Nursing Board Review: Psychiatric Nursing Practice Test Part 2

Diphenhydramine, 25 to 50 mg I.M. or I.V., would quickly reverse this condition. Prochlorperazine and haloperidol are both capable of causing dystonia, not reversing it. Midazolam would make this patient drowsy.

Fluphenazine decanoate is a long-acting antipsychotic agent given by injection. Because it has a 4-week duration of action, it’s commonly prescribed for outpatients with a history of medication noncompliance. Chlorpromazine, also an antipsychotic agent, must be administered daily to maintain adequate plasma levels, which necessitates compliance with the dosage schedule. Imipramine, a tricyclic antidepressant, and lithium carbonate, a mood stabilizer, are rarely used to treat clients with chronic schizophrenia.

Pseudoparkinsonism is a side effect of antipsychotic drugs characterized by mask-like facies, pill rolling tremors, muscle rigidity. Tardive dyskinesia is manifested by lip smacking, wormlike movement of the tongue. Akinesia is characterized by feeling of weakness and muscle fatigue. Dystonia is manifested by torticollis and rolling back of the eyes.

The nurse should directly orient a delusional patient to reality, especially to place and person. Options A and C encourage further delusions by denying poisoning and offering information related to the delusion. Validating the patient’s feeling, as in option D, occurs during a later stage in the therapeutic process.

This response informs the client of the nurse's planned actions and allows time to discuss the client's actions. Options A and B put the client on the defensive and may lead to a power struggle. Option C ignores the psychological implications of the client's actions.

Seizures are the most common serious adverse effect of using flumazenil to reverse benzodiazepine overdose. The effect is magnified if the client has a combined tricyclic antidepressant and benzodiazepine overdose. Less common adverse effects include shivering, anxiety, and chest pain.

Inpatient care is the best intervention for a client who is thinking about suicide every day. Implementing a no-suicide contract is an important strategy, but this client requires additional care. Weekly therapy wouldn't provide the intensity of care that this case warrants. Obtaining a second opinion would take time; this client requires immediate intervention.

An open-ended statement or question is the most therapeutic response. It encourages the widest range of client responses, makes the client an active participant in the conversation, and shows the client that the nurse is interested in his feelings. Asking the client why he drove while intoxicated can make him feel defensive and intimidated. A judgmental approach isn't therapeutic. By giving advice, the nurse suggests that the client isn't capable of making decisions, thus fostering dependency.

Borderline personality disorder is characterized by lack of self-esteem, strong dependency needs, and impulsive behavior. Instability in interpersonal relationships, mood, and poor self-image also is common. Typically, the client can't tolerate being alone and expresses feelings of emptiness or boredom. Flat affect, social withdrawal, and unusual dress are characteristic of schizoid personality disorder. Suspiciousness, hypervigilance, and emotional coldness are seen in paranoid personality disorders. In antisocial personality disorder, clients are usually insensitive to others and act out sexually; they may also be violent.

Circulation as well as skin and nerve damage can occur within 15 minutes. Checking every hour, 2 hours, or 8 hours isn’t often enough and could result in permanent damage to the client’s extremities. Restraints should be removed every 2 hours, and range-of-motion exercises should be performed.

Empathy, the understanding of another’s perception of a situation, is key to establishing a therapeutic rapport with a patient. Empathy encourages a patient’s trust and promotes the patient’s self-expression. In this situation, it’s the most important aspect of the nursing role that should be expressed.

The crucial phase is marked by physical dependence. The prealcoholic phase is characterized by drinking to medicate feelings and for relief from stress. The early phase is characterized by sneaking drinks, blackouts, rapidly gulping drinks, and preoccupation with alcohol. The chronic phase is characterized by emotional and physical deterioration.

A side effect of ECT which is life threatening is respiratory arrest. Options A and C, Confusion and disorientation are side effects of ECT but these are not the highest priority.

Extreme behaviors such as Mrs. Gil distorted response to the ambulance are indicative of panic. In the lesser degree of anxiety, the patient’s typical behavior is changed, but not exaggerated level that is seen in panic.

Total abstinence is the only effective treatment for alcoholism. Psychotherapy, attendance at AA meetings, and aversion therapy are all adjunctive therapies that can support the client in his efforts to abstain.

Bulimia nervosa can lead to many complications, including diabetes, heart disease, and hypertension. The eating disorder isn't typically associated with allergies, cancer, or hepatitis A.

The client with schizophrenia is commonly socially isolated and withdrawn; therefore, having the client spend more time by himself wouldn’t be a desirable outcome. Rather, a desirable outcome would specify that the client spend more time with other clients and staff on the unit. Delusions are false personal beliefs. Reducing or eliminating delusional thinking using talking therapy and antipsychotic medications would be a desirable outcome. Protecting the client and others from harm is a desirable client outcome achieved by close observation, removing any dangerous objects, and administering medications. Because the client with schizophrenia may have difficulty meeting his or her own self-care needs, fostering the ability to perform self-care independently is a desirable client outcome.

Although most phenothiazine produces some effects within minutes to hours, their antipsychotic effects may take several weeks to appear.

Acute withdrawal symptoms from alcohol may begin 6 hours after the client has stopped drinking and peak 1 to 2 days later. Delirium tremens may occur 2 to 4 days — even up to 7 days — after the last drink.

The client’s statement is a verbal cue of suicidal ideation not anxiety. While suicide is common among clients with major depression, this occurs when their depression starts to lift. Hopelessness indicates no alternatives available and may lead to suicide, the statement and non verbal cue of the client indicate suicide.

Early grief involves shock, disbelief and denial; therefore, statements such as “it’s a dream” and “it didn’t really happen” are expected reactions in that stage. Job retaining questions are more suggestive of either the acceptance phase or dysfunctional grief, in which the individual is failing to grieve. Anger is the second phase of grief. Isolation is more suggestive of the depression phase of grief.

“I only need access to your arm. Putting up your sleeve is fine.” The nurse needs to deal with the client with sexually connotative behavior in a casual, matter of fact way. Options A and B, these responses are not therapeutic because they are challenging and rejecting. Option C, threatening the client is not therapeutic.

A structured lifestyle demonstrates acceptance and caring provides a sense of security. A critical environment erodes a person’s esteem. Inconsistent boundaries lead to feelings of insecurity and lack of concern. Physical discipline can decrease self-esteem.

These are the characteristics of an individual with antisocial personality. Narcissistic personality disorder is characterized by grandiosity and a need for constant admiration from others. Individuals with paranoid personality demonstrate a pattern of distrust and suspiciousness and interprets others motives as threatening. Individuals with histrionic have excessive emotionality, and attention-seeking behaviors.

When a patient is experiencing panic, it’s most important for the nurse to remain with the patient to provide physical and verbal assurance as well as to protect her from further injury. During panic, teaching her to discuss her feelings is less appropriate intervention because they can agitate the patient even more. Use of restrains requires a doctors order and can cause injury to the skin and joints.