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NCLEX > Psych > Flashcards

Psych Flashcards

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1
Q

Anhedonia

A

Loss of pleasure in usually pleasurable things

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2
Q

Mild depression weight

A

Gain

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3
Q

Severe depression weight

A

Loss

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4
Q

Severe depression crying

A

No more tears

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5
Q

Mild-moderate depression crying

A

Crying spells

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6
Q

Why might depressed clients be irritable?

A

Decreased serotonin

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7
Q

Do you compliment depressed clients?

A

No, they might make them feel worse

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8
Q

Do you isolate the depressed client?

A

No, seek them out

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9
Q

How to help the severely depressed client

A

Sit with them and make no demands, they can’t make simple decisions, they will worry about the decisions they do make

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10
Q

Suicide risk with depressed clients

A

It increases once the depression lifts, because now they have the energy to do it

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11
Q

Thoughts with depression

A

Slowed thoughts, use silence and slow speaking to them. They can’t concentrate

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12
Q

Can depressed clients have delusions/hallucinations?

A

Yes

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13
Q

Sleep with depression

A

In mild depression, hypersomnia-want to sleep all the time. In moderate to severe, insomnia

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14
Q

S/S of mania

A 
Labile (changing) emotions
Flight of ideas
Delusions-false ideas
Delusions of grandeur
Delusions of persecution
Inappropriate dress
Can't stop to eat-give snacks
Spending sprees 
Poor judgement, no inhibitions (no filter)
Hypersexual, exploiting
Manipulation-gets mad when they fail
Decreased attention span
Hallucinations
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15
Q

Delusions of grandeur

A

You think you’re Jesus

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16
Q

Delusions of persecution

A

Think someone’s out to get them

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17
Q

How to deal with a delusional client

A

Make them feel safe, don’t argue, don’t talk about it. Tell them you accept they believe it, but you do not believe it.

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18
Q

How to treat the manic client

A 
Set limits, be consistent
Decrease stimuli
Limit group activities
One on one relationships are the best
Remove hazards
Stay with them if anxious
Structured schedule
Writing activities work well
Finger foods
Weigh daily
Walk with them during meals
Don't try to argue or reason
Brief, frequent contact with staff. Too much conversation stimulates them
Maintain their dignity
They blame everyone
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19
Q

S/S of schizophrenia

A 
Inward focus on their own world
Inappropriate affect
Disorganized thoughts
Loose associations (interrupted connections in thought and confused thinking)
Rapid thoughts, jump from idea to idea
Echolalia
Neologism (make up new words)
Concrete thinking
Word salad (jumble of words)
Delusions/hallucinations
Child-like mannerisms
Religiosity
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20
Q

Nu Dx for schizophrenia

A

Alteration in communication

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21
Q

Most common hallucinations with schizophrenia?

A

Auditory, then visual

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22
Q

What type of hallucinations with schizophrenia should you assess for?

A

Command; they’re auditory that tell the client to hurt themselves or others. They scare the client and can signal a psychiatric emergency

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23
Q

As an RN, can you go into a psych client’s room alone?

A

Yes

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24
Q

How to care for the schizophrenia client

A 
Decrease stimuli
Observe frequently-don't look suspicious
Orient frequently (they may be oriented x3 but still have delusions/hallucinations)
Keep conversations reality based
Make sure personal needs are met
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25
Q

What are some of the most lethal methods of suicide?

A

Guns, car crashes, hanging, carbon monoxide

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26
Q

Contract to postpone suicide

A

They sign saying they won’t harm themselves or others for 24 hours. Don’t forget to renew the contract

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27
Q

How to you speak to the suicidal client?

A

Direct, closed ended statements. Ask if they have a plan to hurt themselves.

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28
Q

How to answer exercise questions

A

Pick the answer that is most exerting that won’t hurt them. Just bc you haven’t seen a punching bag at a hospital doesn’t mean there isn’t one at the NCLEX hospital.

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29
Q

Restraints

A

Check q 15 minutes
Remember hydration, nutrition, & elimination
Not used much more on psych units
On NCLEX, stay away from restraints as long as possible
Observation at 15 to 30 minutes intervals or one to tone if the client cannot contract for safety

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30
Q

How to answer questions about staying with clients

A

Don’t act like you have other patients, only worry about the patient on the question

31
Q

Which client thinks life has been unfair to them?

A

Paranoia

32
Q

Which client do you HAVE to be reliable and keep your word with?

A

Paranoia

33
Q

Which client thinks everyone else has the problem?

A

Paranoid

34
Q

How to treat the paranoid client

A

Brief visits, careful with touch, don’t mix meds, don’t hide them, be matter of face, always ID meds, they eat sealed foods, they need consistent nurses, no competitive activities, be honest

35
Q

S/S of generalized anxiety disorder

A

Chronic anxiety
Fatigue due to constant muscle tension
Uncomfortable
Seek help

36
Q

Tx for GAD

A

Short term use of anxiolytics
Relaxation techniques
Journaling over time to gain insight into anxiety, peaks and valleys and triggers

37
Q

Which client is emotionally numb and detached

A

PTSD

38
Q

Which client has difficulty with relationships, isolates themselves

A

PTSD

39
Q

Tx for PTSD

A

Support groups
Talk about it, don’t push
Meds may help

40
Q

OCD

A

Comes from an unconscious conflict/anxiety
Need schedule
Give time for their rituals
Do not verbalize disapproval
You should never take away the ritual without replacing it with another coping mechanism, such as anxiety reduction techniques

41
Q

Obsession

A

Recurrent thoughts

42
Q

Compulsion

A

Recurrent acts

43
Q

Tx of OCD

A

Time delay techniques and relaxation

Meds-SSRIs or TCAs

44
Q

Dissociative disorders s/s

A

Client uses dissociation as a coping mechanism to protect self from severe physical or psych trauma
Hx of abuse
Not commonly seen
Client or others may be aware of the problem, but may have periods of time or events not remembered

45
Q

Dissociative identity disorder

A

Multiple personalities, extreme example of a dissociative disorder

46
Q

Tx of dissociative disorder

A

Process trauma over time

Meds may be used to treat co-existing depression or anxiety

47
Q

Alcohol is what?

A

A depressant

48
Q

Stages of alcohol withdrawal

A

1-mild tremors, nervous, nausea
2-increased tremors, hyperactive, nightmares, disorientation, hallucinations, increased HR/BP
3-most dangerous, severe hallucinations (visual and kinesthetic are most common), grand mal seizures

49
Q

Stage II and III alcohol withdrawal

A

DT’s (withdrawal delirium) keep light on

50
Q

Stage I and II alcohol withdrawal

A

Walk and talk to them, reorient them a lot

51
Q

Tx for alcohol withdrawal

A

Anxiolytics-don’t be afraid to give

  • They have a tolerance to alcohol, and a cross-tolerance to other CNS depressants
  • They can handle meds every two hours
  • DTs should be prevented, don’t let them suffer through
  • They will be very frightened
52
Q

What is an anxiolytic that is frequently given for outpatient alcohol detox?

A

Chlordiazepoxide

53
Q

Alcohol detox protocol consists of what?

A

Thiamine injections, multivitamins, maybe mag

54
Q

Complications of alcohol withdrawal caused by B vitamin (thiamine) deficiencies

A

Korsakoff’s syndrome (disorientated to time, confabulate-they don’t mean to lie but they make up things to fill in gaps)
Wernicke’s syndrome (emotions labile, moody, tire easily)

55
Q

Peripheral neuritis

A

Nerve problem with alcohol withdrawal, think B vitamin deficit

56
Q

Other S/S of alcohol withdrawal

A

Impotence-can’t get an erection
Liver/pancreas problems
Gastritis
Mg and K loss from diuresing

57
Q

Major defense mechanism used in alcohol withdrawal

A

Denial and rationalization

58
Q

Antabuse

A

Deterrent to drinking alcohol
Before they’re given it, they have to sign consent and say they’ll stay away from ANY for of alcohol: cough syrup, aftershave, perfume, alcohol prep

59
Q

What must a client have prepared after alcohol detox?

A

Relapse prevention plan

60
Q

S/S of anorexia

A

Lanugo, decreased sexual development, lose weight, exercise, periods stop, plan meals for others, hight achiever, perfectionistic, use intellectualization as defense mechanism

61
Q

Tx of anorexia

A

Increase weight gradually
Monitor exercise
Allow their input on choosing healthy foods for meals
Limit activity and decisions if weight is low enough to be life threatening

62
Q

S/S of bulimia

A

Teeth decay, laxatives, diuretics, strict dieter: fasts and exercise, binge alone and secret, NORMAL weight, the binge is initially pleasurable but when they’re done they are very self critical

63
Q

When do bulimia and anorexic pts feel in control?

A

As long as they can eat and not eat how they want

64
Q

Tx for bulimia

A

Sit with them at meals, observe for 1 hour after
Allow 30 minutes for meals
Take focus off of the food, don’t talk about it with them
Self esteem building is important

65
Q

Causes of bulimia

A

Usually family problems, they usually deny conflicts

66
Q

Personality disorder s/s

A 
Intensely emotional
Manipulative
Suicidal gestures
Self mutilation
Depressed or bulimic
Substance abuse
Fear of abandonment, many negative relationships
To them, any relationship is better than no relationship
67
Q

Most common personality disorder

A

Borderline

68
Q

Tx of personality disorders

A 
Improve self esteem
Treat co diagnoses
Enforce rules and limits
Don't reinforce negative behaviors
Treat self mutilation and suicide gestures in matter of fact way
69
Q

Phobia s/s

A

The object they’re scared of doesn’t present danger
Must have trusting relationship
Don’t talk about the phobia a lot
Follow up is the key to successful tx
Desensitization (gradual exposure to the fear) must occur over time

70
Q

Panic disorder

A 
Stay 6 feet away
Simple words
Have to learn how to stop the anxiety
Teach that symptoms should peak within 10 minutes
Teach journaling to manage anxiety
71
Q

Hallucinations

A 
Warn before touching
Don't say "they"
Involve in an activity
Elevate head of bed
Decrease stimuli
Offer reassurance, they're scared
72
Q

Electro-Convulsive Therapy

A 
*Last resort tx*
Can induce grand mal seizure
For severe depression, manic episodes
NPO, void, atropine to dry up secretions
Signed permit is necessary
Series of tx, depends on client response
Very effective, very humane with current meds
Succinylcholine chloride-relaxes muscles
73
Q

Post procedure ECT

A 
Position on side
Stay with client
Temporary memory loss
Reorient
Involve in day's activities ASAP
Always look for injuries
Tell family that the client will be confused for a while, will get better over time

NCLEX (14 decks)

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