Psychiatric Mental Health Nursing Test Part 2

Client safety is the paramount concern and must be maintained. Therefore, setting consistent limits on potentially harmful ritualistic behavior takes highest priority. Although the other options are important, they take lower priority. For instance, helping the client identify how the ritualistic behavior interferes with daily activities increases the client's motivation for using more effective coping behavior. Exploring the purpose of the ritualistic behavior helps the client see this behavior as an attempt to control anxiety. As the client learns new ways to manage anxiety, the ritualistic behavior is likely to decrease.

OCD is characterized by repetitive thoughts that the client can't control or exclude from consciousness, along with recurring, irresistible impulses to perform a particular action. Physical signs and symptoms with no physiologic cause typify somatoform disorder. Apprehension and inability to concentrate characterize anxiety disorders.

Participating in a daily exercise group refocuses the client's time toward adaptive activities and may reduce anxiety. Option A isn't stated specifically enough to allow for evaluation; for this goal to be measurable, specific objectives must be stated such as, "The client will verbalize feeling less anxious." Option C is incorrect because identifying the underlying reasons for rituals takes time and isn't a realistic goal after 1 week. Most clients with OCD are aware that the ritual is irrational but can't stop it, making option D inappropriate as well.

Option A focuses on the client's feelings in an empathetic way, helping to reduce the intensity of the ritualistic behavior and promoting trust and rapport. Implying that the client's behavior is tiring, bothersome, or foolish would convey disapproval, impede trust and rapport, promote dysfunctional behavior, and worsen anxiety.

The nurse should prepare a client for ECT in a manner similar to that for general anesthesia. For example, the client should receive nothing by mouth for 8 hours before ECT to reduce the risk of vomiting and aspiration. Also, the nurse should have the client void before treatment to decrease the risk of involuntary voiding during the procedure; remove any full dentures, glasses, or jewelry to prevent breakage or loss; and make sure the client is wearing a hospital gown or loose-fitting clothing to allow unrestricted movement. Usually, these preparations aren't indicated for a client undergoing physical therapy, neurologic examination, or cardiac stress testing.

Potentiating effect refers to a drug's ability to increase the potency of another drug if taken together. Therefore, the client should be instructed to avoid alcohol while taking Librium because it potentiates the drug's CNS depressant effect. Taken at bedtime, this drug will induce sleep. Librium comes in capsule form and usually can be taken with water. Aged cheese is restricted with monoamine oxidase inhibitors, not Librium.

Reserved for clients with acute depression who don't respond to pharmacologic or psychiatric measures, ECT is the passage of an electrical current through the brain to induce a brief seizure. According to ECT proponents, the seizure causes desirable changes in neurotransmitters and receptor sites similar to those caused by antidepressant drugs. ECT is administered by a physician or an anesthesiologist. Although ECT may reduce the severity of depression, it doesn't necessarily cure it. Before ECT, the client receives a medication that provides short-term amnesia of the entire event.

The client with PTSD needs encouragement to examine and understand the meaning of the traumatic event and consequent losses. Otherwise, symptoms may worsen and the client may become depressed or engage in self-destructive behavior such as substance abuse. The client must explore the meaning of the event and won't heal without this, no matter how much time passes. Behavioral techniques, such as relaxation therapy, may help decrease the client's anxiety and induce sleep. The physician may prescribe antianxiety agents or antidepressants cautiously to avoid dependence; sleep medication is rarely appropriate. A special diet isn't indicated unless the client also has an eating disorder or a nutritional problem.

Providing an opportunity for the client to express concerns about a new medication and to make a choice about taking it can help the client regain a sense of control over his life. The client has the right to refuse the medication. Instead of simply ordering the client to take it, as in option A, the nurse should provide the information the client needs to make an informed decision. Attempting to make the client feel guilty, as in option C, or threatening the client, as in option D, would increase anxiety.

Sympathetic cardiovascular responses to stress include increased heart rate, cardiac contractility, and cardiac output; increased blood pressure; and peripheral vasoconstriction. Syncope is a response to parasympathetic stimulation.

Antidepressant agents, such as imipramine, don't produce antidepressant effects until they reach a therapeutic level in the blood, usually about 2 to 3 weeks after the initial dose. Therefore, the nurse should encourage the client to continue therapy at least until the drug reaches that level. After this time, if the client's depression doesn't abate, the nurse may use the other responses.

Folding towels and pillowcases is a simple activity that redirects the client's attention. Also, because this activity is familiar, the client is likely to perform it successfully. Cards, charades, and aerobic exercise are too complicated for a confused client.

Changes in academic performance and familial communications, social withdrawal, and giving away of treasured possessions suggest that this adolescent is contemplating suicide. Anorexia nervosa would cause weight loss and other related symptoms. This adolescent's signs and symptoms don't suggest fear of school and typify depression, not psychosis.

An obsessive-compulsive client who attempts to resist the compulsion must be evaluated for increased anxiety. A compulsion is a repetitive, intentional behavior that the client performs in response to a certain obsession; it's aimed at neutralizing or decreasing anxiety. Resisting the compulsion may increase the client's anxiety. Although a client with OCD may have feelings of failure, depression, and excessive fear, these aren't responses to resisting the compulsion.

This response appropriately focuses on the emotional content of the client's message and helps the client identify feelings. Focusing on the request for extra medication would allow the client to ignore the underlying emotional issues. Clients with borderline personality disorder commonly divide the staff into "good guys" and "bad guys" to meet their needs; staff members must maintain consistency and a united front at all times. The nurse shouldn't take the client's statements personally because this would interfere with the ability to maintain a therapeutic relationship.

Ipecac syrup is rendered inactive when administered concomitantly with activated charcoal.

In many instances, the nurse can diffuse impending violence by helping the client identify and express feelings of anger and anxiety. Such statements as "What happened to get you this angry?" may help the client verbalize feelings rather than act on them. Close interaction with the client in a quiet activity may place the nurse at risk for injury should the client suddenly become violent. An agitated and potentially violent client shouldn't be left alone or unsupervised because the danger of the client's acting out is too great. The client should be placed in seclusion only if other interventions fail or the client requests this. Unlocked seclusion can be helpful for some clients because it reduces environmental stimulation and provides a feeling of security.

By removing environmental hazards, such as bottles of hydrogen peroxide and benzoin, the nurse can help prevent injury to the client. For a client with Alzheimer's disease, the nurse should provide single, simple instructions, rather than many detailed instructions. The nurse should administer medication as prescribed and as needed — not to keep the client sedated. The nurse should use restraints only when required to prevent self-harm by the client.

This client is at increased risk for injury because of severe hyperactivity, disorientation, and agitation. Although the other options also are appropriate, the client's safety takes highest priority. The nurse should take immediate action to protect the client from injury.

In conversion disorder, the client represses and converts emotional conflicts into motor, sensory, or visceral symptoms with no physiologic cause. Interventions should focus on helping the client identify the underlying emotional problem. A client with conversion disorder can't be convinced that the physical problem isn't real; attempts to convince him may lead him to seek other health care providers who may accept the reality of his symptoms. Treating the physical symptoms as long-term or permanent may encourage the client to maintain them. Ignoring the cause of the symptoms would prevent the client from dealing with his feelings about his wife's beating.

Dose-related adverse reactions to alprazolam include drowsiness, confusion, ataxia, weakness, dizziness, nystagmus, vertigo, syncope, dysarthria, headache, tremor, and a glassy-eyed appearance. These dose-related reactions diminish as therapy continues. Although hepatomegaly may occur with benzodiazepine use, this adverse reaction is rare and isn't dose-related. Idiosyncratic reactions to benzodiazepines may include a rash and acute hypersensitivity reactions; however, they aren't dose-related.

The nurse must be honest with the client by telling her that the paralysis has no physiologic cause while also conveying empathy and acknowledging that her symptoms are real. The client will benefit from psychiatric treatment, which will help her understand the underlying cause of her symptoms. After the psychological conflict is resolved, her symptoms will disappear. Saying that it must be awful not to be able to move her legs wouldn't answer the client's question; knowing that the cause is psychological wouldn't necessarily make her feel better. Telling her that she has developed paralysis to avoid leaving her parents or that her personality caused her disorder wouldn't help her understand and resolve the underlying conflict.

The nurse should determine the specific concerns of the client's wife. Jumping to conclusions regarding the client's need for a nursing home or other care placement options would be inappropriate. The nurse must tailor care to the client and family, focusing on their needs. Although support groups, children, and friends may prove helpful to the client's wife, the nurse must establish a plan for continued care that addresses her specific concerns.

Before an ECT treatment, the nurse should ensure that the client has had a medical evaluation that includes an ECG, a chest X-ray, neurologic and laboratory tests, and spinal X-rays, if indicated. Although making sure that the client sees family members immediately before the procedure would be appropriate, it's unnecessary (unless the client requests this). A brain scan isn't required after ECT because it can't evaluate the therapeutic effects of this treatment. Lithium must be discontinued before ECT because it prolongs the effects of succinylcholine chloride (Anectine), a muscle relaxant given just before the shock is delivered.

The nurse should remain with the client until the attack subsides. If the client is left alone he may become more anxious. Giving false reassurance is inappropriate in this situation. The client should be allowed to move around and pace to help expend energy. The client may be so overwhelmed that he can't follow lengthy explanations or instructions, so the nurse should use short phrases and slowly give one direction at a time.