Mood Disorders & Crisis of Suicide
How long should a depressed mood last in order for it to be considered persistent depressive disorder (dysthymia)? Improvements do not last longer than _____ months at a time
should last at least 2 years
improvements do not last longer than 2 months at a time
The criteria for general anxiety disorder (GAD)
After assessing a client using the Michigan Alcoholism Screening Test (MAST), the nurse identifies a possible problem with alcohol. Which MAST score is consistent with the nurse’s conclusion?
a. One
b. Two
c. Three
d. Four
d. Four
A client has severe anhedonia and regression. Which medication aggravates the condition of the client?
a. Clozapine
b. Quetiapine
c. Olanzapine
d. Haloperidol
d. Haloperidol
Haloperidol is a typical antipsychotic that improves the positive symptoms and worsens the negative symptoms. Therefore, haloperidol aggravates anhedonia and regression in the client.
The health-care provider prescribes lithium carbonate (Eskalith) and olanzapine (Zyprexa) for a client with severe manic episodes. The client’s spouse asks the nurse how Zyprexa works. Which response would the nurse make?
a. “Zyprexa in combination with Eskalith cures bipolar disorder symptoms.”
b. “Zyprexa prevents extrapyramidal side effects.”
c. “Zyprexa increases the effectiveness of the immune system.”
d. “Zyprexa calms the agitation associated with mania.”
D. “Zyprexa calms the agitation associated with mania.”
The nurse should explain to the client’s spouse that olanzapine can calm agitation associated with mania.
Describe the difference between bipolar 1 and bipolar 2
Bipolar 1: experiencing or has experienced a full syndrome of manic or mixed symptoms; some episodes of depression
Bipolar 2: bouts of major depression with episodic occurence of hypomania; never met criteria for full manic episode
Which symptoms does the nurse expect in a client experiencing anticipatory performance anxiety? Select all that apply.
a. Dry mouth
b. Sweaty palms
c. Trembling hands
d. Tremors
e. Rapid breathing
a. Dry mouth
b. Sweaty palms
c. Trembling hands
Which behavioral symptoms will be observed in a child with fetal alcohol syndrome? Select all that apply.
a. Passive behavior
b. Learning disabilities
c. Intellectual disability
d. Ineffective communication
e. Absence of judgmental skills
b. Learning disabilities
c. Intellectual disability
d. Ineffective communication
A client with schizophrenia spectrum disorder presents with bizarre behaviors and delusions. Which nursing action should be prioritized to maintain this client’s safety?
a. Monitor for medication nonadherence.
b. Note escalating behaviors immediately.
c. Interpret attempts at communication.
d.Assess triggers for bizarre, inappropriate behaviors.
b. Note escalating behaviors immediately.
The nurse should note escalating behaviors immediately, to maintain this client’s safety. Early intervention may prevent an aggressive response and keep the client and others safe.
Describe the difference between a manic vs a hypomanic episode.
Manic: distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal directed activity or energy, lasting at least *1 week* and present most of the day. nearly everyday
Hypomanic: lasting throughout at least *4 consecutive days*
A client who has fear of darkness is exposed to a room with darkness for a long time during therapy. Which therapy is the client undergoing?
a. Psychotherapy
b. Cognitive therapy
c. Implosion therapy
d. Behavior therapy
c. Implosion therapy
In implosion therapy (flooding), the client imagines or participates in real-life situations that frighten him or her.
Alcoholism subtypes (difference between type I/type A and type II/type B)
later onset
gradual onset
less genetic influence
equal prevalence btw genders
less severe
type II/type B
earlier onset (<25)
more rapid onset
more genetic influences
alteration in ETOH metabolism
men > women
often severe course
often associated w criminality
The client with schizophrenia has recently begun a new medication, clozapine (Clozaril). Which signs and symptoms of a potentially fatal side effect will the nurse teach the client about?
a. Blurring vision, dry mouth
b. Sore throat, fever, and malaise
c. Tremor, shuffling gait, and rigidity
d. Fine tremor, tinnitus, and nausea
b. Sore throat, fever, and malaise
Sore throat, fever, and malaise are symptoms of agranulocytosis, which is a potentially fatal disorder in which the client’s white blood cell count drops to extremely low levels. This places the client at great risk for infections.
What factors are involved in the etiology of depression?
- Genetics: hereditary factors involved
- Biochemical influences: deficiency of norepinephrine, serotonin and dopamine
- NT deficiency or imbalance
- Brain structure and function
- Neuroendocrine disturbances
During assessment the client says, “I need to visit my daughter.” The client repeats this sentence many times even without any context. What condition would the nurse suspect in the client?
a. Panic disorder
b. Hoarding disorder
c. Generalized anxiety disorder
d. Obsessive-compulsive disorder
d. Obsessive compulsive disorder
The screenings/labs used for alcoholism
CAGE questionnaire
MAST (Michigan Alcoholism Screening Test)
AUDIT (Alcohol Use Disorders Identification Test)
CRAFFT Screening
The client diagnosed with schizophrenia spectrum disorder is prescribed an antipsychotic. Which client symptoms, related to the side effects of this medication, should prompt a nurse to intervene immediately?
a. Sore throat and malaise
b. Light-colored urine and bradycardia
c. Anosognosia and avolition
d. Dry mouth and urinary retention
a. Sore throat and malaise
The nurse should intervene immediately if the client experiences signs of an infectious process—such as a sore throat, fever, and malaise—when taking antipsychotic drugs.
Factors involved in etiology of bipolar disorder
- genetics
- biochemical influences (possible excess of norepinephrine)
- physiological influences (brain lesions, enlarged ventricles, medication SE)
Relaxation response
opposite of fight or flight response
physical state of deep rest that changes our physical and emotional response to stress
s & s
decreased HR
decreased BP
slower breathing
improved oxygen saturation
decreased muscle tensions
The objective vs subjective data assessment techniques for alcoholism
objective data
S&S of intoxication or withdrawal
labs
UDS, BAL, Liver profile ( GGT, AST, ALT) , CBC with diff.(MCV), HIV, Cardiac enzymes, triglycerides
mental status, general behavior
malnutrition (vitamin deficiency)
tolerance to pain medication
needle tracks
nasal passages
dripping, infected, swollen, eroded septum
pupils
subjective data
keep in mind, denial is cornerstone defense mechanism
date, time, amount of last use (specific)
substance use hx (includes Rx meds)
for all substances ever used indicate:
route
amount (dose, frequency, duration)
pattern of use (alone/with others, self-medicating)
Acquisition
Past withdrawal pattern - Hx of tremors, hallucinations or DTs
family hx of subst abuse
Prior drug / alcohol treatment
Type of treatment
Was treatment completed?
Substance of choice
Age/circumstances of first use
Triggers to use
High risk behaviors during intoxication or withdrawal
Longest period of abstinence
Motivation to abstain at that time
Facilitators/barriers to abstinence
Factors contributing to relapse (environmental, intrapersonal)
Which modalities should a nurse recognize as integral parts of a treatment program when planning care for clients diagnosed with schizophrenia spectrum disorder? (Select all that apply.)
a. Group therapy
b. Medication management
c. Deterrent therapy
d. Supportive family therapy
e. Social skills training
a. Group therapy
b. Medication management
d. Supportive family therapy
e. Social skills training