RN Mental Health Practice 2023 B Flashcards

Questions and Answers

Which of the following are relevant indicators? (Select all that apply)

BMI (correct)

Glucose

Bowel movement

Skin temperature (correct)

BUN (correct)

Potassium (correct)

Heart rate (correct)

Peripheral edema

Sodium

Blood pressure

Which of the following statements should the nurse include in the teaching for a client who experienced a traumatic event? (Select all that apply)

You should seek help if you have thoughts of self-harm (correct)

You should avoid talking about the event

It is common for people who survived a traumatic event to experience feelings of anxiety (correct)

A support group might be helpful to you during this time (correct)

Which information indicates the client's condition with anorexia nervosa is deteriorating? (Select all that apply)

BMI (correct)

QT prolongation (correct)

Exercise regimen

Hematemesis (correct)

What is an expected adverse effect that might have caused a client with bipolar disorder to stop taking lithium?

Hand tremors Signup and view all the answers

Which of the following interventions should the nurse include in the plan for a client with bulimia nervosa who is 5% above their ideal body weight?

Identify the client's trigger foods Signup and view all the answers

What should the nurse say to a client dealing with the upcoming loss of a terminally ill child?

It is not uncommon to feel angry toward yourself or others. Signup and view all the answers

What is the priority intervention for a client with a new prescription for olanzapine?

Instruct the client to avoid driving during initial therapy Signup and view all the answers

What therapeutic response demonstrates summarizing to a client with anorexia nervosa?

You're saying that you think you are fat and are using laxatives because you are afraid of gaining weight. Signup and view all the answers

How should the nurse document a client's speech pattern who states, 'I'm red, in the head, and I'm going to bed!'?

Clang association Signup and view all the answers

The client is at greatest risk for _ as evidenced by the client's __.

violent behavior, agitation Signup and view all the answers

Which of the following are positive symptoms of schizophrenia?

Delusions of grandeur Signup and view all the answers

The first action the nurse should take is to address the client's _ due to the client's __.

cardiovascular injury, constant psychomotor activity Signup and view all the answers

Which finding should the nurse expect in a client experiencing a situational crisis?

The client recently lost a grandparent in a motor vehicle crash Signup and view all the answers

Which laboratory finding should the nurse expect for a client with alcoholic cardiomyopathy?

Increased creatine phosphokinase (CPK) Signup and view all the answers

How should the nurse engage a client with dementia looking for their deceased partner?

Talk with the client about activities they enjoyed with their partner. Signup and view all the answers

What should the nurse allow for a client who does not respond when asked about their goals during therapy?

Allow the client time to formulate an answer. Signup and view all the answers

If a client reports feeling that a bomb was placed in their room, what should the nurse do?

Assess the client for evidence of a perceptual disturbance. Signup and view all the answers

What should the nurse include in their teaching about mechanical restraints?

Apply restraints when other means of managing the client's behavior have failed Signup and view all the answers

Which statement by a client with alcohol use disorder indicates denial as a defense mechanism?

I am able to go to work every day, so I don't have a problem. Signup and view all the answers

What finding might indicate neglect in an older adult client?

Inappropriate dress Signup and view all the answers

Which family dynamics might indicate a boundary issue?

Older children who are responsible for their younger siblings Signup and view all the answers

Who can give informed consent in a medical setting?

A 35-year-old client who has major depressive disorder. Signup and view all the answers

What behavior should the nurse report as a priority for a client with bipolar disorder?

Giving away possessions Signup and view all the answers

Which findings in a client in the Emergency Department require follow-up?

Level of consciousness (LOC) Signup and view all the answers

For a client assessment, which findings are consistent with alcohol toxicity?

Nausea and vomiting Signup and view all the answers

The client is at risk for developing _ as evidenced by the client's _.

alcohol withdrawal syndrome, mental status Signup and view all the answers

Which potential prescription should be anticipated for a client with alcohol toxicity?

Initiate IV access Signup and view all the answers

What should the nurse first do after reporting a client at risk of suicide?

Initiate suicide precautions Signup and view all the answers

Which finding indicates a positive response to therapy for alcohol withdrawal syndrome?

Sleep with minimal disruption for 8 hr Signup and view all the answers

What should the nurse do if they observe derogatory comments being made to a client?

Report the occurrence to the charge nurse. Signup and view all the answers

What is the priority goal for a client with borderline personality disorder?

The client will refrain from self-mutilation. Signup and view all the answers

What statement indicates that client rights under the law are understood?

In the event a client threatens harm to others, medications can be administered without consent. Signup and view all the answers

What factors should the nurse include as increasing the risk for depression?

Substance use disorder Signup and view all the answers

What action demonstrates active listening by the nurse?

Attention to body language. Signup and view all the answers

What side effect should be discussed when teaching a patient about fluoxetine?

You might experience difficulties with sexual functioning while taking this medication. Signup and view all the answers

What is a possible indicator of neglect in an older adult client's caregiver?

Inappropriate dress. Signup and view all the answers

What might indicate a client is accepting of their terminal illness?

I am going to order a wheelchair for when I'm unable to walk. Signup and view all the answers

What task should the nurse assign to an LPN?

Change the dressings of a client who has borderline personality disorder and superficial self-inflicted wounds. Signup and view all the answers

Which over-the-counter medication should alert the nurse for a client prescribed tranylcypromine?

Phenylephrine Signup and view all the answers

How much chlorpromazine should be administered to a 110 lb adolescent?

14 Signup and view all the answers

Which client should be reported as a potential victim of abuse?

An older adult client who is bedbound and has a stage IV pressure ulcer. Signup and view all the answers

What interventions should be included in a care plan for a client in seclusion?

Renew the prescription for the client every 4 hr. Signup and view all the answers

What indicates understanding from the partner of a client in alcohol rehabilitation?

I will not take charge of my partner's work responsibilities. Signup and view all the answers

What should the nurse say to a client pushing on a locked unit door?

It appears as though you would like to open the door. Signup and view all the answers

What finding indicates a potential psychiatric emergency for a client with schizophrenia?

The client reports command hallucinations. Signup and view all the answers

What manifestation should the nurse expect from a client experiencing opioid withdrawal?

Rhinorrhea Signup and view all the answers

What is a recommended action for a client experiencing a panic attack?

Assist the client with deep-breathing exercises. Signup and view all the answers

What finding indicates that benztropine should be administered?

Shuffling gait. Signup and view all the answers

What should the nurse do when a client hears voices?

Ask the client what the voices are saying. Signup and view all the answers

What intervention should be included for a client experiencing acute mania to promote sleep?

Encourage frequent rest periods throughout the day. Signup and view all the answers

What should be the priority action by the nurse for a client experiencing mania?

Provide frequent high-calorie snacks. Signup and view all the answers

Which finding should the nurse expect from a client with bulimia nervosa?

Tooth erosion. Signup and view all the answers

What indicates that a client understands the coping strategies being taught?

I will talk about my feelings with a close friend. Signup and view all the answers

What behavior indicates the effectiveness of behavioral therapy in a client with antisocial personality disorder?

Refrains from manipulating others to earn dining room privileges. Signup and view all the answers

What should the nurse do when one client monopolizes group time in therapy?

Ask group members to discuss their feelings about this client's monopolizing behavior. Signup and view all the answers

What findings indicate an improvement in a client with anorexia nervosa after 2 weeks?

To be determined based on clinical assessment. Signup and view all the answers

Study Notes

Bipolar Disorder and Medication

Hand tremors can be an expected adverse effect of lithium, leading clients to discontinue use.
For clients experiencing mania, priority nursing actions include providing high-calorie snacks and promoting frequent rest periods.

Eating Disorders

Identifying trigger foods is a crucial intervention in bulimia nervosa management.
Anorexia nervosa may present with tooth erosion as a physical sign of the disorder.

Grief and Terminal Illness

Emotional responses to impending loss may include anger towards self and others.
Encouraging discussions about joyful memories can support clients dealing with loss.

Schizophrenia and Psychotic Symptoms

Clang association is indicative of disorganized thought processes observed in some schizophrenic clients.
Positive symptoms of schizophrenia include delusions of grandeur and catatonia, whereas negative symptoms encompass alogia and social withdrawal.

Substance Use Disorders

Clients with alcohol use disorder are at risk for violent behavior, especially during states of agitation.
Clients in alcohol withdrawal are monitored for vital signs, temperature, heart rate, and tremors as indicators of therapy effectiveness.

Communication and Therapeutic Techniques

Active listening involves attention to nonverbal cues, fostering a deeper connection with clients.
Summarizing a client's concerns can validate their feelings and enhance therapeutic communication.

Crisis Intervention and Safety

Observe clients for evidence of perceptual disturbances if they express fears, such as believing a bomb is in their room.
Suicide precautions should be initiated for clients expressing harmful ideation.

Client Rights and Legal Considerations

Medications can be administered without consent for clients posing a threat to others.
Reporting concerns about potential abuse is essential, especially for vulnerable populations like older adults.

Group Therapy Dynamics

Encouraging open discussions about monopolizing behaviors in group therapy can foster healthier group dynamics.

Coping Strategies and Acceptance

Expressing feelings with friends is a constructive coping strategy for clients facing depression linked to partner violence.
Accepting the need for adaptive tools, like a wheelchair, signifies progress in accepting terminal illness.

Assessment and Lab Findings

Increased creatine phosphokinase indicates cardiac issues related to alcohol abuse.
QT prolongation may signal deteriorating health in clients with anorexia nervosa.

Nursing Interventions and Care Plans

Care for clients in seclusion should include regular prescription renewals and monitoring.
Focused assessments and individualized care plans are crucial for managing clients with severe mental health disorders.

Education and Understanding Disorders

Providing educational sessions on depression risk factors, such as substance use disorders, helps increase awareness and prevention.
Teaching clients about medication side effects promotes informed self-management of their treatment plans.

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Description

Test your knowledge with these flashcards focused on mental health nursing practices in 2023. Dive into scenarios involving bipolar disorder and bulimia nervosa. Perfect for nursing students and professionals seeking to enhance their understanding of mental health care.