Exam 3 Flashcards
1
Q
Two most common mental health disorders in the United States
A
Depression and anxiety
2
Q
What is an isolated panic attack and what percentage of the population does it affect?
A
1 time event panic attack and affects 22.7 % of population
3
Q
Risk factors for Anxiety disorders include (3)
A
Family history, substance use disorders, and severe stressors
4
Q
True or false- Anxiety does have a familial predisposition and is estimated to be 48% hereditary
A
True
5
Q
Levels of Anxiety
A
Mild, moderate, severe, panic.
Mild is normal and beneficial while moderate becomes negatively impactful- selective attention, can refocus if directed by another person
Severe- Unable to be redirected
Panic- Focus is on scattered details and distorted
6
Q
Panic Attack have an ICD code?
A
No
7
Q
What is a panic attack
A
Discrete period of fear/discomfort. Symptoms develop abruptly and peak within 10 minutes of onset and generally last 30 minutes. 4 of the following are present
- sweating, trembling, chest pain, feeling of choking, palpitations, nausea, etc.
8
Q
What is derealization?
A
Mental state where you feel detached from surroundings
9
Q
Depersonalization definition
A
Detached from ones body or mental processes
10
Q
Panic Attack Nursing Care- Body systems affected, symptoms similar to, and Labs run
A
Systems affected (GI, Cardiac, Respiratory)
Conduct EKG, check troponin levels
Panic attack S/S appear as MI or ACS so you need to rule out medical before focus on mental
11
Q
Panic Disorder
A
Recurrent Panic attacks
At least one of the attacks have been followed by 1 month or more of the following
- Persistent concern about having a panic attack
- Worry about implication of the attack and its consequences
- Significant change in behavior related to the attacks (withdrawal, isolation)
12
Q
Agoraphobia
A
Client exhibits extreme fear of certain places (a bridge or the outdoors) where client feels vulnerable or unsafe
13
Q
Sometimes companion is utilized for those with agoraphobia- true or false
A
True
14
Q
Neurotransmitters involved with those who have anxiety
A
Serotonin, GABA, and norepinephrine
15
Q
Acrophobia
A
Fear of heights
16
Q
Ailurophobia
A
The fear of cats
17
Q
Algophobia
A
Fear of pain
18
Q
Arachnophobia
A
Fear of spiders
19
Q
Brontophobia
A
Fear of thunder
20
Q
Cynophobia
A
the fear of dogs
21
Q
Microphobia
A
the fear of germs
22
Q
Nyctophobia
A
the fear of night or dark places
23
Q
Ophidiophobia
A
the fear of snakes
24
Q
Xenophobia
A
the fear of strangers
25
Social phobia
Client reports difficulty performing or speaking in front of others or participating in social situations due to an excessive fear of embarrassment or poor performance
26
Generalized anxiety disorder defined as
The client exhibits excessive worry that is uncontrollable for the majority of days over at least 6 months time- Can affect sleep, cause depression, difficult to concentrate, common to feel hopeless
27
Separation anxiety
Fearful and anxious about separation from attachment figures that is developmentally inappropriate. Common in children and pets
28
Selective mutism
Consistent failure to speak in social situations where there is an expectation to speak
29
Substance/medical induced anxiety
Anxiety due to excessive substance use, substance withdrawal and medication use (bronchodilators, amphetamines, steroids, caffeine, cocaine, stimulants)
30
Dr. Patricia Benner- theory for patients
Build treatment for patient around their own natural routine and sleep schedule in order to reinforce compliance in the client. Don't put them on the hospital schedule if they are used to something else.
31
What is first line treatment for anxiety disorders
Cognitive Behavioral Therapy. Uses cognitive reframing to help the client identify negative thoughts that produce anxiety, examine the cause, and develop supportive ideas that replace negative self-talk.
32
Psychosocial Intervention for Anxiety
Distractive behavior to aid and distract during the trigger of anxiety
33
Exposure Therapy for anxiety
Prolonged exposure to stimulus and aids in cognitive processing
34
Best treatment for Interventions of anxiety include ______ and ______.
Therapy and psychopharmacology
35
SSRIs and SNRI's take to work for anxiety and depression
Typically 2-6 weeks
36
Benzodiazepines utilized for
Fast acting, prescribed in conjunction with SSRIs for acute anxiety. They can help with alcohol withdrawal, very addictive, enhance effects of GABA, used an adjunct medication to help alleviate the worsening of symptoms on medications
37
Most common SNRI prescribed for anxiety
Venlafaxine
38
What will happen if you stop taking benzodiazepines abruptly
Rebound anxiety and panic, taper off over 2-4 weeks
39
3 Drugs for long-term Benzo treatment
Xanax, Alprazolam, and Clonazepam (Klonopin)
40
A nurse observes a client who has OCD repeatedly applying, removing, and then reapplying makeup. The nurse identifies that repetitive behavior in a client who has OCD is due to which of the following underlying reasons?
A. Narcissistic behavior
B. Fear of rejection from staff
C. Attempt to reduce anxiety
D. Adverse effect of antidepressant medication
C.
41
A nurse is caring for a client who experiencing a panic attack. Which of the following actions should the nurse take?
A. Discuss new relaxation techniques
B. Show the client how to change the behavior
C. Distract the client with a television show
D. Stay with the client and remain quiet
D. Quietly remain with client to promote safety and reassurance. TV could increase anxiety
42
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A nurse is assessing a client who has GAD, which of the following findings should the nurse expect- select all that apply
A. Excessive worry for 6 months
B. Impulsive decision making
C. Delayed reflexes
D. Restlessness
E. Sleep disturbance
```
A, D, E
| Muscle tension and procrastination are not symptoms for this individual
43
Nurse is planning care for a client who has body dysmorphic disorder. Which of the following actions should the nurse plan to take first?
A. Assess the clients risk for self harm
B. Instill hope for positive outcomes
C. Encourage client to participate in group therapy sessions
D. Assist the client to participate in treatment decisions
A. Safety is key, biggest priority for this patient
44
A nurse is caring for a client who has GAD and is experiencing severe anxiety. Which of the following statements actions should the nurse make?
A. Tell me about how you are feeling right now
B. You should focus on the positive things in your life to decrease your anxiety
C. Why do you believe you are experiencing this anxiety
D. Lets discuss the medications your provider is prescribing to decrease your anxiety
A
45
Peak illness onset for OCD
Early adolescence to early adulthood (13-early 20s)
46
Adult women who have OCD are more likely to experience OCD related to ___ and mens are more likely to have ______ obsessions
Contamination, Blasphemous (sexual, religion, some violent)
47
Are there genetic and biological factors to OCD?
Yes genetic with link to first degree relatives and no neurotransmitter is identified.
48
Comorbidity with OCD
Anxiety disorders, mood disorders, eating, substance use, etc.
49
OCD is what
Recurrent obsessions or compulsions - not simply obsessive worries about real life problems, individual is aware of how crazy they may appear to others, person attempts to ignore or neutralize them with other thoughts or actions
50
Difference between adults and children with OCD
Adults are aware of how excessive the obsessions or compulsions are while children are not
51
What percentage of patients will have OCD paired with eating disorder
10-17%
52
Big nursing diagnosis for OCD patients
Risk for impaired skin integrity, excessive hand washing or cleaning rituals
53
Interventions for OCD individuals
Maintenance of skin integrity- tepid hand-washing, moisturizing soaps, hand creams, time scheduled hand-washing.
and relaxation techniques
54
SSRIs and Tricyclics used for patients with OCD?
Yes, SSRIS before Tricyclics as less side effects
55
SSRIs used for OCD
Fluoxetine, Fluvoxamine, Sertraline, Paroxetine (10-12 weeks before desirable effects)
56
TCA used for OCD
Clomipramine
57
OCD scale used
Yale-Brown OCD scale, self rating scale, used before and after treatment to gauge the relief
58
Interventions for Therapy (3) in OCD individuals
Exposure and Response Prevention- Expose then develop healthier response
Cognitive Restructuring- Reduce anxiety by restructuring rituals
Acceptance and commitment- Accept obsessions at present, try not to perform rituals- stop them
59
Trichotillomania
Pulling out hair, onset prior to 5 years of age, 1-2% of population
60
What is ACT
Acceptance and Commitment Therapy, Commit to alternate relief techniques
61
Body Dysmorphic disorder
Client is preoccupied with certain defects or flaws in appearance. Practices obsessive mirror checking or covering up of the flaw in order to gain control over the anxiety felt. Generally the flaw is minor and unnoticed by others
62
Does Body Dysmorphic disorder occur in women just as much in men
Yes 2.4%
63
Hoarding disorder Intervention
Cognitive Behavioral Therapy
64
True or false, risk for depression and suicidal ideation in individuals with Body dysmorphic disorder is high
True
65
Onset to remission for women compared to men in traumatic stress disorders
4 years for women compared to 1 year in men
66
Risk factors for PTSD
Prior diagnosis of Acute stress disorder, number and frequency of adverse childhood events. environmental factors (natural disasters and man-made)
67
Acute Stress Disorder diagnosed
Must have symptoms for at least 3 days and up to 1 month after the exposure, experienced directly or indirectly, witnessed or confronted with an event involving actual or threatened death or serious injury or threat to the physical integrity of self or others
Doest not include exposure through e-media, television, movies or pictures unless work realted
68
True or false, Acute stress disorder left unhandled can lead to PTSD
True
69
Avoidance in PTSD is indicated by 3 or more of the following
- Avoids thoughts, feelings, or convos associated with the trauma
- Anhedonia
- Feelings of detachment
- Persistent negative emotional state
- Inability to experience positive emotions
70
PTSD Reactivity examples
- Difficulty falling asleep
- Anger outbursts
- Hyper vigilance
- reckless or self-destructive behavior
- difficulty concentrating
71
Most common SSRIs prescribed for PTSD
Sertraline (Zoloft) and paroxetine (Paxil)
72
A nurse working on an acute mental health unit is caring for a client who has PTSD, which of the following findings should the nurse expect- select all that apply
A. Difficulty concentrating on tasks
B. Obsessive need to talk about the event
C. Negative self image
D. Recurring nightmares
E. Diminished reflexes
A, C, D,
| Client doesn't want to talk about disorder and is easily startled because of hyper vigilance.
73
A nurse is involved in a serious and prolonged mass causality incident in the ER. Which of the following strategies should the nurse use to help prevent developing a trauma related disorder? Select all that apply
A. Avoid thinking about the incident when it is over
B. Take breaks during the incident for food and water
C. Debrief with others following the incident
D. Avoid displays of emotion in the days following the incident
E. Take advantage of offered counseling
B, C, E
74
A nurse is collecting an admission history for a client who has acute stress disorder. Which of the following client behaviors should the nurse expect
A. The client remembers many details about the traumatic incident
B. the client expresses heightened elation about what is happening
C. The client remembers first noticing manifestations of the disorder 6 weeks after the traumatic incident occurred
D. The client expresses a sense of unreality about the traumatic incident
D- Dissociative manifestations regarding the event, which includes a sense of unreality is common in those with ASD
75
A nurse is caring for a client who has a derealization disorder. Which of the following findings should the nurse identify as an indication of derealization?
A. The client describes a feeling of floating above ground
B. The client has suspicions of being targeted in order to be killed and robbed
C. The client states that the furniture in the room seems small and far away
D. The client cannot recall anything that happened during the past 2 weeks
C This is an example of derealization in relation to surroundings. Feeling body floating is example of depersonalization. Cant remember past 2 weeks is amnesia, being targeted for robbery is a paranoid delusion
76
A nurse in an acute mental health facility is planning care for a client who has dissociative fugue. Which of the following interventions should the nurse add to the plan of care?
A. Teach the client to recognize how stress brings on a personality change in the client
B. Repeatedly present the client with information about past events
C. Make decisions for the client regarding routine daily activities
D. Work with the client on grounding techniques
D.
77
What is codependence
Peer pressure of abusing with another person.
78
Is there a genetic component linked to substance use abuse
Yes, relation to 1st degree relative but no special gene identified
79
Neurotransmitter related to substance use abuse
Dopamine
80
Substance use abuse, related to what part of brain
Pleasure center- limbic system
81
What is the lethal dose of alcohol
.4%
82
Substance use definition
Over-indulgence/becoming dependent on addictive substance
83
Tolerance definition
Gradual decrease in the action of a substance at a given amount in the blood. Tolerance increases as you take more
84
Dependence definition
Psych and physically dependent on substance
85
Detoxification
Safely and effectively getting someone off drug, normally under medical supervision
86
Withdrawal definition
adverse S/S when off drug or using less of, both psychological and physical
87
Overdose definition
Too much taken either intentionally or accidentally
88
Codependence definiiton
Relationship, inadvertently need partner to abuse with them
89
Enabling definition
Protecting another person from experiencing full affects of their behavior
90
What is chronic use- wernicke korsakoff Syndrome
chronic memory disorder caused by a severe deficiency of thiamine (Vitamin B-12), can cause psychosis and other long term health problems
91
Alcohol use disorder has criteria in the DSM-5 (true or false)
True
92
What is the purpose of gastric lavage
Induce vomiting in order to prevent unabsorbed alcohol from being absorbed into blood stream
93
What percentage of patients admitted to med surge are at risk for alcohol withdrawal
40%
94
How long does it take for alcohol withdrawal symptoms to appear in a patient? (hours)
6-72 hours after the sudden cessation or decrease in alcohol , depends on the severity of addiction
95
How many hours does it take for delirium tremors, seizures and convulsions to occur in patient undergoing withdrawal
Usually within 48 hours
96
Symptom peak of withdrawal and how long it takes to fully withdrawal, when symptoms of withdrawal start
Feel withdrawal 6-72 hours after stopping alcohol, symptoms peak in day 2. May take 3-5 days to withdraw, yet can take up to 1-2 weeks
97
Is withdrawal life threatening
Yes can be life threatening if not properly managed by healthcare professionals
98
Medication treatment for alcohol withdrawals
- Benzodiazepines (suppress withdrawal symptoms) 1st line option for symptom management- fixed dosing round the clock or titrated based on the CIWA-Ar score
- Banana Bag, thiamine, folic acid, magnesium and multivitamin in 1 liter of NS or dextrose in water solution
- Antiemetic medication
- Blood glucose monitoring due to malnutrition
99
Medication Disulfiram (Antabuse), Patient teaching
deters drinking, causes severe reaction (flushing, N/V, headache) if alcohol is consumed.
**Be sure to educate patient to read all labels of products to see if they contain any alcohol**
100
How long will patient feel affects of antabuse in their system?
Even after discontinuation, could take up to 2 weeks to clear system so could still have reaction to any alcohol products
101
Purpose of Naltrexone (ReVia)
Reduces cravings, usually take daily for 3 months
| Also an opioid antagonist, so can use to deter cravings of opioids
102
Acamprosate (Campral)
Reduces cravings, take 2 tabs, 3 times a day. Side effects are diarrhea, N/V and pruritus, should not be taken if person has renal problems
103
What scale do we utilize assessing the risk of someone having withdrawal
CAGE an AUDIT-C
Audit C has 10 items while cage is the 4 token questions to assess abuse level
CAGE- 2 yes answers for male will be at risk for withdrawal while 1 for female will indicate withdrawal
104
Purpose of CIWA-Ar
Determine the severity of withdrawal
105
Barbiturates
Group of drugs called sedative hypnotics. Lethal in overdose, can cause respiratory arrest, cardiac arrest, come and death
106
How to treat patient with severe alcohol intoxication
Assess ABCs, assess for injury, assess blood glucose, stabilize VS, HOB elevated to prevent aspiration, left side recovery position, allow the person to "sleep it off" yet monitor closely
107
Can you overdose on benzodiazepines?
valium and Xanax are most frequently abused drug in this class, rarely fatal in overdose! Patient can become very lethargic and confused
108
How to treat person who took two many Benzodiazepines
Gastric lavage and activated charcoal
109
Chlorpromazine (Thorazine)
1st Generation, treats positive symptoms of psychosis
110
Cocaine use can lead to what condition
Acute coronary syndrome/ MI
111
What is considered the gateway drug to heroine
hydrocodone
112
What is COIN
Committee on Impaired Nurses
113
What is the focus on Comprehensive treatment for drug abuse
Treat root of addiction, Medications, Coping mechanisms
| Treat basically all aspects
114
Opioid Withdrawal peaks in _____ days and subsides in _____ days or longer
2-3 days, and subsides in 5-7 days
115
What is COWS
Clinical Opioid WIthdrawal Scale, typically done every 4 hours
116
Methadone use
Used as a replacement for opioids (synthetic heroin) coming off heroin can take months or years, this medication replaces heroin and then you wean off this
117
Levomethadyl (Orlaam)
helps with addiction to pain killers when other treatment options fail. Be careful with this drug as arrhythmias can occur, 12 lead EK recommended
118
Symptoms of Opioid Overdose and treatment
Drowsy, slurred speech, slow respirations, pinpoint pupils (morphine)
Treat with Naloxone (Narcan) give until symptoms improve
May require ventilator support
119
Medications for Hallucination intoxication?
No medication interventions- treat the S/S, treatment is supportive (protect airway, decrease BP, Seizure precautions)
*Could see elevated VS, hyperreflexia, dilated pupils, paranoia, depression, etc.
120
Examples of Hallucinogens
LSD, Ecstasy, Peyote, Mushrooms, K2/Spice
121
Long term effects of inhalants
Neuropathy and memory loss
122
Bodily systems affected by Inhalants
heart, lungs, kidneys, and brain
123
Symptoms of inhalant intoxication
Similar to a drunk person, blurred vision, lack of coordination, dizziness, nystagmus, confusion, etc.
124
Treatment for Inhalant Intoxication
No antidote, supportive care (protect the airway, stabilize VS)
125
Marijuana onset peak duration
less than a minute of inhalation, peaks in 20 minutes, duration of 2-3 hours
126
3 of the 5 states with highest opioid use disorder?
West Virginia, Delaware, Maryland
127
What is the most common substance addiction in the world
Tobacco
128
Nicotine gum directions on educating patient on how to use
Chew gum slowly and intermittently for 30 minutes, ensure patient hasn't eaten or drank anything 15 minutes prior, this is a short term therapy that shouldn't be used for over 6 months
129
Nicotine Lozenge teaching
Will dissolve in mouth over 20-30 minutes, 5 total in 6 hours and no more than 20 in 1 day. do not eat or drink 15 minutes prior
130
Nicotine Patches Education
Apply patch to clean dry skin, dont use for over 16 hours, remove the patch for an MRI, dont double up and have a patch on and consume nicotine at the same time
131
What is the priority for individuals suffering from substance use in the medical realm
Detoxification
132
Areas where personality traits can affect personal life to point of personality disorder diagnosis
Enough traits and affects functional life in
- Social
- Occupational
- Interpersonally (w/ others)
- Intrapersonally (Inside self)
133
What is most common comorbidity diagnosis
Depression and anxiety (PTSD, generalized, panic)
134
DSM-5 generally not diagnosed before age 18? True or false
True, can be with a complete history that describes longitudinal impact of traits, the exception is antisocial personality disorder
135
Cluster A Personality Disorders
(Odd Eccentric) Paranoid, Schizoid, Schizotypal
136
Cluster B
(Dramatic, emotional, erratic behavior) Antisocial, Borderline, Histrionic
137
Cluster C (anxious, fearful)
Avoidant, dependent, obsessive compulsive
138
Paranoid personality disorder
Cluster A, pervasive pattern of distrust and suspiciousness of others (4 or more)
suspicion without basis, reluctance to confide in others, persistent grudges, suspicions of infidelity
139
Schizoid Personality disorder
Cluster A
Pervasive pattern of social detachment and restricted range of affect (4 or more)
lacks desire or enjoyment of close relationships
participates in solitary activities
lacks close friends
little pleasure in activities
emotional coldness (flat affect or detachment)
140
Schizotypal Personality Disorder
```
Cluster A
Social and interpersonal deficits, significant discomfort with close relationships, cognitive and perceptual distortions and odd behavior (five or more)
- Ideas of reference
- odd thinking and speech
- odd beliefs
- magical thinking
- bodily illusions
```
141
What cluster is the most common type of personality disorders
Cluster B
142
Antisocial Personality Disorder
Cluster B
Pattern of disregard or violation of the rights of others (three or more)
- Failure to conform to social norms and lawful behavior
- Impulsivity, failure to plan ahead
- lack of remorse, indifferent, rationalizes behavior
- irritable and aggressive, repeated fighting
- deceitfulness, exploitation of others for profit
143
Psychopaths generally have what type of personality disorder
Antisocial
144
In order to be diagnosed with antisocial personality disorder you must be __ years of age, unless
18, unless there is evidence of a conduct disorder prior to age 15
145
Most common type of personality disorder
Borderline personality disorder
146
Borderline personality disorder
Cluster B
Pattern of instability of interpersonal relationships, self image, affect, and marked impulsivity (5 or more)
- frantic efforts to avoid real life or imagined abandonment
- patterns of unstable and intense interpersonal relationships marked by extremes of idealization and devaluation
- Identity disturbance, persistent, and marked unstable self image
147
What is common with Borderline personality disorder
Recurrent suicidal and/or self harm behaviors- provides emotional release
Generally impulsive in two areas that are self damaging (spending, sex, substance abuse, reckless driving, binge eating).
148
Histrionic Personality Disorder
Cluster B
Pattern of Excessive emotionality and attention seeking (5 or more)
- Uncomfortable not being center of attention
- Inappropriate sexually seductive or provocative behavior
- rapidly shifting and shallow expression of emotion
- Uses physical appearance to draw attention to self
- Believe relationships are more intimate than they really are
149
Narcissistic Personality Disorder
Cluster B
Pattern of grandiosity, needs admiration, and lacks empathy (5 or more)
- Grandiose sense of self importance
- Preoccupation with fantasies of unlimited success, power, brilliance
- Belief that he/she is special or unique, believes can only be understood by those who are also special or of higher status
- strong sense of entitlement
- envious of others or believes others are envious of him or her, haughty behaviors, aloof
150
Avoidant Personality Disorder
Cluster C
Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative feedback (4 or more)
- Focuses on criticism or rejection in social situations
- Feelings of inadequacy are inhibiting in new interpersonal situations
- Views self as socially inept, inferior to others
- Unwilling to get involved with others unless certain of being liked
- Avoids new activities for fear of embarrassment
151
Dependent Personality Disorder
Cluster C
Excessive need to be taken care of that leads to submissiveness, clinging behavior, and fears of separation (5 or more)
-Difficulty making everyday decisions without reassurance or advice from others
- Go to excessive lengths to get nurturance from others
- Seeks care and support, strong need to jump into close relationships
- Lack of self confidence in projects and task
- Don't express disagreement for fear of loss of support or approval
152
Dependent Personality Disorder is common for what patients
Patients who are victims of domestic abuse
153
OCD Personality disorder
Cluster C
Pattern of orderliness, perfectionism, and metal and interpersonal control at the expense of flexibility, openness, and efficiency (4 or more)
- Rigid and stubborn
- Miserly spending, money is hoarded for future catastrophies
- unable to discard worn-out worthless objects
- excessively devoted to work and productivity
- Preoccupation with rules, details, lists, order, organization, and schedules, etc.
154
What is dialectal behavior therapy
Is a type of cognitive behavioral therapy but it is focused on talking therapy. The goal is to help you understand and accept your difficult feelings while learning skills to manage them
155
Psychopharmacology in Personality disorders
No specific meds for personality disorders, medications may be used to treat symptoms associated with personality disorders
- Antidepressant meds
- mood stabilizing meds for aggression
- anti anxiety meds
- anti-psychotic meds
156
A nurse manager is discussing the care of a client who has a personality disorder with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?
A. I can promote my clients sense of control by establishing a schedule
B. I should encourage clients who have a schizoid personality disorder to increase socialization
C. I should practice limit-setting to help prevent client manipulation
D. I should implement assertiveness training with clients who have antisocial personality disorder
C
157
A nurse is caring for a client who had avoidant personality disorder. Which of the following statements is expected from a client who has this type of personality disorder?
A. Im scared you're going to leave me
B. Ill go to group therapy if you let me smoke
C. I need to feel that everyone admires me
D. I sometimes feel better if I cut myself
A. Avoidant personality often have fear of abandonment
The manipulation in B would be expected from someone who has antisocial personality disorder, C relates to narcissistic personality disorder, Risk for self injury is related to someone who has borderline personality disorder
158
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A nurse is caring for a client who has borderline personality disorder. The client says, "The nurse on the evening shift is always nice, you are the meanest nurse ever!" The nurse should recognize the clients statement as example of which of the following defense mechanisms?
A. Regression
B. Splitting
C. Undoing
D. Identification
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B. A patient cannot see both good and bad qualities of an individual. The patient will either see them as good or bad
159
A nurse is assisting with a court-ordered evaluation of a client who has antisocial personality disorder. Which of the following findings should the nurse expect? Select all that apply
A. Demonstrates extreme anxiety when placed in a social situation
B. Often engages in magical thinking
C. Attempts to convince other clients to relinquish their belongings
D. Becomes agitated if personal area is not neat and orderly
E. Blames others for personal past and current problems
C and E
| Exploitation, manipulation, and failure to accept responsibility for these individuals
160
A charge nurse is preparing a staff education session on personality disorders. Which of the following personality characteristics associated with all of the personality disorders should the charge nurse include in the teaching? Select all that apply
A. Difficulty in getting along with other members of the group
B. Belief in the ability to become invisible during times of stress
C. Display of defense mechanisms when routines are changed
D. Claiming to be more important than other persons
E. Difficulty understanding why it is inappropriate to have a personal relationship with staff.
A, C, E
161
A nurse is planning a staff education program on substance use in older adults. Which of the following info should the nurse include in the presentation
A. Older adults require higher doses of a substance to achieve a desired effect
B. Older adults commonly use rationalization to cope with a substance use disorder
C. Older adults are at an increased risk for substance use following retirement
D. Older adults develop substance use to mask manifestations of dementia
C
162
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A nurse is assessing a client who has alcohol use disorder and is experiencing withdrawal. Which of the following findings should the nurse expect? (select all that apply)
A. Bradycardia
B. Fine tremors of both hands
C. Hypotension
D. Vomiting
E. Restlessness
```
B, D, E
163
A nurse is planning care for a client experiencing benzo withdrawal, which of the following interventions should the nurse identify as the priority?
A. Orient the client frequently to time, place, person
B. Offer fluids and nourishing diet as tolerated
C. Implement seizure precautions
D. Encourage participation in group therapy sessions
C
164
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A nurse is caring for a client who has alcohol use disorder. The client is no longer experiencing withdrawal manifestations. Which of the following medications should the nurse anticipate administering to assist the client with maintaining abstinence from alcohol.
A. Chlordiazepoxide
B. Bupropion
C. Disulfiram
D. Carbamazepine
```
C
A- acute alcohol withdrawal rather than to maintain abstinence from alcohol
B- Nicotine withdrawal
D- acute alcohol withdrawal
165
A nurse is providing teaching to the family of a client who has a substance use disorder. Which of the following statements by a family member indicates an understanding of the teaching? Select all that apply
A. We need to understand that our sibling is responsible for their disorder
B. Eliminating codependent behavior will promote recovery
C. Our sibling should participate in al-anon group to assist with recover
D. The primary goal of treatment is abstinence from substance abuse
E. Our siblings need to discuss personal feelings about substance use to help with recovery
B, D, E
| Patients are not responsible for disease only responsible for recovery
166
Typical age to begin dieting
8 years old
167
What percentage of teens exercise in order to improve their shape or lose weight?
%50
168
Anorexia
Without appetite
169
Bulimia
Derived from cow- eating then regurgitation
170
3 types of eating disorders in DSM 5
Anorexia, Bulimia, and binge eating disorder
171
Anorexia Nervosa has a comorbidity often with
OCD
172
Body weight of anorexia nervosa patient
less than 85% of that expected for height, gender, age etc
173
Psychological problems with someone who has anorexia nervosa
intense fear of gaining weight or becoming fat
disturbance in which the way body weight or shape is viewed
Denial of low body weight and consequences
174
Two types of behaviors of anorexia nervosa
restricting and binge eating/purging
175
Binge eating/purging anorexia patient problems
Don't understand negative health consequences
Increased impulsivity
More likely to abuse drugs, alcohol, and nicotine
176
Onset of anorexia often associated with
life stressor (puberty, going off to college)
177
Bulimia definition
Recurrent episodes of binge eating, lack of control to stop eating, self induced vomiting, misuse of laxatives, diuretics etc
178
Two types of Bulimia
Purging and non-purging
179
Purging occurence
1x a week for 3 month occurrence is common
180
True or false patients with anorexia deny any abnormal eating behavior, turn away food in order to cope and are preoccupied with losing more weight
true
181
True or false, bulimia patient recognize abnormal eating behavior and use food in order to cope, Preoccupied with attaining an ideal but often unrealistic weight
True
182
Binge eating disorder severity is rated by what
The number of binges per week that patient is experiencing
183
Health problems associated with binge eating
Weight gain increase risk for DM, HTN, Cardiovascular conditions
184
Bulimia patients typical BMI
18.5-30%, generally normal or slightly higher
185
Lanugo
Anorexia associated fine, soft hair on face and back that compensate for the loss of fat
186
Russel Sign
Lacerations and calluses on knuckles via the contact of fingers with teeth during self induced vomiting episodes
187
What meds can be used for patients with eating disorders
SSRI's can help patients with eating disorders, 1-3 weeks for initial response and up to 2 months for maximal response
Anti psych meds- second generation can increase appetite
188
Lab abnormalities and health irregularities for purging patients
GI problems, MSK problems, Anemia, Abnormal glucose levels, hypokalemia, hyponatremia, hypochloremia, abnormal thyroid tests
Can also cause period irregularities
Always rule out physical problems before addressing mental issues
189
A nurse is obtaining a nursing history from a client who has a new diagnosis of anorexia nervosa. Which of the following questions should the nurse include in the assessment? Select all that apply
A. What is your relationship like with your family
B. Why do you want to lose weight
C. How would you describe your current eating habits
D. At what weight do you believe you will look better
E. Can you discuss your feelings about your appearance
A, C, E
190
A nurse is caring for an adolescent client who has anorexia nervosa with recent rapid weight loss and a current weight of 90 lbs. Which of the following statements indicates the client is experiencing the cognitive distortion of catastrophizing?
A- the clients perception of their appearance or situation is much worse than their current condition
191
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A nurse is performing an admission assessment of a client who has bulimia nervosa with purging behavior. Which of the following is an expected finding- select all that apply
A. Amenorrhea
B. Hypokalemia
C. yellowing of the skin
D. Slightly elevated body weight
E. Presence of lanugo on the face
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B and D
192
A nurse is planning care for a client who has anorexia nervosa with binge eating and purging behavior. Which of the following actions should the nurse include in the plan of care?
A. Allow the client to select preferred meal times
B. Establish consequences for purging behavior
C. Provide the client with a high-fat diet at the start of treatment
D. Implement one-to-one observation during meal times
D
193
A nurse is caring for a client who has bulimia nervosa and has stopped purging behavior. The client tells the nurse about fears of gaining weight. Which of the following responses should the nurse make?
A. Many clients are concerned about their weight. However, the dietitian will ensure that you don't get too many calories in your diet
B. Instead of worrying about your weight, try to focus on other problems at this time
C. I understand that you have concerns about your weight but first lets talk about your recent accomplishments
D. You are not overweight, and the staff will ensure that you do not gain weight while you are in the hospital. We know that is important to you.
C. Promote positive self image
