Podcast
Questions and Answers
Which of the following findings should the nurse report to the provider as potential adverse effects of sertraline? (Select all that apply)
Which of the following findings should the nurse report to the provider as potential adverse effects of sertraline? (Select all that apply)
- Insomnia (correct)
- Elevated blood pressure (correct)
- Decreased sodium level (correct)
- Increased temperature (correct)
- Diaphoresis (correct)
- Headache (correct)
What is the maladaptive use of a defense mechanism demonstrated by the client who is agitated after exercise?
What is the maladaptive use of a defense mechanism demonstrated by the client who is agitated after exercise?
Maladaptive use of a defense mechanism
What is the term for when a client views an exercise instructor as being evil despite having many things in common?
What is the term for when a client views an exercise instructor as being evil despite having many things in common?
Splitting
Which finding indicates the child is experiencing post-traumatic stress disorder (PTSD)?
Which finding indicates the child is experiencing post-traumatic stress disorder (PTSD)?
Which finding should the nurse report for a client taking lamotrigine?
Which finding should the nurse report for a client taking lamotrigine?
What WBC count indicates a contraindication for receiving clozapine?
What WBC count indicates a contraindication for receiving clozapine?
What statement indicates the client has a decreased risk for suicide?
What statement indicates the client has a decreased risk for suicide?
What assumption should be made based on the client's nonverbal behavior?
What assumption should be made based on the client's nonverbal behavior?
What intervention should be included for a client reporting auditory hallucinations?
What intervention should be included for a client reporting auditory hallucinations?
What nursing intervention is anticipated for a client who has impaired cognition?
What nursing intervention is anticipated for a client who has impaired cognition?
What information about relapse should be included in discharge teaching for a client with depression?
What information about relapse should be included in discharge teaching for a client with depression?
Which strategy should be utilized for a client with antisocial personality disorder?
Which strategy should be utilized for a client with antisocial personality disorder?
What manifestation should be included in teaching families about PTSD?
What manifestation should be included in teaching families about PTSD?
What action should be taken if a client is pacing with clenched fists?
What action should be taken if a client is pacing with clenched fists?
What situation requires an incident report?
What situation requires an incident report?
What intervention can reduce anxiety among clients with PTSD?
What intervention can reduce anxiety among clients with PTSD?
What intervention should be performed for a client with alcohol toxicity?
What intervention should be performed for a client with alcohol toxicity?
What finding should the nurse expect after cocaine use?
What finding should the nurse expect after cocaine use?
What action should be taken for a client with bipolar disorder and severe depression?
What action should be taken for a client with bipolar disorder and severe depression?
At what level of anxiety should relaxation techniques be taught?
At what level of anxiety should relaxation techniques be taught?
What adverse effect should be monitored in a child taking methylphenidate?
What adverse effect should be monitored in a child taking methylphenidate?
What information should include in teaching about a 12-step program for alcohol use disorder?
What information should include in teaching about a 12-step program for alcohol use disorder?
What intervention should be included in a care plan for a client with bipolar disorder experiencing mania?
What intervention should be included in a care plan for a client with bipolar disorder experiencing mania?
What finding should be expected in a client with borderline personality disorder?
What finding should be expected in a client with borderline personality disorder?
What response should be given to an older adult client expressing feelings of punishment from God?
What response should be given to an older adult client expressing feelings of punishment from God?
How many mL of diazepam should the nurse administer for a 7.5 mg dose?
How many mL of diazepam should the nurse administer for a 7.5 mg dose?
What finding supports suspicion of delirium?
What finding supports suspicion of delirium?
What statement indicates risk for complicated grief?
What statement indicates risk for complicated grief?
What lab result should be reviewed before administering clozapine?
What lab result should be reviewed before administering clozapine?
What action should be included in the care plan for electroconvulsive therapy (ECT)?
What action should be included in the care plan for electroconvulsive therapy (ECT)?
What adverse effect should be reported for a child taking atomoxetine?
What adverse effect should be reported for a child taking atomoxetine?
What finding should the partner report for a client with bipolar disorder?
What finding should the partner report for a client with bipolar disorder?
Which client should be assessed first?
Which client should be assessed first?
What manifestation of autism spectrum disorder should be included in teaching?
What manifestation of autism spectrum disorder should be included in teaching?
What secondary prevention strategy should be included for partner violence?
What secondary prevention strategy should be included for partner violence?
What treatment option offers interdisciplinary services for a client with schizoaffective disorder?
What treatment option offers interdisciplinary services for a client with schizoaffective disorder?
What statement indicates manipulative behavior?
What statement indicates manipulative behavior?
What finding must be reported due to a threat of harm?
What finding must be reported due to a threat of harm?
What action should be suggested to parents grieving a child?
What action should be suggested to parents grieving a child?
What therapeutic nursing intervention is the priority for a child with conduct disorder?
What therapeutic nursing intervention is the priority for a child with conduct disorder?
What intervention should be included for an older adult client experiencing delirium?
What intervention should be included for an older adult client experiencing delirium?
What action exemplifies the ethical principle of justice?
What action exemplifies the ethical principle of justice?
What statement indicates an understanding of updating nursing care plans for depressive disorders?
What statement indicates an understanding of updating nursing care plans for depressive disorders?
What action should be taken for a client requiring restraints?
What action should be taken for a client requiring restraints?
What finding should be documented as a negative symptom of schizophrenia?
What finding should be documented as a negative symptom of schizophrenia?
What ethical principle applies when transferring a violent client to a different unit?
What ethical principle applies when transferring a violent client to a different unit?
What finding indicates the client is experiencing alcohol withdrawal?
What finding indicates the client is experiencing alcohol withdrawal?
What initial action should be taken when a client appears withdrawn and fearful?
What initial action should be taken when a client appears withdrawn and fearful?
What behavior suggests a client has dependent personality disorder?
What behavior suggests a client has dependent personality disorder?
What intervention should be included for a client with anorexia nervosa?
What intervention should be included for a client with anorexia nervosa?
What immediate action should be taken if a client with acute mania assaults another client?
What immediate action should be taken if a client with acute mania assaults another client?
What risk factor for depression should be identified?
What risk factor for depression should be identified?
What findings suggest manifestations of a personality disorder?
What findings suggest manifestations of a personality disorder?
Which therapies are expected for the treatment of obsessive-compulsive disorder (OCD)?
Which therapies are expected for the treatment of obsessive-compulsive disorder (OCD)?
What medications are appropriate for dementia treatment?
What medications are appropriate for dementia treatment?
Which treatment is recommended for borderline personality disorder?
Which treatment is recommended for borderline personality disorder?
What findings confirm consistent health assessment of schizophrenia?
What findings confirm consistent health assessment of schizophrenia?
What findings may indicate maladaptive uses of defense mechanisms for a client with panic disorder?
What findings may indicate maladaptive uses of defense mechanisms for a client with panic disorder?
Study Notes
Trauma and Stress Disorders
- Post-traumatic stress disorder (PTSD) can manifest as a lack of interest in activities, e.g., upcoming holidays, particularly in children who have experienced significant loss.
- Common clinical manifestations of PTSD include feelings of isolation.
Medications and Side Effects
- Lamotrigine use may lead to dangerous rashes which must be reported immediately.
- Clozapine treatment requires monitoring for low white blood cell counts (WBC < 2,500/mm3) as it is a contraindication.
- Methylphenidate may cause tachycardia, necessitating monitoring in pediatric clients.
- Early identification of depressive symptoms, such as reduced social involvement, is vital for preventing relapse.
Clinical Interventions and Relationships
- Establishing real limits when communicating with clients exhibiting antisocial personality disorder is crucial for effective engagement.
- Nonverbal behaviors, such as maintaining eye contact and leaning forward, indicate a client’s interest in the therapeutic conversation.
- For clients with schizophrenia experiencing auditory hallucinations, utilizing music can serve as a beneficial coping strategy.
Ethical and Safety Considerations
- Ensuring safety is critical in aggressive situations; having security personnel ready during escalated client behavior is crucial.
- Incident reports should be completed for medication administration errors, e.g., administering half the prescribed medication dose.
- The ethical principle of nonmaleficence is applicable when transferring clients to units equipped for managing violence.
Assessment and Diagnosis
- Symptoms like emotional lability and feelings of fear or withdrawal may characterize borderline personality disorder.
- Distinguishing between delirium and dementia can involve noting signs such as distractibility.
- Risk factors for depression include chronic illnesses, such as COPD.
Therapeutic Techniques and Support
- Encouraging engagement in high-calorie snacks for clients experiencing mania helps address nutritional needs.
- Establishing support groups for grieving parents can aid in collective healing after loss.
- Risky behaviors such as threats in borderline personality disorder should be communicated to appropriate staff or authorities.
Client Care and Family Education
- Family members should be educated on the need for a recovery sponsor in 12-step programs for alcohol disorders.
- For clients undergoing electroconvulsive therapy (ECT), it’s essential to monitor cardiac rhythms throughout the procedure.
- Teaching parents about autism spectrum disorder may include key manifestations like language delay.
Crisis Situations
- In a crisis where a client behaves aggressively, calling for assistance supports safety and intervention.
- Prioritizing client assessments in acute mental health settings is essential; those expressing delusions should be seen first.
Long-term Management
- Assertive community treatment is ideal for clients with severe schizoaffective disorder, providing necessary support at home.
- Regular updates to care plans should reflect changes in clients’ depressive symptoms as they evolve.
Defense Mechanisms in Maladaptive Behaviors
- Recognizing maladaptive defense mechanisms such as splitting can help in understanding clients' responses to stressors, especially in panic disorders.
Medication Monitoring
- The use of selegiline transdermal patches requires monitoring for potential hypertensive crises, particularly after consuming tyramine-rich foods.
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Description
This quiz consists of flashcards designed to help nursing students understand mental health concepts, particularly in relation to post-traumatic stress disorder (PTSD) in children. Each flashcard presents a scenario for nurses to think critically about mental health assessments and interventions.
