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Psychology/ Mental Health Nursing ATI

Terms in this set (640)

◯ Level of consciousness is described The Mental Status Examination (MSE)using the following terms, and observed behavior included in documentation.

■ Alert- The client is responsive and able to fully respond by opening her eyes and attending to a normal tone of voice and speech. She answers questions spontaneously and appropriately. ■ Lethargy - The client is able to open her eyes and respond but is drowsy and falls asleep readily.
■ Stupor - The client requires vigorous or painful stimuli (pinching a tendon or rubbing the sternum) to elicit a brief response. She may not be able to respond verbally.
■ Coma - No response can be achieved from repeated painful stimuli:
Abnormal posturing in the client who is comatose: 1) Decorticate rigidity - flexion and internal rotation of upper-extremity joints and legs 2) Decerebrate rigidity - neck and elbow extension, wrist and finger flexion

The Mental Status Examination (MSE)using the following terms, and observed behavior included in documentation are?

◯ Physical appearance ◯ Behavior ☐ Mood ☐ Affect ◯ Cognitive and intellectual abilities

◯ Physical appearance

Examination includes assessment of personal hygiene, grooming, and clothing choice. Expected findings with regard to this assessment are that the client is well-kept, clean, and dressed appropriately for the given environment.

Examination includes assessment of voluntary and involuntary body movements, and eye contact

☐ Mood
☐ Affect

- A client's mood provides information about the emotion that she is feeling.
- A client's affect is an objective expression of mood, such as a flat affect or a lack of facial expression.

◯ Cognitive and intellectual abilities

■ Assess the client's orientation to time, person, and place.
■ Assess the client's memory, both recent and remote.
■ Assess the client's level of knowledge.
■ Assess the client's ability to calculate.
■ Assess the client's ability to think abstractly.
■ Perform an objective assessment of the client's perception of his illness
■ Assess the client's judgment based on his answer to a hypothetical question.
■ Assess the client's rate and volume of speech, as well as the quality of his language.

■ Assess the client's memory, both recent and remote.
☐ Immediate -

☐ Recent -

☐ Remote -

-Ask the client to repeat a series of numbers or a list of objects.

- Ask the client to recall recent events, such as visitors from the current day, or the purpose of the current mental health appointment or admission.

- Ask the client to state a fact from his past that is verifiable, such as his birth date or his mother's maiden

■ Assess the client's level of knowledge.

For example, ask him what he knows about his current illness or hospitalization.

■ Assess the client's ability to calculate.

For example, can he count backward from 100 in serials of 7?

■ Assess the client's ability to think abstractly.

For example, can he interpret a cliché such as, "A bird in the hand is worth two in the bush"? The ability to interpret this demonstrates a higher-level thought process.

■ Assess the client's judgment based on his answer to a hypothetical question.

For example, how would he answer the question, "What would you do if there were a fire in your room?" His response to the question should be logical.

■ Assess the client's rate and volume of speech, as well as the quality of his language.

His speech should be articulate and his responses meaningful and appropriate.

● Standardized Screening Tools

◯ Mini-Mental State Examination
◯ Glasgow Coma Scale

◯ Mini-Mental State Examination

■ This examination is used to objectively assess a client's cognitive status by evaluating the following: ☐ Orientation to time and place ☐ Attention span and ability to calculate by counting backward by seven ☐ Registration and recalling of objects ☐ Language, including naming of objects, following of commands, and ability to write

◯ Glasgow Coma Scale

■ This examination is used to obtain a baseline assessment of a client's level of consciousness, and for ongoing assessment. Eye, verbal, and motor response is evaluated, and a number value based on that response is assigned. The highest value possible is 15, which indicates that the client is awake and responding appropriately. A score of 7 or less indicates that the client is in a coma.

Children and Adolescent Assessment :

◯ Assess this age group for mood; anxiety; developmental, behavioral, and eating disorders; and risk for self-injury or suicide.
◯ Use the standardized assessment tool: Home, Education/employment, peer group Activities, Drugs, Sexuality, and Suicide/depression (HEADSS) psychosocial assessment, to evaluate risk factors in the adolescent.

◯Mentally healthy children and adolescents should trust others, view the world as safe, accurately interpret their environments, master developmental tasks, and use appropriate coping skills. ◯ Children and adolescents experience some of the same mental health problems as adults. ◯ Mental health and developmental disorders are not always easily diagnosed, potentially resulting in delayed or inadequate treatment interventions. Factors contributing to this include the following.

■ Lack of the ability or necessary skills to describe what is happening
■ A wide variation of "normal" behavior, especially in different developmental stages.

● The Older Adult
◯ In addition to the aforementioned assessments, a comprehensive assessment of the older adult client includes the following:

■ Functional ability, such as the ability to get up out of a chair ■ Economic and social status ■ Environmental factors, such as stairways in the home, that may affect the client's well-being and lifestyle ■ Physical assessment ◯ Standardized assessment tools that are appropriate for the older adult population, include: ■ Geriatric Depression Scale (short form) ■ Michigan Alcoholism Screening Test - Geriatric Version ■ Mini-Mental Status Exam ■ Pain assessments including visual analogue scales, Wong-Baker FACES Pain Rating Scale, the McGill Pain Questionnaire (MPQ), and the Pain Assessment in Advanced Dementia (PAINAD) scale

◯ Conduct an assessment of all clients, including older adult clients in the following manner:

■ Use a private, quiet space with adequate lighting to accommodate for impaired vision and hearing. ■ Make an introduction, and determine the client's name preference. ■ Stand or sit at the client's level to conduct the interview, rather than standing over a client who is lying in bed or sitting in a chair. ■ Use touch to communicate caring as appropriate. However, respect the client's personal space if he does not wish to be touched■ Be sure to include questions relating to difficulty sleeping, incontinence, falls or other injuries, depression, dizziness, and loss of energy. ■ Include the family and significant others as appropriate. ■ Obtain a detailed medication history. ■ Following the interview, summarize and ask for feedback from the client.

Mental Health diagnoses

● The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), published by the American Psychiatric Association, is used as a diagnostic tool to identify mental health diagnoses. It is used by mental health professionals for clients who have mental health disorders.

● Nurses use the DSM-5 in the mental health setting to

identify diagnoses and diagnostic criteria to guide assessment; to identify nursing diagnoses; and to plan, implement, and evaluate care.

therapeutic strategies in the Mental Health setting: Mental Health Nursing Interventions include:

COUNSELING:
Using therapeutic communication skills
Assisting with problem solving
› Crisis intervention
› Stress management Milieu therapy
› Orienting the client to the physical setting
› Identifying rules and boundaries of the setting
› Ensuring a safe environment for the client
› Assisting the client to participate in appropriate activities
PROMOTION OF SELF-CARE:
› Offering assistance with self-care tasks
› Allowing time for the client to complete self-care tasks
› Setting incentives to promote client self-care
PSYCHOBIOLOGICAL NTERVENTIONS:
› Administering prescribed medications
› Providing teaching to the client/family about medications
› Monitoring for adverse effects and effectiveness of pharmacological therapy COGNITIVE AND BEHAVIORAL THERAPIES:
› Modeling
› Operant conditioning
› Systematic desensitization Health teaching
› Teaching social and coping skills Health promotion and health maintenance
› Assisting the client with cessation of smoking
› Monitoring other health conditions
CASE MANAGEMENT:
› Coordinating holistic care to include medical, mental health, and social

APPLICATION EXERCISES

1. A charge nurse is discussing mental status examinations with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching?A. "To assess cognitive ability, I should ask the client to count backward BY 7"
B. "To assess affect, I should observe the client's facial expression."
C. "To assess language ability, I should instruct the client to write a sentence." D. "To assess remote memory, I should have the client repeat a list of objects."

1. A. INCORRECT: This statement does not require further teaching. Counting backward by 7 is an appropriate technique to assess a client's cognitive ability.
B. INCORRECT: This statement does not require further teaching. Observing a client's facial expression is appropriate when assessing affect.
C. INCORRECT: This statement does not require further teaching. Writing a sentence is an indication of language ability.
D. CORRECT: This statement requires further teaching. Asking the client to repeat a list of objects is appropriate to assess immediate, rather than remote, memory.

2. A nurse is planning care for a client who has a mental health disorder. Which of the following is appropriate to include as a psychobiological intervention?
A. Assist the client with systematic desensitization therapy.
B. Teach the client appropriate coping mechanisms.
C. Assess the client for comorbid health conditions.
D. Monitor the client for adverse effects of medications.

2. A. INCORRECT: Assisting with systematic desensitization therapy is a cognitive and behavioral, rather than a psychobiological intervention.
B. INCORRECT: Teaching appropriate coping mechanisms is a counseling or health teaching, rather than a psychobiological intervention.
C. INCORRECT: Assessing for comorbid health conditions is health promotion and maintenance, rather than a psychobiological, intervention.
D. CORRECT: Monitoring for adverse effects of medications is an example of a psychobiological intervention.

3. A nurse in an outpatient mental health clinic is preparing to conduct an initial client interview. When conducting the interview, which of the following is the highest priority action?
A. Respect the client's need for personal space.
B. Identify the client's perception of her mental health status.
C. Include the client's family in the interview.
D. Teach the client about her current mental health disorder.

A. INCORRECT: It is appropriate to respect the client's need for personal space. However, it is not the highest priority action when taking the nursing process approach to client care.
B. CORRECT: Assessment is the priority action when taking the nursing process approach to client care. Identifying the client's perception of her mental health status provides important information about the client's psychosocial history.
C. INCORRECT: If the client wishes, it is appropriate to include the client's family in the interview. However, it is not the highest priority action when taking the nursing process approach to client care.
D. INCORRECT: It is appropriate to teach the client about her disorder. However, it is not the highest priority action when taking the nursing process approach to client care.

4. A nurse is told during change-of-shift report that a client is stuporous. When assessing the client, which of the following is an expected finding?
A. The client arouses briefly in response to a sternal rub.
B. The client has a Glasgow Coma Scale score less than 7.
C. The client exhibits decorticate rigidity.
D. The client is alert but disoriented to time and place.

4. A. CORRECT: A client who is stuporous requires vigorous or painful stimuli to elicit a response.
B. INCORRECT: A GCS score of less than 7 indicates a comatose, rather than stuporous, level of consciousness.
C. INCORRECT: Abnormal posturing is associated with a comatose, rather than stuporous, level of consciousness.
D. INCORRECT: A client who is stuporous is not alert.

5. A nurse is planning a peer group discussion about the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Which of the following is appropriate to include in the discussion? (Select all that apply.)
A. The DSM-5 is used to identify mental health disorders.
B. The DSM-5 establishes diagnostic criteria.
C. The DSM-5 indicates recommended pharmacological treatment.
D. The DSM-5 assists nurses in planning care.
E. The DSM-5 indicates expected assessment findings.

5. A. CORRECT: The DSM-5 is used as a diagnostic tool to identify mental health diagnoses.
B. CORRECT: The DSM-5 establishes diagnostic criteria for mental health disorders.
C. INCORRECT: The DSM-5 is a diagnostic tool for the diagnosis of mental health disorders but does not indicate pharmacological treatment.
D. CORRECT: Nurses use the DSM-5 to plan, implement, and evaluate care.
E. CORRECT: The DSM-5 identifies expected findings for mental health disorders.

6. A nurse is using therapeutic communication while counseling a client who has a mental health disorder. Use the ATI Active Learning Template: Basic Concept and the Fundamentals review module to complete this item to include the following sections:
A. Topic Descriptor: Define therapeutic communication.
B. Underlying Principles: Identify the characteristics of therapeutic communication.
C. Underlying Principles: Identify at least three essential components of therapeutic communication.
D. Nursing Interventions: Identify at least three specific therapeutic communication techniques.

6. Using ATI Active Learning Template: Basic Concept and the Fundamentals review module
A. Topic Descriptor: Therapeutic communication is the purposeful use of communication to build and maintain helping relationships with clients, families, and significant others.
B. Underlying Principles: Characteristics of therapeutic communication ● Client-centered ● Purposeful, planned, and goal-directed
C. Underlying Principles: Essential components of therapeutic communication ● Plan for and allow adequate time for communication. ● Demonstrate active listening. ● Demonstrate a caring attitude. ● Be honest. ● Establish trust. ● Demonstrate empathy. ● Have a nonjudgmental attitude.
D. Nursing Interventions ● Silence ● Open-ended questions ● Clarifying techniques, such as restating, reflecting, paraphrasing, and exploring ● Offering general leads or broad opening statements ● Showing acceptance and recognition ● Focusing ● Asking questions ● Giving information ● Presenting reality ● Summarizing ● Offering self

A nurse who works in the mental health setting is responsible for practicing ethically, competently, safely, and in a manner consistent with all local, state, and federal laws.

● Nurses must have an understanding of ethical principles and how they apply when providing care for clients in mental health settings. ● Nurses are responsible for understanding and protecting client rights.legal Rights of Clients in the Mental Health setting ● Clients who have been diagnosed and/or hospitalized with a mental health disorder are guaranteed the same civil rights as any other citizen.

Civil Rights include the following:

◯ The right to humane treatment and care, such as medical and dental care
◯ The right to vote
◯ The right to due process of law, including the right to press legal charges against another person
◯ Informed consent and the right to refuse treatment
◯ Confidentiality (The client's right to privacy is protected by the Health Insurance Portability and Accountability Act (HIPAA) of 2003.)
◯ A written plan of care/treatment that includes discharge follow-up, as well as participation in the care plan and review of that plan
◯ Communication with people outside the mental health facility, including family members, attorneys, and other health care professionals
◯ Provision of adequate interpretive services if needed
◯ Care provided with respect, dignity, and without discrimination
◯ Freedom from harm related to physical or pharmacologic restraint, seclusion, and any physical or mental abuse or neglect
◯ Provision of care with the least restrictive interventions necessary to meet the client's needs without allowing him to be a threat to himself or others ●

Some legal issues regarding health care may be decided in court using a specialized civil category called a tort.

A tort is a wrongful act or injury committed by an entity or person against another person or another person's property.
Torts can be used to decide liability issues, as well as intentional issues that may involve criminal penalties, such as abuse of a client.

Ethical issues are

philosophical ideas regarding right and wrong (morals and values)

Bioethical issues

● Nurses are frequently confronted with ethical dilemmas regarding client care Because ethics are philosophical and involve values and morals, there is frequently no clear-cut, simple resolution to an ethical dilemma.

● Ethical principles must be used to decide ethical issues. These include the following: Ethical principle definition examples

Beneficence › This relates to the quality of doing good and can be described as charity. (A nurse helps a newly admitted client who has psychosis feel safe in the environment of the mental health facility).
Autonomy › This refers to the client's right to make her own decisions. (But the client must accept the consequences of those decisions. The client must also respect the decisions of others and/or rather than giving advice to a client who has difficulty making decisions, a nurse helps the client explore all alternatives and arrive at a choice).
Justice › This is defined as fair and equal treatment for all. ( During a treatment team meeting, a nurse leads a discussion regarding whether or not two clients who broke the same facility rule were treated equally).
Fidelity (Non- Maleficence) › This relates to loyalty and faithfulness to the client and to one's duty. ( A client asks a nurse to be present when he talks to his mother for the first time in a year. The nurse remains with the client during this interaction).
Veracity › This refers to being honest when dealing with a client. (A client states, "you and that other staff member were talking about me, weren't you?" The nurse truthfully replies, "We were discussing ways to help you relate to the other clients in a more positive way.")

Health Insurance Portability and Accountability Act (HIPAA) of 2003.

● Information about the client, verbal and in writing, must be shared only with those who are responsible for implementing the client's treatment plan. ● Information may be shared with other persons not involved in the client treatment plan by client consent only.

Specific mental health issues include disclosing HIV status, the duty to warn and protect third parties, and the reporting of child and elder abuse. Resources for solving ethical Client issues

● Code of Ethics for Nurses, found at http://nursingworld.org ● Patient Care Partnership, found at www.aha.org ● The nurse practice act of a specific state ● Legal advice from attorneys ● Facility policies ● Other members of the health care team, including facility bioethics committee (if available) ● Members of the clergy and other spiritual or ethical counselors

Types of Commitment to a Mental Health Facility

● Voluntary commitment
● Involuntary (civil) commitment
● Emergency involuntary commitment
● Observational or temporary involuntary commitment
Long-term or formal involuntary commitment

● Voluntary commitment

The client or client's guardian chooses commitment to a mental health facility in order to obtain treatment. A voluntarily committed client has the right to apply for release at any time. This client is considered competent, and so has the right to refuse medication and treatment.

● Involuntary (civil) commitment

The client enters the mental health facility against her will for an indefinite period of time. The commitment is based on the client's need for psychiatric treatment, the risk of harm to self or others, or the inability to provide self-care. The need for commitment could be determined by a judge of the court or by another agency. The number of physicians, which is usually two, required to certify that the client's condition requires commitment varies from state to state.

●Emergency involuntary commitment

A type of involuntary commitment in which the client is hospitalized to prevent harm to self or others. Emergency commitment is usually temporary (may be up to 10 days). This type of commitment is usually imposed by primary care providers, mental health providers, or police officers.

● Observational or temporary involuntary commitment

A type of involuntary commitment in which the client is in need of observation, a diagnosis, and a treatment plan. The time for this type of commitment is controlled by state statute and varies greatly between states. This may be imposed by a family member, legal guardian, primary care provider, or a mental health provider.

●Long-term or formal involuntary commitment

A type of commitment that is similar to temporary commitment but must be imposed by the courts. Time of commitment varies, but is usually 60 to 180 days. Sometimes, there is no set release date.

Clients admitted under involuntary commitment are still considered competent and have the right to refuse treatment, unless they have gone through a legal competency hearing and have been judged incompetent.

The client who has been judged incompetent has a temporary or permanent guardian, usually a family member if possible, appointed by the court. The guardian can sign informed consent for the client. The guardian is expected to consider what the client would want if he were still competent.

Client Rights Regarding Seclusion and Restraint ● Nurses must know and follow federal/state/facility policies that govern the use of restraints. ● Use of seclusion rooms and/or restraints may be warranted and authorized for clients in some cases.

● In general, seclusion and/or restraint should be ordered for the shortest duration necessary, and only if less restrictive measures are not sufficient. They are for the physical protection of the client and/or the protection of other clients and staff. ● A client may voluntarily request temporary seclusion in cases in which the environment is disturbing or seems too stimulating. ● Restraints can be either physical or chemical, such as neuroleptic medication to calm the client. ● Seclusion and/or restraint must never be used for: ◯ Convenience of the staff ◯ Punishment of the client ◯ Clients who are extremely physically or mentally unstable ◯ Clients who cannot tolerate the decreased stimulation of a seclusion room ● When all other less restrictive means have been tried to prevent a client from harming self or others, the following must occur in order for seclusion or restraint to be used: ◯ The treatment must be ordered by the primary care provider in writing. ◯ The order must specify the duration of treatment. ◯ The provider must rewrite the order, specifying the type of restraint, every 24 hr or the frequency of time specified by facility policy. ◯ Nursing responsibilities must be identified in the protocol, including how often the client should be: ■ Assessed (including for safety and physical needs), and the client's behavior documented ■ Offered food and fluid ■ Toileted ■ Monitored for vital signs ◯ Complete documentation includes a description of the following: ■ Precipitating events and behavior of the client prior to seclusion or restraint ■ Alternative actions taken to avoid seclusion or restraint ■ The time treatment began ■ The client's current behavior, what foods or fluids were offered and taken, needs provided for, and vital signs ■ Medication administration ● An emergency situation must be present for the charge nurse to use seclusion or restraints without first obtaining a provider's written order. If this treatment is initiated, the nurse must obtain the written order within a specified period of time (usually 15 to 30 min).

Intentional Tort Example

false imprisonment › Confining a client to a specific area, such as a seclusion room, is false imprisonment if the reason for such confinement is for the convenience of the staff. assault › Making a threat to a client's person, such as approaching the client in a threatening manner with a syringe in hand, is considered assault. battery › Touching a client in a harmful or offensive way is considered battery. This would occur if the nurse threatening the client with a syringe actually grabbed the client and gave an injection.

sign of anorexia

signs of bulimia

tooth erasion
Russell's sign= callused knuckles from self induced vomitting

what lab value do you expect with alcohol cardiomyopathy

which PD- pt needs external input to make everyday decisions

a client that demonstrates a dedication to his job that excludes time for leisure activitites

adheres to a rigid set of rules

a client who has trouble starting new relationships unless he feels accepted

avoidant personality disorder

healthy adolescnet behavior

realistic self concept

healthy preschool behavior

displays an egocentric apprach to problem solving

toddler healthy behavior

requires literal explanations

who displays mistrust of others

what should you teach parents about autism spectrum disorder

does an autistic kid have fear of abandonment

nope- a kid with separation anxiety does

does an autistic kid have hostile behavior

no- a kid with oppositional defiant disorder does

what demonstrates active listening

attention to body language (identifying verbal and nonverbal communication)

a pt is getting a new Rx of haldol- what symptom should you tell them to report

shuffling gait
(dry mouth and blurred vision are common- also teach the client to stay out of sun)

the nurse is caring for a client who has anorexia- which criteria requires hospitalization

weight loss of over 30% in 6 months
hypothermia- less than 96.8
K less than 3
HR less than 40

how often should you offer the client food in seclusion

every hour
also document behavior every 15-30 min

a nurse is planning DC teaching to a family member of a pt newly diangosed with depression= what should the nurse teach about relapse

early identification of changes such as decreased social involvement is important

is this true= medication compliance will prevent further need for inpatient hospitalization

intoxication of _____
HR 104
BP 152/94
dilated pupils

intoxication of _____
constricted pupils
low BP

would a high BP and HR be common if intoxicated with inhalants

nope- these are depressants

SE of imipramine (4)

mild tachycardia (not brady)
urinary retention
increased appetite and wt gain
tinnitus

distressing dreams
difficulty concentrating
exaggerated startle response
(not delusions and compulsions)

purpose of attending support group

provide assurance that others have a similar problem

sign of delerium

sudden onset- rapid inappropriate speeach

do clients with delerium have slow speech

do clients with delerium have a flat affect

do they have normal moods?

no- mood swings

can ECT increase risk of parkisnons

how often does ECT happen

2-3 times a week for 6 to 12 treatments so 4-6 weeks

should you move a pt with depression to a private room

no- they are risk of self harm and isolated
better to move the bipolor patient

what lab should you do if patient is getting risperidone

glucose- can cause diabetes

defense mechanism of conversion

uncosciously converting anxiety into physical symptoms

transferring feeling about illness to another less threatening situations

client demonstrates opposite action of what she is really feelings

reaction formation

priority goal for a client with borderline personality disorder

client will refrain from self mutiliation

in the presence of low ____ levels renal excretion of lithium is reduced and client is at risk for toxicity

NA
so less than 135 is bad

what is tranylcypromine

is bologna okay to eat with MAOI

no- processed meet

can you have avocodos

can a client with MD make informed health desicions and give consent

who can not give consent

kids less than 18
intoxicated- blood alcohol level of .08
client with a dose of morphine

what should you do to help encourage a silent group member to participate in group

divide the group into pairs to discuss a topic, then summarize the discussion to the group

wht should you do if people try to monopolize the discussion

encourage the group that everyone should have a chance to participate
ask the group to share observations of other group members (dont do this for the silent patient)

what should you do if a patient exhibits demoralizing or negative behavior

focus on the group member and emphasize their helpfullness

___ increases the likelyhood of family violence

substance use
"my son has a few drinks each night to unwind" is a sign

clinical findings of mild anxeity

restless, irritable, nail biting, fidgeting

moderate anxiety

tensions, palpitation, increase heart rate, sweating

trouble sleeping
light headed
nausea
tremors
sense of impending doom

hyperactive
severe tremors
uncoordinated impulsive behavior

sign that valporic acid is working

less pressured speech (remember for bipolar)
less insmonia
less gradiose

a client was admitted as involuntary for substance abuse and is refusing the lorazepam- what do you do

dont give it- they still have the right to refuse treatment

when the client maintains eye contact and leans forward

shows he trusts the nurse

child with conduct disorder is behaving in a destructive manner- throwing things and kicking people- what is highest priority intervention
1. encourage kid to express feelings
2. promote attendance at an assertive training group
3. try relaxing breathing
4. use a therapeutic holding technique

4- hold- need to maintain safety

to establish a trusting nurse relationship th enurse should first

inform the client that her admission will be confidential (express confidentiality in the initial phase or relationships)

what should you do in working phase

introduce clients to others in the day room
assist the client to make behavioral changes
determine coping strategies the client has used in the past

what indicates a risk for complicated grief (cmplicated when it affects daily functioning)

when a client has trouble carrying on normal activities after a loss "I feel so empty without my wife, its hard to get up every morning"

dementia patient- useful to help orient them to reality

place a large calendar on the wall

the tx plan is for a pt with schizo to gain autonomy from his parents. Prior to DC the nurse should plan to

schedule a family conference
not stress to the client that he needs to be more independent

in group a bipolar patient begins bragging and dominating the situation- what should the nurse do

tell the client to calm down or he will dismiss him from the group

example of situational crisis

lost a grandparent in a motor vehicle crash
an unexpected even

adventitious crisis

town hit by tornado
external disaster

maturational crisis

son leaves for college or fear of upcoming retirement
natural life event

a nurse is developing a plan of care for a patient who exhibits anger, aggression, and violent behavior, what is the priority nursing intervention

create a large personal space- this helps provide safety
not use therapeutic communiciton (this only prevent escalation of agression and is a part of ongoing therapy)

to use peer support to maintain abstinence

client in group gets angry and yells "listening to you people is making me worse. how do you respond

you sound angry and frustrated. tell us more about how you are feeling

what drug should you give for alcohol withdwaral

chlordiazepocide (librium)- benzo

does the code of ethics esure the right to tx and individualized care

the duty to protect third parties requires a nurse to testify about a client

no- only if she is given info regarding potential harm

a nurse is caring for a client with a hx of agression, the client is playing cards and throws them at other patients- what should you do

ask the client how he is feeling (therapeutic cmcn)
not take the cards away (this will increase aggression)
explaining unit rules will not help either

SE of lithium that causes them to stop takin it

hand tremors- prevents them from doing ADLs

if you overhear another nurse talking bad about a client what should you do

do not confont that person directly
report it to charge nurse

anorexic client who needs to increase oral intake- what interventions should the nurse take

restrict caffiene - diuretic

should you increase or decrease fiber

increase to prevent constipation

should you offer rewards for the amt of weight gained

no- for the amt of calories taken in though can reward

should you increase daily intake to 2500 cals

initial intake should not go below 1200 but 2500 may be too overwhelming (want small frequent meals)

a nurse in a 24 hr mental health facility is planning DC for a client with a long history of alcohol use disorder- what postdischarge activity should the nurse plan to inlcude

attending a relapse prevention group several times each week
like AA 12 steps

is buprenorphine for alcohol

no- opioids- heroin

is methadone for alcohol

a client is experiencing alcohol withdrawal delerium- which roommate is most appropriate for this patient

one with depression- will allow client to rest
pt with acl withdrawal needs uninterrupted rest

why would a hypervigilant roommate not be good

this pt will not let the pt with alcohol withdrawal get the most rest he needs

example of the displacement defese mechanism

the client critizises the nurse each med administration time (really mad about meds but taking it out on nurse)

what defense mechanism is (the client reports a HA each day when group therpay is scheduled)

what defense mech (client always talks about healthy eating habbits)

reaction formation

defense mech (the pt complains about the taste of the food)

rationilization

good statement that shows that suicide risk has decreased

"it is easier to talk about my feelings now"

"im relieved now that my finanical affairs are in order"

more at risk when afairs are in order

"thank you for taking such good care of me"

more at risk- people show an appreciation for loved ones when contemplating suicide

who is at great risk for injury when doin gADLS

stage 6 alzheimers disease

maintenanc ephase of schizo

calm and able to preform self care

how can you help with OCD behaviors

assist the lcient to set limits of behaviors

should the client with OCD monitor the number of times he has obsessive thoughts

no- this can be ven more time consuming

how should you assess spirituality

discuss spiritual issues in a conversational manner not in a formal manner (this should be done by a pastor)

a client is taking an SSRI like paroxetine- what should you tell the client to report to you if they notive

FEVER- Serotnonin syndrome
not sex dysfunciton- this is normal

priority assessment finding for a client taking valporic acid

pt has not slept in 24 hours
not fine hand tremors (this is normal effect)

highest priority intervention for a pt with OCD

help client id sources of anxiety
not teach client focused relaxation techniques (good but not better that identifying sources of anxiety)
could also use + reinforcement for nonritual behavior but not best

admitting a pt experiencing alcohol withdrawal, is nauseas, shaking, and irritable- priority interventin

date and time of last drink (worst withdrawal 24-48 hrs after last drink)

when client is unable to openly acknowledge nd express grief

disenfranchised grief

exxaggerated grief

distorted grief

what do you expect with masochism

fantasized being humiliated and bound
recurrent, sex urges of being beaten, bound, and humiliated

exposing genitals to strangers

sex fantasies about non living objects

urges to touch and rub against non consenting individuals

exaple of enmeshed boundaries

children taking care of their younger siblings

what do you say if a pt becomes verbally abuseive

i am leaving now but returning in a few minutes to see if you are calmer

which label worries us with clozapine

intervention for patient with delerium

permit the client daily rituals to decrease anxiety
dont keep lighting dim (want to be able to see invironment)
dont give too man decisions because may get frustrated

teach about light therapy for SAD

wear sunglasses when go outside- bc light therapy can cause eye strain and sensitivity to light
(dont need to increase fluids bc will not cause dehydration)

should you get a no suicide contract from a pt who recently attempted suicide and is angry over being admitted

no- should wait til pt is no longer angry and you can develop rapport first

so what should you do with this patient (just attempted suicide and is angry about admission)

administer adntidepressant
1 to 1 observation

a client says about ECT "I will be able to stop taking my antidepressants after the tx"

nope= sorry need maintenacne

planning teaching about relapse prevention to a client who just began an outpatient substance use disorder tx program- what should you teach at the beginning

simple rules and objectives or program (pt still may have cog impairment RT detix)

teach about resperidone

1. may cause high blood sugar
2. mestrual irregularities may occur while on this med
3. you make experience dizziness while taking this med
(no increase in hair or excess sexual desire)

how do you use simple restitution as a behavior managment technique for a child with conduct disorder

make the child pick up books after he threw them all over the room

"Im not going to my family reunion because no one asked me to help plan it"

sign of uselessness is a sign of depression

refer families to a grief counselor following suicide

work with nurse to determine students at risk for suicide

primary (preventing suicide)

establish a telephone hotline for individuals experiencing a suicide crisis

review suicide precautions with nursing staff

secondary (involves treating a client during suicide crisis)

an impotant consideration in promoting client adherence to treatment regiment

providing care to a clients physical health needs

teach about buspar

dont take with grapefruit bc will intensify effects
takes 3-4 weeks to work
will not cause withdrawal

early stage of grief= denial

"i think my labs got mixed up with someone elses"

highest priority intervention for a kid with ADHD

remove unesarry stuff from childs surroundings cb greatest risk if injury to impulsive behabior
not use + reinforcement when the pt gets a task done

behavior that indicates that the client shoul dhave restraints removed

listens to nurses directions

sign of recovery for someone who was sexually assulted

client expresses interest in intimate relationships

signs of depression

flat affect
anhedonia
feeling hopeless

which lab value of a pt on lithium should make you hold med and call dr

BUN of 45- lithium is hard on kidneys
BUN normal is 6-20

primary prevention

promoting self esteem

administering meds to minimize long term efects of violence

what shoul dyou do if one pt is talking too much in group

ask the clients to discuss their feelings about the monopolizing behavior

important teaching need for a pt on olonazpine

do not drive after initial doses- will make you drowsy and dizzy

order the phases of the nurse client relationship

1. pre-orientation= identify safety risks
2. orientation phase= set parameters
3. workin gphase= promote problem solving skills
4. summarize goals

secondary dementia caused by thiamine def.

korsakoff's syndrome- be sure to help client with ambulation

first action when you witness one client with dementia slap another

call team members for help
do not try to go by self

priority action by nurse to client just admitted with bipolar

provide frequent high calorie snacks

voluntary admission- doing initial assessment and pt says "I've lost control of everything in my life"

are you having thoughts of killing yourself

How do you set limits for a patient

1. Tell the patient calmly and directly what he must do a particular situation, such as, "I need you to stop yelling and walk with me to the dayroom where we can talk"
2. Use physical activity, such as walking, to de-escalate anger and behaviors
3. Inform the patient of the consequences of his behavior, such as loss of privileges

What are olanzapine and ziprasidone used for

They are atypical antipsychotics used to control aggressive and impulsive behaviors. They are used more frequently than haloperidol because of the severity of side effects of haloperidol

When a patient is taking haloperidol what should you monitor the patient for

One. Parkinsonian and anti-cholinergic side effects

Two. Keep the patient hydrated, check vital signs and test for muscle rigidity due to risk of neuroleptic malignant syndrome

What are some signs that you might see in a patient in the preassaultive stage of violence

Defensive responses to questions

Agitation

Rapid breathing

Facial grimacing

What are two factors that increase the risk for abuse towards a child

One. The child is under three years of age

2. The perpetrator precedes the child is being different such as the child is disabled

Cycle of violence: what is the tension building phase

The abuser has minor episodes of anger and may be verbally abusive and responsible for some minor physical violence. The victim is tense during this stage and tends to except the blame for what is happening

Cycle of violence: acute battering phase

The tension becomes too much to bear and serious abuse takes place. The victim may try to cover up the injury or may get help

Cycle of violence: what is the honeymoon phase

The situation is defused for a while after the violent episode

What do you assess the baby for when there is suspected shaken baby syndrome

Respiratory distress

Retinal hemorrhage

Increase in head circumference

Bulging fontanelles

What is veracity

Refers to being honest when dealing with a patient

What is the usual time period For an emergency involuntary commitment

Long term or formal involuntary commitment is a type of commitment that is similar to temporary commitment but must be imposed by the courts. Time of commitment varies but is usually between blank and blank days however sometimes there's no release date

Patients admitted under involuntary commitment are still considered competent and have the right to refuse treatment unless

They have gone through a legal competency hearing and have been judged incompetent

What are the guidelines for restraints or seclusion to be used

What are three examples of intentional torts

False imprisonment, assault and battery

What is an example of assault and battery

Assault would be threatening a client with a syringe in hand and battery would be actually giving that injection against the patients will

What is the example of a maintenance role in group therapy

The harmonizer who attempts to prevent conflict in the group

What is an example of a task role in group therapy

Someone who takes notes or records the session

What is an example of an individual role in group therapy

Someone who prevents teamwork such as the dominator or the recognition seeker

What are three concepts related to family dysfunction

What is a democratic group leader

This style supports group interaction and decision-making to solve problems

What type of group leader involves the group process progresses without any attempt by the leader to control the direction

What type of group leader completely controls the direction and structure of the group without allowing group interaction or decision-making to solve problems

What is oppositional defiant disorder

It is characterized by recurrent pattern of antisocial behaviors (negativity, disobedience, hostility, limit testing, etc.)

What is disruptive mood dysregulation disorder

Patients who have this disorder exhibit recurrent temper outbursts that are severe and do not correlate with the situation

Patients that demonstrate a persistent pattern of behavior that violates the rights of others or rules and norms of society would be categorized as having

Conduct disorder

What are ways to promote positive behavior in a child that has oppositional defiant disorder

Develop a reward system for acceptable behavior

Encourage the child to participate in school sports

Be consistent when addressing unacceptable behavior

What are three expected findings of a patient who has depression

Substance use
Irritability
Weight gain

What are three expected findings of a 12-year-old who has conduct disorder

Bullying of others
Threats of suicide
Law breaking activities

What are medications that support detoxification from alcohol

What are three medications that can be given to help a patient abstain from using alcohol

Disulfiram, Naltrexone, and Acamprosate

What is a situational/external crisis

Often unanticipated loss or change

What is a maturational/internal crisis

Achieving new developmental stages, which requires learning additional coping mechanism

What is an adventitious crisis

The occurrence of natural disasters, crimes or national disasters

What are the different phases of a crisis

What are symptoms of mild anxiety

Restlessness, increased motivation, irritability

What are symptoms of moderate anxiety

Agitation, muscle tightness

What are symptoms of severe anxiety

Inability to function, ritualistic behavior, and unresponsive

What are symptoms of panic

Distorted perception, loss of rational thought, immobility

What is acute stress disorder

Exposure to a Traumatic event causes numbing, detachment and amnesia about the event for at least three days but for no more than one month following the event

What does modeling therapy do

Allows a client to see a demonstration of appropriate behavior in a stressful situation. The goal of therapy is that the client will imitate the behavior

What is flooding therapy

Involves exposing the patient to a great deal of an undesirable stimulus in the attempt to turn off the anxiety response

What is response prevention

Focuses on preventing the patient from performing a compulsive behavior with the intent that anxiety will diminish

What is thought stopping

Teaches a patient to say stop when negative thoughts or compulsive behaviors arise and substitute a positive thoughts

What are two defense mechanisms that are always healthy

Altruism, sublimation

What is altruism

Dealing with anxiety by reaching out to others (volunteering)

What is sublimation

Dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression (using exercise as a release of anxiety)

What is suppression

Voluntarily denying unpleasant thoughts and feelings (A person who has lost his job states he will worry about paying his bills next week)

What is repression

Putting unacceptable ideas, thoughts and emotions out of conscious awareness (A person who has a fear of dentists drill continually "forgets"his dental appointments)

What is displacement

Shifting and feelings related to an object, person, or situation to another less threatening object, person or situation (A person who is angry about losing his job destroys his child's favorite toy)

What is reaction formation

Overcompensating or demonstrating the opposite behavior of what is felt (A person who dislikes her sister's daughter offers to babysit so that her sister can go out of town)

What is undoing

Performing an act to make up for prior behavior

What is dissociation

Temporarily blocking memories and perceptions from consciousness

What is splitting

Demonstrating an inability to reconcile negative and positive attributes of self or others (A patient tells the nurse that she is the only one who cares about her, yet the following day, the same patient refuses to talk to the nurse)

What is a regression

Demonstrating behavior from an earlier developmental level. Often exhibited as childlike or immature behavior (A school age child begins wetting the bed and sucking his thumb after learning that his parents are separating)

Different levels of anxiety

If I were to have a patient that has mild to moderate levels of anxiety what can I do to help this patient

1. Use active listening to demonstrate willingness to help and use specific communication techniques (Open ended questions, exploring, etc)
2. Provide a calm presence
3. Evaluate past coping mechanisms
4. Explore alternatives to problem situations
5. Encourage participation in activities such as exercise

What can I do for a patient that is having trouble with severe to panic levels of anxiety

1. Provide an environment that meets the physical and safety needs of the patient. Remain with the patient
2. Provide a quiet environment
3. Use medications and restraint if necessary
4. Encourage gross motor activities, such as walking or other forms of exercise
5. Set limits by using firm, short and simple statements
6. Direct the patient to acknowledge reality and focus on what is present in the environment

A nurse should use open ended questions to obtain the following information for the nursing history of the patient who has a substance-abuse problem

1. Type of substance or addictive behavior
2. Pattern and frequency of substance use
3. Amount of substance used
4. Age at onset of substance use
5. Changes in occupational or school performance
6. Changes in use patterns
7. Periods of abstinence in history
8. Previous withdraw manifestations
9. Date of last use

Anabolic steroids can have negative long-term effects such as

Liver damage, hypertension and infertility

What are medications for alcohol withdrawal

Benzo's, Tegretol, clonidine, librium

What are medications for alcohol abstinence

Disulfiram, naltrexone, Acamprosate

What are medications for opioid withdrawal

Methadone, clonidine, buprenorphine

What are medications for nicotine withdrawal

Bupropion (zyban), and nicotine replacement products

What is intrapersonal communication

Communication that occurs within an individual

What is interpersonal Communication

Communication that occurs between two or more people

What is transpersonal communication

Communication that addresses an individuals spiritual needs and provides interventions to meet those needs

Content of the message chart

Effective skills and techniques of communication chart

A nurse is conducting therapy with several clients and their families. Effective communication with clients and families is based on

Attending to verbal and nonverbal behaviors

A therapeutic nurse - client relationship is what four things

1. Purposeful and goal directed
2. Well defined with clear boundaries
3. Structured to meet the clients needs
4. Characterized by an interpersonal process that is safe, confidential, reliable and consistent

Phases and tasks of a therapeutic relationship chart

What are four medications commonly used for bipolar disorder

Lithium, valproic acid, tegretol and lamictal

How does lithium work

Produces neurochemical changes in the brain, including serotonin receptor blockade

What are some adverse effects of lithium

G.I. upset, fine hand tremors, polyuria, mild thirst, weight gain, renal toxicity, goiter and hypothyroidism, Bradydysrhythmias, hypotension and electrolyte and imbalances

Adverse effects and nursing intervention chart for lithium

What are some signs of lithium toxicity

Diarrhea, vomiting, slurred speech, tremors, mental confusion, muscle weakness, blurred vision, severe hypotension and seizures

What are medications that interact with lithium

Diuretics, NSAIDs and anticholinergics

Plasma levels of lithium greater than blank can result in toxicity

What are some things to nurse should be aware of when administering lithium

Adverse effects of carbamazepine and Lamotrigine

Adverse effects of valproic acid

All of the medications including lithium are contraindicated in

Carbamazepine is contraindicated in patients who have

Bone marrow suppression or bleeding disorders

Valproic acid is contraindicated in patients who have

Liver disorders

Medication/food interactions of carbamazepine, valproic acid and lamictal

What three letters do tricyclic antidepressants end in

ine with the exception of doxepin

How did Tricyclic antidepressants work

Block reuptake of norepinephrine and serotonin in the synaptic space, thereby intensifying the effects of these neurotransmitters

Adverse effects chart of tricyclic antidepressants

Amitriptyline is a pregnancy risk category C medication. It is also contraindicated in patients who have

Seizure disorders

Medication/food interaction chart with tricyclic antidepressants

What are adverse effects of SSRIs

Sexual dysfunction, CNS stimulation, weight loss in the beginning and then weight gain, withdrawal syndrome, hyponatremia, rash, sleepiness, lightheadedness, G.I. bleeding and bruxism

What are food/medication interactions with SSRIs

If a patient is taking MAOIs what should they avoid in their diet

Tyramine (can cause hypertensive crisis)

What are some side effects of MAOIs

What are manifestations of a hypertensive crisis

Headache
Increased HR and BP
Nausea

Food/medication interactions with MAOIs

How does Wellbutrin work

By inhibiting dopamine uptake

What are side effects of Wellbutrin

What are some other atypical antidepressants other then Wellbutrin

What is a sign of toxicity with TCAs

Cardiac dysrhythmias

When should you administer TCAs

At bedtime due to sedation and risk for orthostatic hypotension

When should SSRIs be taken

In the morning to minimize sleep disturbances

Should SSRIs be taken with or without food

For older adults taking diuretics and SSRIs what should you obtain

Baseline sodium levels

What type of antidepressant is most commonly used for seasonal pattern depression

Wellbutrin (atypical antidepressant)

Wellbutrin should not be administered to patients with a high risk for seizures such as a patient who sustained

What are some MAOIs

Positive symptoms of schizophrenia are related to behavior, thought and speech such as

Agitation, delusions, hallucinations, tangential speech patterns

Negative symptoms of schizophrenia are things like

Social withdrawal, lack of emotion, lack of energy, flattened affect, decreased motivation and decreased pleasure in activities

First generation of antipsychotic medications are used mainly to control what kind of symptoms

Positive symptoms and a reserved for clients who use them successfully or who are violent or particularly aggressive

Second-generation (atypical) antipsychotic medications are choice for patients receiving

Initial treatment and for treating breakthrough episodes for patients on conventional medicine

What are advantages of atypical antipsychotic agents

First-generation antipsychotic medications generally end in zine. What are some first generation antipsychotic medications

How do first-generation antipsychotic medications work

Block dopamine, acetylcholine, histamine and norepinephrine in the brain and periphery

What are complications of first-generation antipsychotic medications

Agranulocytosis (look for fever or sore throat)
Anticholinergic effects
Orthostatic hypotension
Sedation
Seizures
Severe dysrhythmias
Neuroleptic malignant syndrome

What are the extrapyramidal symptoms of first-generation antipsychotic medications

Use of conventional antipsychotic medications is contraindicated in older adults who have

What are food/medication interactions with first-generation antipsychotic medications

What are manifestations of neuroleptic malignant syndrome

Sudden high fever
Blood pressure fluctuations
Dysrhythmias
Muscle rigidity
Changes in LOC
Coma

What are six anticholinergic symptoms

Dry mouth
Urinary retention
Blurred vision
Photophobia
Constipation
Tachycardia

What are nursing considerations for administering first-generation antipsychotic medications

Second generation antipsychotic medications typically end in done or pine. What are some examples of these medications

How do second-generation antipsychotic medications work

Mainly by blocking serotonin and to a lesser degree dopamine. They also block receptors for norepinephrine, histamine and acetylcholine

What are adverse effects of risperidone

What should patients avoid while on second-generation antipsychotic medication

Pregnancy risk category C and alcohol

Other atypical antipsychotic medications chart 1

Other atypical antipsychotic medications chart 2

What are some medication/food interactions associated with atypical antipsychotics

Risperidone is available as what kind of injection

IM every two weeks for patients who have difficulty adhering to a medication schedule. Therapeutic effect occurs 4 to 6 weeks after first injection

Patients taking asenapine should avoid eating or drinking blank minutes after each steps

What should you administer lurasidone with

Bipolar phase versus treatment chart

What is rapid cycling

Four or more episodes of acute mania within a year

What is bipolar one disorder

The patient has at least one episode of mania alternating with major depression

What is bipolar 2 disorder

The patient has one or more hypomanic episodes alternating with major depressive episodes

What is cyclothymia

The patient has at least two years of repeated hypomanic manifestations that do not meet the criteria for hypomanic episodes alternating with minor depressive episodes

What are four comorbidities that are associated with bipolar disorder

Substance use disorder
Anxiety disorder
ADHD
Eating disorders

Bipolar disorder clinical manifestations

What is schizophrenia

The patient has psychotic thinking or behavior present for at least six months

What is schizotypal personality disorder

The patient has impairments of personality functioning. However, impairment is not as severe as with schizophrenia

What is delusional disorder

The patient experiences delusional thinking for at least one month

What is schizophreniform disorder

The patient has manifestations similar to those of schizophrenia but the duration is from 1 to 6 months

What is schizoaffective disorder

The patient's disorder meets both the criteria for schizophrenia and depressive or bipolar disorder

Characteristic dimensions of psychotic disorders

Examples of delusions

What are four standardized screening tools for patients with psychotic disorders

1. GAF scale
2. Scale for assessment of negative symptoms
3. Brief psychiatric rating scale (BPRS)
4. Abnormal involuntary movement scale (AIMS)

What are some alterations in behavior

Teaching and types of medications for psychotic disorders

What are risk factors and protective factors of suicide

How do you assess the patient's suicide plan

1. Does the patient have a plan
2. How lethal is the plan
3. Can the patient described the plan exactly
4. Does the patient have access to the intended method
5. Has the patient's mood changed

Classifications of medications to prevent suicide

Free patient on suicide precautions how often should you document the patient's location, mood, quoted statements and behavior

Every 15 minutes or per the study protocol

Suicide precautions within the facility should be

What is primary prevention in reference to community care of patients with mental health illnesses

Promotes health and prevent mental health problems from occurring (such as teaching a class)

What is secondary prevention

Focuses on early detection of mental illness (such as screenings)

What is tertiary prevention

Focuses on rehabilitation and prevention of further problems impatiens previously diagnosed (A nurse leads a support group for patients who have completed a substance use disorder program)

Community based mental health programs

Different types of loss

Theories of grief

Patients that have depression along with anxiety disorders have a poor prognosis with a higher risk for

Suicide and disability

Depressive disorders recognized and defined by the DSM - 5

What is dysthymic disorder

A milder form of depression that usually has an early onset and last at least two years in length for adults and one year in length for children

Different phases of depression

When a person is experiencing depression it is better to make observations rather than asking blank

Direct questions. For example the nurse might say "I noticed that you attended the unit group meeting today" rather than asking "did you enjoy the group meeting"

Medication classifications/examples for depression

What is an herb that can be used for mild depression but should not be mixed with other antidepressants especially SSRIs or foods containing tyramine

St. John's wort

What is the first line treatment for seasonal affective disorder

Transcranial magnetic stimulation (TMS) uses electric magnetic stimulation of the brain. It is indicated for depressive disorders that are

Resistant to other forms of treatment

Vagus nerve stimulation (VNS) uses an implanted device that stimulates the Vagus nerve. It can be used for patients who have depression that is

Resistant to at least four antidepressant medications

Objective assessment findings for eating disorders

What are patients with bulimia at a higher risk for

What are three common electrolyte imbalances that are associated with bulimia

Hypokalemia

Hyponatremia

Hypochloremia

What is a type of medication that may be used for patients with eating disorders

What is refeeding syndrome

Potentially fatal complication that can occur when fluids, electrolytes and carbohydrates are introduced to a severely malnourished patient

Lanugo on the face is an expected finding of

Benzodiazepine sedative hypnotic anxiolytics

Complications of benzodiazepines

What is an atypical anxiolytic

What are four therapeutic uses of buspirone

Panic disorder
OCD
Social anxiety disorder
PTSD

What are complications of buspirone

CNS effects such as dizziness, nausea, headache, lightheadedness, agitation

If buspirone is mixed with MAOIs what might occur

Hypertensive crisis

What are food/medication interactions with buspirone

Grapefruit juice
Erythromycin
Ketoconazole
St. John's wort

How should buspirone be taken and when does it take effect

With food and 3 to 6 weeks to reach full therapeutic benefit

What are some SSRIs that are used for anxiety disorder

What is the first line treatment for trauma and stress related disorders such as PTSD

Therapeutic uses for SSRIs

Adverse side effects of SSRIs

Contraindications and food/medication interactions with SSRIs

When should you take paroxetine

In the morning with food

What are symptoms of serotonin syndrome

Agitation
Anxiety
Confusion
Disorientation
Difficulty concentrating
Diaphoresis
Hallucinations
Hyperreflexia
Fever
Incoordination
Tremors

redirecting of thoughts feelings and impulses from an object that gives rise to anxiety to a safer, more acceptable one.

the refusal to accept reality and to act as if a painful event, thought, or feeling did not exist

the reversion to an earlier stage of development in the face of unacceptable impulses

attribution of one's undesired impulses onto another.
this is the defense mechanism that is operative in delusional thinking

test taking strategy

ALWAYS PICK ANSWER THAT FOCUSES ON CLIENTS FEELINGS

what is usually a parent's first response to terminal illness in children

denial and disbelief

reminiscence therapy

sharing of memories of past experiences and events

countertransference

the phenomenon of the nurse unconsciously attributing feelings about another to the client

the client attributing feelings to the nurse

self-evaluation

nurse's self reflection of feelings and attitudes as they relate to a client or group of clients

when one idea or object comes to stand for another

unconsciously removing something from one's awareness

not progressing beyond a given level of development

core issues surrounding anorexia nervosa

alterations in self image and self-identity

relating to others as if they are all good or all bad

reaction formation

expressing an attitude that is the direct opposite of one's true feelings and wishes

overestimating admired qualities of another person

adopting characteristics of a loved one

conversion of unacceptable drives into socially sanctioned activities

when a client detaches emotional or behavioral processes from usual conscious behavior patterns or identity

What is the defense mechanism that is operative in delusional thinking?

the performance of a symbolic act that cancels out an unacceptable act or idea. it is an unconscious defense mechanism that negates a painful feeling or unacceptable act. rituals in OCD are form of undoing to reverse or negate unacceptable impulses

somatoform disorder in which the individual expresses his anxiety in the form of sensorimotor symptoms
example: eyewitness to violent crime complains of headaches when looking at mugshots

one side effect of tricyclic antidepressants that should be brought to provider attention promptly?

urinary retention (nurse should monitor I & O), nurse should also check for any abdominal distension

Drug of choice to counteract EPS

bentropine mesylate (Cogentin)

eps side effect muscle spasms

eps side effect restlessness

eps side effect hand tremor (symptoms similar to Parkinsons)

Tardive dyskinesia

irreversible EPS involuntary movement, lip smacking

ritualistic behavior

ocd disorder, behaviors alleviate anxiety

clang association

repeating words together that rhyme

pathologic, consistent repeating of anothers words by imitation. seen in autism and tourettes

pressured speech

forceful, rapid speech that exudes energy. seen in mania

mixture of phrases and words strung together without meaning

how does the nurse help a client obtain relief?

speak in calm manner and remain with client

most common SE of tricyclic antidepressants

filling in gaps in memory by fabrication

a misinterpretation of a real sensory experience. it is not associated with a memory problem

false, fixed belief. seen with schizophrenia and other psychotic disorders

fear of being in crowded places

Phobic disorder

anxiety is displaced from the original source to another object or situation, resulting in the phobia. displacement

rationalization

offering a socially acceptable or logical explanation for otherwise unacceptable impulses, feelings, behaviors

Chlorpromazine (Thorazine)

antipsychotic that will help calm a patient, it is not a sedative

somatization disorder

characterized by the unconscious repression of the anxiety feelings which are then manifested as physical illness

hypochondriasis

exaggerated preoccupation with physical health

benzos side effects

anticholinergic effects (dry mouth, blurred vision), dizziness, drowsiness, sedation. withdrawal (gradually decrease dose)

conversion disorder

client has physical symptoms suggesting a medical problem (such as blindness or paralysis) but no organic pathology can be diagnosed

characterized by recurrent panic attacks that are not associated with any specific stimulus or situation but seem to occur spontaneously

characterized by recurrent obsessional thoughts and/or ritualistic behavior

newer antipsychotic that targets both positive and negative manifestations of schizophrenia with fewer side effects. weight gain is LESS common

frequently prescribed, in low doses, for elderly clients to control agitation and promote sleep

antisocial personality disorder

client will exhibit a pattern of irresponsible behavior that lacks morals and ethics and brings the client into conflict with society. the most common response of clients with antisocial behavior is a lack of concern about their situations, as well as an absence of sensitivity to the feelings of persons whom they have harmed

post traumatic stress disorder

a disorder in which an overwhelming traumatic event is re-experienced, causing intense fear, helplessness, horror, and avoidance of stimuli associated with trauma

most common side effect of BuSpar

drowsiness, headaches, dry mouth, agitation

potent CNS depressants

antianxiety agents (Valium, Ativan, Librium)

long-acting CNS depressants that are used to manage symptoms of alcohol withdrawal

Wernicke Korsakoff syndrome

a brain disorder involving loss of specific brain functions due to vitamin B1 deficiency (Thiamine) usually occurring in clients with long-standing alcoholism who have poor nutrition. symptoms include short term memory loss, confusion, disorientation

bipolar/depression symptoms

mood swings, suicidal ideation

symptoms of borderline personality disorder, antisocial personality disorder

aggression and impulsiveness

test taking strategy

always address clients feelings first!

does not prevent progression of alzheimer's but prolongs time and functioning of the individual in the early stages of diseases. given in the pm

most common early manifestations in anorexia

amenorrhea, bradycardia, disturbed body image, and loss of 15% pre-illness body weight

desensitization

type of behavioral therapy where client is gradually exposed to the feared situations under controlled conditions and learns to overcome the anxious response

depakote (valproic acid) what instructions should nurse give patient?

anti seizure med that can cause severe hepatic dysfunction. nurse should monitor liver function and hematology levels

cocaine effect on pupils

early signs of heroin withdrawal

restlessness, irritability, piloerection (goose bumps), tremors, loss of appetite

what anti seizure drug can be safely administered with lithium

depakote (Valproic acid)

alzheimer's early manifestation

short term memory problems

most common side effects of benzos

sedation, dizziness, drowsiness

symptoms of delirium

acute confusion and inattention

symptoms of alzheimer's

disorientation, impaired judgement, personality change, apathy, anxiety, and memory loss

what makes a schizo pt at the greatest risk for self injury or injury to others?

command hallucinations

restlessness, irritability, nail biting, fidgeting

imipramine side effect

urinary retention, tinnitus, tachy, weight gain

risperidone. what lab test should the nurse monitor?

blood glucose, can cause DM to develop

two drugs that help with sleep disordrs

benzos and nonbenzos

benzos indications

relieve anxiety, insomnia, help with moderate sedation, relax muscle spasms, treat status epilepticus

Benzos end with

benzos drug action

enhance inhibitory effects of GABA, CNS depressant

benzos signs of toxicity

weakness, slurred speech, ataxia, resp depression

benzos pregnancy category

do not give benzos with..

other cns depressant, kava kava, valerian, cimetidine, smoking (decreases effects)

non benzo used to treat sleep disorder

zolpidem (ambien) admin on empty stomach for best effect. take before bedtime and no with other cps depressants

drowsiness, headaches, anxiety, dizziness, confusion, amnesia,

treatment for ADHD

amphetamines (adderall prototype)

amphetamine drug action

increase release of neurotransmitters NE and dopamine in brain and peripheral nervous system

insomnia, HTN, Tachy, Palpitations, schedule 2 drug, can suppress child growth (use "holidays" for children to allow growth)

amphetamines - what drugs can you take to increase or decrease effects?

sodium bicarb - increase effects
vit C/ammonium chloride - decrease effects

Methylphenidate

orthostatic Hypotension is a side effect of...

imipramine (tricyclic antidepressant). change positions slowly

Buproprion (Wellbutrin) SE

nausea, vomiting, headache, insomnia
atypical antidepressant

Valproic acid SE

amitriptyline teaching instruction

med for major depression
change positions slowly
do not stop taking abruptly
take at bedtime
increase fiber/fluid intake

hypothyroidism,

Xanax nurse teaching

avoid other CNS depressants like alcohol. Xanax is a benzo

HCP should monitor an older patient taking xanax for...

tolerance, anxiety, resp depression, sedation

Patient taking Lithium should avoid

chlorpromazine nurse teaching

can cause photosensitivity, wear sunscreen when exposed to sunlight

Buspirone nurse teaching

allow 2-4 weeks before expecting to feel better

Wellbutrin indications
CAUTION

depression, seasonal affective disorder, nicotine addiction
Inappropriate for patients with seizure disorders, CNS tumor, or history of head trauma

IV Chlorpromazine precautions

must monitor BP, at risk for hyptotension

lithium toxicity

tremors, confusion, nausea, muscle weakness

what can risperidone cause in the patient?

atypical antipsychotic, can cause new onset of DM

Valium - benzodiazepine

Xanax - benzodiazepine

chlordiazepoxide

Librium - benzodiazepine

Tranxene - benzodiazepine

Serax - benzodiazepine

Klonopin - benzodiazepine

Romazicon - benzodiazepine toxicity antidote

Cymbalta - SSNRI

BuSpar - atypical anxiolytic

Wellbutrin, Zyban - atypical antidepressant, decrease craving/withdrawal from nicotine

Trofranil - TCA

Surmontil - TCA

Lithane, Eskalith, Lithobid - Mood stabilizer

Tegretol - mood stabilizing anti-epileptic

Depakote - mood stabilizing anti-epileptic

Lamictal - mood stabilizing anti-epileptic

Thorazine - conventional antipsychotic

Haldol - conventional antipsychotic

Prolixin - conventional antipsychotic

Moban - conventional antipsychotic

Loxitane - conventional antipsychotic

Mellaril - conventional antipsychotic

Navane - conventional antipsychotic

Risperdal - atypical antipsychotic

Zyprexa - atypical antipsychotic

Seroquel - atypical antipsychotic

Abilify - atypical antipsychotic

Geodon - atypical antipsychotic

Clozaril - atypical antipsychotic

methylphenidate

Ritalin, Methylin - CNS stimulant

dexmethylphenidate

Focalin - CNS stimulant

dextroamphetamine

Dexedrine - CNS stimulant

amphetamine mixture

Adderal - CNS stimulant

Stratterra - SNRI (ADHD)

Antabuse - alcohol aversion therapy

ReVia - suppress alcohol craving, opioid withdrawal

Campral - abstinence maintenance, decrease anxiety

Dolophine - substitution

Catapres - reduction of diarrhea, n/v (withdrawal)

Subutex or suboxone - detox maintenance, craving reduction

Alprazolam (Xanax)

Benzodiazepine Sedative Hypnotic Anxiolytics

Benzodiazepine Sedative Hypnotic Anxiolytics

Lorazepam (ativan)

Benzodiazepine Sedative Hypnotic Anxiolytics

Chlordiazepoxide (Librium)

Benzodiazepine Sedative Hypnotic Anxiolytics

Clorazepate (Serax)

Benzodiazepine Sedative Hypnotic Anxiolytics

Clonazepam (Klonopin)

Benzodiazepine Sedative Hypnotic Anxiolytics

Buspirone (Buspar)

Atypical Anxiolytic/Nonbarbituate Anxiolytic

Sertraline (Zoloft)

Escitalopram (Lexapro)

Fluoxetine (Prozac)

Paroxetine (Paxil)

Fluvoxamine (Luvox)

Dloxetine (Cymbalta)

Amitriptyline (Elavil)`

Tricyclic Antidepressant

Imipramine (Tofrranil)

Tricyclic Antidepressant

Doxepine (Sinequan)

Tricyclic Antidepressant

Nortriptyline (Aventyl)

Tricyclic Antidepressant

Amoxapine (Asendin)

Tricyclic Antidepressant

Trimipramine (Surmontil)

Tricyclic Antidepressant

Isocarboxazid (Marplan)

Tranylcypromine (Parnate)

Selegiline (Emsam)

Bupropion (Wellbutrin)

Atypical Antidepressant

Venlafaxine (Effexor)

Atypical Antidepressant

Duloxetine (Cymbalta)

Atypical Antidepressant

Mirtazapine (Remeron)

Atypical Antidepressant

Reboxetine (Edronax)

Atypical Antidepressant

Trazadone (Desyrel)

Atypical Antidepressant

Mood Stabilizer

Chlorpromazine (Thorazine)

Conventional Antipsychotic

Haloperidol (Haldol)

Conventional Antipsychotic

Fluphenazine (Prolixin)

Conventional Antipsychotic

Molindone (Moban)

Conventional Antipsychotic

Loxapine (Loxitane)

Conventional Antipsychotic

Thioridazine (Mellaril)

Conventional Antipsychotic

Thiothixene (Navane)

Conventional Antipsychotic

Olanzapine (Zyprexa)

Atypical Antipsychotic

Quetiapine (Seroquel)

Atypical Antipsychotic

Aripiprazole (Abilify)

Atypical Antipsychotic

Ziprasidone (Geodon)

Atypical Antipsychotic

Clozapine (Clozaril)

Atypical Antipsychotic

A nurse is caring for a client who states, " I am so stressed at work because of my coworker. He expects me to finish all of his work!" When discussing appropriate communication, which of the following statements indicates client understanding?

D. When I have to pick up extra work I feel overwhelmed. I need to focus on my own responsibilites."

General Adaptation syndrome

body's response to an increased demand created by stressors

Stage 1 Alarm Reaction

body's initial adaptive response to a stressor. Also known as fight or flight. elevated BP, heart rate, increased epinephrine and norepinephrine

Stage 2 Resistance Stage

body function normalizes while responding to stressor

Stage 3 Exhaustion stage

body functions are no longer able to maintain an adaptive response to the stressor

A nurse is discussing acute vs. prolonged stress with a client. Which of the following should the nurse identify as an acute stress response?

A. Decreased appetite. B. Depressed immune system C. Increased BP E. Unhappiness

major depressive disorder that is not responsive to medications, actively suicidal or homicidal, psychotic manifestations

ECT and Bipolar

used with rapid cycling of four or more episodes of acute mania within a year

ECT Precautions

Recent MI, history of CVA, lesion on brain, increased ICP

any meds that decrease seizure threshold must be discontinues, MAOI's and lithium stopped 2 weeks before ECT

Atropine sulfate

given 30 minutes prior to decrease secretions and counteract vagal stimulation

ECT expected findings

Memory loss, nausea, tachycardia

Vagus nerve stimulation

Voice changes, dysphagia, neck pain

ECT description

induces seizure activity, which increases neurotransmitters in the brain

Preprocedure meds

stop MAOI's and lithium 2 weeks before, stop any meds that decrease seizure threshold several days, admin atropine or glycopyrrolate, establish IV access

Intraprocedure ECT

bite guard, intubation, cardiac monitoring, place cuff on leg to monitor distal seizure activity, monitor vitals and seizure activity

restless, increased motivation, irritability

agitation, muscle tightness

can't function, ritualistic behavior, unresponsive,

distorted perception, loss of rational thought, immobility

Generalized anxiety disorder

exhibits uncontrollable, excessive worry for more than 3 months

Obsessive compulsive disorder

intrusive thoughts of unrealistic obsessions and tries to control these thoughts with compulsive behaviors

Acute stress disorder

exposed to traumatic event causes numbing, detachment, and amnesia for atleast 3 days but for not more than 1 month

exposed to trauma that causes intense fear, horror, flashbacks, detachment, foreboding, restricted affect for longer than a month after even

more likely to occur in women

has equal prevalence in men and women

attacks usually last 15 to 30 minutes, palpitations, shortness of breath, choking or smothering, chest pain, nausea, depersonalization, fear of dying

fear of embarrassment, unable to perform in front of others, has a dread of social situations, believes others are judging him

client avoids being outside and has impaired ability to work

Specific phobias

client is afraid of snakes, spiders, strangers, flying, being in the dark,

Manifestations of GAD

restlessness, muscle tension, avoiding stressful events, increased time and effort required to prepare for stressful event, procrastination in decision making, seeks repeated reassurance

Onset of Acute stress disorder

begin immediately following the trauma persist for atleast 3 days lasting for a month

indications of increased arousal such as irritability, difficulty concentrating, sleep problems, avoiding anything associated with the trauma

Systematic desensitization

exposes clients to increasing levels of an anxiety producing stimulus

Major depressive disorder

depressed mood, sleeping problems, indecisiveness, decreased ability to concentrate, suicidal ideation, increase or decrease in motor activity, inability to feel pleasure, increase or decrease in weight over 1 month

MDD with psychotic features

presence of auditory hallucinations

Postpartum onset

begins within 4 weeks of childbirth, may include delusions which may put the baby at high risk of being hurt by the mom

Seasonal characteristics

occurs during winter and may be treated with light therapy

Dysthymic disorder

milder form of depression usually has early onset, such as in childhood or adolescent and last at least 2 years in length for adults and 1 year for kids. contains atleast 3 of the clinical findings of depression

Premenstrual dysphoric disorder

depressive disorder associated with the luteal phase, emotional lability, severe anger, irritability, lack of energy, overeating and hard time concentrating

severe clinical findings, treatment is 6 to 12 weeks long, hospitalized, assess suicide risk

Continuation of MDD

increased ability to function, treatment is 4 to 9 months, relapse prevention through education, medication therapy, and psychotherapy

remission of manifestations, this phase may last for years, prevent future depressive episodes

Depression and dementia

memory loss, confusion, behavior issues, social isolation, agitation

Make observations, don't ask questions

communication in depression

Antidepressant teaching

do not discontinue, several weeks to notice effects, avoid hazardous activities, notify provider if any thoughts of suicide, avoid alcohol

Tricyclic Antidepressants

change positions slowly, increase fluid intake to 2 to 3 L per day

MAOI's phenelzine

hypertensive crisis avoid tyramine

avocados, figs, smoked meats, liver, fish, most cheeses, some beers and wine, protein dietary supplements

Buproprion wellbutrin

observe for headache, dry mouth, GI, constipation, increased heart rate, monitor food intake for appetite suppression, avoid in clients with seizures

Venlafaxine, duloxetine

adverse effects include nausea, weight gain, and sexual dysfunction

adverse effects include photo sensitivity, skin rash, rapid heart rate, GI distress, ABD pain, fatal serotonin syndrome, avoid tyramine foods

Acute bipolar phase

Acute mania, hospitalization may be required, reduction of mania and safety, risk of harm to self determined

Continuation phase

remission of clinical manifestations, treatment generally 4 to 9 months, relapse prevention

Maintenance phase

treatment continues through lifetime, prevention is the goal

abnormally elevated mood, expansive or irritable, usuallly requires hospitalization

less severe than mania, last atleast 4 days

a manic episode and an episode of depression experienced at the same time

should not be used in clients with sleep apnea, respiratory depression, and glaucoma

Serotonin syndrome

hallucinations, diaphoresis, and agitation

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QUESTION

According to research on the bystander effect, which of the following people is most likely to stop and help a stranger? a. Jacob is on his way to a doctor's appointment with his young son. b Xavier lives in a crowded city. c. Malika is in a terrible mood, having just learned that she foiled her midterm exam. d. Ciera just saw a young girl offering her arm, to help an older woman cross the street. e. Mahmood is lost in thought as he walks to work, worrying about his upcoming presentation.

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