MH FINAL EXAM Flashcards
Which of the following may be influential in the predisposition of PTSD?
A. Un satisfactory parent-child relationship
B. Excess of NT serotonin
C. Distorted, negative cognitions
D. Severity of the stressor and availability of support systems
Which of the following statement indicates an understanding of personality d/o by the RN?
A. Promote a sense of control by establishing a schedule
B.. Incourage a schizoid personality to increase socialization
C. Practice limit setting to help prevent client manipulation
D. Implement assertivenes training w/ antisocial personality d/o
C
Which of the following is expected from a client who has avoidant personality d/o?
“I’m scared you’re going to leave me.”
RN is caring for a client experiencing loss, blaming the doctor. Which of the following is an appropriate response?
You sound angry. Anger is a normal feeling associated w/ loss.
John is Dx w/ PTSD. Which of the following therapy regimens would be most appropriate?
A. Paroxetine and gorup therapy
B. Dizepam and implosion therapy
C. Alprazolam and behavior therapy
D. Carbamazepine and cognitive therapy
A. Paroxetine and group therapy – want them to talk about it and work through it
An order for Sertraline (Zoloft) for a client w/ adjustment d/o w/ depressed mood. This med is used for?
Increased E and elevated mood
Which of the following is true regarding the dx of adjustment d/o?
A. LT psychotherapy to achieve relief
B. This is an inherited d/o
C. S/Sx will remit once client has accepted change in their life
D. Higher education will decrease the d/o
C,
RATIONALE: adjustment d/o patients will have difficulties adjusting to a change
Which of the following is the priority RN dx for adjustment d/o w/ depressed mood after divorce?
A. Risk-prone health behavior r/t loss of dependency
B.
C. Ineffective communication r/t problems w/ dependency
D. Social isolation related to divorce
B. Complicated grieving related to breakup of marriage
Which of the following demonstrates an undertanding of the use of ECT for bipolar disorder?
A. ECT is the recommenede initial tx for bipolar d/o
B. ECT is contraindicated for SI
C. ECT is effective for clients experiencing severe mania
D. ECT is prescribed to prevent relapse of bipolar d/o
C. ECT is effective for clients experiencing severe mania
Initial treatment = Lithium = “Gold standard”
– Will not use for Bipolar 2
Priority RN action for client w/ bipolar d/o?
A.Set consistent limits for expected client behavior
B. Adminster prescribed meds as scheduled
C. Provide step-by-step instruction during hygiene
D. Monitor client for escalating behavior
Think: harming self
Actions should the RN include in client’s plan of care of anorexia w/ binge and purge?
A. Allow client to select preferred meal times
B. Establish consequences of purging behavior
C. Provide client w/ high-fat diet at start of tx
D. Implement 1-to-1 observation during meal times
D. Implement 1-to-1 observation during meal times
– Eat for 30 minutes, monitor for 1hr after meals
Following reponses should the RN make to a hospitalized bulimia client who has fears of gaining weight?
I understand your concerns, lets talk about your recent accomplishments
anorexic = underweight
bulimic = @ weight
binge = OVERweight
Statement indicates depersonalization for a schizoaffective d/o?
“I am no one, and everyone is me.”
Removes and reapplies makeup is a repetitive behavior is due to
Attempt to reduce anxiety
Patient experiencing a panic attack. The RN should take which of the following actions?
Stay with the client and remain quiety
Client w/ MDD and anxiety. What is the priority RN action?
1-to-1 observation
think: SAFETY, b/c more likely to do it w/ anxiety
Voices saying, “kill your doctor.” Actions should RN take first?
1-to1 observation
Example of aggressive communication?
You better listen to me
Client is screaming at everyone. Which of the following is a therapeutic response?
Stop screaming and walk outside w/ me
Client throws char across the room. RN priority action?
A. Encourage the client to express feelings outload.
B. Maintain eye contact w/ client
C. Move the client away form others
D. Tell the client the behavior is not acceptable.
C. Move the client away from others
- Cognitive reframing and stress management: “I will change my negative talk..”
- Insight feel you need tx how will you get money for your needs? governor of state?
hx of depression and ID of protective factors against suicide - my 4th child
crohns dis
my family hx of suicide
licensed to practice medicine
6 RN Processes
think: ADOPIE
Assessment
Diagnosis
Outcomes identification
Planning
Implementation
Evaluation
Purpose of psychostimulants
Increasing norepinephrine, serotonin, dopamine release
Purpose of benzodiazepines
Facilitate transmission of the inhibitory NT GABA
Purpose of antipsychotic medications
Block dopamine receptors, some affect muscarinic cholinergic, histaminergic, α-adrenergic receptors
Modalities relevant to treatment of TBI + PTSD
Psychosocial therapies — CBT, prolonged exposure therapy, group/family, eye-movement desensitization, reprocessing
Psychopharmacology — SSRIs = 1st line tx
Complementary therapies
Rehabilitation therapies
Antianxiety Agent Interactions
INCREASES — EtOH, barbiturates, narcotics, antipsychotics, antidepressants, antihistamines, cimetidine, disulfiram, herbal depressants
DECREASES effects — cigarette smoking and caffeine consumption
Which of the following medications would be an appropriate p r n medication for an individual with anxiety symptoms?
A. Buspirone
B. Alprazolam
C. Fluoxetine
D. Sertraline
B. Alprazolam — Benzodiazepine that works as a CNS depressant to produce quick-acting effects for relaxation
Antidepressant MOA
For MDD and dysthymia d/o’s
Increase concentration of norepinephrine, serotonin, and/or dopamine in the body either by blocking their reuptake by the neurons (tricyclics, tetracyclics, S S R I’s, SNRI’s) or by inhibiting the release of monoamine oxidase inhibitors (M A O I’s).
Antidepressant Drug Interactions w/ SSRI’s
Serotonin syndrome — Buspirone (BuSpar), TCA (esp. Clomipramine, Selegiline (Eldepryl), Saint John’s Wort
____________
HTN’ive crisis — MAOI’s
Increased risk for bleeding — Warfarin, NSAID’s
_____________
Increased sedation — EtOH, benzos
_____________
Lowered seizure threshold — Antiepileptics
Therapeutic levels for Lithium maintenance
For acute mania — 1.0 to 1.5 mEq/L
For maintenance — 0.6 to 1.2 mEq/L
NOTE: considering adequate amount of Na and H2O
Mental Status Assessment Criteria
General Description: Appearance, Motor Activity, Speech Patterns, General Attitude
__________
Emotions: Mood + Affect
_________
Thought Process: Form of thought, Content of thought,
Perceptual disturbances
Sensorium + Cognitive Ability
Impulse Control
Judgment — “What are your plans for the future?”
Insight — “Do you think you have a problem?”
Which of the following psychosocial therapies has been shown to be helpful for clients with traumatic brain injury (TBI)?
a. Eye movement desensitization
b. Psychoanalysis
c. Reality therapy
d. Cognitive behavioral therapy
D, Cognitive behavioral therapy
What are the 5 stages of deployment?
Predeployment
Deployment
Sustainment
Redeployment
Postdeployment
Potential indicators for increased risk for maladaptive grief
■Additional financial problems posed by the loss
■Lack of coping skills or lack of experience in responding to loss
■Emotional or physical dependence on the lost person or item
■History of mental illness or substance abuse
■History of trauma, including abuse
■Multiple losses within a short time frame
