for a client diagnosed with alcohol abuse who is receiving counseling. Which is a primary goal of counseling for the client?
Assist the client to identify factors that trigger alcohol use
The psychiatric nurse provides care for a client with a phobic disorder. The client states “I am so terrified of heights that the thought of going up my stairs makes me feel like I am going to hyperventilate. I know it sounds ridiculous.” Which response by the n nurse is best?
“You feel like your fear does not make sense, but it is very real to you”
The client is brought to the emergency department by family members after taking an overdose of diazepam. The family reports the client has become increasingly depressed and withdrawn during the previous month. Which question is most important for the nurse to ask during the initial interview?
“Exactly what, how much, and when did you take the medication”
The nurse leads a weekly support group for family caregivers of elderly parents. During the second group session, the nurse notes one caregiver in particular takes the lead in most of the discussions. The nurse recognizes the gourd is in which stage of group development?
Initial stage
The middle-aged client is admitted to the hospital with a diagnosis of terminal lung cancer. The client’s spouse reports to the nurse that the client did not want to come to the hospital and “refuses to slow down.” The nurse gives priority to which measure?
Encourages the client to participate in planning care
The nurse instruct a client about phenelzineu sulfate. Which client statement indicates to the nurse that further teaching is necessary?
- “I can’t wait to eat a hotdog without sauerkraut.”
- “I usually have a beer or two to relax in the evening”
The nurse provides care for a client who is diagnosed with bipolar disorder. During the period of elation, which behavior does the nurse expect to see in the client?
Frenzied and irritable
During a group therapy session, several clients verbally attack another client for behaving passively. Which is the most effective action for the nurse to take to move the group in a positive direction?
Call on another client in the group as a diversion
The nurse provides care for a client with anorexia nervosa. the nurse knows which statements are true regarding anorexia nervosa?
- Adolescent females are most affected
- Anorexia nervosa has the highest mortality rate of all mental disorders
- Clients diagnosed with anorexia nervosa often see themselves as overweight
The nurse in an inpatient psychiatric unit provides care for a client diagnosed with catatonic schizophrenia. The client stands in a corner of the day room in a stuper and exhibits mutism and a waxy flexibility of the arms. The nurse understands the treatment plan for the cent likely contains which interventions?
Benzodiazepines and electroconvulsive therapy
The nurse provides care for an older adult client with a diagnosis of UTI who has becomes disoriented and agitated. The nurse suspects the client has developed delirium due to which factors?
The symptoms developed rapidly
The psychiatric nurse provides care for a client with a diagnosis of paranoid schizophrenia in an inpatient facility. The client refuses to eat food served from the cafeteria and states, “I can’t eat this food. Someone is trying to poison me”. Which is the most appropriate action for the nurse to take?
Offer foods in closed container that the client can open
A client with a diagnosis with bipolar disorder is boisterous, quarrelsome, and unusually energetic. Which intervention I most important fro the nurse to include in the client’s plan of care?
Orient the client to reality
The nurse understands a client’s needs must be prioritized. According to Maslow’s hierarchy of needs, which needs are most basic to a clients health maintenance plan?
Physiological
The client is diagnosed with dementia. The nurse overhears the client tell a story about something the nurse knows is not true. Which action by the nurse is best?
Allow the client to continue the story
A client diagnosed with anxiety reports to the nurse, “I start my new job next week and I am so afraid my new employer will find out I don’t know enough to do my job! What if I get fired?” the nurse understands this concern is typical of which kind of anxiety disorder?
Signal anxiety disorder
The nurse provides care for an older adult client with dementia who has multiple care needs. The client’s adult child provides all care for the client and refuses to let anyone else help. The client’s child states, “I created a lot of problems for my parents when I was younger.” The nurse understands the clients adult child is using which defense mechanism?
Undoing
The nurse providing mechanism education to an older adult client with a diagnosis of heart failure who is preparing for discharge. The client repeatedly interrupts the nurse to talk about the client’s grandchildren. Which is the best response by the nurse?
“Thank you for telling me about your grandchildren. Lets talk about this medication you will be taking when you get home.”
The nurse provides care to a client who has been informed that results of the client’s liver biopsy are positive for cancer. The client is extremely upset and repeats, “What am I going to do?” Which response by the nurse is most appropriate?
Express concern then sit quietly with the client
The nurse provides care for a cellist diagnosed with depression who is scheduled for group therapy. The client asks the nurse, “What’s the point of having to talk to a group of people? Which is the most appropriate response?
Members learn new ways to cope with stress and develop insight into their behaviors
The nurse prepares to lead a group session for clients who has a dependence on alcohol. The nurse knows that a cellist with a diagnosis of alcoholism drinks because of which reason?
- the client diagnosed with alcoholism uses alcohol to escape from problems
- The client diagnosed with alcoholism uses alcohol to cover up depression or anxiety
A client is diagnosed with schizophrenia, paranoid type. The nurse evaluates the readiness of the client for participation in unit group activities. Which situation indicated readiness?
The client plays game with the nurse and one other client
A client is brought to the emergency department following a motor vehicle accident. The client is agitated and fights against the nurse while care is being provided. The client’s drug screen returns positive for cocaine. it is most important for the nurse to provide which intervention?
provide a calm atmosphere and monitor respiratory and cardiac status
An older adult cellist diagnosed with a terminal illness dies while the family is visiting. Which action is appropriate for the nurse to take?
Offer the family the opportunity to privately spend time with the clients body
A client with a diagnosis of depression is places on sertraline 50 mg daily. The nurse instructs the clients to observe for which adverse effect?
Dizziness, insomnia, decreased libido
The nurse provides care for a client diagnosed with OCD. The client must wash, rinse, and ry door handles before entering or leaving a room. Which action by the nurse is best?
Provide time for the cellist to complete the ritual before expecting the client to move from one are to another
The nurse provides care for a cellist diagnosed with chronic depression who attempts suicide. The client’s spouse says, “Was there any way to know my spouse was contemplating suicide/” The nurse knows which behavior is associated with impending suicide?
Finalizing business or personal affairs
The nurse provides care for a client diagnosed with depression. The nurse becomes most concerned after observing which behavior?
The client repeatedly burns self with a cigarette
A client with a diagnosis of type 2 diabetes mellitus has very poor control of blood glucose and develops gangrenous ulcers on the feet. After being told the feet will need to be amputated, the clients states, “I am sure if I start taking my medications like I am supposed to my feet will heal, ” The nurse identifies this as an examples of which behavior?
Denial
The nurse provides care for a client diagnosed with schizophrenia who is having an auditory hallucination of dogs barking. The client asks, “Do you hear those dogs barking? make them stop!” Which is the best response by the nurse?
“I do not hear the dogs barking. It sounds like that barking upsets you”
The nurse assess a client with bipolar disorder, acute manic phase. Which symptom does the nurse expect to observe in the client ?
Hyperactivity
The nurse provides care for a client diagnosed with a terminal illness who has been elected to have hospice care. Which information is most important for the nurse to obtain?
The client’s preferences for care
The nurse provides care for a client diagnosed with alcoholism. Which statement by the client indicates to the nurse that the client is in denial of the problem?
‘When I can learn to stop after one drink, I will have problems beat”
A client diagnosed with paranoid schizophrenia tells the nurse, “Do you see those cameras in the ceiling? I am being watched all the time.” The nurse see that the client pointing to the sprinkler system in the ceiling. Which response by the nurse is most appropriate?
“Those are sprinklers in the ceiling that come on if there is a fire. How does it feel to think you are being watched?”
A client diagnosed with post-traumatic stress disorder was held hostage in a back robbery about 6 weeks ago. The cellists states that one of the employees was shot and still remains in a coma in a nearby hospital. The client reports daily flashbacks on the incident. Which action by the nurse is best when the client experiences flashbacks?
Stay with client, offer assurance of safety, and tell the cellist these feelings are normal
The nurse provides care for ace lint diagnosed with depression and finds the client crying alone in the room. The client has refused to eat breakfast or have morning care. Which intervention by the nurse is best?
Offer to sit with the cellist and help the cellist get dressed
The nurse provides care for an adolescent client with suspected gonorrhea. The client reports being sexually abused by a parent for the past 5 years. Which action does the nurse perform first?
Contact the child protection agency and report the client’s statement immediately
The nurse provides care for a client diagnosed with dependent personally disorder. Which client statement best indicates improvement in the client’s condition?
“I am planning which herbs I want to plant in my garden”
The nurse plans care for a client with a history of substance abuse who will be participating in group therapy. The nurse understands which is the primary benefit of group therapy fo this client?
Groups reduce isolation in structured, controlled environments
The homes care nurse makes a visit to a client diagnosed with claustrophobia. Which statement by the nurse is most appropriate when talking the client about the phobia?
“I am going to show you some breathing exercising to help you relax when you begin to feel anxious”
The nurse provides care clients on the detoxification unit. One client says to the nurse, “I know you despise me.” Which defense mechanism does the nurse interpret that the cellist is using?
Projection
The nurse provides care for a cellist who paces and shouts obscenities at other clients and staff. Which is activity is best for the nurse to suggest for this client?
Accompanying the nurse to a quite area
A client witnessed the suicide of the client’s spouse, and developed total blindness with no identifiable cause after the incident. The client’s response to becoming blind is calm and unconcerned. The nurse determines which is the appropriate interpretation of the client’s behaviors?
This is a characteristic response to the physical ailment in a conversion reaction
A client reports an inability to walk since the sudden death of the client’s father 2 months ago. A thorough physical examination shows no physiological basis for the client’s physical condition. Which intervention is priority?
Provide for basic physiological needs that the client cannot meet
The nurse provides cares for client scheduled for surgery. The client reports drinking socially but had a beer to relax the previous evening. During The readmission interview, the client states. “I rally don’t sleep well and wake up at 4 in the morning. Right now, I am anxious and shaking inside.” The client’s vital signs are T 100 F (38C), P 120 beats/minute, R 24/minute, and BP 130/90 mmHg. Which conclusion does the nurse make?
The clients has early signs of alcohol withdrawal
The nurse provides care for a client with diagnosis of Alzhemier disease who has an indwelling urinary catheter. While the nurse is checking the catheter, the client begins to kick and hit at the nurse. The client screams, “What are you doing? Leave me alone!” The nurse takes which action first?
Calmly identifies self as the nurse and reorients the client
A client uses taken heroin several times day. Which signs and symptoms does the nurse expect to observe?
- Constricted pupils, depressed respirations
- Drowsiness or sedation
- Slurred or incoherent speech
The nurse observes which characteristic in a client diagnosed with a personality disorder?
Needs are met primarily through manipulation
True or False: Bipolar disorder is a mood disorder
True
What is the acronym for the S/S of Bipolar Disorder?
DIGFAST
(distractible, insomnia, grandiosity, flight of ideas, agitation, speech, thoughtlessness/impulsivity)
What medications are used to treat bipolar disorder?
lithium and anticonvulsants
Which type of bipolar disorder has a combination of depressive and manic episodes?
Type 1
Which type of bipolar disorder has major depressive episodes and hypomania
Type 2
What do barbiturates do?
depress the CNS
What are barbiturates used for?
sedation, anesthesia, seizure disorders
True or false: Barbiturates are highly addictive
True
What are the two Barbiturates?
Pentobarbital, Phenobarbital
What is needed with long term use of Barbiturates?
folic acid
Benzos can relieve what?
acute abuse symptoms
What age is autism usually seen by?
3
What are the S/S of autism?
social/communicational impairment, language delay/absence, repetitive actions (swaying, rocking head banging), lack of responsiveness to others, rigid with routine
Nursing Role with Autistic patients?
impulse control, psychomotor skill development, provide emotional support, follow routine, avoid injuries, decrease tantrums
Medications used with Autistic patients?
methylphenidate, SSRI, lithium, risperdal, aripiprazole
What is behavior modification?
giving positive reinforcements
What is cognitive therapy?
correcting distorted beliefs
What is a behavioral contract?
agreement of patients, if they follow can be given a reward
What is ECT?
induced seizures to treat depression
What is milieu therapy?
structure environment to provide therapeutic growth
What is reminiscence therapy?
remembering past memories
What is required with restraints and why are they used?
must document, prevents injury to client or others
What is seclusion?
a type of restraint, alone in room
What is the highest priority with mental health?
suicide precautions
What are clues that a patient is going to harm themselves?
change in behavior, increased engird after anti-depressants, finalizing business, giving away possessions, withdrawing, having means/plan, writing a note, indirect/direct statements
What are risk factors for suicide?
genetics, male, comorbid disorders, access, previous attempts,
What is mental health?
the appropriate/adaptive response to stressors (noted by thoughts, mood, behaviors, feelings)
What are risks for mental health disorders?
poor, unemployed, less educated
What are the numbers to represent involuntary admission?
302/303
What is the number to present voluntary admission?
201
What does lithium do?
controls mania in bipolar disorder
How frequently must lithium be monitored
2-3 times/week
What is the maintenance level for lithium?
1-1.5
What should be done while on lithium?
Increase fluid intake, watch for dehydration
What is cocaine?
a stimulant
What are S/S of cocaine use?
dilated pupils, tacky,brady, altered BP, sweating, chills, decreased weight, euphoria, violence, pacing
What is heroin?
a derivative of opioids
What are S/S of heroin use?
impaired social interaction, use of others to fund habit, euphoria, mood changes, clouding, decreased pain, constricted pupils, constipation, decreased BP, impotence
What are S/S of a heroin OD?
respiratory distress, seizures, sweating, stupor, septum perforating
What is LSD?
a hallucinogen, AKA acid
What does LSD do?
alters perception/cognition rapidly
What are S/S of marijuana use?
red eyes, tacha, dry mouth, increased appetite
What is PCP?
a hallucinogen, AKA angel dust
What are S/S of PCP use?
hallucinations, violence, increased BP, tacky, blank stare nystagmus, seizure, respiratory failure
What is a chronic, progressive, and degenerative disease seen over those >65years old?
Alzheimer’s Disease
What are S/S of Alzheimer’s Disease?
personality changes, restless, pacing, memory loss, impaired language/recognition
What is the nurses role with a patient with Alzheimer’s Disease?
reorient, speak slow, provide clocks/calendars, promote sleep/hygiene/safety
What medications are given for a patient with Alzheimer’s Disease?
anti cholinesterase (tacrine, donzepil, riuagtigmine), Haldol/Risperdal
What is the continuous pattern of disregard/violation of rights of others and formerly referred to as “Psychopath?”
Antisocial Personality Disorder
What are S/S of antisocial PD?
lying, cheating, stealing, risk behavior, appear charming/intellectual, aggressive, lack of guilt, feel entitled
What are nursing interventions for someone with antisocial PD?
set limits, confront behaviors consistently, enforce consequences, group therapy
What is the difficulty of maintaining stable interpersonal relationships and self image?
Borderline PD
What are S/S of borderline PD?
impulsive, outburst, irritable, sad, fearful, fluctuating attitude, boredom, lack of identity/life path
What is the continuous need to be taken care of?
Dependent PD
What are S/S of dependent PD?
submissive, clingy, need help with decisions, problem doing work by themselves, anxious when alone, fear to be alone
What are nursing interventions for someone with dependent PD?
increase responsibility, teach assertiveness, increase self-esteem
What is a pattern of grandiosity and need for admiration?
Narcissistic PD
What are the S/S of Narcissistic PD?
lack of empathy, arrogant, lack of consideration of others, need “special” treatment, exaggerate talents
What are nursing interventions for someone who has Narcissistic PD?
focus on here and now, set limits, show that mistakes are okay
What is the demonstration of mistrust/suspicion?
Paranoid PD
What are S/S of paranoid PD?
feel they are being “singled out,” show sensitivity to hyperactivity of environment
NO Hallucinations
What is purposeful behavior to better ones own needs without regards for others?
manipulative behavior
True or False: with personality disorders, you treat the disease itself
False (you treat comorbid conditions and have milieu therapy)
What are S/S of elder abuse?
battering, bruises, under/over medication, poor nutrition/dehydration
What should be done when meeting with a client you suspect is being abused?
Tell them and their partner that this is part of the assessment that must be done alone in private and that everyone has to do it, not just them
What is domestic abuse?
manipulation of ones partner using emotional, psychical, sexual abuse, financial exploitation, intimidation, social isolation, neglect, or humiliation
What is the disorder that is common in females age 8-18 and has the highest mortality rate among mental disorders?
Anorexia Nervosa
What are the S/S of anorexia nervosa?
decrease weight, distorted body image, fear of obesity, anemia, amenorrhea, imbalances, depression
What are treatments for someone with anorexia nervosa?
therapy, behavior modification, physical assessment
What is the disorder that includes binge eating followed by purging (vomiting, laxatives/diuretics)?
Bulimia Nervosa
What are S/S of bulimia nervosa?
depression, anxiety, impulsivity, dental caries/erosion, GI dilation, scars on fingers, electrolyte imbalances
What should you monitor on a patient with bulimia nervosa?
sodium, potassium, heart
What medications are used in the treatment of eating disorders?
TCAs, SSRIs
What is AIDs Dementia Complex?
dementia from HIB infection (also know as HIV encephalopathy – causes neurological problems)
What medications are used in the treatment of AIDS?
antiretrovirals and anti-depressants
What is disorder characterized by repetitive/uncontrollable thoughts (obsessions) and actions (compulsions)?
OCD
What should be done for patients with OCD?
accept ritualistic behavior, let them complete tasks at first then start to help them diminish, provide structure
What is the sudden onset of extreme fear and feels like an MI?
panic attack
What is the persistent irrational fear that the person knows does not make sense?
Phobia
What is the treatment for phobias?
relaxation techniques, systematic desensitization, avoid stressor
What is signal anxiety?
involves known stressor that may be anticipatory
What is it called when someone has severe anxiety when in social/performance situations and fears they will be negatively seen?
Social Anxiety Disorder
What medications are used for the treatment of anxiety disorders?
benzos, MAOIs, SSRIs, TCAs
How long after the cessation of drinking does withdraw symptoms occur?
4-6 hours
With serious withdraw symptoms, what should be monitored?
signs of delirium tremens (occurs 48-72 hours after withdraw)
What medications can be used for delirium tremens?
phenobarbital and chlordiazepoxide
What is the choleric illness resulting in psychotic behavior?
Schizophrenia
What are the 4 phases of schizophrenia?
premorbid, prodromal, active, residual
What are positive S/S of schizophrenia?
delusions, hallucinations
What are negative S/S of schizophrenia?
apathy, anhedonia, no motivation, flat/blunted affect
What are nursing interventions for someone with schizophrenia?
do not challenge delusions or hallucinations, do not argue, decrease stimuli, remove tension, validate reality, keep calm
What is Schizoaffective?
similar to schizophrenia, but with more mood symptoms (inappropriate, labile, flat)
What does catatonic behavior look like?
decrease in movement, may not move for hours (keep client safe and assess skin)
What do TCAs do?
increase serotonin and norepinephrine
What S/S do TCAs cause?
anticholinergic and antihistamine
What is important with TCAs?
increased risk for suicide 10-14 days after starting therapy
What are examples of TCAs?
amitriptyline, clomipramine, imipramine, doxepin
What do MAOIs do?
increase dopamine, epinephrine, serotonin
What is important education with MAOIs?
avoid foods high in tyramine
(alcohol, aged cheese, processed meat, chocolate, avocados, caffeines, yogurt, peanuts, soy sauce, sauerkraut)
What are S/S of child abuse?
inconsistency of type/location of injury, chip/spiral fractures, abdominal injury, disturbance in parental relationship, sexual abuse, increased anxiety/fear, regression, neglect, weight changes
What is important to remember with child abuse patients?
be nonjudgmental, encourage expression, monitor safety, reassure child, protective placement
What is bupropion, trazadone, SSRIs and SNRIs?
reuptake inhibitors
What are side effects of bupropion?
seizure, dry mouth, insomnia, SIADH
What are teaching points with bupropion?
Take in morning to prevent insomnia, do not stop abruptly, suck on candies to prevent dry mouth
What are side effects of trazadone?
can cause sedation, priapism, decrease BP, avoid alcohol
What are side effects of SSRIs?
serotonin syndrome (restless, agitated, tachy, BP)
What are examples of SSRIs?
excitalopram, citalopram, fluoxetine, sertraline, paroxetine
What are side effects of SNRIs?
serotonin syndrome, NMS, long QT, syncope
What are examples of SNRIs?
venlafaxine, atomoxetine
How often must restraints be removed?
every 2 hours
What are side effects of typicals?
anticholinergic, decrease BP, EPS, dysphagia, cogwheel, tar dive dyskinesia, NMS
What are examples of typicals?
chlorpromazine, fluphenazine, loxapine, perphenazine, thiothixene, haldol
What is cytochrome P450?
don’t take typicals with grapefruit juice
What are side effects of atypicals?
agranulocytosis, decreased seizure threshold, hyperglycemia, hyper salivation, metabolic syndrome
What are examples of atypicals?
clozapine, olanzapine, quetiapine, risperidone, siprazidone, aripiprazole
Off label use for anti-psychotics?
Alzheimer’s disease
What are C/I of anti-psychotics?
alcohol, barbiturates, TCAs, antacids, lithium, etc.
What is the normal response to hurt, fear, or frustration?
anger
What are S/S of anger?
fight/flight, increased BP, tacky, suppressed anger can cause chest pain, headache, depression
What should a nurse watch for in aggressive clients?
S/S of agitation (increased activity, pacing)
What should a nurse do when interacting with an aggressive/agitated client?
speak calm/firm, use a normal tone, use non-threatening body language, do not disagree/threaten, decrease stimuli
What is indirect/non-assertive expression of aggression towards others?
Passive-aggressive behavior
What is dissociative amnesia?
temporary/sudden inability to recall information
What is Dissociative Identity Disorder?
2 or more identities/personality states that take control
What interventions should the nurse use for a patient with Dissociative Identity Disorder?
Encourage expression of feelings/stress, maintain impartiality with all identities, provide a safe/quiet/supportive/structured environment
What disorder results from exposure to a traumatic even? Normal response to an abnormal stressor?
PTSD
What disorder is associated with the frequent seeking/obtaining of treatment for many physical symptoms?
Somatization Disorder
What are the S/S of Somatization Disorder?
physical symptoms not explained by a medical disease
What are nursing interventions for someone with Somatization Disorder?
identify stressors, use problem-solving techniques, do not reinforce habits, avoid secondary gains, treat what needs treating
What is conversion disorder?
physical symptoms (like paralysis, blindness, and deafness) that have no organic basis
What is the key sign with conversion disorder?
La Belle Indifference
What is the abnormal feeling of sadness, low self-esteem, helplessness, hopelessness, and/or doom?
depression
What physical S/S can depression cause?
Gi distress, increase/decrease appetite, sleep problems, anhedonia, anergia, fatigue
What is the acronym for S/S of depression?
SIGECAPS
What is the name for the disorder characterized by chronic, depressed mood for more than 50% of the time over the last 2 years (adult) or 1 year (child)?
Persistent Depressive Disorder (Dysthymic Disorder)
What is the childhood disorder that is characterized by repetitive patterns of violating other’s basic rights?
Conduct Disorder
What are S/S of conduct disorder?
aggression towards people/animals, poverty destruction, theft (can coexist with anxiety, ADHA, and learning disorders)
What can conduct disorder change into when entering adulthood?
can change into antisocial PD
What is Oppositional Defiant Disorder?
starts in childhood, “other people are the problem, not me”
What are nursing interventions for a patient with Conduct Disorder?
set limits, alternate methods of expressing anger, focus of the here and now
What are S/S of oppositional defiant disorder?
hostile, disobedient, negative, stubborn, fight, school underachievement, tests other’s limits
What are nursing interventions for a patient with oppositional defiant disorder?
reward good behaviors, accept person NOT behavior, immediate feedback, structure, set limits, promote trust
What is the feeling of dread/terror in absence of threat or disproportionate to the threat?
anxiety
What are S/S of anxiety?
pounding heart, cold/clammy skin, poor concentration
Four stages of anxiety?
mild (can learn, healthy), moderate (selective attention), severe (one detail), panic (can’t focus at all)
What is accountability?
being responsible for one’s actions
What is advocacy?
representing client, doing what’s best for them
What is beneficence?
promote good, do no harm
What is the duty to warn?
therapists duty to warn target, target’s family, and police about direct threats
What are examples of Benzos?
diazepam, lorazepam, alprazolam, clonazepam)
What is an example of a non-benzo?
buspirone
What are benzos and non-benzos used for?
anxiety
What are side effects of benzos?
withdraw, mental slowing, depression, unsteady gait, slurred speech, delirium
What are nursing interventions for a patient who was sexually assaulted?
attend to physical needs, be nonjudgmental, do NOT promise secrecy, no leading statements, reassure client that they did the right thing, protective placement, ER protocol
What is the benefit of setting limits?
providing boundaries prevents/responds to unclear or inappropriate behaviors and maximizes therapeutic effect
What is the disorder characterized by inappropriate degree of inattention, impulsiveness, or hyperactivity?
ADHD
What are S/S of ADHD?
short attention, inattention to details, lack of follow-through, forgetfulness, fidgeting, excessive talking, constantly active, interrupts conversations
What medications are used to treat ADHD?
dextroamphetamine, methylphenidate, pemoline, donidine, guanfacine, atomoxetine
What is Erikson’s first stage of development?
trust v mistrust (infant – 18 mo)
What is Erikson’s second stage of development?
autonomy v shame (18mo-3yr)
What is Erikson’s third stage of development?
initiative v guilt (3-5yr)
What is Erikson’s fourth stage of development?
industry v inferiority (5-13yr)
What is Erikson’s fifth stage of development?
identity vs. role confusion (13-21yr)
What is Erikson’s sixth stage of development?
intimacy v isolation (21-39yr)
What is Erikson’s seventh stage of development?
generatively v stagnation (40-65yr)
What is Erikson’s eighth stage of development?
ego integrity v despair (>65yr)
One morning at a group therapy session, several clients begin to pick on another client for their passive behavior. The nurse leader says that the client is a very sensitive person who has problems, and they should stop picking on the client. Which is the most likely effect of this statement?
The client’s isolation from the group will increase.
The client comes to the local clinica reporting dizziness and a racing heart. The client’s physical exam is normal. The client reports that the client’s company recently lost a large sum of money, and the client feels responsible. The clinet tells the nurse that the client is extremely anxious. Which respinse by the nurse is best?
“When did you first notice that you were feeling anxious?”
The client is brought to the emergency room by family members after taking an overdose of diazepam.
“Exactly what, how much, and when did you take the medication?”
The nurse finds the client diagnosed with schizophrenia standing in the dayroom of the psychiatric inpatient unit completely undressed.
Lead the client back to the room and help the client get dressed.
The client is admitted to the hospital with a diagnosis of paranoid schizophrenia. The spouse states the client has not slept in three nights. Which nursing goal takse priority?
Promote trust
The nurse cares for clients in the pediatric clinic. The parent of the younger child asks the nurse why the child is invovled in play therapy. Which statemtent by the nurse is best?
Young children have difficulty verbalizing emotions.
The mother of two delivers a newborn with cleft palate.
Sit in that rocking chair so that you can hold your baby.
The nurse cares for clients on the medical/surgical unit. The nurse admits a client for possible appendicitis. During the admission interview the client states, “Most days I drink about one pint of vodka.”
48-72 hours
Nursing care for the client diagnoses with substance abuse is based on which principle?
the client has limited ability to tolerate anxiety
The nurse orients the client to the unit. The nurse observes the client is pacing, talking rapidly, and has elevated respirations. Which action by the nurse is best?
keep the explanation simple
The nurse overhears the client diagnosed with dementia tell a story about something that the nurse knows is not true. Which action by the nurse is best?
allow the client to continue the story
The nurse knows that, according to Maslow’s hierarchy of needs, which needs are most basic to any client’s health maintenace plan?
safety and security
The client diagnosed with a phobic disorder joins a group meeting with a psychiatric nurse-leader. During the first meeting, the client states, “I know my feeling of being terrified of closed spaces is dumb. It doesn’t make any sense. I just can’t seem to do anything about it. Right now I get nervous and scared just thinking about it.” WHhich response by the nurse is correct?
knowing that your fears don’t make sense doesn’t always help you feel better
During the second session of individual therapy, a client sits quietly with arms folded and eyes cast down. Which approach by the nurse is best?
use broad openings and leads to encourage discussion
During the period of elation for the client diagnosed with bipolar disorder, which approach should the nurse plan to use frequently?
attempt to distract and redirect the client
One of the NAP on the unit is critical of a client admitted after an accidental overdose. The NAP says “The clients family worries about the client but the client doesn’t seem to care how anybody feels.”
sometimes it’s difficult to see how anxious the client’s really are
The nurse instructs the client about phenelzine sulfate
I can’t wait to eat a hot dog with sauerkraut
The middle-aged client admitted to the hospital with a diagnosis of terminal lung cancer. The client’s spouse reports to the nurse that the client did not want to come to the hospital
encourage the client to participate in planning care
The client with a diagnosis of antisocial personality disorder fails to arrive on time for a scheduled appointment with the nurse.
are you having some difficulty with the time you agreed to?
The nurse anticipates which group symptoms when caring for a client with disorientation due to dementia.
judgement alterations, memory defecit, irritibilty
In the day unit of an outpatient mental health program, the nurse finds the client diagnosed with undifferentiated schizophrenia dancing alone next to the radio.
point out that the client that has stopped dancing and seems upset
The client is brought to the hospital by the spouse. The client is boisterous, quarrelsome, and unusually energetic.
the client is easily stimulated by the surroundings
The parent of two school-age children tells the nurse that the spouse has recently become unemployed and the client reports feeling depressed. The nurse understands which statement to be true?
the spouse’s unemployment is a significant potential stressor
The nurse volunteers in a homeless shelter. The nurse notices that another volunteer develops an overly close relationship with the older women in the shelter.
undoing
The nurse cares for clients in the pediatric clinic. The nurse understands according to Erikson’s stages of psychosocial development, trust and significant early attachments develop during which year of life?
birth – 18 months
The nurse cares for clients in the mental health clinic. A client diagnosed with obsessive-compulsive disorder tells the nurse that they are afraid of contracting AIDS.
a symbolic expression of conflict and guilt
The nurse cares for clients in an inpatient psychiatric unit and leads an adolescent social/support group to discuss the difficulties of growing up in today’s society.
the group members’ sense of belonging
The nurse knows which statement is true regarding anorexia nervosa?
5-20% of clients diagnosed with anorexia nervosa die
The client diagnosed with inoperable cancer has difficulty walking after chemotherapy. When the nurse comes to assist the client to the bathroom, the client says, “Leave me alone. You treat me like a child.”
the client wants to maintain independence
The client responds incorrectly when a nurse asks the date and day of the week. The nurse best describes the client’s mental state by which term?
disoreinted