Psych Nursing

Question 1

Best candidate for depot antipsychotic therapy

1. Elderly man psychosis secondary to dementia who lives with daughter
2. Homeless vet with schizophrenia who occasionally sleep in a homeless shelters
3. House wife with bipolar prone to psychotic features during manic phase
4. Student recently diagnosed with schizophrenia lives with parents

Answer 1

2. Homeless vet with schizophrenia who occasionally sleep in a homeless shelters

Depot antipsychotics are long-acting injectables for maintenance of schizophrenia for people with problems adherence to med schedule

Question 2

How do you handle a hypochondriac

1. Present reality
2. Encourage expression of feelings
3. Set boundaries
4. Respect their wishes

Answer 2

3. Set boundaries

None of the other techniques will be helpful

Question 3

Patient with Conversion Syndrome ( Disuse of body system without an organic / neurological cause) experiences sudden blindness after fight between son and husband.

Priority therapeutic approach

1. Reassure blindness is temporary and will resolve soon
2. Gently point out that she can see well enough to function
3. Encourage expression of feelings and link emotional trauma to blindness
4. Teach ways to cope with blindness, ie. Methodically arranging personal items.

Answer 3

4. Teach ways to cope with blindness, ie. Methodically arranging personal items.

Priority: Most important is that the patient can function in this state.

Question 4

Med surg unit patient of several months. Hostile, rude, belligerent. How should nurse handle assignment

1. Rotate schedule so Noone has to work with him too often
2. Pair float nurse & nursing student for a fresh perspective
3. ID 2 or 3 experienced nurses as primary caregivers and dev plan including psychological intervention
4. Assign self as primary caregiver

Answer 4

ID 2 or 3 experienced nurses as primary caregivers and dev plan including psychological intervention

Consistent caregiver & Psychosocial interventions represent best chance for dev relationship

Question 5

Question which order

1. Fluoxtine for middle-aged patient with depression
2. Chlorpromazine younger patient with schizophrenia
3. Loxapine older adult with dementia and psychosis
4. Lorazepam young adult with generalized anxiety disorder

Answer 5

3. Loxapine older adult with dementia and psychosis

Antipsychotics are not generally prescribed to elderly with psychosis 2ndary to dementia due to Death by HF

Question 6

Match

Commanding hallucinations
Clang associations
Ideas of reference
Neologisms

Song on the radio is talking about the patient

Stating: “I tied the rope soap the slope nope.”

Stating: “I got so angry I picked up a dish and threw it at the geshinker”

TV directly telling the patient to hide inside the shower to prevent the impending nuclear fallout

Answer 6

Ideas of reference
Song on the radio is talking directly to the patient

Clang associations
Stating: “I tied the rope soap the slope nope.”

Neologisms
Stating: “I got so angry I picked up a dish and threw it at the geshinker”

Commanding hallucinations
TV directly telling the patient that everyone is against them

Question 7

Which patient needs priority assessment

1. Commanding hallucinations
2. Clang associations
3. Ideas of reference
4. Neologisms

Answer 7

Commanding hallucinations

Question 8

Panic disorder. Which is greatest concern

1. HR increase, tightness in chest
2. Demonstrates tachycardia and carpopedal spasms
3. Pacing and pounding fist together
4. Muttering to self and easily startled

Answer 8

3. Pacing and pounding fist together

Ready for physical violence to self or others

Question 9

Patient with suicidal ideation and history of major depression. Which cause is of greatest concern.

1. I have had problems with depression fir most my adult life.
2. My father & brother both committed suicide
3. My wife is having problems, she relies on me
4. I am afraid to kill myself, I wish I had more courage

Answer 9

2. My father & brother both committed suicide

Family History of suicide is a increase risk factor.

Question 10

Acute psychiatric unit. Patient develops Neuroleptic Malignant Syndrome. Delegate which to UAP

1. Wiping body with cool moist towels
2. Monitoring and interpretation of vital signs
3. Attachment of ECG
4. Transport patient to ICU

Answer 10

1. Wiping body with cool moist towels

Neuroleptic malignant syndrome = rare, fatal reaction to antipsychotic medications.

S/S
Fever
Altered Mental State
Muscle rigidity
Autonomic instability

Question 11

Stronger antipsychotics, like fluphenazine and haloperidol, are more likely to trigger this rare, fatal reaction.

S/S

Answer 11

Neuroleptic malignant syndrome(NMS)

Symptoms:
high fever,
confusion,
rigid muscles,
variable blood pressure,
sweating, and fast heart rate.

Complications may includerhabdomyolysis,
high blood potassium,
kidney failure,
seizures.

Question 12

Med surg UAP floated to acute psychiatric unit. Delegate which to UAP

1. One-on-one observation of suicidal patient
2. Assist occupational therapist conduct craft class
3. Accompany older patient who wanders on a walk outside
4. Assist med nurse who is having a problem with a patient

Answer 12

3. Accompany older patient who wanders on a walk outside

Med Surg will be used to ambulation with older confused patients

Question 13

Restraining combative patient. Which requires charge nurse intervention

1. Psychiatric nursing assistant uses quick-release knot to tie restraints
2. HCP secures the restraint to side rail
3. RN checks pulses distal to restraints
4. LPN explains to the patient why he is being restrained.

Answer 13

2. HCP secures the restraint to side rail

Restraints must be tied to stationary part of bed. BED FRAME.

HCP or RN will explain why they are being restrained. Not LPN

Question 14

LPN complains to charge nurse that she is always assigned the same chronically depressed patient everyday. What should the charge nurse do?

1. Look at assignments sheet & see if there is another LPN to switch with
2. Tell her to care for the patient today but that her request will be considered for future assignments
3. Remind her that continuity of care and patient-centered care are primary goals
4. Explain patients with chronic conditions are more likely to fall under scope of LPN

Answer 14

2. Tell her to care for the patient today but that her request will be considered for future assignments

Switching assignments midshift creates delays for everyone.

Depressed patients may benefit from seeing new faces

Question 15

Nicotine has this affect on BP

Answer 15

Increases

Vasodilation

Question 16

Muscle spasms of face, neck, and tongue, upward gaze. Prescribed Haloperidol. Priority action

1. Maintain eye contact and stay with him until spasms pass
2. Place patient on aspiration precautions until spasms subside
3. Obtain order for diphenhydramine
4. Obtain order for antiseizure medications

Answer 16

3. Obtain order for diphenhydramine

Prevents extra piramidal effects

From: antipsychotics, antidepressants, lithium, anticonvulsants, antiemetics, and oral contraceptives.

These side effects can affect the motor system and can be uncomfortable and frightening

Question 17

Place in order Most to Least Serious

1. Trifluoperazine Temp 103.6, tachycardia, muscular rigidity and Dysphagia
2. Fluphenazine dry mouth & eyes, urinary hesitancy, Constipation & photo sensitive
3. Loxapine protruding tongue with lip smacking and spastic facial distortion
4. Clozapine, sore throat, fever, malaise, and flu like symptoms that began 6 weeks ago after starting new antipsychotic med. WBC 2000

Types of medications are each…

Answer 17

1.Trifluoperazine Temp 103.6, tachycardia, muscular rigidity and Dysphagia t syndrome (Fatal/ Rare)
Neuroleptic malignant hyperthermia
(Antipsychotic/ Anxiety- Chemo N/V)

4. Clozapine, sore throat, fever, malaise, and flu like symptoms that began 6 weeks ago after starting new antipsychotic med. WBC 2000 (Agranulocytosis: Treatment: Discontinue meds, infection precautions) - (Antipsychotic treats schizophrenia)
5. Loxapine protruding tongue with lip smacking and spastic facial distortion (Tardive dyskinesia- valentine for treatment) - (Antipsychotic/Schizophrenia)
6. Fluphenazine (Antipsychotic/Schizophrenia)

Question 18

Which comes first for a psych patient who is causing a safety issue.

Place in isolation room with UAP observing Or physical restraints

Answer 18

Place in isolation room with UAP observing - Comes First

Question 19

Rivastigmine

Class

Use

SE

Contradictions

Answer 19

Cholinesterase inhibitors.
Mild to moderate dementia associated with Alzheimer’s disease or Parkinson’s disease.

SE: GI problems / Black stools

Contradictions: PUD

Question 20

62 lives with wife. Prescribed rivastigmine 2x daily. What assessment will you perform first.

1. Psychotic (Hallucinations)
2. Pain assessment
3. Cognitive Deficts / memory loss
4. Fine & Gross motor deficits

Answer 20

3. Cognitive Deficts / memory loss

It is prescribed for Dementia for Mild to Moderate Alzheimer’s/ Parkinsons

Question 21

Most problematic & requires vigilance to prevent danger to self & others

1. Avolition
2. Echolalia
3. Motor agitation
4. Stupor

Answer 21

3. Motor agitation

Physical activity such as running & flailing about creates risk of injury for others / self due to exhaustion

1. Avolition = lack of energy starting activities
2. Echolalia = pathological repeating other people’s words or phrases
3. Stupor = state of motionless for prolonged periods

Question 22

Patient comes in to clinic 3 times monthly. Complains of N/V, Constipation, Excruciating stomach pain. Multiple diagnostic test have consistently yielded negative results

Priority nursing intervention

1. Advocate for psychiatric consultation
2. Make appointment with same HCP for continuing of care
3. Perform physical assessment to ID any physical abnormalities.
4. Assess for concurrent symptoms of depression or anxiety

Answer 22

3. Perform physical assessment to ID any physical abnormalities

Must always be vigilante for physical disease. Although, this is most likely undiagnosed somatoform disorder ( psychological conditions which manifest physiological symptoms with no organic cause)

Question 23

Terminal cancer wife states “We don’t want hospice we treatment” After discharge from hospital man commits suicide. Which people should participate in a root cause analysis of this sentinel event.

1. Wife & immediate family members
2. Only HCP who discharged patient
3. Any nurse who cared for patient during hospitalization
4. Case manager who arranged home visits for the patient
5. Only the nurse who discharged the patient
6. All HCP who were involved in patient care.

Answer 23

3. Any nurse who cared for patient during hospitalization
4. Case manager who arranged home visits for the patient
5. All HCP who were involved in patient care.

Everyone who had direct patient care should be invited to participate.

This review is done to review behaviors, signs, and signals that can be learned from to prevent future events

Question 24

Male-to-female (transwoman) admitt3d to acute psychiatric unit for suicide ideations. She is harassed verbally and insulted by other patients. What should nurse do first?

1. Isolate patient and explain that it is for their safety
2. Make general announcement and staff that bullying will not be tolerated
3. Assess patients reaction to the comments/ bullying
4. Gently suggest they could temporarily adopt natal gender appearance

Answer 24

3. Assess patients reaction to the comments/ bullying

Patient is in a fragile state and should be encouraged to verbalize feelings & preferences. Based on findings nurse can plan interventions to help patient feel safe & comfortable