Mental Health Exam 3 Flashcards by Cindy Kwak

What disorder manifests persistent, unrealistic, and excessive anxiety/worry that is intense enough to cause clinically significant social, occupational, or functional impairment?

Generalized Anxiety Disorder (GAD)

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What are some characteristsics of GAD?

Avoids activities/events resulting in negative activities
Procrastinate in behavior or decision-making
Sleep disturbance
Increased time and effort required to prepare for stressful activities/events

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What is the purpose of rituals in OCD?

Attempt to decrease anxiety

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What disorder is characterized by more than 6 months of fear/anxiety about social situations, being observed, performing in front of others, being negatively evaluated that results in impairment of social, occupational, or other important areas of functioning?

Social Anxiety Disorder

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What’s the term for support, empathic listening, and reinforcing adaptive coping skills?

Validation

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What are the nursing interventions for anxiety?

Safe, quiet environment
Recognize triggers
Intervene before panic
Patient safety
Coping/relaxation technique

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If a person is afraid to leave the house, having more than 6 months of 2 of the following: using public transportation, being in enclosed/open spaces, standing in line or being in a crowd, or being outside of home alone, they are most likely experiencing what?

Agoraphobia

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What anti-anxiolytic medication has life-threatening withdrawal and may cause increased symptoms of depression, paradoxical excitement, and blood dyscrasias?

Benzodiazepine

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What do you need to teach the patient about Benzodiazepine?

Don’t stop abruptly
Don’t adjust dosage
Notify paradoxical excitement immediately
S/S blood dyscrasias: sore throat, bleeding, bruising, fever, malaise

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What’s obsession?

Intrusive THOUGHT

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What’s compulsion?

Repetitive BEHAVIOR

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What medication is used for the long-term treatment of anxiety?

Buspirone. Takes about 2 weeks to diminish symptoms

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What are some interventions for severe-panic anxiety?

Use simple words and brief messages
Calm, clear voice
Explain things
Lower stimuli
Antianxiety meds; assess effectiveness and s/e

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What are the neurotransmitters that influence anxiety?

Serotonin (so use SSRI)
Norepinephrine (SNRI)
GABA (anti-anxiolytic, benzo)

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In which anxiety level is learning, perception, awareness, and alertness is enhanced?

Mild anxiety

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What happens when a person has moderate anxiety?

Decreased perception, alertness, attention span, and ability to concentrate
Learning can occur but not optimal
Increased restlessness, HR, RR, muscle tension, perspiration, gastric discomfort, speech rate, volume, and pitch

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Which anxiety level shows extremely limited attention span, unable to concentrate or problem solve, no effective learning, hyperventilation, urinary frequency, total focus on self, dreading, and horror?

Severe anxiety

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Which anxiety level is characterized by unable to focus, misperception of environments, unable to concentrate and comprehend simple directions, sense of impending doom, terror, hallucinations, delusions, and extreme withdrawal into self?

Panic anxiety

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What are some cues for anorexia nervosa?

Restricting caloric intake, but can also have binging, purging, and compensation (use of laxative, diuretic, etc)

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In which eating disorder do you see predominantly underweight, decreased muscle tone, lanugo, decreased circulation, and usually in female teens?

Anorexia nervosa

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Which eating disorder is characterized by binge eating at least once a week followed by compensation such as the use of laxatives, diuretics, diet pills, and purging?

Bulimia nervosa

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What’s the expected BMI for a binge eating disorder?

> 30

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How’s the physical appearance of a patient with bulimia nervosa?

Normal to slightly overweight

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What medication is used to treat anorexia nervosa?

Fluoxetine

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How does fluoxetine work to treat anorexia nervosa?

It’s an SSRI; Serotonin is responsible for appetite. But it may decrease carb craving

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What’s the hypothalamus’s role in appetite?

Hypothalamus is the appetite regulation center in brain

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What are some nursing interventions for patients with anorexia nervosa?

Work with dietitian
NG tube if needed
Strict I&Os
Stay with patient while they eat (limit time to 30 minutes) and observe them for 1hr following eating. Make sure they eat
Daily weight
VS with orthostatic
Skin turgor & Integrity

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What are some significant physical assessment findings for a patient with bulimia nervosa?

Russell’s sign on dominant hand
Enlarged parotid glands
Edema

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What are some oral cavity findings for purging?

Tooth enamel erosion
Mouth ulcers
Tears in gastric/esophageal mucosa

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What technique will you be using when weighing a patient with eating disorder?

Make sure the number on scale is covered so patient cannot see
Same scale every time
Weigh them first thing in the morning, right after their first void

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What are some abnormal lab values for bulimia nervosa?

Electrolyte imbalance from purging and compensations
Phosphate, potassium, calcium, magnesium, sodium, etc.

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What are some complications related to anorexia nervosa?

Amenorrhea, hypothermia, hypotension, arrhythmias, bradycardia, peripheral edema, lanugo, bone fracture, cold intolerance, chest pain, abdominal bloating, dehydration, SI, severe dehydration

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What are some therapeutic communication skills will the nurse use with patients with eating disorder?

Promote feelings of control through independent decision making
Focus on strengths and past accomplishments
Validate patient

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What is prazosin used for in PTSD?

Decrease hypervigilance, insomnia, and nightmares

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What’s the major difference between Acute Stress Disorder and PTSD?

ASD lasts less than a month while PTSD lasts more than a month, up to years

What does paroxetine do in treating PTSD?

It’s an SSRI; decrease depression and anxiety

What disorder has manifestations of sustained anxiety/arousal, recollection/nightmares, depression, painful guilt, substance abuse, amnesia, and anger & aggressive behavior?

PTSD

What do you do when a patient with PTSD is experiencing nightmares/flashbacks?

Stay with them
Ensure pt safety
Don’t wake or touch them

Why would you use an anti-anxiolytic on patients with PTSD?

Due to sustained anxiety and hypervigilance

What disorder is caused by patterns of life-long difficulty accepting change and learned pattern of difficulty with social skills or coping strategies?

Adjustment disorder

What are the cues of adjustment disorder?

Maladaptive response to stressors
Symptoms greater than expected
Depression, anxiety, or both
Disturbance of conduct, emotion, or both (change in behavior)

How does trauma affect the hippocampus?

It reduces the volume of hippocampus
Traumatic event => stored in hippocampus as memory

What can you teach the patient about stress management?

Relaxation technique (walking, music, yoga, exercise, essential oil, etc)
Journaling
Recognize triggers

What are the biological responses to stress?

Fight or flight.
Tachycardia, dilated pupils, tachypnea, hypertension, slow digestion, heightened hearing

What factors can increase stress?

Severity & duration of stressor, exposure to death, location where the trauma was experienced, amount of control over recurrence, number of times affected by life threat, extent of anticipatory preparation for the event

Stress responses that disrupt the integrity of the individual, are harmful (alcohol, drugs, bottling up stress), and unhealthy are called

Maladaptive stress responses

What are some nursing interventions for PTSD?

Consistent staffing, build rapport and trust, don’t isolate, make sure they are taking their medication, encourage communication at patient’s pace

What’s the thalamus’s role in stress response?

It’s the brain’s relay station. Also affects sleep, wakefulness, consciousness, learning, and memory

What disorder is characterized by temporary inability to recall important personal information?

Dissociative amnesia

What are some interventions for dissociative amnesia?

Lower stress
Grounding techniques
Don’t give too much information about their past
Psychotherapy
Hypnosis
Cognitive-behavioral therapy
Amobarbitol to retrieve memory

What’s conversion disorder?

When a patient presents neurological symptoms (voluntary motor and sensory affected) without any evidence or diagnosis of neurological disease

What are some interventions for somatic symptom disorder?

Identify secondary gains (ex. attention)
Report new symptoms
Independence in self-care
Verbalize feelings
Assertiveness technique
Alternative coping

What disorder is characterized by physical symptoms without demonstrable organic pathology that is mostly seen in primary care?

Somatic symptom disorder

What are some cues of somatic symptom disorder?

Pain/functional changes, frequent doctor visit, vague, dramatized, and exaggerated symptoms, excessive time spent worrying, remission and exacerbation depending on stress level, and adamantly reject & irritated by stress implication

What are some interventions for factitious disorder?

Self-assessment
No confrontation
Safety of patient and patient’s vulnerable personnel who is affected
Communicate openly with team members
Stress and coping mechanism

What would you do to a patient with conversion disorder?

Build rapport and trust, patient safety, encourage verbalize feelings, identify triggers, coping and stress management

What are some teaching points for conversion disorder?

Individual/group therapy, attend community support group, take prescribed medications

What’s depersonalization?

When someone sees their own personality or body from a distance

What’s derealization?

When an object seems smaller/larger than expected, feeling that outside events are unreal or part of dream

What are some cues of dissociative identity disorder?

Existence of more than 2 personality states
Each personality is unique with complex set of memories, behavior patterns, and social relationships
Transition may be sudden or gradual

What is the goal of treatment for dissociative identity disorder?

Decrease the number of personality/fragments into one. It might be the original, it might not be original.

What’s localized amnesia?

Unable to recall all incidents associated with stressful period
“I was driving and when I woke up, I was at the hospital.”

What’s dissociative fugue?

Sudden, unexpected travel away from home or bewildered wandering
Inability to recall some/all of one’s past

In what dissociative disorder can a person not recall personal identity and sometimes assume new identity?

Dissociative fugue

What is illness anxiety disorder?

Unrealistic/inaccurate interpretations of symptoms
Preoccupation with sensations and fear of serious disease
Fear persists and becomes disabling
Highly anxious about undiagnosed, serious illness
Can be either care seeking or avoiding

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. Attempt to reduce anxiety

A nurse is caring for a client who is 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 TV show
D. Stay with the client and remain quiet

D. Stay with the client and remain quiet

A nurse is assessing a client who has generalized anxiety disorder. Which of the following findings should the nurse expect? SATA

A. Excessive worry for 6 months
B. Impulsive decision making
C. Delayed reflexes
D. Restlessness
E. Sleep disturbance

A. Excessive worry for 6 months
D. Restlessness
E. Sleep disturbance

GAD pts usually procrastinate making decision and have muscle tension

A 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 client’s risk for self-harm
B. Instill hope for positive outcomes
C. Encourage the client to participate in group therapy sessions
D. Assist the client to participate in treatment decisions

A. Assess the client’s risk for self-harm

A nurse is caring for a client who has generalized anxiety disorder 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. “Let’s discuss the medications your provider is prescribing to decrease your anxiety.”

A. “Tell me about how you are feeling right now.”

Never ask a “why” question
Medication should be the last resort since it’s a chemical restraint. Also, in severe anxiety, learning is not possible.

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? SATA

A. Difficulty concentrating on tasks
B. Obsessive need to talk about the traumatic event
C. Negative self-image
D. Recurring nightmares
E. Diminished reflexes

A. Difficulty concentrating on tasks
C. Negative self-image
D. Recurring nightmares

Usually has anxiety instead of diminished reflexes. And will avoid talking about traumatic eventA n

A nurse is involved in a serious and prolonged mass casualty incident in the ED. Which of the following strategies should the nurse use to help prevent developing a PTSD? SATA

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. Take breaks during the incident for food and water
C. Debrief with others following the incident
E. Take advantage of offered counseling

A nurse is collecting an admission history for a client who has ASD. 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. The client expresses a sens of unreality about the traumatic incident

ASD often expresses dissociative manifestations

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 the 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 to be small and far away
D. The client cannot recall anything that happened during the past 2 weeks

C. The client states that the furniture in the room seems to be small and far away

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. Work with the client on grounding techniques

Derealization & other dissociative disorders = Grounding techniques

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? SATA
A. “What is your relationship like with your family?”
B. “Why do you want to lose weight?”
C. “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. “What is your relationship like with your family?”
C. “Would you describe your current eating habits?”
E. “Can you discuss your feelings about your appearance?”

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 statement indicates the client is experiencing the cognitive distortion of catastrophizing?

A. “Life isn’t worth living if I gain weight.”
B. “Don’t pretend like you don’t know how fat I am.”
C. “If I could be skinny, I know I’d be popular.”
D. “When I look in the mirror, I see myself as obese.”

A. “Life isn’t worth living if I gain weight.”

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? SATA

A. Amenorrhea
B. Hypokalemia
C. Yellowing of the skin
D. Slightly elevated body weight
E. Presence of lanugo on the face

B. Hypokalemia
D. Slightly elevated body weight

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 client’s 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. Implement one-to-one observation during meal times

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 you have concerns about your weight, but first, let’s 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. “I understand you have concerns about your weight, but first, let’s talk about your recent accomplishments.”

A nurse is discussing the factors for somatic symptoms disorder with a newly licensed nurse. Which of the following risk factors should the nurse include? SATA

A. Age older than 65 years
B. Anxiety disorder
C. Childhood trauma
D. CAD
E. Obesity

B. Anxiety disorder
C. Childhood trauma

A nurse is reviewing the medical record of a client who has conversion disorder. Which of the following findings should the nurse identify as placing the client at risk for conversion disorder?

A. Death of a child 2 months ago
B. Recent weight loss of 30 lbs
C. Retirement 1 year ago
D. History of migraine headaches

A. Death of a child 2 months ago

A nurse is assessing a client who has illness anxiety disorder. Which of the following are expected for this disorder?

A. Obsessive thoughts about disease
B. History of childhood abuse
C. Avoidance of health care providers
D. Depressive disorder
E. Narcissistic personality

A. Obsessive thoughts about disease
B. History of childhood abuse
C. Avoidance of health care providers

A nurse is developing a plan of care for a client who has conversion disorder. Which of the following actions should the nurse include?

A. Encourage the client to spend time alone in their room
B. Monitor the client for self-harm once per day
C. Alllow the client unlimited time to discuss physical manifestations
D. Discuss alternative coping strategies with the client

D. Discuss alternative coping strategies with the client

Must monitor for self-harm continuously, and limit time to talk about physical manifestations

A nurse is counseling several clients. Which of the following client statements should the nurse identify as expected for factitious disorder imposed on another?

A. “I had to pretend I was injured in order to get disability benefits.”
B. “I know that my abdominal pain is caused by a malignant tumor.”
C. “I needed to make my child sick so that someone else would take care of them for a while.”
D. “I became deaf when I heard that my partner was having an affair with my best friend.”

C. “I needed to make my child sick so that someone else would take care of them for a while.”

A is imposed on self, B is illness anxiety disorder, D is conversion disorder

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Mental Health Exam 3 Flashcards

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