MH final exam Flashcards
Expected findings with mania
restlessness, grandiosisty, flight of ideas, poor judgement, denial of illness, and attention seeking behavior
Numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode, AND numerous periods with depressive symptoms that do not meet criteria for a major depressive disorder, for at least 2 years (at least 1 year in children and adolescents)
cyclothymic disorder
The client has one or more major depressive episode accompanied by at least one hypomanic episode
bipolar 2 disorder
The client has at least one episode of mania alternating with major depression
bipolar 1 disorder
fluoxetine (Prozac); SSRI used to manage a major depressive episode
anti-depressants
valproate (Depakote), lamotrigine (Lamictal), carbamazepine (Tegretol); slows the entrance of sodium and calcium back into the neuron, thus extending the time it takes for the nerve to return to its active state
anti-epileptic medication
lithium carbonate; exact mechanism unknown; may work by altering the distribution of calcium, sodium and magnesium ions
mood stabilizers
lorazepam (Ativan), clonazepam (Klonopin); depress the CNS, increase the effects of GABA which produces relaxation and may depress the limbic system
anti-anxiety medications
nursing intervention for manipulative behavior
Set clear, consistent, realistic, and enforceable limits, and communicate expected behaviors
nursing intervention for deescalation technique
Maintain safety for the client, other clients and self; maintain a large personal space and use a nonaggressive posture. Use a calm approach and communicate with a calm, clear tone of voice; avoid verbal struggles
nursing intervention for aggressive behavior
Assist the client in identifying feelings of frustration and aggression. Assist the client in identifying precipitating events or situations that lead to aggressive behavior
nursing intervention for manipulative behavior
Be clear about consequences associated with exceeding set limits and follow through with consequences in a nonpunitive manner, if necessary
manifestation of moderate to severe lithium toxicity (2-3)
ataxia, giddiness, tinnitus, blurred vision, large output of dilute urine, delirium, nystagmus
manifestation of severe lithium toxicity (more than 3)
seizures, organ failure, renal failure, coma, death
manifestation of mild to moderate lithium toxicity (1.5-2)
coarse hand tremor, diarrhea, vomiting, drowsiness, dizziness, muscular weakness, lack of coordination, dry mouth
manifestation of therapeutic levels of lithium (0.6-1)
fine hand tremor, memory problems, goiter, hypothyroidism, mild diarrhea, anorexia, nausea, edema, weight gain, polydipsia, polyuria
A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
manic episode
A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
hypomanic episode
are there psychotic features in a hypomanic episode?
No psychotic features
are there psychotic features in a manic episode?
yes
during a hypomanic episode are mood disturbances severe enough to cause impairment in social or occupational functioning?
Not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization.
during a manic episode are mood disturbances severe enough to cause impairment in social or occupational functioning?
Mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning and can necessitate hospitalization to prevent harm to self or others
type of medication that are primarily used for the treatment of persons with bipolar disorder
mood stabilizers
An in-patient psychiatric client recently diagnosed with bipolar disorder has been prescribed lithium carbonate (Lithium). What should the nurse include in client teaching regarding Lithium
Take lithium as prescribed; must be administered in 2 to 3 doses daily due to a short half -life. Adhere to laboratory appointments needed to monitor lithium effectiveness and adverse effects. Stress side effects that require immediate notification of prescriber (vomiting, severe tremor, sedation, muscle weakness, vertigo) and stopping of medication
What suggestions did our guest lecturer provide to help in dealing with others who display behaviors consistent with personality disorders?
Document everything, preferably in email and in writing. “Turn off” intimacy and maintain serious emotional boundaries. Be cautious over providing personal info, thoughts, and opinions. Keep your guard up.
According to our guest lecturer, which personality disorder can best be described by the mantra: Loves attention (loves it, LOVES it)?
Histrionic personality disorder
According to our guest lecturer, which personality disorder can best be described by the mantra: Instability, instability, instability?
Borderline personality disorder
A mechanism used to symbolically negate or cancel out a previous action or experience that one finds intolerable; performing an act to make up for prior behavior
undoing
The unconscious blocking of unpleasant feelings and experiences from one’s awareness
repression
The inability to integrate positive and negative feelings, resulting in a tendency to view people and situations as all good or all bad; a primitive defense against fear of abandonment
splitting
The voluntary blocking from one’s awareness of unpleasant feelings and experiences
suppression
A retreat to an earlier level of development and the comfort measures associated with that level of functioning
regression
When preparing to interview a patient diagnosed with narcissistic personality disorder, a nurse can anticipate the assessment findings will include:
grandiosity, attention-seeking, arrogance
high anxiety, outward signs of fear, and insecurity and inadequacy can describe which category of personality disorders?
Cluster C Disorders (Avoidant, Dependent, Obsessive-Compulsive)
odd or eccentric/ have unusual beliefs can describe which category of personality disorders?
Cluster A Disorders (Paranoid, Schizoid, Schizotypal)
manipulation, poor impulse control, dramatic, emotional, and erratic traits can describe which category of personality disorders?
Cluster B Disorders (Antisocial, Borderline, Histrionic, Narcissistic)
When working with a client with a personality disorder, the nurse would expect to assess
Impaired interpersonal relationships, Inability to empathize with others, Minimal insight
Joseph presents in the Emergency Room actively hallucinating, paranoid and makes aggressive threats to staff. What medications will likely be ordered for rapid tranquilization?
haloperidol (Haldol) and lorazepam (Ativan)
A nurse teaching a patient about a tyramine-restricted diet would include which of the following foods as ones to avoid:
aged cheese, wine, pickled foods, and avocados
citalopram (Celexa), fluoxetine (Prozac), sertraline (Zoloft) are what type of meds
selective serotonin reuptake inhibitors (SSRIs)
Which of the following statements is true about the consequences of using atypical (second generation) antipsychotic medication versus typical (first generation) antipsychotic medication?
Atypical (second-generation) antipsychotics target the negative symptoms of schizophrenia as well as the positive symptoms and have fewer motor side effects
Which of the following medications is most likely to cause extrapyramidal side effects?
chlorpromazine (Thorazine)
clozapine (Clozaril), olanzapine (Zyprexa), risperidone (Risperdal) are what type of meds>?
atypical (second generation) antipsychotics
is addiction a risk of using antipsychotics?
no
The nurse is teaching an elderly patient about their newly prescribed medication risperidone (Risperdal). Which of the following statements by the patient would best indicate a correct understanding of the teaching?
“I will move slowly from lying to standing to prevent a fall”
Tricyclic antidepressants work by:
Blocking reuptake of norepinephrine and serotonin at the nerve synapse
A nurse is caring for a client who is experiencing extreme mania due to bipolar disorder. Prior to administration of lithium carbonate, the client’s lithium blood level is 1.2 mEq/L. Which of the following actions should the nurse take?
Administer the next dose of lithium carbonate as scheduled.
amitriptyline (Elavil) is what type of med?
tricyclic antidepressant (TCA)
cautions when benzodiazepines are used as anti-anxiety medications
risk of dependence, caution when driving, do not use with alcohol, and do not stop abruptly
what can happen if Nardil (phenelzine) is taken with aged cheese with red wine
a hypertensive crisis could occur
David, age 24, is currently being treated for schizophrenia. He presents to the ER with symptoms of muscle rigidity, temperature of 105.2, pulse rate of 126, pulse oximetry of 89%, and a labile BP. What are you most concerned may be occurring?
neuroleptic malignant syndrome
Emma is admitted to the medical unit for observation after being diagnosed with Serotonin Syndrome by her psychiatrist. Of the following combinations of medications, which was she most likely taking?
fluoxetine (Prozac) and sertraline (Zoloft)
Tricyclic antidepressants have more sedating and anticholinergic effects than the SSRIs
true
MAOIs work by
inhibiting the MAOI enzyme
antipsychotics work by
blocking dopamine receptors
SSRIs work by
blocking the reuptake of serotonin
A nurse is caring for a client who has early stage Alzheimer’s Disease and a new prescription for donepezil (Aricept). The nurse should include which of the following statements when teaching the client about the medication?
“You can expect improvement in the patient’s ability to perform self-care and the progression of cognitive decline to slow with donepezil.”
Forgetting events of one’s own history; difficulty performing tasks that require planning and organization; personality and behavioral changes; may be incontinent
moderate alzheimer’s (middle stage)
Losing ability to converse with others; assistance required for ADLs; incontinence; losing awareness of one’s environment; progressive difficulty with physical abilities
severe alzheimers
Memory lapses; losing or misplacing items; difficulty concentrating; still able to perform ADLs
mild alzheimer’s
Onset: recent, may relate to life events/changes; LOC: clear; duration: variable ; may be chronic
depression
Onset: insidious, slow, over years, often unrecognized; LOC: clear; duration: years; irreversible
dementia
Onset: sudden; LOC: reduced; duration: hours to weeks; reversible with timely medical intervention
delirium
Both the client and the family members can refuse to believe that changes, such as loss of memory, are taking place, even when those changes are obvious to others
denial
The client may make up answers to fill in memory gaps
confabulation
The client avoids answering questions by repeating phrases or behavior
perseveration
Which of the following statements would indicate that teaching about somatic symptom disorder has been effective?
“I will feel better when I begin handling stress more effectively.”
When planning care for a client with somatic symptoms disorder, the nurse would include the following interventions
Encourage the client to participate in daily exercise.
Help the client see the relationship between physical symptoms and life stress/events.Accept somatic symptoms as being real to the client.
conversion disorder
Also known as functional neurological disorderResults when a client exhibits neurologic manifestations in the absence of a neurologic diagnosisClients who have conversion disorder transmit emotional or psychological stressors into physical manifestations
Somatization is the expression of psychological stress through physical manifestations; the physical manifestations cannot be explained by underlying pathology
somatic symptom disorder
Misrepresents physical manifestations as evidence of a serious disease process; previously known as hypochondriasis
illness anxiety disorder
Previously known as Munchausen syndrome; the client falsely reports physical or psychological manifestations
factitious disorder
Previously known as Munchausen syndrome by proxy; client deliberately causes injury or illness to a vulnerable person
factitious disorder imposed on another
Also known as functional neurological disorder; results when a client exhibits neurologic manifestations in the absence of a neurological diagnosis
conversion disorder
The client’s family asks the nurse, “What is illness anxiety disorder?” The best response by the nurse is, “Illness anxiety disorder is…
a persistent preoccupation with getting or having a serious disease.”
risk factor for physical or sexual abuse
witnessing or experiencing traumatic events
risk factor for Associated with some disorders, such as schizophrenia, bipolar disorder, autism spectrum disorder, ADHD, and intellectual development disorder
genetics
risk factor for Severe marital discord, foster care placement, parental criminality, substance use disorders, parental depression
social and environmental
risk factor for Alterations in neurotransmitters, including norepinephrine, serotonin, or dopamine
biochemical
risk factor for Difficulty with assimilation, lack of cultural role models, lack of support from the dominant culture
cultural and ethnic
Complex neurodevelopmental disorder thought to be of genetic origin with a wide spectrum of behaviors affecting an individual’s ability to communicate and interact with others. Cognitive and language development are typically delayed. Characteristic behaviors include inability to maintain eye contact, repetitive actions, and strict observance of routines.
autism spectrum disorder
Client demonstrates persistent difficulty in acquiring reading, writing, or mathematical skills; Performance in one or more academic areas is significantly lower than the expected range for the client’s age, level of intelligence, or educational level; Clients who have specific learning disorder benefit from an individualized education program (IEP)
specific learning disorder
Involves the inability of a person to control behaviors requiring sustained attention Inattention, impulsivity, and hyperactivity characteristic behaviors of ADHD; Inattention – difficulty in paying attention, listening, and focusing; Hyperactivity – fidgeting, inability to sit still, running and climbing inappropriately, difficulty with playing quietly, talking excessively; Impulsivity – difficulty waiting for turns, constantly interrupting others, acting without the consideration of consequences; Behaviors associated with ADHD must be present prior to age 12 and must be present in more than one setting to be diagnosed as ADHD.
attention deficit hyperactivity disorder
Onset of deficits and impairments occurs during the developmental period of infancy or childhood; Client has intellectual deficits with mental abilities such as reasoning, abstract thinking, academic learning, and learning from prior experiences; Clients demonstrate impaired ability to maintain personal independence and social responsibility, including activities of daily living, social participation, and the need for ongoing support at school
intellectual development disorder
Demonstrate a persistent pattern of behavior that violates the rights of others or rules and norms of society; Categories of conduct disorder include the following: aggression to people and animals, destruction of property, deceitfulness or theft, serious violations of rules
conduct disorder (child adolescent onset)
Characterized by a recurrent pattern of the following antisocial behaviors: negativity, disobedience, hostility, defiant behaviors (especially toward authority figures), stubbornness, argumentativeness, limit testing, unwillingness to compromise, refusal to accept responsibility for misbehavior; Misbehavior usually demonstrated at home and directed toward the person best known; Child/adolescent does not see themselves as defiant; view their behavior as a response to unreasonable demands and/or circumstances; May exhibit low self-esteem, mood lability, and a low frustration threshold; May develop into conduct disorder
oppositional defiant disorder
Exhibit recurrent episodic violent and aggressive behavior with the possibility of hurting people, property or animals; Characterized by aggressive overreaction to normal events followed by feelings of shame and regret; Prevents the client’s ability to have healthy relationships and/or employment; Can lead to the development of chronic disease(hypertension or diabetes mellitus)
intermittent explosive disorder
Exhibit recurrent temper outbursts that are severe and do not correlate with situation; Manifested verbally and/or physically and can include aggression; Not appropriate for the client’s developmental level; Temper outbursts are present three or more times/week and are observable by others, such as parents, peers, and teachers, in at least two settings, such as home and school; Mood between the temper outbursts is angry and irritable
disruptive mood dysregulation disorder
Ability to model effective coping strategies and use problem-solving skills, Ability to adapt to changes in the environment, Ability to form nurturing relationships, and Ability to distance oneself from the emotional chaos of the parent or family are examples of what type of defense mechanism
Resiliency is considered a protective factor for the development of mental health issues in children and adolescents.
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?
hypokalemia and slightly elevated body weight,
Characterized by recurrently eating large quantities of food over a short period of time without the use of compensatory behaviors
binge-eating disorder
A life-threatening eating disorder characterized by the client’s restriction of nutritional intakes necessary to maintain a minimally normal body weight, intense fear of gaining weight or becoming fat, significantly disturbed perception of the shape or size of the body, and steadfast inability or refusal to acknowledge the seriousness of the problem or even that one exists
anorexia nervosa
Characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid weight gain, such as purging, fasting, or excessively exercising
bulimia nervosa
developmental risk factors of bulimia nervosa
Self-perception of being overweight, fat, unattractive and undesirable
family risk factors of bulimia nervosa
Chaotic family with loose-boundaries; parental maltreatment including possible physical or sexual abuse
sociocultural risk factors of bulimia nervosa
Cultural ideal of being thin; media focus on beauty, thinness, fitness; weight-related teasing
biologic risk factors of bulimia nervosa
Obesity; early dieting, possible serotonin and norepinephrine disturbances
sociocultural risk factors for anorexia nervosa
Cultural ideal of being thin; media focus on beauty, thinness, fitness
biological risk factors for anorexia nervosa
Obesity; dieting at an early age
family risk factors for anorexia nervosa
Lacks emotional support; cannot deal with conflict
developmental risk factors for anorexia nervosa
Issues of developing autonomy and having control over self and environment; developing a unique identity
A nurse is performing an admission assessment of a client who has anorexia nervosa. Which of the following is an expected finding?
amenorrhea, anemia, presence of lanugo on the face
