Mental Health - Exam 4 Flashcards
A client with which of the following personality disorders lacks empathy, has a sense of entitlement, violates the rights of others and impulsively acts out
a. histrionic personality disorder
b. antisocial personality disorder
c. borderline personality disorder
d. narcissistic personality disorder
b. antisocial personality disorder
An appropriate short-term goal for an antisocial client with a nursing diagnosis of Ineffective coping related to use of manipulation would be
a. Client will acknowledge manipulative behavior when it is called to his or her attention.
b. Client will use manipulation only to get his or her needs met.
c. Client will accept staff explanation that a request will be met within an hour rather than immediately.
d. Staff will state fewer negative countertransferences about client.
a. Client will acknowledge manipulative behavior when it is called to his or her attention.
The nurse is assigned to perform an assessment of a client diagnosed as having histrionic personality disorder. When the interview is documented, the nurse is most likely to describe the client as
a. superficially charming
b. intense and impulsive
c. guarded and suspicious
d. friendly and open
b. intense and impulsive
M, a client with borderline personality disorder, tells Nurse J, “You used to care about me. I thought you were wonderful. Now I can see I was mistaken. You’re hateful.” This outburst can be assessed as use of
a. splitting
b. denial
c. reaction formation
d. separation-individuation strategies
a. splitting
Which characteristic in an individual with a personality disorder makes it most necessary for staff to schedule frequent meetings?
a. the client’s flexibility and adaptability to stress
b. the client’s ability to achieve true intimacy
c. the client’s ability to evoke interpersonal conflicts
d. the need for staff to develop strategies to interpret to the client the reasons for his or her behavior
c. the client’s ability to evoke interpersonal conflicts
When a client self harms it is best to
a. ignore the act
b. ask the client why they self harmed
c. treat the resulting injury with a “matter of fact” approach
d. Focus on the self harm during group and community meetings
c. treat the resulting injury with a “matter of fact” approach
Which of the following is considered a maturational crisis?
a. Tornado
b. Sexual assault
c. Car accident
d. Mid life crisis
d. Mid life crisis
A goal of crisis intervention is for the adult client to:
a. Stabilize and return to pre-crisis functioning.
b. Come to terms with childhood sexual abuse.
c. Remain having suicidal ideations.
d. All of the above.
a. Stabilize and return to pre-crisis functioning.
A crisis is considered:
a. Chronic and long lasting.
b. Acute and time limited.
c. Labile and fluctuating.
d. Can be all of the above.
b. Acute and time limited.
Three policemen brought E to the mental health unit. She had been directing traffic and shouting rhymes on a busy city street. Her husband reported that E had stopped taking her lithium 3 weeks ago and had not slept or eaten for 3 days. Which behaviors listed below will be of priority concern as the nurse begins a care plan for E?
a. bizarre, colorful, inappropriate dress
b. grandiose thinking, poor concentration
c. insulting, provocative behavior directed at staff
d. hyperactivity, ignoring eating and sleeping
d. hyperactivity, ignoring eating and sleeping
E is a manic client who became hyperactive after discontinuing her lithium. E’s husband asks what evidence supports the possibility of genetic transmission of bipolar disorders. Which reply is factual?
a. “A higher proportion of clients with bipolar disorders are found among creative writers.”
b. “A higher rate of relatives with bipolar disorder is found among clients with bipolar disorder.”
c. “A higher rate of relatives of clients with bipolar disorder respond in an exaggerated way to daily stress.”
d. “More individuals with bipolar disorder come from higher socioeconomic and educational backgrounds.”
b. “A higher rate of relatives with bipolar disorder is found among clients with bipolar disorder.”
When a manic client is admitted to a psychiatric unit, what initial nursing intervention should be planned?
a. allowing client to act out feelings since a safe environment can be provided
b. providing verbal instructions to client to try to remain calmer
c. being accessible to set limits on client behavior as necessary
d. restraining client to reduce hyperactivity and aggression
c. being accessible to set limits on client behavior as necessary
Of the dinner menus given below, which one should be served to a hyperactive manic client?
a. broiled chicken pattie on a roll, ear of corn, apple
b. spaghetti and meatballs, salad, banana
c. beef and vegetable stew, roll, chocolate pudding
d. goulash, green beans, jello with whipped cream
a. broiled chicken pattie on a roll, ear of corn, apple
During periods of non stop laughter, talkativeness, and banter, a client with manic behavior is noted to abruptly become irritable. Such changes in mood should be assessed as
a. dissociation
b. lability
c. undoing
d. flight of ideas
b. lability
A client who lives at home and is on maintenance doses of lithium should be advised to maintain an adequate dietary intake of
a. protein
b. calcium
c. glucose
d. sodium
d. sodium
J, age 4, spends much of his day in constant motion. His mother tries to get him interested in playing with his toys, but he is easily distracted and doesn’t seem to listen. He talks appropriately, but excessively. He gets out of bed in the morning before his mother. She reports that one morning he broke the screen on the TV. She enrolled him in preschool, but the teacher was unable to handle him. The suggestion was made that J be evaluated at the mental health clinic. The nurse establishes the nursing diagnosis Altered growth and development related to neurological changes, as evidenced by hyperactivity and distractibility. What goal is related to this nursing diagnosis? Within 6 weeks, with the aid of medication, J will
a. seek out the nurse to talk to him or her
b. express his anger in an acceptable manner
c. sit and play with a toy for 10 minutes
d. not destroy things in his environment
c. sit and play with a toy for 10 minutes
When assessing a 2-year-old child with suspected autistic disorder, the nurse should be particularly alert for
a. failure to develop interpersonal skills
b. hyperactivity and attention deficits
c. high levels of anxiety when separated from the mother
d. a history of disobedience and destructive acts
a. failure to develop interpersonal skills
When C, age 5, is disruptive, the nurse tells her, “C, you must take a time-out.” What is expected of C? She will
a. go to her room until called for the next meal
b. slowly count to 20 before returning to the milieu
c. sit quietly on the lap of one of the staff members
d. sit on the periphery of the activity until regaining self-control and reviewing the episode
d. sit on the periphery of the activity until regaining self-control and reviewing the episode
Side effects of Ritalin include:
a. Sedation, delusions, tactile hallucinations
b. Sedation, lethargy and proteinuria
c. Anxiety, insomnia, decreased appetite
d. Dehydration, tremors and seizures
c. Anxiety, insomnia, decreased appetite
Lithium: Early signs of toxicity
Blood level: 1.5 mEq/L
Signs: N & V Diarrhea Thirst Polyuria Slurred speech Muscle weakness
Lithium: Advanced signs of toxicity
Blood level: 1.6 mEq/L
Signs: Coarse hand tremor Persistent gastrointestinal upset Mental confusion Muscle hyperirritability Incoordination
Lithium: Severe Toxicity > 2.5 mEq/L
Signs: Hospitalization Confusion Incontinence of urine or feces Coma Cardiac arrhythmias Peripheral circulatory collapse Abdominal pain Proteinuria Oliguria Death
Lithium Contraindications
Cardiovascular disease Brain damage Renal disease Thyroid disease Myasthenia Gravis Pregnancy Breastfeeding mothers Children younger than 12 years
Lithium carbonate
therapeutic blood level
maintenance blood level
toxic blood level
therapeutic blood level: 0.8 to 1.4 mEq/L
maintenance blood level: 0.4 to 1.3 mEq/L
toxic blood level: 1.5 to 2.0 mEq/L
Bipolar Outcomes Identification
Acute, Continuation and Maintenance phase
Acute-prevention
Continuation-relapse prevention
Maintenance phase-
Bipolar Acute phase
Acute-highest priority is always safety
- prevent injury
- medical stabilization
- maintaining safety
- self-care needs (shower, hydration, nutrition and making sure they get rest)
Bipolar Continuation phase
Continuation
- relapse prevention
- maintain medication adherence
- psychoeducational teaching
- referrals
- patients often think they are stable so often will stop taking meds, or do not like being stable-they prefer the manic phase
Bipolar Maintenance phase
Maintenance
- prevent relapse..with follow up care
- upon relapse symptoms coming back worse than initial episode
Anticonvulsant drugs
Valproate (Depakote)-mood stabilization w/o complications
Carbamazepine (Tegretol)-mood stabilization
Lamotrigine (Lamictal)-for acute and maintenance phase
*Lamictal can cause a life threatening rash!!
Antianxiety drugs
Clonazepam (Klonopin)
Lorazepam (Ativan)
Atypical Antipsychotics
Olanzapine (Zyprexa)
Risperidone (Risperdal)
Bipolar continuation phase
This stage can last forever (focusing on relapse prevention)
Teach the patient about illness and medication maintenance
ADHD
stimulants
M, a client with borderline personality disorder, has come back from a pass having lacerated her wrists. The physician orders daily dressing changes for the lacerations. The nurse performing this care should
a. encourage M to express anger
b. provide care in a matter-of-fact manner
c. be sympathetic and concerned
d. offer to listen to M’s feelings about cutting
b. provide care in a matter-of-fact manner
