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PSYCHIATRIC NURSING > PSYCH QUIZ 2 > Flashcards

PSYCH QUIZ 2 Flashcards

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1
Q

Application of the Nursing Process

A

Assessment
Data Analysis
Outcome Identification
Nursing Interventions
Evaluation

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2
Q

Assessment

A

History
General Appearance and Motor Behavior
Mood and Affect
Thought Process and Content
Sensorium and Intellectual Processes
Judgment and Insight
Self-Concept
Roles and Relationships
Physiologic and Self Care Consideration
Depression Rating Scales

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3
Q

data can be collected from the client and family or significant others

A

History

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4
Q

data collection should not be rushed

A

History

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5
Q

client will look sad, sometimes looks ill

A

General Appearance and Motor Behavior

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6
Q

posture often is slouched with head down and make minimal eye contact

A

General Appearance and Motor Behavior

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7
Q

latency of response is seen when clients take up to 30 seconds to respond to a question

A

General Appearance and Motor Behavior

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8
Q

clients with depression may describe themselves as hopeless, helpless, down, or anxious

A

Mood and Affect

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9
Q

presence of anhedonia and they are maybe apathetic

A

Mood and Affect

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10
Q

they are overwhelmed by noise, so they withdraw from the stimulation of interaction with others

A

Mood and Affect

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11
Q

depressed clients have a slow thinking process

A

Thought Process and Content

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12
Q

they are negative and pessimistic in their thinking

A

Thought Process and Content

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13
Q

most clients readily admit suicidal thinking

A

Thought Process and Content

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14
Q

Some clients are oriented to TPP others are having difficulty in orientation

A

Sensorium and Intellectual Processes

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15
Q

Memory impairment is common

A

Sensorium and Intellectual Processes

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16
Q

Clients have difficulty in concentration or paying attention
If psychotic there is presence of hallucination (voices)

A

Sensorium and Intellectual Processes

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17
Q

impaired judgment because they cannot use their cognitive abilities to solve problems or to make decision

A

Judgment and Insight

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18
Q

insight maybe intact especially if they have previous depression

A

Judgment and Insight

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19
Q

they feel guilty about not being able to function and often personalize events or to take responsibility for incidents over which they have no control

A

Self-Concept

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20
Q

sense of self concept is greatly reduced, good for nothing or just worthless to describe themselves

A

Self-Concept

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21
Q

a belief that others would be better without them, which can lead to suicidal thoughts

A

Self-Concept

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22
Q

there is difficulty fulfilling roles and
responsibilities

A

Roles and Relationships

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23
Q

the more severe the depression the greater the difficulty

A

Roles and Relationships

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24
Q

lose interest in sexual activities, men often experience impotence

A

Physiologic and Self Care Consideration

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25
Q

pronounced weight loss because of lack of appetite or disinterest in eating

A

Physiologic and Self Care Consideration

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26
Q

sleep disturbance
exhaustion and unrefreshed no matter how much time they stay in bed

A

Physiologic and Self Care Consideration

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27
Q

Self-rating scales of depressive symptoms

A

Depression Rating Scales

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28
Q

Self-rating scales of depressive symptoms

A

Zung-Self Rating Depression Scales
Beck depression Inventory
Hamilton Rating Scale

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29
Q

for depression is a clinician rated depression scale

A

Hamilton Rating Scale

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30
Q

nursing diagnoses commonly established for the client with depression

A

Data Analysis

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31
Q

nursing diagnoses commonly established for the client with depression

A

Risk for suicide
Imbalanced nutrition: less thanbody
requirements
Anxiety
Ineffective coping
Hopelessness
Ineffective role performance
Self-care deficit
Chronic low self esteem
Disturb sleep pattern
Impaired social interaction

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32
Q

Outcome Identification

A
  • Client will not injure himself or others
  • Client will independently carry out ADL
  • Client will establish a balance of rest, sleep, and activity
  • Client will establish a balance of adequate nutrition, hydration, and elimination
  • Client will evaluate self attributes realistically
  • Client will socialize with staff, peers, and family and friends
  • Client will return to occupation or school activities
  • Client will comply with antidepressant regimen
  • Client will verbalize symptoms of a recurrence
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33
Q

Nursing Interventions

A
  • providing for safety of client and others
  • institute suicide precautions if indicated
  • begin a therapeutic relationship by spending non-demanding time with the client
  • promote completion of activities of daily living
    by assisting the client only as necessary
  • establish adequate nutrition and hydration
  • promote sleep and rest
  • engage the client in activities
  • encourage the client to verbalize and describe emotions
  • work with the client to manage medications and side effects
  • providing client and family teaching
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34
Q

based on achievement of individual client outcomes.

A

evaluation of care plan

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35
Q

involve extreme mood swings from episode of mania to episode of depression

A

Bipolar Disorder

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36
Q

during manic phases clients are

A

Euphoria
Grandiose
Energetic
Sleepless
Poor judgment
Rapid thoughts, actions, and speech

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37
Q

if a person presentation is like a major depression, it will be diagnosed as what?

A

Depression

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38
Q

if a client experiences a manic stage, it can only be diagnosed as what?

A

bipolar disorder

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39
Q

if a person 1st episode of bipolar illness is depressed stage it will be diagnosed as?

A

major depression

40
Q

the lifetime risk for bipolar disorder is at least _ with a risk of completed
suicide for _?

A

1.2%, 15%

41
Q

___ ____ are at high risk in the early course of the disease of suicide

A

Young men

42
Q

bipolar disorders occur almost equally among men and women. T or F?

A

True

43
Q

more common among highly
educated people. T or F?

A

True

44
Q

a person with bipolar disorder cycles between ___,___,____.

A

depression, normal behavior,
or mania

45
Q

alternates between major depressive and manic episode interspersed with period of normal behavior

A

bipolar mixed episodes

46
Q

the mean age for 1st manic episode is?

A

early twenties

47
Q

Treatment

A

Psychopharmacology

48
Q

involve a lifetime regimen of medication

A

Psychopharmacology

49
Q

Anti-manic agent called

A

lithium/anticonvulsants medications

50
Q

used as mood stabilizers

A

lithium or anticonvulsants medications

51
Q

protects against the effects of
bipolar depressive cycles

A

lithium and anticonvulsants

52
Q

is a salt contained in the human body; it is similar to gold and other trace elements

A

Lithium

53
Q

the response rate in acute mania to
lithium is

A

70 to 80%

54
Q

Lithium action peaks in

A

30min to 4 hours for regular forms
4 to 6 hours for the slow-release form

55
Q

Anticonvulsant Drug

A

Carbamazepine
Valproic acid

56
Q

used for grand mal epilepsy
and temporal lobe epilepsy

A

Carbamazepine

57
Q

was the 1st anticonvulsant
found to have mood stabilizing
properties, but the threat of
agranulocytosis was of great
concern

A

Carbamazepine

58
Q

therapeutic level

A

4 to 12 𝜇g/ml

59
Q

Provision of Safety for the client and those around the client

A

Set limits on client’s behavior when needed
Use short, simple sentences to communicate
Clarify the meaning of clients communication
Frequently provide finger foods that are high in calories and protein
Promote rest and sleep
Protect the clients dignity when inappropriate behavior occurs
Channel clients need for improvement into socially acceptable motor activities.

60
Q

not metabolized rather it is reabsorbed by the proximal tubule and excreted into the urine.

A

Lithium

61
Q

used to monitor therapeutic or maintenance level.

A

Periodic serum lithium levels

62
Q

Maintenance level

A

(0.5 to 1 mEq/L

63
Q

treatment level

A

0.8 to 1.5mEq/L)

64
Q

Toxic levels

A

1.5mEq/L and above)

65
Q

potentially fatal in overdose

A

Lithium

66
Q

Clients should drink adequate water

A

(approximately 2L/day)

67
Q

High salt

A

low lithium level

68
Q

high H2O

A

low lithium level

69
Q

low H2O

A

High lithium level= toxicity

70
Q

ordered as baseline and every 6 mos. during treatment.

A

Thyroid Function Test

71
Q

Lithium is contraindicated for client with

A

renal function, brain or cardiovascular damage

72
Q

men commit approx.__ of suicide

A

72%

73
Q

methods of suicide

A

shooting, hanging, jumping from a high building.

74
Q

Clients with increased risk for suicide

A

Depression
Bipolar disorder
Schizophrenia
Substance abuse
Post traumatic stress disorder
Borderline personality disorder

75
Q

Medical problems associated with suicide

A

HIV or AIDS
Diabetes
Cerebrovascular accidents
Head and spinal cord injury

76
Q

Environmental Factors that increase risk for suicide

A

Unemployment
Critical life events
Family history of depression or suicide

77
Q

Behavioral Factors that increase suicide risk

A

Impulsivity
Erratic

78
Q

means thinking about killing oneself.

A

Suicidal Ideation

79
Q

when a person thinks about and seek ways to commit suicide.

A

Active Suicidal Ideation

80
Q

Considered more lethal.

A

Active Suicidal Ideation

81
Q

a suicidal act that either failed or was incomplete.

A

Attempted suicide

82
Q

when a person thinks about wanting to die or wishes he or she were dead but has no plans to cause his or her death.

A

Passive suicidal ideation

83
Q

People with suicidal ideation send either direct or indirect signals to others about their intent to harm themselves

A

Warnings of Suicidal Intent

84
Q

Where and when does the client intend to carry out the plan

A

Warnings of Suicidal Intent

85
Q

Few people give no warning signs

A

Risky Behaviors

86
Q

Overall Goal

A

To keep the client safe and later to help him or her to develop new coping skills that do not involve self harm.

87
Q

INTERVENTION

A

Using an authoritative role
Providing a safe environment
Initiating a no suicide contract
Creating a support system list

88
Q

ultimate rejection of family and friends

A

Suicide

89
Q

effective in many situations, they work well with certain clients.

A

No self harm/No suicide contracts

90
Q

In outpatient settings , the interval maybe ____; inpatient interval may range from every shift to ___

A

1 week; every 1 to 3 days

91
Q

salt contained in the human body;

A

lithium

92
Q

the response rate in acute mania to
lithium

A

70 to 80%

93
Q

Lithium action peaks in

A

30min to 4
hours for regular forms and 4 to 6
hours for the slow-release form

94
Q

used for grand mal epilepsy
and temporal lobe epilepsy

A

Carbamazepine

95
Q

Anticonvulsant Drug

A

Carbamazepine, Valproic acid

PSYCHIATRIC NURSING (2 decks)

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