Vocab
•Which of the following would be considered a neurologic side effect of antipsychotic therapy?
A. Blurred vision
B. Agranulocytosis
C. Sedation
D. Tardive dyskinesia
D. Tardive dyskinesia
Rationale: Tardive dyskinesia is a neurologic side effect of antipsychotic therapy.
–Blurred vision, sedation, and agranulocytosis are nonneurologic side effects.
Tardive dyskinesia: characterized by abnormal, involuntary movements such as smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform movements are embarrassing for clients may cause them to become more socially isolated.
The primary medical treatment for Schizophrenia is Psychoparmacology
ECT, Thorazine
A client with which psychiatric disorder is at high risk for suicide?
a. Personality disorders
b. Anxiety disorders
c. Eating disorders
d. Schizophrenia
d
Schizophrenia
Suicide is a high risk for peoeple diagnosed with schizophrenia
Which would most likely be a type of behavior that would be manifested by a client who has histrionic personality disorder?
A. Insisting that others follow the rules of the unit
B. Wondering why others are being friendly to the client
C. Having a tantrum if not getting enough attention
D. Getting others to make decisions for the client
C Rationale: Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. These characteristics may prompt the client to act out if the client is not getting his or her own way. This disorder does not focus on monitoring others' adherence to rules and structures. A focus on others being unfriendly is suggestive of paranoia or possibly dependent personality disorder. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of, which may cause a desire to have others make decisions.
a nurse is collecting data on a client who is actively hallucinating. Which nursing statement would be therapeutic at this time?
1."I know you feel they are out to get you, but its not true"
2."I can hear the voice and she wants you to come to dinner"
3."sometimes people hear things or voices others can't hear"
4."I talked to the voices you're hearing and they won't hurt you now"
3."sometimes people hear things or voices others can't hear"
What is Persecutory/ paranoid delusions?
involve the client’s belief that “others” are planning to harm him or her or are spying, following, ridiculing, or belittling the client in some way.
What are some neurologic effects that a patient will have when taking medications for schizophrenia?
–Extrapyramidal side effects
•Acute dystonic reactions
•Akathisia
•Parkinsonism
–Tardive dyskinesia
–Seizures
–Neuroleptic malignant syndrome
Is the following statement true or false?
Positive symptoms of schizophrenia include a flat affect and social withdrawal.
False
Rationale: Flat affect and social withdrawal are negative symptoms of schizophrenia.
The staff nurse that has a student assigned to nurse's unit today notices that the nursing student appears to cooperate with the group but does not complete agreed upon tasks at the appropriate time repeatedly and then displays negativity. The nursing student may be showing signs of which personality disorder or behavior?
A. Paranoid
B. Borderline
C. Narcissistic
D. Passive-aggressive behavior
D Rationale: Passive-aggressive behavior is characterized by a negative attitude and a pervasive pattern of passive resistance to demands for adequate social and occupational performance. These clients may appear cooperative, even ingratiating, or sullen and withdrawn, depending on the circumstances. Paranoid peabrsirbo.ncoamli/teystdisorder is characterized by pervasive mistrust and suspiciousness of others. Borderline personality disorder is characterized by a pervasive pattern of unstable interpersonal relationships, self-image, and affect as well as marked impulsivity. Narcissistic personality disorder is characterized by a pervasive pattern of grandiosity, need for admiration, and lack of empathy
The nurse knows that the most dangerous time period following a previous suicide attempt is which of the following?
a.. First 9 months
b. First 3 months
c. First 6 months
d. First year
b
First 3 months
The first 2 years after an attempt represent the highest risk period, especially the first 3 months
What is Tactile Hallucination?
sensations such as electricity running through the body or bugs crawling on the skin. Tactile hallucinations are found most often in clients undergoing alcohol withdrawal; they rarely occur in clients with schizophrenia (pg. 268)
•Agranulocytosis: Severe and dangerous leukopenia (decrease in WHITE BLOOD CELLS)
Client will experience, fever, chills, sore throat and weakness.
The client has been diagnosed with depression. The client asks the nurse what imbalances influence depression. Which best explains the neurochemical processes responsible for depression?
A. Increased activity of dopamine.
B. Decreased glucocorticoid activity
C. Decreased serotonin and norepinephrine activity
D. Potentiating of the kindling process
ANS: C
Rationale: Deficits of serotonin, its precursor tryptophan, or a metabolite (5-hydroxyindole acetic acid, or 5-HIAA) of serotonin found in the blood or cerebrospinal fluid occur in people with depression. Norepinephrine levels may be deficient in depression and increased in mania. Elevated glucocorticoid activity is associated with the stress response, and evidence of increased cortisol secretion is apparent in about 40% of clients with depression.
Kindling is the process by which seizure activity in a specific area of the brain is initially stimulated.
Which would the nurse expect to assess in a client with narcissistic personality disorder?
A. Genuine concern for others
B. Mistrust of others
C. Grandiose and superior self-concept
D. Dependence on others for decision making
C
Rationale: Clients with narcissistic personality disorder believe themselves superior to others and expect to be treated as such. They lack concern for the interests of others and tend not to seek input from others when making decision because of their perceived superiority. Mistrust is more closely associated with paranoid personality disorder than narcissistic personality disorder.
3. A client diagnosed with depression is being treated with phenelzine (Nardil). The nurse should teach the client to avoid which of the following foods?
a. Aged cheese
b. Chicken
c. Oranges
d. Rice
a
Aged cheese
Hypertensive crisis is the most serious side effect and is life-threatening when a client prescribed a MAOI ingests tyramine-containing foods, such as aged cheese.
What is echolalia?
repetition or imitation of what someone else says. Repeats the nurse’s statement!
what is Benztropine (Cogentin) used to treat?
used to treat symptoms of Parkinson's disease or involuntary movements due to the side effects of certain psychiatric drugs
A client presents to the emergency department with a flat affect. The nurse suspects the client may be experiencing a major depressive episode. Which variable would the nurse need to keep in mind as representing the highest risk for this condition? Select all that apply.
A. Male gender
B. Mood disorder in first-degree relatives
C. Substance abuse
D. Divorced
E. Older adult age group
ANS: B,C,D
Rationale: Major depression is twice as common in women and has a 1.5 to 3 times greater incidence in first-degree relatives than in the general population. Incidence of depression decreases with age in women and increases with age in men so being an older adult is not necessarily a risk factor for depression. Single and divorced people have the highest incidence. There is a higher incidence of depression among people who abuse alcohol or drugs.
The nurse is planning the type of approach that will be most effective in developing a therapeutic relationship with the client. The nurse should use a matter-of-fact approach with clients with which types of personality disorders? Select all that apply.
A. Paranoid
B. Antisocial
C. Schizotypal
D. Narcissistic
E. Avoidant
A,B,D Rationale: Paranoid, antisocial, and narcissistic personalities need a serious, straightforward approach that includes limit setting and a matter-of-fact approach. Schizotypal personalities need to improve community functioning through social sakbiirlbl.scotmra/teinsting. Using a matter-of-fact approach may further alienate and isolate the client. Avoidant personalities require a more gentle approach including support and reassurance to promote self-esteem.
A nurse suspects that a client has overdosed on the prescribed tricyclic antidepressants. Which assessment finding would support this suspicion? Select all that apply.
a. Orthostatic hypotension
b. Blurred vision
c. Headache
d. Agitated delirium
e. Warm, dry skin
b, d, e
Blurred vision, Warm & dry skin, Agitated delirium
What is echopraxia?
The client may imitate the movements and gestures of someone whom he or she is observing
List two things you have to do before ECT?
Before the ECT the nurse keeps the client NPO after Midnight
Nail polish should be removed to detect lack of oxygen
Have the client void before the ECT
Inform the client of the reasons you are using these preparations
A client who is depressed states, "I think my family would be better off without me. They don't need to worry." Which would be the most appropriate response by the nurse?
A. "Are you planning to commit suicide?"
B. "What do you think they are worried about?"
C. "Where are you going?"
D. "You don't mean that. Your family loves you.
A
Rationale: The nurse never ignores any hint of suicidal ideation regardless of how trivial or subtle it seems and the client's intent or emotional status. Asking clients directly about thoughts of suicide is important. Asking about the family's worries or their love for the client does not directly address the client's risk for suicide. Asking, "Where are you going?" is less direct and less effective than asking explicitly about suicide.
A client with borderline personality disorder says to the nurse, "I feel so comfortable talking with you. You seem to have a special way about you that really helps me." Which would be the most appropriate response by the nurse?
A. "I'm glad you feel comfortable with me."
B. "I'm here to help you just as all the staff members are."
C. "You feel others don't understand you?"
D. "I cannot be your friend. We need to be clear on that."
ANS: B
Rationale: For the borderline personality disorder client, personal boundaries are unclear, and clients often have unrealistic expectations. Clients easily can misinterpret the nurse's genuine interest and caring as a personal friendship, and the nurse may feel flattered by a client's compliments. The nurse must be quite clear about establishing the boundaries of the therapeutic relationship to ensure that neither the client's nor the nurse's boundaries are violated. Stating that the nurse's role is no different from that of the other staff denies that the nurse is somehow "special" to the client. The nurse should not implicitly validate the client's view by thanking him or her or by exploring the lesser role of other staff with the client. Stating "I'm glad you feel comfortable with me" misses an opportunity to reinforce healthy boundaries. Conversely, stating "I cannot be your friend" is unnecessarily direct and is not empathic; such a response may jeopardize therapeutic rapport with the client. Redirection is preferred over confrontation.
a client is admitted to the in-patient unit and is being considered for electroconvulsive therapy (ECT). The client appears calm, but the family is hypervigilant and anxious. the client's mother begins to cry and states, "my child's brain will be destroyed. How can the doctor do this?" the nurse makes which therapeutic response?
1."it sounds as though you need to speak to the psychiatrist."
2."perhaps you'd like to see the ECT room and speak to the staff"
3.your child has decided to have this treatment. you should be supportive of the decision"
4.it sounds as though you have some concerns about the ECT procedure. Why don't we sit down together and discuss any concerns you may have?"
4.it sounds as though you have some concerns about the ECT procedure. Why don't we sit down together and discuss any concerns you may have?"