Mental Health Nursing Review Flashcards

These flashcards cover key questions and answers regarding mental health nursing concepts, including disorders, medications, symptoms, interventions, and patient care.

Schizophrenia

A complex and chronic mental disorder characterized by significant disturbances in thought processes, perception, emotion, and behavior. Key symptoms include delusions (firmly held false beliefs, such as believing angels are whispering secrets), hallucinations (perceiving things that aren't there), disorganized speech, and impaired social or occupational functioning.

Which mental disorder is characterized by thought disturbances, including delusions and hallucinations, such as believing angels are whispering secrets?

1. Bipolar Disorder

2. Schizophrenia

3. Obsessive-Compulsive Disorder

4. Generalized Anxiety Disorder

Correct Answer: 2. Schizophrenia

Risperidone Side Effects

Severe muscle rigidity, high fever, altered mental status, and autonomic dysfunction in a client taking risperidone are hallmark signs of Neuroleptic Malignant Syndrome (NMS), a rare but life-threatening reaction that requires immediate medication cessation and urgent provider notification.

Bipolar Mania Sleep Deprivation

For a bipolar client experiencing mania who has gone 36 hours without sleep, the priority nursing intervention is to provide a quiet, low-stimulation environment to promote rest and reduce agitation, which can worsen manic symptoms and lead to exhaustion.

Lithium Toxicity Signs

Early signs of lithium toxicity often include nausea, vomiting, diarrhea, and fine tremors. These symptoms necessitate a priority assessment of the client's recent sodium and fluid intake, as dehydration or hyponatremia can increase lithium levels and lead to toxicity due to lithium's renal excretion.

Borderline Personality Disorder

Clients with Borderline Personality Disorder (BPD) often exhibit splitting, a defense mechanism where they categorize people as 'all good' or 'all bad'. A common manifestation is the belief that 'the nurse is the only one who cares.' The best nursing response emphasizes that all staff members care and are working together for their well-being, promoting consistent boundaries and a unified treatment approach.

Nighttime Wandering in Dementia

Nighttime wandering in clients with dementia can be challenging. Management strategies include ensuring a safe environment with adequate lighting (e.g., nightlights), increasing physical activity during the day, maintaining a structured routine, and avoiding daytime naps to promote better sleep at night.

Waxy Flexibility

Waxy flexibility is a psychomotor symptom characteristic of catatonia, primarily seen in individuals with schizophrenia or mood disorders. It describes a state where a person's limbs or body parts can be passively placed into unusual positions, which they then maintain for extended periods, much like wax.

Interventions for Bipolar I

For a patient with Bipolar I disorder experiencing a manic episode, who is hyperactive, intrusive, and overstimulated, the best nursing intervention is to redirect them to a quiet, low-stimulus environment. This helps reduce external stimuli, prevent escalation of agitation, and promote a sense of calm and safety.

Medications for Lewy Body Dementia

Patients diagnosed with Lewy Body Dementia (LBD) have a profound heightened sensitivity to conventional antipsychotic medications, such as haloperidol. Administration of these drugs can lead to severe side effects like worsened parkinsonism, delirium, and irreversible neuroleptic malignant syndrome, making them generally contraindicated.

Valproic Acid Side Effects

For clients taking valproic acid (Depakote), the emergence of severe abdominal pain accompanied by jaundice are critical signs that require immediate provider notification. These symptoms can indicate serious adverse effects such as pancreatitis or hepatotoxicity, which are potentially life-threatening and warrant urgent medical evaluation and intervention.

Ideas of Reference

Ideas of reference are a type of delusional thinking where an individual believes that unrelated, innocuous, or commonplace events, objects, or people in the environment have a particular and unusual significance, often for themselves. An example is believing a newscaster on TV is sending them special, personal messages.

Symptoms of Hypomania

Hypomania is a milder form of mania characterized by a persistently elevated, expansive, or irritable mood that is clearly different from a non-depressed mood. Expected symptoms include increased energy, decreased need for sleep, talkativeness, and increased goal-directed activity, but without the psychotic features, marked impairment in social or occupational functioning, or necessity for hospitalization seen in full-blown mania.

Delirium Management

When a client experiencing delirium becomes agitated, the priority nursing action is to assess for and address potential underlying causes. Infection, particularly urinary tract infections (UTIs) or pneumonia, is a common and treatable cause of delirium and agitation in vulnerable populations, requiring prompt investigation and intervention.

Tardive Dyskinesia Symptoms

Tardive Dyskinesia (TD) is an irreversible neurological disorder characterized by involuntary, repetitive movements, often affecting the face, mouth, tongue, and limbs. Common symptoms include lip smacking, grimacing, tongue protrusion, and chewing motions, typically developing after prolonged use of antipsychotic medications.

Paranoia and Nutrition

When a paranoid client refuses food due to fears of poisoning or contamination, a therapeutic nursing intervention is to offer packaged or sealed food and beverage options. This approach respects their delusional beliefs by providing items they perceive as untouched and safe, thereby promoting adequate nutritional intake while building trust.

Sertraline Risks in Bipolar

For clients diagnosed with bipolar disorder, taking an antidepressant like sertraline (Zoloft) without a concomitant mood stabilizer (e.g., lithium, valproic acid) can paradoxically induce a manic or hypomanic episode. Antidepressants can disrupt mood stability in susceptible individuals, leading to a 'switch' into mania.

Lithium Toxicity Indicators

Severe diarrhea is a critical indicator of lithium toxicity, especially when accompanied by other pronounced symptoms such as persistent nausea and vomiting, coarse tremors, ataxia, blurred vision, or confusion. These signs suggest that serum lithium levels may be dangerously high and require immediate medical intervention.

Avoidant Personality Disorder Treatment

For clients with Avoidant Personality Disorder, who typically experience intense feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of social interaction, therapeutic interventions should focus on gradually encouraging independence. This helps build self-esteem, challenge their fear of criticism, and develop social skills, fostering a sense of accomplishment and self-efficacy.

Command-type Hallucinations

When assessing a client who reports hearing voices, even if they initially deny the voices are giving commands, the nurse's priority is to determine if the hallucinations are 'command-type'. This assessment is crucial for safety, as command hallucinations can instruct the client to harm themselves or others, necessitating immediate risk evaluation and intervention.

Obsessive-Compulsive Personality Disorder

Obsessive-Compulsive Personality Disorder (OCPD) is characterized by a pervasive pattern of preoccupation with orderliness, perfectionism, mental and interpersonal control, at the expense of flexibility, openness, and efficiency. Individuals with OCPD often exhibit a rigid, inflexible personality, excessive devotion to work, and an inability to delegate tasks, driven by a need for control rather than anxiety-driven rituals like in OCD.

Routine CBC Monitoring

Clients prescribed carbamazepine (Tegretol), an anticonvulsant and mood stabilizer, require routine monitoring of their complete blood count (CBC). This is crucial due to the medication's dose-related risk of severe hematological adverse effects, most notably agranulocytosis (a drastic reduction in white blood cells) and aplastic anemia, which can compromise the immune system and be life-threatening.

Stages of Alzheimer's Disease

In the late stage of Alzheimer's Disease, cognitive and physical decline becomes profound. A key indicator of this severe stage is the loss of ability to perform basic activities of daily living (ADLs), such as forgetting how to eat or swallow, necessitating total care for feeding, hygiene, and mobility.

Refusal of Medications in Mania

When a client experiencing a manic episode refuses medication, the best nursing response is to avoid confrontation and instead calmly discuss their concerns and perceptions. This approach validates their feelings, allows for therapeutic communication, and may help identify reasons for refusal, potentially leading to improved adherence or alternative solutions.

Catatonic Risk Precautions

Clients in a catatonic state, characterized by psychomotor immobility, stupor, or extreme negativism, are at high risk for several physical complications. Due to their refusal or inability to eat or drink, they are especially vulnerable to dehydration and malnutrition, requiring vigilant monitoring and interventions to ensure adequate fluid and nutritional intake.

Flat Affect in Schizophrenia

Flat affect, a common negative symptom of schizophrenia, refers to a severe reduction in emotional expressiveness. The individual's face appears unresponsive, their voice lacks modulation, and they show little or no eye contact. Negative symptoms represent the absence or diminution of normal behaviors and functions.

Repetitive Questions in Alzheimer's

For a client with Alzheimer's disease who repeatedly asks the same questions due to short-term memory impairment, the most therapeutic nursing response is to offer simple, consistent, and calm reassurance with each repetition. Providing detailed explanations or getting frustrated will not be effective; instead, validate their feeling and re-orient gently if appropriate or distract.

Sexual Inappropriateness in Mania

A manic client may exhibit disinhibited behavior, including sexual inappropriateness, due to impaired judgment and elevated mood. The most appropriate nursing intervention is to firmly and calmly redirect them to a more appropriate, less stimulating activity. This sets clear boundaries, protects other clients, and maintains a therapeutic environment without shaming the client.

Lithium and Renal Function Monitoring

For clients prescribed lithium, regular monitoring of renal function, specifically serum creatinine levels and estimated glomerular filtration rate (eGFR), is essential. Lithium is primarily excreted by the kidneys, and impaired renal function can lead to increased lithium levels and a heightened risk of toxicity, as well as potential long-term kidney damage.

Neuroleptic Malignant Syndrome Symptoms

Neuroleptic Malignant Syndrome (NMS) is a rare but life-threatening idiosyncratic reaction to antipsychotic medications, particularly typical antipsychotics like haloperidol. Key symptoms include severe muscle rigidity ('lead pipe' rigidity), extremely high fever (hyperthermia), altered mental status, and autonomic instability (e.g., fluctuating blood pressure, tachycardia). It requires immediate recognition and emergency medical intervention.

Cyclothymia Symptoms

Cyclothymia is a chronic mood disorder characterized by fluctuating mood swings that involve numerous periods of hypomanic symptoms (milder highs) and numerous periods of depressive symptoms (milder lows) over at least two years. Unlike bipolar I or II, these mood swings are not severe enough to meet the full criteria for a hypomanic or major depressive episode, but they cause significant distress or impairment.

Antisocial Personality Disorder Traits

Antisocial Personality Disorder (ASPD) is characterized by a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15. Common traits include manipulation, deceitfulness, impulsivity, irritability and aggression, a consistent lack of empathy or remorse, and a failure to conform to social norms or laws.

Delirium Treatment Approach

The most effective and essential approach to treating delirium is to identify and treat its underlying cause(s). Delirium is often a symptom of an acute medical condition, such as infection, electrolyte imbalance, medication side effects, or dehydration. Symptomatic management (e.g., safety measures, environmental modifications) is helpful, but resolving the root physiological issue is paramount for recovery.

Clozapine Warning Signs

Clients prescribed clozapine (Clozaril) must be vigilant and report any signs of infection, such as a sore throat, fever, or flu-like symptoms, immediately to their healthcare provider. Clozapine carries a significant risk of agranulocytosis, a severe reduction in white blood cells, which can lead to life-threatening infections if not detected and managed promptly through regular blood monitoring.

Pressured Speech

Pressured speech is a common symptom observed in clients experiencing manic or hypomanic episodes of bipolar disorder. It is characterized by speaking rapidly, forcefully, and almost continuously, often difficult to interrupt, and may include an urgent or insistent quality. The client may feel compelled to keep talking, regardless of whether anyone is listening.

Handling Confused Patients

When a confused client, particularly one with cognitive impairment or delirium, is observed pulling at IV lines, catheters, or other tubes, the nurse's first and priority action should be to assess for underlying causes such as pain, discomfort, urinary retention, or environmental overstimulation. Pain or discomfort can manifest as agitation and self-extubation behaviors, requiring assessment before resorting to restraints or sedation.

Sundowning Management

Sundowning is a phenomenon in dementia clients where confusion and agitation worsen in the late afternoon or evening. Effective management strategies include maintaining a consistent daytime routine, reducing or eliminating daytime naps to promote better nighttime sleep, providing adequate lighting in the evening, engaging in calming activities, and ensuring a safe, familiar environment.

Schizoid Personality Preference

A young adult with Schizoid Personality Disorder is characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression. They typically prefer social isolation, show little interest in forming close relationships, and often appear indifferent to praise or criticism from others, deriving little pleasure from social activities.

Dehydration Effects on Lithium Dosing

Dehydration significantly increases the risk of lithium toxicity because lithium is primarily excreted by the kidneys. When a patient becomes dehydrated, the kidneys retain more sodium and water, which also leads to increased reabsorption of lithium, elevating serum lithium levels. Therefore, a nurse should hold the lithium dose and notify the provider if a patient shows signs of dehydration to prevent toxicity.

Delusions of Spying

Persecutory delusions are a type of delusional belief where an individual is convinced that they are being malevolently treated or conspired against by others. For example, a client with schizophrenia believing their neighbors are spying on them or plotting to harm them is a classic manifestation of persecutory delusions.

Aggression during Bathing in Dementia

If a client with dementia becomes aggressive or resistant during bathing, a common challenge often triggered by fear, discomfort, or confusion, the best nursing approach is to stop the activity, offer reassurance, and try again later with a different approach (e.g., a different caregiver, time of day, or method like a sponge bath). Forcing the issue can increase distress and resistance.

Nutritional Needs in Mania

For a manic client who is too agitated, distracted, or restless to sit down for traditional meals, offering high-calorie, nutrient-dense finger foods or beverages like a milkshake and crackers is the best option. These items are easy to consume on the go, provide essential calories and energy, and help maintain nutritional status during periods of high activity and decreased concentration.

Management of Visual Hallucinations

When a psychotic client experiences visual hallucinations, the best nursing approach is to acknowledge and validate the client's feelings (e.g., 'I understand you're seeing something that frightens you') rather than validating the content of the hallucination itself (e.g., 'I don't see the monster, but I can see you are scared'). This approach maintains reality without dismissing the client's experience, while ensuring safety and building trust.

Goal for Dependent Personality Disorder

For clients with Dependent Personality Disorder, characterized by an excessive need to be cared for, leading to submissive and clinging behavior and fears of separation, the primary therapeutic goal is to gradually increase their independence. This involves encouraging autonomous decision-making, developing self-efficacy, and building skills to function more independently in various life areas, thereby reducing their reliance on others.

IV Removal in Delirium

If a delirious patient, who is confused and disoriented, pulls out an IV catheter, the first crucial nursing action (after ensuring immediate safety like applying pressure to the site) is to reassess their level of consciousness, mental status, and investigate potential underlying causes for their new agitation or confusion (e.g., pain, full bladder, hypoxia, medication side effects). This determines appropriate next steps for both the patient's condition and ensuring continued access for necessary treatments.

Carbamazepine and WBC Monitoring

A significant decrease in white blood cell (WBC) count, particularly neutropenia (low neutrophil count), in a client taking carbamazepine (Tegretol) is a serious concern due to the risk of agranulocytosis. This finding requires immediate discontinuation of the drug and urgent notification of the healthcare provider, as it can severely compromise the immune system and increase susceptibility to life-threatening infections.

Narcissistic Personality Disorder Traits

Narcissistic Personality Disorder (NPD) is characterized by a pervasive pattern of grandiosity (in fantasy or behavior), a constant need for admiration, and a lack of empathy. Individuals with NPD often have an inflated sense of self-importance, believe they are special, exploit others for personal gain, and are hypersensitive to criticism.

Bipolar Depression and Suicide Risk

For a client experiencing bipolar depression, the priority assessment includes a thorough evaluation of suicide risk. This involves directly asking about suicidal ideation, the presence of a specific plan (e.g., method, access to means, time frame), intent, and any past attempts. A detailed assessment is crucial for risk stratification and implementing immediate safety interventions.

Communication with Disoriented Dementia Patients

When communicating with disoriented dementia clients, effective strategies include using simple, clear, and concise language, speaking slowly, maintaining eye contact, and frequently offering gentle and repeated orientation to person, place, and time as appropriate. This helps reduce confusion, anxiety, and facilitates understanding, promoting a sense of security and connection.

A client receiving haloperidol develops sudden muscle rigidity, hyperthermia (39.5^{\circ}C), and an altered mental status. Which of the following is the nurse's PRIORITY action?

1. Administer a PRN sedative to calm the client.

2. Continue routine vital sign monitoring every 4 hours.

3. Notify the healthcare provider immediately.

4. Encourage oral fluid intake.

Correct Answer: 3. Notify the healthcare provider immediately.

A client with schizophrenia reports hearing voices that are telling them to do things. The nurse's first action should be to:

1. Document the report in the client's chart.

2. Ask the client if they intend to follow the commands.

3. Distract the client with an engaging activity.

4. Administer a PRN antipsychotic medication.

Correct Answer: 2. Ask the client if they intend to follow the commands.