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Questions and Answers
Which nursing interventions are particularly well chosen for addressing a population at high risk for developing schizophrenia? (Select all that apply)
Which nursing interventions are particularly well chosen for addressing a population at high risk for developing schizophrenia? (Select all that apply)
- Forming a support group for females aged 25 to 35 who are diagnosed with substance use disorders.
- Teaching ways to cope and build resiliency. (correct)
- Educating about the risk of psychosis with marijuana use. (correct)
- Screening 15- to 25-year-olds for early symptoms. (correct)
What should the nurse frequently assess for in a patient taking a second-generation antipsychotic?
What should the nurse frequently assess for in a patient taking a second-generation antipsychotic?
Metabolic syndrome
What information should the nurse provide to a patient prescribed a first-generation antipsychotic medication regarding signs and symptoms?
What information should the nurse provide to a patient prescribed a first-generation antipsychotic medication regarding signs and symptoms?
She should experience a reduction in hallucinations.
Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia?
Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia?
Which therapeutic communication statement might a psychiatric-mental health registered nurse use when a patient's nursing diagnosis is hallucinations? (Select all that apply)
Which therapeutic communication statement might a psychiatric-mental health registered nurse use when a patient's nursing diagnosis is hallucinations? (Select all that apply)
When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that:
When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that:
What is the priority nursing intervention for a patient on haloperidol who is diaphoretic and unresponsive?
What is the priority nursing intervention for a patient on haloperidol who is diaphoretic and unresponsive?
What can self-medicating with excessive alcohol provide for a patient with schizophrenia?
What can self-medicating with excessive alcohol provide for a patient with schizophrenia?
Which helpful nursing response could be used when a patient reports that 'the voices are really bad today'?
Which helpful nursing response could be used when a patient reports that 'the voices are really bad today'?
What question should the nurse ask initially when attempting to help a patient de-escalate moderate anxiety?
What question should the nurse ask initially when attempting to help a patient de-escalate moderate anxiety?
Which patients are at increased risk for the development of anxiety and will require frequent assessment? (Select all that apply)
Which patients are at increased risk for the development of anxiety and will require frequent assessment? (Select all that apply)
Which medication should the nurse prepare to educate patients on when prescribed an SSRI for panic attacks?
Which medication should the nurse prepare to educate patients on when prescribed an SSRI for panic attacks?
Which statements show effective use of relaxation therapy for anxiety management? (Select all that apply)
Which statements show effective use of relaxation therapy for anxiety management? (Select all that apply)
Which lifestyle practice should the nurse discourage for a patient recently prescribed an antianxiety medication?
Which lifestyle practice should the nurse discourage for a patient recently prescribed an antianxiety medication?
What is a likely contributor to the extremely shy behavior of the 8-year-old girl in the context of parental involvement?
What is a likely contributor to the extremely shy behavior of the 8-year-old girl in the context of parental involvement?
What effective teaching about mild anxiety can be recognized when a patient states?
What effective teaching about mild anxiety can be recognized when a patient states?
What drug facilitates the action of gamma-aminobutyric acid (GABA)?
What drug facilitates the action of gamma-aminobutyric acid (GABA)?
Which test should be ordered for a patient using kava, which inhibits P450?
Which test should be ordered for a patient using kava, which inhibits P450?
What is the medic most likely counting while talking with Luc and his family?
What is the medic most likely counting while talking with Luc and his family?
What assessment findings would indicate lithium toxicity in Tatiana?
What assessment findings would indicate lithium toxicity in Tatiana?
What dosage adjustment is the psychiatric nurse practitioner likely to prescribe for a patient ready to enter maintenance therapy?
What dosage adjustment is the psychiatric nurse practitioner likely to prescribe for a patient ready to enter maintenance therapy?
What treatment may the psychiatric nurse practitioner recommend for Ted to reduce his mania?
What treatment may the psychiatric nurse practitioner recommend for Ted to reduce his mania?
What does the nurse recognize about Laura, who drinks alcohol instead of taking prescribed medications?
What does the nurse recognize about Laura, who drinks alcohol instead of taking prescribed medications?
What should the nurse instruct the patient with a lithium level of 1.7 mEq/L to do?
What should the nurse instruct the patient with a lithium level of 1.7 mEq/L to do?
What nursing diagnosis is most appropriate for a patient expressing hopelessness?
What nursing diagnosis is most appropriate for a patient expressing hopelessness?
Why is psychotherapy important for a patient preparing for discharge?
Why is psychotherapy important for a patient preparing for discharge?
What treatment option acts quickly for a patient with severe paranoia and refuses to eat?
What treatment option acts quickly for a patient with severe paranoia and refuses to eat?
What medication presents a high risk for a patient with bipolar disorder and epilepsy?
What medication presents a high risk for a patient with bipolar disorder and epilepsy?
What medication should be anticipated for a manic patient who is highly agitated?
What medication should be anticipated for a manic patient who is highly agitated?
What education should be provided to a patient prescribed valproate and risperidone?
What education should be provided to a patient prescribed valproate and risperidone?
Which is a characteristic of bipolar II?
Which is a characteristic of bipolar II?
The onset of bipolar II typically occurs around what age?
The onset of bipolar II typically occurs around what age?
Which statement regarding generalized anxiety disorder (GAD) is true?
Which statement regarding generalized anxiety disorder (GAD) is true?
Which treatment would the team most likely choose to understand specific anxiety-provoking situations?
Which treatment would the team most likely choose to understand specific anxiety-provoking situations?
Which intervention should the team initiate first for a patient with GAD?
Which intervention should the team initiate first for a patient with GAD?
What statement made by a patient indicates an understanding of cognitive behavioral therapy?
What statement made by a patient indicates an understanding of cognitive behavioral therapy?
What education does the nurse anticipate providing for a patient taking a benzodiazepine with an added antidepressant?
What education does the nurse anticipate providing for a patient taking a benzodiazepine with an added antidepressant?
Why does the psychiatric nurse practitioner suggest discontinuing the patient's herbal remedy?
Why does the psychiatric nurse practitioner suggest discontinuing the patient's herbal remedy?
What assessment finding requires immediate action by the nurse for a patient with severe anxiety?
What assessment finding requires immediate action by the nurse for a patient with severe anxiety?
What intervention is appropriate for a patient exhibiting moderate levels of anxiety?
What intervention is appropriate for a patient exhibiting moderate levels of anxiety?
What nursing intervention will help a patient with panic levels of anxiety to participate in psychotherapy?
What nursing intervention will help a patient with panic levels of anxiety to participate in psychotherapy?
Which question should the nurse ask to determine if a patient with GAD is exercising regularly?
Which question should the nurse ask to determine if a patient with GAD is exercising regularly?
Which statement regarding obsession is true?
Which statement regarding obsession is true?
Which intervention is most appropriate for a patient diagnosed with OCD who hasn't responded positively to treatment?
Which intervention is most appropriate for a patient diagnosed with OCD who hasn't responded positively to treatment?
What medication would be beneficial for a patient recently diagnosed with OCD experiencing increased anxiety?
What medication would be beneficial for a patient recently diagnosed with OCD experiencing increased anxiety?
What is the definition of Isocarboxazid?
What is the definition of Isocarboxazid?
Which possible side effect is most important for the interdisciplinary health care team to monitor in a patient prescribed an SSRI?
Which possible side effect is most important for the interdisciplinary health care team to monitor in a patient prescribed an SSRI?
Which nursing diagnosis is most appropriate for a patient with OCD who has decreased anxiety but continues organizing belongings?
Which nursing diagnosis is most appropriate for a patient with OCD who has decreased anxiety but continues organizing belongings?
Which patient outcome best demonstrates adherence to the treatment plan for a patient with OCD?
Which patient outcome best demonstrates adherence to the treatment plan for a patient with OCD?
Which statement made by the nurse to a patient diagnosed with OCD is most therapeutic?
Which statement made by the nurse to a patient diagnosed with OCD is most therapeutic?
Which statement made by the patient indicates an understanding of OCD and its treatment?
Which statement made by the patient indicates an understanding of OCD and its treatment?
Which statement regarding panic disorder is true?
Which statement regarding panic disorder is true?
Which type of therapy is recommended to help a patient understand the connection between feelings of impending doom and difficulty breathing?
Which type of therapy is recommended to help a patient understand the connection between feelings of impending doom and difficulty breathing?
Which medication is recommended for a patient with several complex medical conditions experiencing anxiety from public speaking?
Which medication is recommended for a patient with several complex medical conditions experiencing anxiety from public speaking?
Which statement by the patient indicates understanding of systematic desensitization therapy?
Which statement by the patient indicates understanding of systematic desensitization therapy?
Which assessment tool is most effective for evaluating a patient with panic disorder?
Which assessment tool is most effective for evaluating a patient with panic disorder?
Which nursing diagnosis requires immediate intervention in a patient with an anxiety disorder?
Which nursing diagnosis requires immediate intervention in a patient with an anxiety disorder?
Which nursing intervention is most effective for a patient with social phobia?
Which nursing intervention is most effective for a patient with social phobia?
Which observations indicate medication effectiveness for a patient's positive symptoms of schizophrenia?
Which observations indicate medication effectiveness for a patient's positive symptoms of schizophrenia?
Which medication is suitable for a non-compliant patient with schizophrenia?
Which medication is suitable for a non-compliant patient with schizophrenia?
Which patient teaching scenario is most effective for a patient diagnosed with a thought disorder?
Which patient teaching scenario is most effective for a patient diagnosed with a thought disorder?
Which statement made by the nurse is most therapeutic for a patient with schizophrenia claiming royal lineage?
Which statement made by the nurse is most therapeutic for a patient with schizophrenia claiming royal lineage?
Which observations suggest a therapeutic relationship has been established between the nurse and patient?
Which observations suggest a therapeutic relationship has been established between the nurse and patient?
Which communication principle should the nurse use when caring for an agitated patient with schizophrenia?
Which communication principle should the nurse use when caring for an agitated patient with schizophrenia?
Which nursing intervention is most appropriate for a withdrawn patient?
Which nursing intervention is most appropriate for a withdrawn patient?
Which best describes milieu therapy?
Which best describes milieu therapy?
Which patient has the lowest risk for developing schizophrenia?
Which patient has the lowest risk for developing schizophrenia?
What should the nurse's best response be to a mother asking about the cause of her daughter's schizophrenia?
What should the nurse's best response be to a mother asking about the cause of her daughter's schizophrenia?
Which developmental theorist explains a patient's disorder as an outcome of failing to learn trust in infancy?
Which developmental theorist explains a patient's disorder as an outcome of failing to learn trust in infancy?
Which assessment finding would confirm suspicion of delusions in a patient diagnosed with schizophrenia?
Which assessment finding would confirm suspicion of delusions in a patient diagnosed with schizophrenia?
Which part of this patient's history supports a diagnosis of schizophrenia?
Which part of this patient's history supports a diagnosis of schizophrenia?
How should the nurse respond to a mother asking why her daughter doesn't talk or engage?
How should the nurse respond to a mother asking why her daughter doesn't talk or engage?
Which information should the nurse provide regarding neurotransmitters related to schizophrenia?
Which information should the nurse provide regarding neurotransmitters related to schizophrenia?
How should the nurse document a patient's auditory hallucination where they hear someone say, 'You are horrible'?
How should the nurse document a patient's auditory hallucination where they hear someone say, 'You are horrible'?
How should the nurse explain a patient appearing distractible and in their own world?
How should the nurse explain a patient appearing distractible and in their own world?
How should the nurse document a patient's affect changing from happy to sad to angry?
How should the nurse document a patient's affect changing from happy to sad to angry?
Which behavior observed by the nurse would support a conclusion of delusions?
Which behavior observed by the nurse would support a conclusion of delusions?
Which question would be most appropriate for assessing subjective symptoms of schizophrenia?
Which question would be most appropriate for assessing subjective symptoms of schizophrenia?
Which characteristics suggest a man is experiencing the prodromal phase of schizophrenia?
Which characteristics suggest a man is experiencing the prodromal phase of schizophrenia?
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Study Notes
Bipolar Disorder and Treatment
- Full manic episodes often lead to emergency medical intervention; energy drink containers may be present during assessments.
- Indicators of lithium toxicity include ataxia, severe hypotension, and a large volume of dilute urine.
- Maintenance therapy for bipolar I disorder typically involves dosage adjustments to lower levels of lithium after stable functioning.
- Electroconvulsive therapy (ECT) is recommended for patients with severe mania and paranoia impeding essential functions like eating.
- Substance use disorders are prevalent in bipolar disorder; self-medication with alcohol may occur.
- Nursing interventions for manic patients include monitoring vital signs, providing protein drinks, and offering calm, clear instructions.
Lithium Monitoring and Education
- A lithium level of 1.7 mEq/L is toxic; instruct patients to hold doses and contact their providers.
- Early signs of lithium toxicity include nausea and tremors; patients should understand these symptoms.
- Effective lithium management includes hydration, monitoring diuretic interactions, and arranging for outpatient lithium level checks.
Patient Education and Support
- Understanding the link between alcohol/caffeine and symptom relapse is crucial; patients must communicate sleep patterns and changes in health.
- Medication education emphasizes that antidepressants are rarely combined with bipolar treatment due to potential manic triggers.
- Family support and awareness of the disease's cyclical nature aid in managing bipolar disorder.
Nursing Diagnoses and Interventions for Bipolar Disorder
- Hopelessness is a critical concern; nursing diagnoses may include risk for injury and ineffective coping during depressive episodes.
- Engaging patients in psychotherapy helps manage stressors following stabilization from acute mania.
- Paranoia in manic patients necessitates rapid interventions, often involving ECT for quick action.
Anxiety Disorders
- Generalized anxiety disorder (GAD) involves persistent worry impacting function; evidence suggests both environmental and hereditary factors contribute.
- Effective interventions for anxiety include positive interaction, inclusion in care plans, and early recognition of escalating behavior.
- Cognitive-behavioral therapy is informed by the acknowledgment of irrational catastrophic thinking patterns.
Obsessive-Compulsive Disorder (OCD)
- Neurological evidence for OCD includes dysfunction in the basal ganglia and altered serotonin function; increased anxiety can lead to compulsive behaviors.
- Patients with OCD often grapple with feelings of shame and loneliness; intervention strategies may involve deep brain stimulation for those unresponsive to treatment.
- SSRIs combined with benzodiazepines can effectively manage OCD symptoms; monitoring for suicidal ideation is essential.
Key Characteristics and Considerations
- Hypomania features impulsivity, distractibility, and risky behavior but does not severely impair global functioning.
- Bipolar II disorder is often characterized by excessive involvement in pleasurable activities, with typical onset around 25 years of age.
- Nursing strategies for managing anxiety or OCD should focus on maintaining supportive environments and encouraging healthy coping mechanisms.### Panic Attack Symptoms
- Common feelings during a panic attack include impending doom, separation from self, and disorganized surroundings.
- Lack of impulse control and intense fear of a specific object or place are less typical.
Panic Disorder Insights
- A diagnosis of panic disorder requires persistent worry for longer than three months.
- Panic attacks related to substance withdrawal are excluded from the diagnosis.
Effective Therapies
- Cognitive behavioral therapy (CBT) is recommended to understand connections between feelings of doom and physical symptoms.
- Systematic desensitization therapy helps patients learn relaxation techniques in response to anxiety-provoking stimuli.
Medication for Anxiety and Phobia
- Propranolol is recommended for patients facing anxiety related to public speaking.
- Patients diagnosed with specific phobias benefit from supportive interventions like engaging in online chat groups.
Nursing Assessments and Diagnostics
- The mental status exam is crucial for assessing panic disorders.
- Immediate intervention is required for patients experiencing stress overload.
Therapeutic Relationships
- Establishing a therapeutic relationship is supported by active listening and appropriate responses to patient behavior.
Patient Safety and Communication
- Calm communication is essential when interacting with agitated patients.
- Direct and respectful communication is necessary for paranoid schizophrenia patients, avoiding unnecessary pressure or touch.
Knowledge of Schizophrenia
- Patients with schizophrenia may show both positive symptoms (like hallucinations) and negative symptoms (like lack of motivation).
- Expectation of weight gain and understanding of medication side effects are important educational components for patients and families.
Risk Factors and Development
- Heritability of schizophrenia is significant, with a 70-90% estimated risk for those with a family history.
- Prenatal exposure to toxins or complications is linked to an increased risk of developing schizophrenia.
Challenging Behaviors and Symptoms
- Delusions, like false beliefs of being targeted, indicate active psychosis in patients with schizophrenia.
- Symptoms like labile affect demonstrate rapid emotional changes, necessitating careful nursing documentation.
Coping Mechanisms and Self-medication
- Patients often self-medicate with alcohol to cope with social discomfort and anxiety, impacting their mental health.
Priority Nursing Interventions
- For patients experiencing severe reactions to antipsychotics, immediate nursing actions include holding medication and contacting a prescriber.
Effective Communication Techniques
- Therapeutic responses to hallucinations should acknowledge patient experiences while gently steering towards reality.
General Understanding
- Schizophrenia is complex, warranting ongoing support and tailored interventions to address individual patient needs.### Patient Care and Anxiety Management
- Encouragement of competing auditory stimuli like humming or music can aid patients in managing anxiety.
- When addressing moderate anxiety, a pertinent question for the nurse is, "Can you identify what was happening when your anxiety began to increase?" This helps in understanding triggers.
- Patients at heightened risk of anxiety include individuals with exacerbated asthma, chronic obstructive pulmonary disease (COPD), unstable angina pectoris, or a history of traumatic brain injury.
Medications and Treatment
- Selective serotonin reuptake inhibitors (SSRIs), such as Fluoxetine (Prozac), are recommended for treating panic attacks.
- The effectiveness of relaxation therapy is indicated by statements like, "Muscle relaxation promotes the relaxation response," and showing patients deep breathing techniques.
- Lifestyle changes are crucial; for example, purchasing large amounts of coffee with added sugar is discouraged for patients on antianxiety medications.
Behavioral Observations
- A profoundly shy child may exhibit traits learned from parents; inherited shyness is a significant factor.
- Students with mild anxiety, such as a straight-A student experiencing test anxiety, may understand the positive aspect of anxiety as it helps them focus.
Pharmacodynamics
- Gamma-aminobutyric acid (GABA) plays a critical role in slowing neural activity; benzodiazepines enhance the effect of GABA, aiding in anxiety control.
- Long-term use of herbal kava can inhibit P450 enzymes, necessitating liver enzymes testing for patients self-medicating with this substance.
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