Mental Health Exam 3 PDF

lOMoARcPSD|40142722 Mental health exam 3 Mental Health Theory & Application (Arizona College of Nursing) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or unive...

lOMoARcPSD|40142722 Mental health exam 3 Mental Health Theory & Application (Arizona College of Nursing) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 - Major Depressive Disorder  Symptoms o Loss of interest and pleasure in usual activities o No history of manic behavior o Nothing medical going on and cannot figure out why patient is depressed o Long term o Part of every mental health disorder - Bipolar Disorder  What is it o Associated with increased mortality in general, particularly with death by suicide o Mood swings from profound depression to extreme euphoria (mania) with intervening periods of normally  Nurse client relationship o Utilizing communication techniques  Humor  Bargaining  honest feedback  distraction  Therapeutic communication  Who determines length of stay that hospitals can hold a patient involuntary? o Interdisciplinary team  When can a patient be held involuntarily? o Harm to themselves or others o Patient is unable to take care of basic personal needs  NMS is associated with what med class? o Antipsychotic o What disorders would this class of med treat?  Schizophrenia  Bipolar - Stress  Understand the concept of maladaptive coping o Not able to satisfactorily progress through the stages of grieving to achieve resolution o Fixed in the denial or anger stage  What are some examples? o Psychological stress can impact medical conditions Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 - Somatic Symptom Disorder  Symptoms o Unrealistic or inaccurate interpretation of physical symptoms or sensations leading to a preoccupation with and fear of having a serious disease o Extremely conscious of bodily sensations and changes o Some have a history of doctor shopping while others avoid seeking medical assistance o Anxiety and depression are common and obsessive-compulsive traits frequently accompany the disorder o Preoccupied by medical symptoms o Multiple issues that can’t be explained o Anxiety that leads to depression because there is no cure  Treat the anxiety o  Clinical Manifestations o Increased emotions  Sad all the time  Crying all the time o Anxiety o Strong dependency needs  Nursing Interventions: o Recognize symptoms o Understand that symptoms  inability to cope o Recognize that this is a disorder, no personalization - Conversion Disorder  What happens in this disorder? o Lack of patient concern over the physiological changes o Loss of function that cannot be explained by an known medical diagnosis o Unconsciously triggered o Difficulty diagnosing  Because the issues may be caused by anxiety or fear  Are they aware of their symptoms? o No o A loss of or change in body function that cannot be explained by any known medical disorder or pathophysiological mechanism Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 o Conversion symptoms affect voluntary motor or sensory functioning suggestive of neurological disease  Paralysis  Decreased respiratory  Decreased swallow ability  Seizures  Coordination problem o Some instances of conversion disorder may be precipitated by psychological stress o “La belle indifference”  Absence of psychological distress despite having a serious medical illness or symptoms related to a health condition  This condition is most common associated with conversion disorder (CD) - Factitious Disorders  Consciously, intentional feigning of physical and or psychological symptoms  Secondary gain is ATTENTION  Increased hospital visits  Vague symptoms o Drag out the attention  Its real to patients o Treat them until we have valid diagnostics can rule out medical issues  Open ended questions for assessments  Also known as the o Munchausen syndrome  Self-induced o EX:  taking laxatives to induce diarrhea  taking blood thinning agents to cause bleeds - Hypochondriasis  Illness anxiety disorder  Unrealistic or inaccurate interpretation of physical symptoms or sensations, leading to preoccupation and fear of having a serious disease  Constant anxiety (worry)  Frequent hospital visits  What do they look like? o Hypervigilance  Very upset Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722  They think they are going to die  They know the S&S before you tell them because they researched themselves - Obsessive Compulsive Disorder  RITUALISTIC TASKS AND COMPULSIONS o Rituals  Cannot interrupt because they must start over  HOW DO WE SLOW TASKS AND COMPULSIONS? o Explore the triggers of that OCD o Treat the trigger that will get rid of those feelings and anxiety - Dissociative Disorders  inability to recall important information  not directly caused by substance or neurological dysfunction  May not get back full memory  Fugue o Complete memory return o Acute o Wandering  Bewildered  They move from one point to the next with no idea why they got there o inability to recall some or all of one’s past  Treatment for both dissociative disorders o Family must be involved in the therapy  Family inclusion-helps patients to maintain their role performance o Provide safety - Dissociative Identity Disorders  Multiple personality disorder o Split into multiple personalities to protect themselves  Common in schizoaffective o Must have a secondary disorder  This brings down the client and they cannot control  The adaptation of personalities following traumatic events o Sexual abuse  Nursing Interventions: o Establish rapport and trust Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722  PRIORITY! Without rapport and trust the patient will not feel comfortable to interact and could lead to rapid personality changes - Body Dysmorphic Disorder  Exaggerated belief that the body is deformed o Symptoms and signs  OCD  Anorexia  Bulimia  Depression  Social isolation  Decreased sleep  Decreased appetite  Multiple plastic surgeries  To fix what is wrong in their eyes - Schizophrenia  Four phases o Social maladjustment (premorbid)  They don’t go out anymore  Shy  Poor in school o Prodromal phase  Significant deterioration in function  Social withdrawn  Cognitive impairment  Obsessive compulsive behavior o Active psychotic phase  Neurocognitive issues  Positive symptoms  Hallucinations and delusions  Disorganized speech  Movement disorders (echopraxia)  Negative symptoms  Depressed (lack of pleasure) o Lack of interest o Insomnia o Withdrawal Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 o Isolation o Not following through o Not sleeping o Alogia  Poverty of speech (not inability, they just can’t) o Gustatory (tactile)  Touchable or sensed by touch o Residual phase  Active psychotic phase symptoms are either absent or no longer prominent  Positive symptoms may remain  Flat affect and impairment in role functioning are common - Schizoaffective Disorder (Essay question)  If you have a patient with schizoaffective disorder with potentially other co- occurring mental health disorders, create a plan of care that include the following information o Safety, discharge planning and evaluating outcomes  Safety  De-escalate  Distract client  Help client out of their own head and away from the voices  Important to be med compliant  Discharge  Medication compliance  Long term medical facility  ADL support o Person to monitor  Monitor for improvement or decline in disease process  Housing can lead to reorientation o Patient is not always in touch with reality o This reorientation is considered educational - Acute Anxiety  What behaviors do you anticipate seeing in patients? o Social withdrawal Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 - General Anxiety Disorder (GAD) o Signs and symptoms  Irritability  Pacing  Fatigue  Insomnia  Restlessness - Panic Anxiety (impending doom)  Signs and symptoms? o Hyperventilation o Insomnia o Loss of reasoning o inability to concentrate o short of breath o chest pain  Nursing interventions o Decrease the stimulation o PRN medications (what is your fast acting med for anxiety?)  Benzos  Lorazepam o Leave client?  No! - Social Anxiety  Excessive fear of situations in which the affected person might do something embarrassing or be evaluated negatively by others o Signs and symptoms  Depression or fear  Palpitations  Social isolation  Sweating  Upset GI  Nausea  Muscle tension  Interventions to help patient cope: Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 o Flooding o Systematic desensitization o CBT o Thought stopping - Phobia  Agoraphobia o Fear of going outside the home o Leaving safety of personal space o Fear of being in places or situations from which escape might be difficult or in which help might not be available if panic like symptoms or other incapacitating symptoms  EX  Traveling in public transportation  Being in open spaces  Being in shops, theaters, cinemas  Standing in the line or being in the crowd  Being outside of the home alone in other situations - Substance Use Disorder (SUD)  Wernicke’s encephalopathy o Pathophysiology  Most serious form of thiamine deficiency in alcoholic patients  Vitamin B12 deficiency  Muscle rigidity  Decreased motor function  Seizures are most severe  Know the difference of COW and CIWA o COW  Opioids o CIWA  Nausea  Vomiting  Anxiety/agitation  Tremors/seizures  Hallucinations/visual disturbances  Tachycardia  Headache and migraine  Treatment o Withdrawal (alcohol)  Disulfiram (Antabuse) Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722  Alcohol deterrent therapy  Benzodiazepines  Anticonvulsant medications  Alcohol abstinence  N-acetylcysteine (OTC) o Opioid  Narcan (Naloxone)  Nursing priority: o Hydration o Nutrition o Rest  How does genetics play a role? o 40-60% of clients who have family with alcohol abuse - Key terms  Malingering o Creating situations to avoid having to deal with the reality of another situation  Positive & Negative Symptoms o Hallucinations o Delusions o Erotomania o Echopraxia o Alogia o Paranoia o Neologism o Echolalia Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 Quizlet 1) A nursing instructor is teaching about specific phobias. Which student statement should indicate that learning has occurred?  “These clients have overwhelming symptoms of panic when exposed to the phobic stimulus.” 2) A client has a history of excessive fear of water. What is the term that a nurse should use to describe this specific phobia, and under what subtype is this phobia identified?  Aquaphobia, a natural environment type of phobia 3) How would a nurse differentiate a client diagnosed with a social phobia from a client diagnosed with schizoid personality disorder?  Clients diagnosed with social phobia avoid interacting only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life 4) How would a nurse differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder?  Depersonalization is commonly seen in panic disorder and absent in GAD 5) Which treatment should a nurse identify as most appropriate for clients diagnosed with generalized anxiety disorder?  Long-term treatments with buspirone (BuSpar) 6) A client refused to go on a cruise to the Bahamas with his spouse because of fearing that the cruise ship will sink, and all will drown. Using a cognitive theory perspective, the nurse should use which of these statements to explain to the spouse the etiology of this fear?  “Your spouse may be experiencing a distorted and unrealistic appraisal of the situation.” o From a cognitive perspective, fear is described as the result of faulty cognitions 7) Arthur, who is diagnosed with obsessive compulsive disorder, reports to the nurse that he can’t stop thinking about all the potentiality life threatening germs in the environment. What is Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 the most accurate way for the nurse to document this symptom?  Patient is expressing an obsession with germs o Obsessions are unwanted, intrusive, repetitive thoughts o Compulsions are unwanted, repetitive behavior patterns in response to obsessive thoughts that are efforts to reduce anxiety 8) A cab driver stuck in traffic is suddenly lightheaded, tremulous, and diaphoretic and experiences tachycardia and dyspnea. An extensive work-up in an emergency department reveals no pathology. Which medical diagnosis is suspected, and which nursing diagnosis is the priority?  Panic disorder and a nursing diagnosis of panic anxiety o The priority nursing diagnosis should be panic anxiety o Panic disorder is characterized by recurrent, sudden onset panic attacks in which the person feels intense fear, apprehension, or terror 9) A client diagnosed with panic disorder states, “When an attack happens, I feel like I am going to die.” Which is the nurse’s most appropriate reply?  “I know it’s frightening but try to remind yourself that it will only last a short time.” o The nurse’s most appropriate reply is to empathize with the client and provide encouragement that panic attacks last only a short period. Clients experiencing a panic attack often fear that they are dying and experience intense physical discomfort. The physical sensations can be so intense that the individual believes they are having a heart attack or other critical illness. Symptoms of depression are common with this disorder 10) A nursing instructor is teaching about the medications used to treat panic disorder. Which student statement indicates that learning has occurred?  “Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder.” Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 o Clonazepam is a type of benzodiazepine that can be abused and lead to physical dependence and tolerance. o It can be used on an as needed basis to reduce anxiety and its related symptoms 11) A family is seeking advice about an elderly parent who seems to worry unnecessarily about everything. The family member states, “Should I seek psychiatric help for my mother?” Which is an appropriate nursing reply?  “Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning.” o Anxiety is a normal reaction to a realistic danger or threat to biological integrity or self-concept 12) A client is experiencing a severe panic attack. Which nursing intervention would meet the clients immediate need?  Stay with the client and offer reassurance of safety o The nurse can meet the clients immediate need by staying with the client and offering reassurance of safety and security. The client may fear for his or her life, and the presence of a trusted individual provides assurance of personal safety 13) A college student is unable to take a final exam because of severe test anxiety. Instead of studying, the student relieves stress by attending a movie. Which priority nursing diagnosis should a campus nurse assign for this client?  Altered coping R/T anxiety o The nurse should assist in implementing interventions that should improve the client’s healthy coping skills and reduce anxiety 14) A client living on the beachfront seeks help with an extreme fear of crossing bridges, which interfere with daily life. A psychiatric nurse practitioner decides to try systemic desensitization. Which explanation if this therapy should the nurse convey to the client?  “Through a series of increasingly anxiety provoking steps we will gradually increase your tolerance to anxiety.” o Systemic desensitization exposes the client to a series of increasingly anxiety provoking steps that will gradually increase anxiety tolerance Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 15) A client diagnosed with obsessive compulsive disorder is admitted to a psychiatric unit. The client has an elaborate routine for toileting activities. Which would be an appropriate initial client outcome during the first week of hospitalization?  The client will wake early enough to complete rituals prior to breakfast o The nurse should provide a structured schedule of activities and later in treatment begin to gradually limit the time allowed for rituals 16) A nurse is providing discharge teaching to a client taking a benzodiazepine. Which client statement would indicate a need for further follow-up instructions?  “I will need scheduled bloodwork in order to monitor for toxic levels of this drug.” o Taking extra doses of a benzodiazepine may result in addiction and the drug should not be taken in conjunction with alcohol o No blood work is needed when taking a short acting benzo 17) A client diagnosed with an obsessive-compulsive disorder spends hours bathing and grooming. During a one-on- one interaction, the client discusses the rituals in detail but avoids and feelings that the rituals generate. Which defense mechanism should the nurse identify?  Intellectualization o Attempt to avoid expressing emotions associated with a stressful situation by using the intellectual processes of logic, reasoning, and analysis 18) A client is newly diagnosed with obsessive compulsive disorder and spends 45 minutes folding clothes and rearranging them in drawres. Which nursing intervention would best address the client’s problem?  Discuss the anxiety provoking triggers that precipitate the ritualistic behaviors 19) A nursing student questions an instructor regarding the order for fluvoxamine (Luvox), 300mg daily, for a client diagnosed with obsessive compulsive disorder. Which instructor reply is most accurate? Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722  “SSRI doses, in excess of what is effective for treating depression, may be required for OCD.” o SSRI have been approved by FDA for the treatment of OCD o Common side effects include  Headache  Sleep disturbances  Restlessness 20) A client presents in the emergency department with complaints of overwhelming anxiety. Which of the following is a priority for the nurse to assess?  Cardiac status o Priority is to evaluate cardiac status since a person having an MI, CHF, or mitral valve prolapse can present with symptoms of anxiety 21) A client is prescribed alprazolam (Xanax) for acute anxiety. What client history should cause a nurse to question this order?  History of alcohol dependence o Benzos have increased risk for physiological dependence and tolerance o Client with substance abuse may be more likely to abuse addictive substances and/or combine this drug with alcohol 22) Warren’s college roommate actively resists going out with friends whenever they invite him. He says he can’t stand to be around other people and confides to Warren “They wouldn’t like me anyway.” Which disorder is Warren’s roommate likely suffering from?  Social anxiety disorder (Social phobia) o Excessive fear of social situations R/T fear that one might do something embarrassing or be evaluated negatively by others 23) A client has the following symptoms: preoccupation with imagined defect, verbalizations that are out of proportion to actual physical abnormalities, and numerous visits to plastic surgeons to seek relief. Which nursing diagnosis would best describe the problems evidenced by these symptoms? Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722  Disturbed body image 24) How should a nurse best describe the major maladaptive client response to panic disorder?  Clients perceive having no control over life situations o Major maladaptive client response to panic disorder is the perception of having no control over life situations, which leads to nonparticipation in decision making and doubts regarding role performance 25) A client diagnosed with generalized anxiety states “I know the best thing for me to do now is to just forget my worries.” How should the nurse evaluate this statement?  The client has a distorted perception of problem resolution o Clients should be encouraged to openly deal with anxiety and recognize the triggers that precipitate anxiety responses 26) A client taking chlordiazepoxide (Librium) for generalized anxiety disorder symptoms. In which situation should a nurse recognize that this client is at greatest risk of drug overdose?  When the client combines the drug alcohol o Both Librium and alcohol are central nervous system depressants. In combination, these drugs have an additive effect and can suppress the respiratory system, leading to respiratory arrest and death 27) A college student has been diagnosed with GAD. Which of the following symptoms should a campus nurse expect this client to exhibit? Select all the apply  Fatigue *  Anorexia  Hyperventilation  Insomnia *  Irritability * 28) A nurse is discussing treatment options with a client whose life has been negatively impacted by claustrophobia. The nurse would expect which of the following behavioral Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 therapies to be most commonly used in the treatment of phobias? Select all that apply  Benzodiazepine therapy  Systemic desensitization *  Imploding (flooding) *  Assertiveness training  Aversion therapy 29) A nurse has been caring for a client diagnosed with GAD. Which of the following nursing interventions would address this client’s symptoms? Select all that apply  Encourage the client to recognize the signs of escalating anxiety *  Encourage the client to avoid any situation that causes stress  Encourage the client to employ newly learned relaxation techniques *  Encourage the client to cognitively reframe thoughts about situations that generate anxiety *  Encourage the client to avoid caffeinated products * 30) A client who has been diagnosed with a phobic disorder asks the nurse if there are any medications that would be beneficial in treating phobic disorders. Which of the following would be accurate responses by the nurse? Select all that apply?  Some antianxiety agents have been successful in treating social phobias *  Some antidepressant agents have been successful in diminishing symptoms of agoraphobia and social anxiety disorder (social phobia) *  Specific phobias are generally not treated with medication unless accompanied by panic attacks *  Beta-blockers have been used successfully to treat phobic responses to public performance * 31) A nurse is assessing a client diagnosed with paranoid schizophrenia. The nurse asks the client “Do you receive special messages from certain sources, such as television or radio?” Which potential symptom of this disorder is the nurse assessing? Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722  Delusions of reference 32) A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should be taught by the nurse?  How to make eye contact when communicating o Social skills, such as making eye contact, can assist clients in communicating needs and maintaining connectedness 33) A 16-year-old client diagnosed with paranoid schizophrenia experiences command hallucinations to harm others. The client’s parents ask a nurse “Where do the voices come from?” which is the appropriate nursing reply?  “Your child has a chemical imbalance of the brain, which leads to altered thoughts.” 34) Parents ask a nurse how they should reply when their child, diagnosed with paranoid schizophrenia, tells them that voices command him to harm others. Which is the appropriate nursing reply?  “Focus on the feelings generated by the hallucinations and present reality.” 35) A client diagnosed with schizophrenia tells a nurse, “The Shopatouilens took my shoes out of my room last night.” Which is an appropriate charting entry to describe the client’s statement?  “The client is expressing a neologism” o Neologism is when a client invents a new word that is meaningless to others but may have symbolic meaning to the client o Word salad refers to a group of words that are put together randomly 36) During an admission assessment, a nurse asks a client diagnosed with schizophrenia, “Have you ever felt certain objects or persons have control over your behavior?” the nurse is assessing for which type of thought disruptions?  Delusions of influence Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 o Delusions of control or influence are manifested when the client believes that his or her behavior is being influenced. o An example would be if a client believes that a hearing aid receives transmissions that control personal thoughts and behaviors 37) A client diagnosed with schizophrenia states “Can’t you hear him? It’s the devil. He’s telling me I’m going to hell.” Which is the most appropriate nursing reply?  “I’m sure the voices sound scary. The devil is not talking to you. This is part of your illness.” o Reminding the client that “the voices” are a part of his or her illness is a way to help client accept that the hallucinations are not real 38) A client diagnosed with psychosis NOS (not otherwise specified) tells a nurse about voices telling him to kill the president. Which nursing diagnosis should the nurse prioritize for this client?  Risk for violence: directed toward others o Other risk factors for violence include  Aggressive body language  Verbal aggression  Catatonic excitement  Rage reactions 39) Which nursing intervention would be most appropriate when caring for an acutely agitated client diagnosed with paranoid schizophrenia?  Provide personal space to respect client’s boundaries o Providing personal space may serve to reduce anxiety and reduce the client’s risk for violence 40) Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia?  Being reliable, honest, and consistent during interactions o The nurse should also convey acceptance of the client’s needs and maintain a calm attitude when dealing with agitated behavior Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 41) A client diagnosed with paranoid schizophrenia states, “My psychiatrist is out to get me. I’m sad that the voice is telling me to stop him.” What symptom is the client exhibiting, and what is the nurse’s legal responsibility related to his symptom?  Command hallucinations; warn the psychiatrist o A client who is demonstrating a risk for violence could potentially become physically, emotionally, and/or sexually harmful to others or to self 42) Which statement should indicate to a nurse that an individual is experiencing a delusion?  “There’s an alien growing in my liver” o Delusions are false personal beliefs that are inconsistent with the person’s intelligence or cultural background 43) A client diagnosed with schizophrenia is a slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address this type of symptom?  Risperidone (Risperdal) to address the positive symptom o Risperidone (Risperdal) is an atypical antipsychotic used to reduce positive symptoms, including disturbances in content of though (delusions), form of thought (neologisms), or sensory perception (hallucinations) 44) A client is diagnosed with schizophrenia. A physician orders haloperidol (Haldol) 50mg bid, benztropine (Cogentin) 1 mg prn, and zolpidem (Ambien) 10mg HS. Which client behavior would warrant the nurse to administer benztropine?  Restless and muscle rigidity o An anticholinergic medication such as benztropine would be used to treat extrapyramidal symptoms of restlessness and muscle rigidity 45) A nurse is caring for a client who is experiencing a flat affect, paranoid delusions, anhedonia, anergia, neologisms, and echolalia. Which statement correctly differentiates the client’s positive and negative symptoms of schizophrenia?  Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 o Positive symptoms of schizophrenia include  Paranoid delusions  Neologism  Echolalia o Negative symptoms of schizophrenia include  Flat affect  Anhedonia  Anergia o Positive symptoms reflect an excess of distortion of normal functions. o Negative symptoms reflect a decrease or loss of normal functions 46) A client diagnosed with chronic schizophrenia presents in an emergency department (ED) with uncontrollable tongue movements, stiff neck, and difficulty swallowing. The nurse would expect the physician to recognize which condition and implement which treatment?  Tardive dyskinesia and treat by discontinuing antipsychotic medications o Tardive dyskinesia is a condition of abnormal involuntary movements of the mouth, tongue, trunk, and extremities that can be an irreversible side effect of typical antipsychotic medications 47) After taking chlorpromazine (Thorazine) for 1 month, a client presents to an emergency department with severe muscle rigidity, tachycardia, and a temperature of 105 F. The nurse expects the physician to recognize which condition and implement which treatment?  Neuroleptic malignant syndrome and treat by discounting Thorazine and administering dantrolene (Dantrium) o Neuroleptic malignant syndrome is a potentially fatal condition characterized by muscle rigidity, fever, altered consciousness, and autonomic instability. o The use of typical antipsychotics is largely being replaced by atypical antipsychotics due to fewer side effects and lower risks Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 48) A client diagnosed with schizophrenia takes an antipsychotic agent daily. Which assessment finding should a nurse immediately report to the client’s attending psychiatrist?  Temperature of 104 F o A temperature this high can be a symptom of the rare but life-threatening neuroleptic malignant syndrome (NMS) 49) An aging client diagnosed with chronic schizophrenia takes an antipsychotic and a beta-adrenergic blocking agent (propranolol) for hypertension. Understanding the combined side effects of these drugs, which statement by the nurse is most appropriate?  “Raise slowly when you change position from lying to sitting or sitting to standing.” o Antipsychotic medications and beta blockers cause a decrease in blood pressure. o When given in combination, this side effect places the client at risk for developing orthostatic hypotension 50) A client diagnosed with schizophrenia is prescribed clozapine (Clozaril). Which client symptoms related to the side effects of this medication should prompt a nurse to intervene immediately?  Sore throat, fever, and malaise o Clozapine (Clozaril) can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur o Symptoms of infectious processes would alert the nurse to this potential 51) If clozapine (Clozaril) therapy is being considered, the nurse should evaluate which laboratory test to establish a baseline for comparison in order to recognize a potentially life- threatening side effect?  White blood cell count o Clozapine can have a serious side effect of agranulocytosis in which a potentially fatal drop in while blood cells can occur 52) During an admission assessment, a nurse notes that a client diagnosed with schizophrenia has allergies to penicillin, Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 prochlorperazine (Compazine) and bee stings. Based on this assessment data, which antipsychotic medication would be contraindicated?  Thioridazine (Mellaril) because of cross-sensitivity among phenothiazines o Prochlorperazine (Compazine) and thioridazine are both classified as phenothiazines 53) A college student has quit attending classes, isolates self-due to hearing voices, and yells accusations at fellow students. Based on this information, which nursing diagnosis should the nurse prioritize?  Risk for other-directed violence R/T yelling accusations o Hearing voices and yelling accusations indicates a potential for violence, and this potential safety issue should be prioritized 54) A client has been recently admitted to an inpatient psychiatric unit. Which intervention should the nurse plan to use to reduce the client’s focus on delusional thinking?  Focus on feelings suggested by the delusion o The nurse should focus on the client’s feelings rather than attempt to change the client’s delusional thinking by the use of evidence or logical explanations. o Delusional thinking is usually fixed, and clients will continue to have the belief in spite of obvious proof that the belief is false or irrational 55) A client states, “I hear voices that tell me that I am evil.” Which outcome related to these symptoms should the nurse expect this client to accomplish by discharge?  The client will identify events that increase anxiety and illicit hallucinations o It is unrealistic to expect the client to completlety stop hearing voices. Even when compliant with antipsychotic medications, client may still hear voices o It would be realistic to expect the client to associate stressful events with an increase in auditory hallucinations. But this recognition the client can Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 anticipate symptoms and initiate appropriate coping skills 56) A newly admitted client has taken thioridazine (Mellaril) for 2 years with good symptom control. Symptoms exhibited on admission included paranoid delusions and hallucinations. The nurse should recognize which potential cause for the return of these symptoms?  The client has not taken the medication as prescribed o Altered thinking can affect a client’s insight into necessity for taking antipsychotic medications consistently. When symptoms are no longer bothersome, clients may stop taking medications that cause disturbing side effects o Clients may miss the connection between taking the medications and an improved symptom profile 57) Which of the following components should a nurse recognize as an integral part of a rehabilitative program when planning care for clients diagnosed with schizophrenia? Select all that apply  Group therapy *  Medication management *  Deterrent therapy  Supportive family therapy *  Social skills training * 58) A nurse is administering risperidone (Risperdal) to a client diagnosed with schizophrenia. The therapeutic effect of this medication would most effectively address which of the following symptoms? Select all that apply  Somatic delusions *  Social isolation  Gustatory hallucinations *  Flat affect  Clang associations * Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 o Risperidone is an atypical antipsychotic that has been effective in the treatment of the positive symptoms of schizophrenia and in maintenance therapy to prevent exacerbation of schizophrenic symptoms 59) Laboratory results reveal decreased levels of prolactin in a client diagnosed with schizophrenia. When assessing the client, which symptoms should a nurse expect to observe? Select all that apply  Apathy *  Social withdrawal *  Anhedonia *  Auditory hallucinations  Delusions o Decreased levels of prolactin can cause depression which would result in the above symptoms 60) The diagnosis of catatonic disorder associated with another medical condition is made when the client’s medical history, physical examination, or laboratory findings provide evidence that symptoms are directly attributed to which of the following? Select all that apply  Hyperthyroidism  Hypothyroidism  Hypoadrenalism  Hypoadrenalism  Hyperaphia o Types of medical conditions that have been associated with catatonic disorder include metabolic disorders  Hepatic encephalopathy  Hypo and hyperthyroidism  Hypo and hypoadrenalism Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722  Vitamin B12 deficiency o Neurological conditions  Epilepsy  Tumors  Cerebrovascular disease  Head trauma  Encephalitis o Hyoerpahia is an excessive sensitivity to touch 61) The nurse expects a client experiencing prodromal symptoms of schizophrenia to demonstrate which of the following?  Significant deterioration o An individual begins to show signs of significant deterioration in premorbid functioning during the prodromal phase of schizophrenia 62) What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal?  Risk for injury R/T central nervous system stimulation o Alcohol withdrawal may include the following symptoms  Course tremors of hands, tongue, or eyelids  Nausea or vomiting  Malaise or weakness  Tachycardia  Sweating  Hypertension  Anxiety Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722  Depressed mood  Hallucinations  Headache  Insomnia 63) A nurse evaluates a client’s patient-controlled analgesia (PCA) pump and notices 100 attempts within 30-minute period. Which is the best rationale for assessing this client for substance addiction?  Clients who are addicted to alcohol or benzodiazepines may develop cross tolerance to analgesics and require increased doses to achieve effective pain control 64) On the first day of a client’s alcohol detoxification, which nursing intervention should take priority?  Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol o Administration of medication to prevent alcohol withdrawal takes priority due to client safety o Chlordiazepoxide is a benzo and is often used for substitution therapy in alcohol withdrawal to reduce life-threatening complications 65) Which client statement indicates a knowledge deficit related to a substance use disorder?  “Marijuana is like smoking cigarettes. Everyone does it. Its essentially harmless.” 66) A lonely, depressed divorcee has been self-medicating with small amounts of cocaine for the past year. Which term should a nurse use to best describe this individual's situation?  Psychological addiction o Client is considered to be psychologically addicted to a substance when there is an overwhelming desire to use a drug in order to produce pleasure or avoid discomfort Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 67) Which term should a nurse use to describe the administration of a central nervous system depressant during the substance induced disorder of alcohol withdrawal?  Substitution therapy o Various medications have been used to decrease the intensity of symptoms in an individual who is withdrawing from, or who is experiencing the effects of excessive use of, alcohol and other drugs. This is called substitution therapy and may be required to reduce life threatening effects of alcohol withdrawal 68) A client diagnosed with chronic alcohol addiction is being discharged from an inpatient treatment facility after detoxification. Which client outcome, related to AA, would be most appropriate for a nurse to discuss with the client during discharge teaching?  After discharge, the client will immediately attend 90 AA meetings in 90 days o AA is a major self-help organization for the treatment of alcohol addiction. It accepts alcohol addiction as an illness and promotes total abstinence as the only cure 69) A client with a history of heavy alcohol use is brought to an emergency department by family members who state that the client has had nothing to drink in the last 48 hours. When the nurse reports to the ED physician, which client symptoms should be the nurse’s first priority?  Blood pressure of 180/100 mm/Hg o Complications associated with alcohol withdrawals syndrome may progress to alcohol withdrawal delirium in about the second- or third day following cessation of prolonged alcohol abuse 70) Which client statement demonstrates positive progress toward recovery from a substance use disorder?  “Taking those pills got out of control. It cost me my job, marriage, and children.” o A client who takes responsibility for the consequences of substance use disorder or substance addiction is making positive progress toward recovery. This would indicate completion of the first step of a 12-step program. Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 71) A nurse holds the hand of a client who is withdrawing from alcohol. What is the nurse’s rationale for this intervention?  To assess for fine tremors o Fine tremors secondary to alcohol withdrawal o Alcohol withdrawal can also cause  Headache  Insomnia  Transient hallucinations  Depression  Irritability  Anxiety  Hypertension  Sweating  Tachycardia  Malaise  Coarse tremors 72) A client presents with symptoms of alcohol withdrawal and states “I haven’t eaten in three days.” A nurse’s assessment reveals BP 170/100 mm/Hg, Pulse 110, RR 28 and Temp 97 F with dry mucous membranes and poor skin turgor. What should be the priority of nursing diagnosis?  Imbalances nutrition: less than body requirements o The client is exhibiting signs and symptoms of malnutrition, as well as alcohol withdrawal. 73) A client’s wife has been making excuses for her alcoholic husband’s work absences. In family therapy she states, “His problems at work ae my fault.” Which is the appropriate nursing response?  “Your husband needs to deal with the consequences of his drinking.” o The client’s wife may be in denial and enabling the husband’s behavior Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 o Codependency is a typical behavior or spouses of alcoholics. Partners of clients with substance addiction must comes to realize that the only behavior they can control is their own 74) Which medication orders should a nurse anticipate for a client who has a history of benzodiazepine withdrawal delirium?  Chlordiazepoxide (Librium) and phenytoin (Dilantin) o It is common for long lasting benzos to be prescribed for substitution therapy 75) A nurse is reviewing the stat laboratory data of a client in the emergency department. At what minimum blood alcohol level should a nurse expect intoxication to occur?  100mg/dL o Intoxication usually occurs between 100 and 200 mg/dL o Death has been reported at concentrations ranging from 400 to 700 mg/dL 76) A client diagnosed with major depressive disorder and substance use disorder has an altered sleep pattern and demands a psychiatrist to prescribe a sedative. Which rationale explains why a nurse should encourage the client to first try nonpharmacological interventions?  Sedative hypnotics are potentially addictive, and their effectiveness will be compromised owing to tolerance o The effects of central nervous system depressants are addictive with one another, capable of producing physiological and psychological addiction 77) A client diagnosed with gambling disorder asks the nurse about medications that may be ordered by the client’s physician to treat this disorder. The nurse would give the client information on which medication?  Lithium carbonate (Lithobid) and sertraline (Zoloft) o These meds have been used successfully in the treatment of pathological gambling as a form of obsessive-compulsive disorder Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 78) A nurse is assessing a pathological gambler. What would differentiate this client’s behavior of a non-pathological gambler?  Pathological gamblers have abnormal levels of neurotransmitters, whereas non-pathological gamblers do not o There is a correlation between pathological gambling and abnormalities in the serotonergic, noradrenergic, and dopaminergic neurotransmitter system. This is not the case with non-pathological gambling 79) A nursing instructor is teaching about the impaired nurse and the consequences of this impairment. Which statement by a student indicates that further instruction is needed?  “All state boards of nursing have passed laws that, under any circumstances, do not allow impaired nurses to practice.” o Several state boards of nursing have passed diversionary laws that allow impaired nurses to avoid disciplinary action by agreeing to seek treatment. This may require successful completion of inpatient, outpatient, group, or individual counseling treatment programs; evidence of regular attendance at nurse support groups or 12-step program; random negative drug screens; and employment or volunteer activities during the suspension period 80) Which of the following nursing statements exemplify the cognitive process that must be completed by a nurse prior to caring for clients diagnosed with a substance-related disorder? Select all that apply  “I am easily manipulated and need to work on this prior to caring for these clients.” o Nurse should complete a cognitive process prior to caring for clients diagnosed with substance abuse disorders  “Because of my father’s alcoholism, I need to examine my attitude toward these clients.” Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 o Its important for nurses to identify potential areas of need within their own cognitions that may affect their relationships with clients diagnosed with this problem  “I need to review the side effects of the medication used in the withdrawal process.”  “I’ll need to set boundaries to maintain a therapeutic relationship.” o Determining the need to set boundaries is an example of a cognitive process that must be completed by a nurse prior to client care  “I need to take charge when dealing with clients diagnosed with substance disorders.” 81) A nursing instructor is teaching nursing students about cirrhosis of the liver. Which of the following statements about the complications of hepatic encephalopathy should indicate to the nursing instructor that further teaching is needed? Select all that apply  “A client rich in protein will promote hepatic healing” o The treatment of hepatic encephalopathy requires abstention from alcohol and temporary elimination of protein from the diet  “This condition results from a rise in serum ammonia, leading to impaired mental functioning.”  “In this condition, an excessive amount of serous fluid accumulates in the abdominal cavity.”  “Neomycin and lactulose are used in the treatment of this condition”  “This condition is caused by the inability of the liver to convert ammonia to urea” 82) A clinic nurse is about to meet with a client diagnosed with a gambling disorder. Which of the following symptoms and/or behaviors is the nurse likely to assess? Select all that apply  Stressful situations precipitate gambling behaviors  Anxiety and restlessness can only be relieved by placing a bet  Winning brings about feelings of sexual satisfaction  Gambling is used as a coping strategy Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722  Losing at gambling meets the client’s need for self- punishment 83) A nursing supervisor is about to meet with a staff nurse suspected of diverting client medications. Which of the following assessment data would lead the supervisor suspect that the staff nurse is impaired? Select all that apply  The staff nurse is frequently absent from work  The staff nurse experiences mood swings  The staff nurse makes elaborate excuses for behavior  The staff nurse frequently uses the restroom  The staff nurse has a flushed face 84) A nursing supervisor is offering an impaired staff member information regarding employee assistance programs. Which of the following facts should the supervisor include? Select all that apply  a hot line number will be available in order to call for peer assistance  a verbal contract detailing the method of treatment will be initiated prior to the program  peer support is provided through regular contact with the impaired nurse  contact to provide peer support will last one year  one of the program goals is to intervene early in order to reduce hazards to clients 85) A nursing counselor is about to meet with a client suffering from codependency. Which of the following data would further support the assessment of this dysfunctional behavior? Select all that apply  the client has a long history of focusing thoughts and behaviors on other people  the client, as a child, experienced overindulgent and overprotective parents Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722  the client is a people pleaser and does almost anything to gain approval  the client exhibits helpless behaviors but actually feels very competent  the client can achieve a sense of control only through fulfilling the needs of others 86) Order the following stages of codependents recovery process to Cermak  The survival stage o Must begin to let go of denial  The Reidentification stage o The individual begins to glimpse their true selves  The core issues stage o The individual must face the fact that relationship cannot be managed by force or will  The reintegration stage o Control is achieved through self-discipline and self confidence 87) The concept of ___________ arose out of a need to define the dysfunctional behaviors that are evident among members of the family and chemically dependent person  Codependency o The term has been expanded to include all individuals from families that harbor secrets of physical or emotional abuse, other cruelties, or pathological conditions 88) Which of the following defense mechanisms may be observed in a patient diagnosed with obsessive-compulsive disorder?  Undoing 89) A client is admitted for alcohol detoxification. During detoxification, which symptoms should the nurse expect to assess?  Gross tremors, delirium, hyperactivity, and hypertension Downloaded by James Jonez ([email protected])  lOMoARcPSD|40142722 90) A nurse is caring for a client who has been prescribed disulfiram (Antabuse) as a deterrent to alcohol relapse. Which information should the nurse include when teaching the client about this medication?  Reactions to combining Antabuse with alcohol can occur for as long as 2 weeks after stopping the drug Downloaded by James Jonez ([email protected])