EXAM 4 Flashcards
personality disorders are
maladaptive and inflexible - enduring patterns of behavior that deviates from the norm
paranoid disorder nursing intervention 3
Serious, straightforward approach;
teach client to validate ideas before taking action;
involve client in treatment planning
shizoid symptoms 3 and intervention 2
Detached from social relationships;
restricted affect; involved with
things more than people
Improve client’s functioning in the community
schizotypical symptoms 3 and interventions 3
Acute discomfort in relationships;
eccentric behavior
Develop self-care skills;
social skills training
antisocial intervention
Limit setting;
BPD intervention
Promote safety!
narcissic intevrention
Matter-of-fact approach
aviodant intervention
support self esteem
dependent disorder inteventions 3
Foster client’s self-reliance and autonomy; teach
problem-solving and decision-making skills;
OCPD intevrentions 3
change perspective
cog restructure
risk taking
3 steps to limit setting
- State the limit.
- Identify the consequences of exceeding the limit.
- Identify the expected or acceptable behavior.
intoxication
use of a substance that results in maladaptive behavior
withdrawal syndrome
the negative psychological and physical reactions that occur when use of a substance ceases or dramatically decreases.
substance abuse vs dependence
Substance abuse: using a drug in a way that is inconsistent with medical or social norms, and despite negative consequences (problems in social, vocational, or legal areas of a person’s life.
Substance dependence: problems associated with addiction (e.g., tolerance, withdrawal, and unsuccessful attempts to stop using the substance.
10 long term effects of substances
- Cardiac myopathy
- Wernicke encephalopathy
- Korsakoff psychosis
- Pancreatitis
- Esophagitis
- Hepatitis
- Cirrhosis
- Leukopenia
- Thrombocytopenia
- Ascites
4 classes of cns depressants
CNS depressants:
Benzodiazepines, barbiturates, nonbarbiturate hypnotics, anxiolytics
alcohol intoxication
Slurred speech, unsteady gait, ↓coordination, ↓attention and concentration, impaired judgment, blackouts
cns depressant intoxication
Drowsiness, ↓anxiety, slurred speech, ↓coordination, unsteady gait, labile mood, impaired attention or memory, lethargy, confusion, stupor, coma (similar to alcohol)
bath salt intoxication
↑energy and agitation; cardiac symptoms (such as racing heart, high blood pressure, and chest pains) and psychiatric symptoms including paranoia, hallucinations, and panic attacks, dehydration, breakdown of skeletal muscle tissue, and kidney failure
opioid intoxication
Initial euphoric feelings, then apathy, lethargy, listlessness, impaired judgment, psychomotor retardation or agitation, constricted pupils, drowsiness, slurred speech, impaired attention and memory
PCP intoxication
belligerence, aggression, impulsivity, unpredictable behavior.
inhalants intoxication
Dizziness, nystagmus, lack of coordination, slurred speech
alcohol withdrawal symptoms
(usually begin 4-12 hrs. after last drink; peak 24-48 hrs.)
Tremors, sweating, ↑pulse and BP, insomnia, anxiety, N&V, agitation, perceptual disturbances, headache, ↓orientation, clouding of sensorium, seizure, death
stimulant withdrawal
Dysphoria, fatigue, vivid and unpleasant dreams, insomnia or hypersomnia,
OPIOID WITHDRAWL
Nausea, vomiting, dysphoria, lacrimation, rhinorrhea, sweating, diarrhea, yawning, fever, insomnia, anxiety, insomnia, dysphoria, anhedonia and drug cravings.
5 tx meds for alc withdrawal
Benzodiazepines (lorazepam) for detox on tapering dosing or symptom-triggered dosing
Disulfiram (antabuse): can be used as a deterrent (makes one sick if alcohol taken)
Naltrexone: reduces alcohol cravings
Thiamine: prevents or treats Wernicke-Korsakoff syndrome
chlordiapoxide
stimulant withdrawal tx
PRN chlorpromazine
inhalant withdrawal tx
Supporting respiratory and cardiac functioning
marijuana facts
Marijuana refers to the dried leaves, flowers, stems, and seeds from the Cannabis sativa or Cannabis indica plant.
The plant contains the mind-altering chemical THC and other related compounds.
People use marijuana by smoking, eating, drinking, or inhaling it.
Smoking and vaping THC-rich extracts from the marijuana plant (a practice called dabbing) is on the rise.
THC overactivates certain brain cell receptors, resulting in effects such as:
altered senses
changes in mood
impaired body movement
difficulty with thinking and problem-solving
impaired memory and learning
Marijuana use can have a wide range of health effects, including:
hallucinations and paranoia
breathing problems
possible harm to a fetus’s brain in pregnant women
The amount of THC in marijuana has been increasing steadily in recent decades, creating more harmful effects in some people.
It’s unlikely that a person will fail a drug test or get high from passive exposure by inhaling secondhand marijuana smoke.
There aren’t any reports of teens and adults dying from using marijuana alone, but marijuana use can cause some very uncomfortable side effects, such as anxiety and paranoia and, in rare cases, extreme psychotic reactions.
Marijuana use can lead to a substance use disorder, which can develop into an addiction in severe cases.
No medications are currently available to treat marijuana use disorder, but behavioral support can be effective.
what is Wernicke-Korsakoff syndrome and how to prevent
braindamage from lack of B1, give thaimine
methadone (dolophine) use
heroin withdrawl
acamprosate use
decrease alco craving
dual diagnosis
tx both at the same time
3 features of somatic symptpm illness
Physical complaints suggest major medical illness
but have no demonstrable organic basis
Psychological factors and conflicts seem important in initiating, exacerbating, maintaining symptoms
Symptoms or magnified health concerns are not under patient’s conscious control
conversion disorder
unexplained sensory or motor deficits associated with psychological factors; typically involves significant functional impairment; “la belle indifference”
malingering vs facticious vs somatic
somatic = non wilful control
Malingering: intentional false or grossly exaggerated symptoms; external incentives as motivation
Factitious disorder: intentional symptoms to gain attention (Munchausen’s syndrome = imposed upon self)
Munchausen’s syndrome by proxy = imposed upon others
Malingering and factitious disorders: willful control of symptoms
focus of tx for somatic
relieving symtpoms and improving quality of life - build rapport
2 reasons its hard to dx children
Lack of abstract cognitive abilities and verbal skills
Constantly changing and developing
ASD
pervasive and usually severe impairment of
Reciprocal social interaction skills (ability to engage in social reciprocity)
Communication problems, and
Restricted stereotypical behavioral patterns.
10 common aSD behaviors
- Doesn’t show interest by pointing to objects or people by 14 months
of age - Doesn’t play pretend games by 18 months of age
- Avoids eye contact
- Prefers to be alone
- Delayed speech and language skills
- Obsessive interests (e.g., gets stuck on an idea)
- Upset by minor changes in routine
- Repeats words or phrases over and over
- Flaps hands, or rocks or spins in a circle; answers are unrelated to
questions - Unusual reactions to sounds, smells, or other sensory experiences
methylphenidate ritalin monitor
monitor apetite supression
disruptive behavior characterized by
Anger
Hostility
Aggression
Key features of, and differences between
Oppositional defiant disorder
Intermittent explosive disorder
Conduct disorder
Children with ODD have limited abilities to make associations between their behavior and the consequences of that behavior both negative and positive.
Enduring pattern of
uncooperative, defiant, disobedient, hostile behavior
toward authority figures
no major antisocial violations- no breaking laws
**conduct = Persistent behavior that violates social norms, rules, laws, and rights of others
-IED = episodes of outbursts
4 conduct disorder interventions
- Decreasing violence and increasing compliance with treatment
- Protect others from client’s aggression and manipulation.
- Set limits for unacceptable behavior.
- Providing client and family education
3 common causes of delirium
physioligcal
infection
drugs
delirium interventions
Promoting patient safety
Managing patient’s confusion:
orienting cues
speaking in low
clear voice
avoiding sensory overload
Promoting sleep, proper nutrition
delirum vs dementia
A patient with dementia experiences changes in his or her level of consciousness.
false
The nurse is providing care for a client who has been diagnosed with antisocial personality disorder. Which outcome should the nurse prioritize when planning this client’s care?
Question 1Select one:
a.
The client will to express anger in an adaptive, nonviolent manner
b.
The client will be free from self-inflicted harm.
c.
The client will use the support system without becoming overly dependent on it.
d.
The client will establish an adequate balance of rest, sleep, and activity.
a
A group of nurses are working with clients with personality disorders. Which technique would be most important for the group to use to effectively provide care? Select all that apply.
a.
Solve the problems of the client.
b.
Employ ongoing communication with team members to remain firm and consistent about expectations for clients.
c.
Understand that behavior changes in clients with personality disorders can occur quickly.
d.
Discuss feelings of anger or frustration with colleagues to help them recognize and cope with their own feelings.
e.
Consider the client to be a personal friend.
d, b,
Avoidant, dependent, and obsessive-compulsive personality disorders are characterized by what?
anxious/fearful behavior
A nurse is assessing a client diagnosed with avoidant personality disorder. Which would the nurse expect to find? Select all that apply.
a.
Detail oriented
b.
Feelings of superiority
c.
Shyness
d.
Perfectionism
e.
Feelings of inadequacy
ce
The nurse is caring for a client with antisocial personality disorder. Which statement is most appropriate for the nurse to make when explaining unit rules and expectations to the client?
Question 9Select one:
a.
“I and other members of the health care team would like you to attend group therapy each day.”
b.
“You’ll be expected to attend group therapy each day.”
c.
“You’ll find your condition will improve much faster if you attend group therapy each day.”
d.
“Please try to attend group therapy each day.”
b
A nurse is reviewing the medical record of a client diagnosed with antisocial personality disorder. The nurse notes that the client has had numerous episodes involving irritability, aggressiveness, and impulsivity and has exhibited callousness toward others. Based on this information, which nursing diagnosis would the nurse identify as a priority?
a.
Risk for self-directed violence
b.
Risk for other-directed violence
c.
Risk for suicide
d.
Risk for self-injury
b
Which personality disorder is characterized by a pervasive pattern of grandiosity, need for admiration, and a lack of empathy?
narcissic
Which client is most likely to be at risk for drug dependence and difficulties with withdrawal?
Question 1Select one:
a.
A client who has recently begun treatment with propranolol for the treatment of social phobia
b.
A client with generalized anxiety disorder who has responded well since beginning treatment with fluoxetine earlier in the year
c.
A woman who has been taking lorazepam for several months after witnessing a traumatic motor vehicle accident
d.
A man whose obsessive–compulsive disorder is being treated long term with paroxetine
b
Which statement about clients with a dual diagnosis is accurate?
Question 3Select one:
a.
Traditional methods of treatment have not been very successful for these clients.
b.
These clients represent a small percentage of hospitalized clients.
c.
Chances for recovery for clients with a dual diagnosis are better than average.
d.
Addictions and mental disorders should be treated separately.
a
Which are effects of alcohol withdrawal syndrome? Select all that apply.
Question 4Select one or more:
a.
Increased pulse
b.
Seizures
c.
Decreased blood pressure
d.
Delirium tremens
e.
Hand tremors
abde
A client admitted for acute alcohol intoxication begins to experience mild sweating, tachycardia, fever, and nausea and vomiting. Which of the following would be the drug treatment of choice?
chlordiazepoxide
A group of nursing students is reviewing information about nutritional supplementation used during alcohol detoxification. The students demonstrate the need for additional review when they identify which of the following as being used?
acamprosate
ciwa use
identify severity of alc symptoms
Which medication is used to prevent dangerous alcohol withdrawal symptoms?
lorzepam
A client with opioid addiction is prescribed methadone maintenance therapy. When explaining this treatment to the client, which of the following would the nurse need to keep in mind?
The drug helps to satisfy the craving for the opioid
Which term describes a situation that occurs when very small amounts of alcohol intoxicates the person after continued heavy drinking?
tolerance break
A client reports drinking one to two drinks when drinking behavior first began. Now the client reports drinking at least six drinks with every episode in order to “have a good time.” Which term would best describe this phenomenon?
tolerance
The client asks the nurse, “What will happen if I drink while taking disulfiram?” What should be the nurse’s reply?
Question 23Select one:
a.
“You will experience a severe reaction, including a throbbing headache and vomiting.”
b.
“Disulfiram will reverse the effects of alcohol.”
c.
“You will not get any effect from the alcohol you drink.”
d.
“You will not want to drink while taking disulfiram. It reduces the cravings.”
a
The nurse is assessing a client with bulimia nervosa. Which symptoms would the nurse expect to find? Select all that apply.
Question 1Select one or more:
a.
Hypotension
b.
Metabolic alkalosis
c.
Normal weight for height
d.
Dental erosion
e.
Cold intolerance
bcd
Which technique is a type of cognitive behavioral therapy implemented for bulimic clients?
self monitoring
Which are appropriate long-term treatment outcomes for clients who have somatic symptom illness? Select all that apply.
Question 1Select one or more:
a.
The client will verbally express emotional feelings.
b.
The client will identify the relationship between stress and physical symptoms.
c.
The client will assume responsibility for self-care activities.
d.
The client will learn to vary his or her schedule.
e.
The client will demonstrate alternative ways to deal with stress, anxiety, and other feelings.
cbae
When describing the major difference between somatic symptom disorder and factitious disorders, which would the nurse include?
Question 3Select one:
a.
In somatic symptom disorder, clients are not consciously aware that needs are being met through physical complaints.
b.
In factitious disorders, clients are unaware that their symptoms are not real.
c.
In somatic symptom disorder, clients consciously seek attention.
d.
Factitious disorders respond much more readily to psychopharmacologic treatment than does somatic symptom disorder.
a
The client presented to the emergency department with a report of chest pain. The nurse performs a thorough physical examination for this client, who has a history of a somatic symptom illness. Which is the best rationale for the physical exam?
Question 6Select one:
a.
Physical exams are reimbursed by third-party payers.
b.
Physical disorders underlie somatic disorders.
c.
Underlying pathology should be ruled out.
d.
Ease the client’s mind that the nurse is looking for physical illness.
c
A nurse is assessing a child with attention deficit hyperactivity disorder. Which assessment finding is the nurse likely to see in this child? Select all that apply.
Question 8Select one or more:
a.
Impulsiveness
b.
Attentiveness
c.
Overactivity
d.
Stereotypical movements
e.
Stuttering
ac
A nurse is assessing a 2-year-old child diagnosed with autism spectrum disorder. Which findings does the nurse expect to find on assessment? Select all that apply.
Question 9Select one or more:
a.
The child does not relate to parents.
b.
The child becomes upset with minor changes in routine.
c.
The child is extremely playful.
d.
The child becomes frightened when left alone.
e.
The child avoids eye contact.
abe
Which nursing intervention should take priority for a child with attention deficit hyperactivity disorder (ADHD)?
Question 10Select one:
a.
Ensuring the child’s safety and that of others
b.
Simplifying instructions and directions
c.
Structured daily routine
d.
Improved role performance
a
Which interventions should a nurse teach the parents of a child with conduct disorder? Select all that apply.
Question 13Select one or more:
a.
Explore whether they feel authentic love for the child.
b.
Advise them to avoid rescuing their child.
c.
Reassure them that the child will become normal with time.
d.
Encourage them to seek proper treatment for their own problems.
e.
Explain about age-appropriate activities and expectations.
bde
The parents of a 15-year-old adolescent report that their child is behaving abnormally. After obtaining the history of the client, the nurse responds by telling the parents that their child’s behavior is normal for his age. What would the parents have told the nurse regarding their child? Select all that apply.
Question 14Select one or more:
a.
“Our child spends more time playing than studying.”
b.
“Our child has no friends at school.”
c.
“Our child has difficulty learning and understanding concepts.”
d.
“Our child is an extreme pessimist and tends to stay away from everybody.”
e.
“Our child doesn’t listen to us, preferring to listen to friends.”
ae
A nurse is assessing an adolescent with oppositional defiant disorder (ODD). Other than disruptive behavior, what other findings might the nurse expect to see during the assessment? Select all that apply.
Question 15Select one or more:
a.
Impaired decision making
b.
Impaired attention
c.
Impaired physical ability
d.
Impaired sense of direction
e.
Impaired problem-solving abilities
abe
Which is true of the time-out strategy that may be used for persons with conduct disorder?
Question 18Select one:
a.
It is a punishment.
b.
It is retreat to a neutral place, so clients can regain self-control.
c.
It should only be used as a last resort.
d.
It is not a permanent solution; eventually, the goal is for the client to avoid time-out.
b
Which is the primary treatment for delirium?
Question 24Select one:
a.
Provide adequate nutritional food and fluid intake
b.
Maintain intravenous fluid administration
c.
Identify and treat any causal or contributing medical conditions
d.
Apply physical restraints
c
donepezil nursing
for dementia - test stool for GI bleed
rivastigmine
for demetia - monitor for loss of apetite
galantamine
for dementia - monitor for syncope
memantine
for dementia - monitor for HTN, fatigue
