Communication
A client states that life isn't worth living anymore. How should the nurse respond?
"Are you having thoughts of harming yourself?"
Describe nursing interventions appropriate for a client experiencing mania.
Decrease stimulation - private room, quiet location, seclusion if necessary, frequent rest
Monitor nutrition - daily weights, high calorie and high protein foods
Structured activities - not group
Frequent vital signs
Calm neutral attitude
Patient education for the client who is prescribed valproate to decrease mania in bipolar disorder should include information about common side effects. Identify the common side effects of this medication.
Dizziness, drowsiness, tremors, visual disturbances, N/V, weight gain, alopecia, makes oral contraceptives ineffective, can cause liver disease (monitor LFTs)
What dietary restriction is required for a client who is prescribed phenelzine?
Tyramine-rich foods (can cause severe HA, palpitations, neck stiffness, N/V, HTN, stroke, death).
AVOID aged cheeses and meats, beer, red wine
False.
*Double points if you explain the exception to patient confidentiality in mental health!
A client is experiencing delusions and reports that "everyone is out to get him."
Which response by the nurse is the most therapeutic?
1. "Who is out to get you?"
2. "You seem to be very frightened."
3. "What makes you think that?"
4. "Nobody is out to get you."
2. "You seem to be very frightened."
Place these patient concerns in order of highest priority:
Psychoeducation
Signs of malnutrition
Suicidal ideation
Reports of <2 hours of sleep for past 3 nights
1. Suicidal ideation
2. Reports of <2 hours of sleep for past 3 nights
3. Signs of malnutrition
4. Psychoeducation
Identify symptoms of tardive dyskinesia
Also includes trunk and extremities - rocking or hip thrusting
A client is taking amitriptyline and is experiencing dizziness when standing up. What education should be provided to the client to address this side effect?
Stand up or change positions slowly, take the medication at night
A client is prescribed lithium 12 mEq BID. The pharmacy provides a solution containing 8mEq/5mL. How many mL should the nurse administer per dose?
7.5mL
This is an example of which defense mechanism/coping style?
Splitting
Describe the nursing care of a client receiving ECT.
Witness consent, EKG, NPO, loose clothing, remove anything from the mouth, monitor VS, explain about common side effects (hypo/HTN, brady/tachycardia, arrhythmias, HA, muscle pain, nausea, memory loss or confusion)
Your client is prescribed lithium to treat bipolar disorder. Identify the following:
1. Therapeutic trough levels
2. Signs of toxicity
3. Patient teaching regarding sodium levels
1. 0.4-1.0 mEq/L for maintenance, 0.8-1.4 mEq/L for mania
2. AMS, N/V/D, muscle weakness, myoclonic twitches, nystagmus, EKG changes, seizures, syncope, coma, death
3. Salt and lithium have an inverse relationship. Drink same amount of water each day. Vomiting, diarrhea, diaphoresis, and diuresis can alter lithium retention.
Identify signs of neuroleptic malignant syndrome (NMS), a rare complication of antipsychotic medication.
Hyperthermia, muscle rigidity, HTN, mental status changes, tachycardia
Describe the difference between a voluntary admission versus an involuntary commitment.
How long can a patient remain hospitalized for a 201 or a 302?
Voluntary admission - patient is voluntarily admitted, must remain for 72 hours after notification of plan to leave. Involuntary commitment - patient is determined to be a harm to self or others and is committed against their will to the inpatient psychiatric unit.
201 - no time limit
302 - 5 days
Identify and describe 4 symptoms of schizophrenia.
Hallucinations
Delusions
Ambivalence
Anhedonia
Disorganized thinking
Disorganized Behavior
A client is being disruptive on the unit, making up stories about other clients and trying to cause drama between them. How should the nurse handle it?
1. Place them in seclusion.
2. Discuss the issues during group therapy.
3. Set limits on the client's behavior.
4. Tell the client if they continue this behavior, they will lose privileges on the unit.
3. Set limits on the client's behavior.
Identify 4 side effects of trazodone.
Drowsiness, weight gain, dry mouth, GI upset, dizziness, HA, muscle aches, loss of libido, Black Box warning for risk of suicide in kids, adolescents, and young adults, risk of serotonin syndrome.
Explain serotonin syndrome and identify symptoms of the complication.
Also called serotonin toxicity, occurs when dosages are increased or multiple drugs are used (SSRIs plus triptans to treat migraines, MAOIs).
Symptoms = fever, HTN, GI symptoms, restlessness, confusion, tachycardia, dilated pupils, muscle rigidity or twitching
What signs in a client would indicate to the nurse that the client is under the influence of cocaine?
Avoid self-disclosure
Avoid giving advice
Active listening
Observation
Silence
Validation
Avoid judgmental questions (why?)
And many more...
Identify signs of alcohol withdrawal, name the scale we use to rate the severity of symptoms, and identify the treatment used.
Tachycardia, HTN, diaphoresis, anxiety, restlessness, tremors, hallucinations, seizures.
CIWA Scale
Ativan PRN
A client is prescribed clozapine. What lab value indicates a complication from this medication? What should you do if the lab values are abnormal?
Agranulocytosis - WBC < 3.5 (normal range 5-10).
Hold the medication, notify the provider immediately, watch for signs/symptoms of infection.
Identify 5 side of effects of risperidone and interventions to help manage them.
Orthostatic hypotension - change positions slowly
Constipation - increase fluid and fiber
Weight gain - nutrition and exercise
Extrapyramidal symptoms - add an anticholinergic medication
Sexual dysfunction - lower the dose, try a different medication, add an erectile dysfunction medication
Identify 5 clinical manifestations of Major Depressive Disorder.
Feelings of sadness or hopelessness
Anhedonia
Decrease in libido
Negative self-worth
Irritability
Insomnia or hypersomnia
Somatic symptoms