HESI Psych Flashcards
The purpose of therapeutic interaction with clients is?
allow them the autonomy to make choices when appropriate. Keep statements value-free, advice-free, and reassurance-free. Remember, just the facts! No opinions!
What action should the nurse take in a psychiatric situation when the client describes a physical problem?
Assess! If a client in the psychiatric unit with paranoid schizophrenia complains of chest pain, take his or her bp.
A question concerning nurse-client confidentiality appears often on the NCLEX-RN. For the nurse to tell a client that he or she will not tell anyone abou their discussion puts the nurse in a difficult position, why?
Some information must be shared with other team members for the client’s safety (eg. suicide plan ) and optimal therapy
What is the most common complaint after ECT?
Nausea. Vomiting by an unconscious client can lead to aspiration. Because post-ECT clients are unconscious, the nurse must observe closely for the possibility of aspiration: maintain a patent airway!
On an in-patient unit, clients are expected to get up at a certain time, attend breakfast at a certain time, and arrive for their medications at the correct time. What form of therapy is incorporated into the unit?
Milieu
the wife of a man killed in a motor vehicle accdent has just arrived at the emergency department and is told of her husbands death. What nursing actions are appropriate for dealing with this crisis?
take her to a quiet room and ask her if there are family members friends or clergy you can call for her. Assess her need for medication and discuss it with health care provider. Stay with her, be firm and directive, and assess previous successful coping strategies
A 66-year old woman is admitted to the psychiatric unit with agitated depression. She has not responded to antidepressants in the past. What would be the medical treatment of choice?
ECT
The nurse should place an anxious client were there are?
reduced stimuli ( a quiet area of the unit, away from the nurses station)
When is the client’s anxiety lowest?
at the competion of the performed ritual.
what acts are used in response to anxiety?
compulsive acts. May or may not be related to obsession. It is the nurse’s responsibility to help alleviate anxiety: actively listen, acknowledge the effects that ritualistic acts have on the client, demonstrate empathy, avoid being judgemental
Avoid giving what to clients with disociative disorder?
avoid giving too much information about past events at one time. The various types of amnesia that accompany dissociative disorders provide protection from pain. Too much too soon may cause decompensation.
Describe the difference between psychogenic amnesia and psycogenic fugue
- Psychogenic amnesia: sudden inability to recall certain events in one’s own life
- Psychogenic fugue: state characterized by the individuals leaving home and bein unable to recall his or her identity or past
obsessive compulsive disorder
orderly, rigid
antisocial
unable to conform to social norms
borderline
needy, always in a crisis, self-mutilating, unable to sustain relationships, splitting behavior
dependent
unable to make decisions for self, allows others to assume responsibility for his or her life
narcissistic
feelings of self-importance and entitlement, may exploit others to get own needs met
histrionic
dramatic, flamboyant, needs to be the center of attention
paranoid
distrustful, suspicious, is watchful and secretive
schizoid
isolated and introverted, no close friends
People with anorexia gain pleasure from?
providing others with food and watchin gthem eat. do not allow these clients to plan or prepare food for unit-based activities
Anorexia nervosa may be precipitated by what factors?
mother-daughter conflicts usually focusing on independence/dependence issues, discomfor with maturation, need for control, desire for perfection
what might the initial treatment include for a client admitted to the hospital with a dx of bulimia nervosa?
blood work to evaluate electrolyte status, replensihment of electrolytes and fluids as indicated, careful monitoring for evidence of vomiting
The most important signs and symptoms of depression are?
a depressed mood with a loss of interest in the pleasures in life. the client has sustained a loss. Other symptoms include” significant chang in appetite, often accompanied by a change in weight, insomnia or hypersomnia, fatigue, hopelessness and worthlessness, guilt, loss of ability to concentrate or think clearly, preocupation with death or suicide
The nurse knows a depressed client is improving when they?
being to take an interest in their appearance or begin to perform self-care activities that were previously of little or no interest to them
The nurse should suspect an imminent suicide attempt if a depressed client becomes?
“better”, be aware that a happy affect may signify that the client feel relieved that a plan has been made and is prepared for the suicide attempt
An important nursing intervention for the depressed client is to ?
sit quietly with the client. When answering NCLEX questions, remember that you are working at Utopia general and there is plenty of time and staff to provide ideal nursing care. Do not let the realitites of clinical situations deter you from choosing the best nursing intervention. The best intervention is to sit quietly with the client, offering support with your presence
Antianxiety drug side effects
sedation, drowsiness
antidepressant drug side effects
anticholinergic effects, postural hypotension
MAOI drug side effects
hypertensive crisis
Lithium requires what to be assessed and monitored.
renal function
phenothiazines cause ?
extrapyramidal effects, tardive dyskinesia
phenothiazines cause?
photosensitivity, so client must wear protective clothing and sunglasses
MAOI require what restrictions?
dietary restrictions to prevent hypertensive crisis
atypical antipsychotic drugs are also indicated for?
mania (risperidone, olansapine, quetiapine, aripiprazole, and siprasidone
Monitor serum lithium levels to be between?
0.5-1.5. Signs of toxicity are eviden when lithium level above 1.5, blood levels should be drawn 12 hours after last dose
What activities are appropriate for a manic client?
noncompetative physical activities that require the use of large muscle groups
what interventions should the nurse use if a client becomes abusive?
- redirect negative behavior or verbal abuse in a calm, firm, nonjudgemental, nondefensive manner
- suggest a walk or other physical activity
- set limits on intrusive behavior
important characteristics of schizophrenia?
- Autism (preoccupied with self)
- affect (flat)
- associations (loose)
- ambivalence (difficulty making decisions)
In a client with delusions, do not?
do not argue, logic does not work, it only increases the client’s anxiety. Be matter-of-fact and divert delusional thought to reality.
what medications can the nurse expect to administer to chemically dependent clients?
In alcohol withdrawl, Librium or Ativan are commonly used. Anatbuse is often used as a deterrent to drink alcohol. Client teaching should include the effects of consuming any alcohol while on antabuse. Encourage client to read all labels of over-the-counter medications and food products that may contain small amounts of alcohol
What type of therapy is used with chemically dependent clients?
Group therapy is effective, as are support groups such as alcoholics anonymous and narcotics anonymous
What basic needs take priority when working with chemically dependent clients?
nutrition is a priotity. Alcohol and drug intake has superseded the intake of food for these clients
With a child who has been abused, how do you assign care to them for their stay?
assign only one nurse to care for them. Abused children have difficulty establishing trust. they will be less anxious with one caregiver
When does battering of women often begin or escalate?
during pregnancy
Basic difference between delirium and dementia?
delirium is acute and reversible, whereas dementia is gradual and permanent
confabulation is?
not lying. It is used by the client to decrease anxiety and protect the ego
what is a priority in planning nursing care for the confused older client?
providing a consistent caregiver
Children also experience depression, which often presents as?
headaches, stomachaches, and other somatic complaints.
NCLEX-RN questions ask about teaching and designing rehavilitation preframs for older adults. The answers should contain?
something about exercise and nutrition
