Mental Health Final (Other 33%)

The correct answer emphasizes the importance of complex communication skills and critical thinking in psychiatric nursing. It highlights that psychiatric nurses are faced with multidimensional problems that require these skills to solve. This response demonstrates an understanding of the unique challenges and opportunities in the field of psychiatric nursing, showing a genuine interest and motivation to pursue this career path.

The nurses have fulfilled the role of advocacy by writing letters to their elected representatives in opposition to the legislation. Advocacy involves speaking up and taking action on behalf of others to promote their rights, needs, and interests. In this case, the nurses are advocating for the care of persons with mental illness by opposing the bill that would reduce funding for their care.

The comment "spends time listening to me talk about my problems. That helps me feel like I’m not alone" indicates that the patient perceived the nurse as caring because the nurse is actively listening and providing emotional support. This shows that the nurse is attentive, empathetic, and willing to spend time with the patient, which can help create a sense of trust and comfort. This kind of interaction fosters a therapeutic relationship and demonstrates a caring attitude from the nurse towards the patient.

The finding that best indicates that the goal "Demonstrate mentally healthy behavior" was achieved is when the patient sees themselves as approaching ideals and capable of meeting demands. This suggests that the patient has a positive self-perception and believes in their own abilities to handle challenges and responsibilities. It indicates a sense of self-confidence and a healthy mindset.

The patient's remark about realizing that they are not alone in feeling afraid indicates universality. This means that the patient has recognized that their fears and emotions are shared by others in the group therapy session. This realization can be comforting and reassuring, as it helps the patient feel understood and less isolated in their experiences.

The group approach described in the question focuses on recognizing dysfunctional behavior and thinking patterns, and then practicing alternate behaviors and thinking that are more adaptive. This approach aligns with the principles of cognitive-behavioral theory, which emphasizes the connection between thoughts, feelings, and behaviors. In cognitive-behavioral therapy, individuals are encouraged to identify and challenge negative or maladaptive thoughts and replace them with more positive and adaptive ones. Therefore, the correct answer is cognitive-behavioral.

The behavior described suggests that a subgroup has formed within the therapy group. The covert glances and subtle put-downs indicate that these members are excluding themselves from the main group and forming their own smaller group within. This behavior may be a result of a lack of trust or dissatisfaction with the larger group dynamic.

A new staff nurse completing orientation to a psychiatric unit can expect an advanced practice nurse to perform the additional intervention of prescribing psychotropic medication. Advanced practice nurses, such as nurse practitioners or clinical nurse specialists, have the authority and expertise to prescribe medications, including psychotropic medications used in psychiatric treatment. This is a specialized skill that is beyond the scope of practice for a staff nurse. Conducting mental health assessments, establishing therapeutic relationships, and individualizing nursing care plans are all within the scope of practice for both staff nurses and advanced practice nurses in a psychiatric unit.

This answer indicates that the patient has a mental illness because it suggests that the patient is conforming to societal norms and expectations without questioning or challenging them. This behavior can be indicative of a lack of independent thinking or impaired judgment, which are common symptoms of mental illness.

The correct answer is "You are wondering whether I have enough experience to lead this group." This response acknowledges the patient's concern and addresses the underlying question about the nurse's experience. It shows empathy and invites the patient to express their thoughts further, allowing for open communication and discussion.

The correct answer acknowledges the change in behavior of the group members and addresses their concerns about the group's progress. It shows empathy and invites the group members to share their thoughts and feelings, creating a safe space for open communication. This intervention allows the nurse leader to gain insight into the group dynamics and address any issues that may be affecting the group's engagement and participation.

The nurse identifies the comment as an example of the group role of an encourager because the member is actively encouraging others to share their experiences and feelings that are different from anger. This role helps create a supportive and inclusive environment where everyone's perspectives and emotions are acknowledged and valued.

The correct answer is "Energizer" because the phrase "let's speed things up and make our decision" suggests that the person wants to increase the pace and efficiency of the decision-making process. An energizer is someone who motivates and encourages others, often by increasing their enthusiasm and energy levels. Therefore, choosing an energizer in this context would be appropriate as they can help to drive the decision-making process forward and keep everyone engaged and focused.

The correct answer is "Organizer" because the statement mentions completing a goal and starting on another one. An organizer is someone who plans and manages tasks and goals, making sure they are completed in an organized and efficient manner. Playboy, Energizer, and Gatekeeper do not fit the context of the statement and do not involve goal-setting or task management.

The most likely explanation for the member's current silence is that he is having trouble dealing with his feelings about the group's ending. This can be inferred from the fact that he has been vocal and shown progress in the past, but has now grown silent. It suggests that something has changed for him emotionally, and the impending end of the group may be causing him difficulty in expressing himself or participating in discussions.

This response by the leader acknowledges that the end of the group can evoke different emotions in individuals. By asking each member to share their feelings about the group coming to an end, it creates a safe space for the quiet member to express themselves and also allows others to reflect on their own experiences. This response shows empathy and understanding towards the members and encourages open communication, which can be helpful for the quiet member and others as well.

The finding that a patient consistently reports a sad, discouraged, and hopeless mood is indicative of a mental illness. This is because persistent negative emotions can be a symptom of conditions such as depression or anxiety. The other options do not directly indicate a mental illness. Responding to rules, routines, and customs of a group is a normal social behavior. Performing tasks within one's abilities and being able to differentiate between the "as if" and the "for real" are indicators of cognitive functioning.

The correct answer is the Diagnostic and Statistical Manual of Mental Disorders. This manual is widely recognized as the standard reference for diagnosing psychiatric disorders. It provides criteria and guidelines for diagnosing various mental health conditions and is used by healthcare professionals, including nurses, to establish a diagnosis. A nursing diagnosis handbook may provide information on nursing interventions and care plans, but it does not provide the criteria for diagnosing psychiatric disorders. A psychiatric nursing textbook may provide general information on psychiatric disorders, but it may not have the specific criteria needed for diagnosis. A behavioral health reference manual may provide information on behavioral health conditions, but it may not have the comprehensive criteria needed for diagnosis.

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The correct answer is "classifies problems in multiple areas of functioning." The multiaxial DSM-IV-TR is a diagnostic tool used in psychiatry to assess and classify mental disorders. It includes five axes, with the fifth axis specifically focusing on problems in multiple areas of functioning such as occupational, social, and psychological functioning. This allows for a comprehensive understanding of the individual's mental health and helps in developing appropriate treatment plans. The other options mentioned, such as focusing on plans for treatment, including nursing and medical diagnoses, and using a specific biopsychosocial theory, are not specific to the multiaxial DSM-IV-TR.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a widely recognized and comprehensive resource for diagnosing mental disorders, including anxiety disorders. It provides detailed descriptions of diagnostic criteria, as well as information on prevalence, risk factors, and treatment options. The ICD-10 also includes diagnostic criteria for mental disorders, but it is more focused on medical coding and classification. Nursing Outcomes Classification and the ANA Psychiatric-Mental Health Nursing Scope and Standards of Practice may provide some information on anxiety disorders, but they are not as comprehensive as the DSM.

The correct answer is "mental disorders people have." The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a widely used classification system for mental disorders. It categorizes and defines various mental disorders based on their symptoms, behaviors, and other diagnostic criteria. Therefore, the DSM classifies the mental disorders that people have, rather than deviant behaviors, people with mental disorders, or present disability or distress.

The belief that assessment findings in mental disorders reflect a person's cultural patterns will best support a nurse's efforts to provide patient advocacy during a multidisciplinary patient care planning session. This belief recognizes the importance of considering cultural factors when assessing and planning care for individuals with mental disorders. It acknowledges that symptoms and behaviors may be influenced by cultural norms, values, and beliefs, and emphasizes the need for culturally sensitive and appropriate care.

The given scenario describes a study where a nurse is working with a multidisciplinary team to measure outcomes for groups of depressed patients. The study involves comparing two groups of patients, one receiving supportive interventions and antidepressant medication, and the other receiving only medication. This type of study, which involves measuring outcomes and comparing different interventions, is known as clinical epidemiology.

The patient's statement suggests that they have a low sense of self-concept. They rely on their parents to make decisions for them and do not socialize much outside of work. This indicates a lack of independence and self-confidence. Improving the patient's self-concept would involve helping them develop a stronger sense of self, assertiveness, and autonomy.

Axis III of the DSM contains information about any physical health problems that may affect treatment. This axis is important for the psychiatric nurse to consider because physical health issues can have a significant impact on the effectiveness of treatment for mental health conditions. By addressing both the psychiatric condition on axis I and any physical health problems on axis III, the nurse can provide comprehensive and holistic care to the patient.

Neurotransmitters are natural chemicals that pass messages between brain cells. This response provides a clear and concise explanation of what neurotransmitters are and their function in the body. It directly addresses the patient's question and provides them with the information they need to understand the concept of imbalanced neurotransmitters.

The nurse's best reply is "PET means positron-emission tomography. An injection is given and images are taken. It shows blood flow and activity in the brain." This answer accurately describes what a PET scan is and how it is performed. It explains that a radioactive tracer is injected into the patient's bloodstream, which allows the scanner to detect areas of high metabolic activity in the brain. This information is important for the parent to understand the purpose and process of the test.

The nurse should expect to prepare the patient for a CT scan as the first diagnostic procedure. A CT scan, or computed tomography, uses X-rays and computer technology to create detailed cross-sectional images of the body. It can help identify structural abnormalities in the brain, such as infarcts or areas of decreased blood flow, which can help differentiate between Alzheimer's disease and multiple infarcts. PET, SPECT, and skull X-ray may also be used in the diagnostic process, but CT is typically the initial imaging test performed.

The nurse administers a medication that potentiates the action of GABA. GABA is an inhibitory neurotransmitter in the brain that helps reduce neural activity and promote relaxation. By potentiating the action of GABA, the medication would enhance its calming effects, leading to a reduction in anxiety. Therefore, the expected effect of the medication would be reduced anxiety.

Disorganized thinking is a symptom commonly associated with schizophrenia. The frontal lobe of the brain is responsible for executive functions such as planning, decision-making, and problem-solving. Dysfunction in the frontal lobe can lead to disorganized thinking and difficulty in organizing thoughts and actions. Neuroimaging would most likely show dysfunction in the frontal lobe of the brain in a patient with disorganized thinking associated with schizophrenia.

When neurotransmitter inhibitors block reuptake, they prevent the reabsorption of neurotransmitters by the presynaptic neuron. This leads to an accumulation of neurotransmitters in the synaptic gap, increasing their concentration. As a result, there is a greater availability of neurotransmitters to bind to receptor sites on the postsynaptic neuron, enhancing the transmission of signals between neurons.

The symptoms described, restlessness and an uncontrollable need to be in motion, are consistent with the side effects of dopamine-blocking medications. Dopamine-blocking medications can lead to a condition called akathisia, which is characterized by restlessness and an inability to sit still. This is a known side effect of antipsychotic medications, which work by blocking dopamine receptors in the brain. Therefore, the correct answer is dopamine-blocking effects.

The nurse suspects increased activity of norepinephrine because fear and increased heart rate and blood pressure are commonly associated with the release of norepinephrine in the body. Norepinephrine is a neurotransmitter that is involved in the body's "fight or flight" response, which is activated during times of stress or fear. It increases heart rate and blood pressure to prepare the body for action.

A patient who has acute anxiety related to an automobile accident would benefit from drugs from the benzodiazepine group. Benzodiazepines are commonly used to treat anxiety disorders as they work by enhancing the effects of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain, which helps to calm down excessive activity and reduce anxiety. Tricyclic antidepressants, antipsychotic drugs, and antimanic drugs are not typically used to treat acute anxiety and may not provide the immediate relief needed in this situation.

The nurse can expect to provide teaching about sertraline (Zoloft) because it is commonly used to treat depression. Chlordiazepoxide (Librium) is a benzodiazepine used to treat anxiety and alcohol withdrawal symptoms. Clozapine (Clozaril) is an antipsychotic medication used to treat schizophrenia. Tacrine (Cognex) is a medication used to treat symptoms of Alzheimer's disease. Therefore, sertraline (Zoloft) is the most appropriate medication to provide teaching about in the context of severe depression.

A drug that causes muscarinic receptor blockade would inhibit the action of acetylcholine on these receptors. Muscarinic receptors are found in various organs including salivary glands, so their blockade would result in decreased saliva production and subsequently dry mouth. Therefore, the nurse should assess the patient for this side effect. Gynecomastia refers to the development of breast tissue in males and is not related to muscarinic receptor blockade. Pseudoparkinsonism refers to symptoms resembling Parkinson's disease, such as tremors and bradykinesia, and is not directly related to muscarinic receptor blockade. Orthostatic hypotension refers to a drop in blood pressure upon standing and is also not specifically associated with muscarinic receptor blockade.

The nurse should reply that paroxetine is a selective norepinephrine reuptake inhibitor. This means that it works by increasing the levels of norepinephrine in the brain, which can help improve mood and relieve symptoms of depression. It is different from Tofranil (imipramine), which is a tricyclic antidepressant. Therefore, the patient should not assume that they will have the same side effects with paroxetine as they did with Tofranil.

Fluphenazine is a typical antipsychotic medication that has strong anticholinergic properties. Anticholinergic side effects include dry mouth, blurred vision, constipation, urinary retention, and confusion. Lithium, buspirone, and risperidone do not typically have anticholinergic side effects.

The instruction to "Report sore throat and fever immediately" has priority when teaching a patient taking clozapine (Clozaril) because these symptoms could indicate a serious condition called agranulocytosis, which is a potentially life-threatening side effect of clozapine. Agranulocytosis is characterized by a severe decrease in white blood cells, which can lead to an increased risk of infection. Therefore, it is crucial for patients taking clozapine to report any signs of infection, such as a sore throat and fever, to their healthcare provider immediately for further evaluation and management.

Phenelzine is a monoamine oxidase inhibitor (MAOI) used to treat depression. MAOIs require dietary restrictions due to potential interactions with certain foods and beverages. Foods high in tyramine, such as aged cheeses, cured meats, and fermented foods, can cause a hypertensive crisis when combined with MAOIs. Therefore, a special diet is necessary for patients taking phenelzine to avoid these foods and prevent complications. Buspirone, haloperidol, and carbamazepine do not have specific dietary restrictions associated with their use.

When a patient takes a drug that inhibits monoamine oxidase (MAO), certain foods and drugs can cause a hypertensive crisis. This is because MAO is responsible for breaking down certain substances in the body, including tyramine, which is found in certain foods and drugs. When MAO is inhibited, tyramine can accumulate and cause a sudden increase in blood pressure, leading to a hypertensive crisis. Therefore, it is important for the patient to avoid these foods and drugs to prevent this potentially dangerous situation.

The nurse's best action in this situation is to report the white blood cell count of 3000 mm3 to the health care provider immediately. This is because clozapine (Clozaril) is known to cause agranulocytosis, a potentially life-threatening condition characterized by a low white blood cell count. The health care provider needs to be informed promptly so that appropriate interventions can be taken to ensure the patient's safety. Giving the next dose as prescribed, giving aspirin and force fluids, or repeating the laboratory test would not address the urgency of the situation.

Valproate (Depakote) belongs with the group of medications carbamazepine (Tegretol), lamotrigine (Lamictal), and gabapentin (Neurontin) because it is also used to treat seizures and certain types of epilepsy.

The patient's statement about her husband visiting her in the night and not being able to understand him suggests that she is experiencing grief and possibly longing for her husband. This is a common reaction to the loss of a loved one and is consistent with the symptoms of grief. The fact that she has lost weight since her husband's death further supports the idea that she is grieving. There is no mention of auditory and visual hallucinations, imbalanced nutrition, or denial of the husband's death, so these options can be ruled out.

The patient's suspicious behavior, angry outbursts, and accusations of discrimination suggest that they may feel powerless in their interactions with the staff. This behavior could be a result of past experiences of discrimination or a lack of trust in the healthcare system. Understanding the patient's feelings of powerlessness can help healthcare providers approach the situation with empathy and cultural sensitivity.

The patient's statement about their energy becoming imbalanced suggests that they may have a belief in traditional Chinese medicine or other alternative healing practices. In these practices, imbalances in energy are often believed to be the cause of illness or disorder. Therefore, the patient may request eating special foods as a way to rebalance their energy and treat their anxiety disorder.

The fourth-generation New England native who is an accountant is the most likely to wish to engage actively in end-of-life planning because individuals in this profession often value organization and planning. Additionally, being a native of the area may indicate a strong sense of community and family ties, which can contribute to a desire to plan for end-of-life care.

Consistently addressing patients by title and surname is the best action by a psychiatric nurse to support the right of patients to be treated with dignity and respect. This shows that the nurse recognizes and acknowledges the individuality and importance of each patient, promoting a sense of dignity and respect in the therapeutic relationship. It also demonstrates professionalism and creates a more equal and respectful environment between the nurse and the patient.

When a patient verbally refuses medication and the nurse gives the medication over the patient's objection, the nurse can be charged with battery. Battery refers to the intentional and unauthorized physical contact with another person, which includes administering medication without the patient's consent. In this scenario, the nurse's action of giving the medication against the patient's objection can be seen as a violation of the patient's bodily autonomy and can be legally considered as battery.

The nursing intervention that demonstrates false imprisonment is when the nurse escorts the irritating and attention-seeking patient down the hall and threatens them with seclusion if they don't stay in their room. False imprisonment refers to the intentional confinement or restraint of a person without proper legal authority. In this situation, the nurse is using the threat of seclusion to restrict the patient's movement, which is a form of false imprisonment.

The correct answer is to withhold the medication and confer with the healthcare provider. This is because the dose of the antidepressant is more than the usual geriatric dose, which could potentially lead to adverse effects or side effects in the elderly patient. It is important for the nurse to consult with the healthcare provider before administering the medication to ensure the safety and well-being of the patient.

The answer provides a detailed account of the patient's behavior leading up to the incident, including the administration of medication and the lack of effect. It also describes the patient's aggressive behavior and the action taken to physically place them in seclusion. Additionally, it mentions that a seclusion order was obtained from a physician after the incident. This documentation accurately captures the sequence of events and the necessary interventions taken, providing a comprehensive record of the situation.

The patient's statement suggests a disturbance in their thought processes, as they are expressing confusion and questioning their beliefs in the face of their recent cancer diagnosis. This diagnosis is focused on the patient's cognitive processes and how they are processing and making sense of their situation, rather than directly addressing their feelings of hopelessness or spiritual distress.

This nursing documentation best meets the requirement for problem-oriented charting because it follows the SOAP (Subjective, Objective, Assessment, Plan) format. The documentation includes the patient's subjective statement ("S: States 'I feel like I'm ready to blow up.'"), objective observations ("O: Pacing hall, mumbling to self"), assessment of the problem ("A: Auditory hallucinations"), plan of action ("P: Offer haloperidol 2 mg PO"), intervention performed ("I: Haloperidol 2 mg PO given at 0900"), and evaluation of the intervention ("E: Returned to lounge at 0930 and quietly watched TV"). This format provides a clear and organized structure for documenting the patient's problem and the nursing actions taken.

The nurse should document the confusion and obtain other assessment data from the grandchild. This is the appropriate next action because the patient is confused and unable to answer questions, indicating a cognitive impairment. By documenting the confusion, the nurse can provide an accurate record of the patient's condition. Obtaining other assessment data from the grandchild can help provide additional information about the patient's medical history, recent events, and potential causes of the confusion. This information will assist the healthcare team in determining the appropriate course of action for the patient's care.

The nurse's best reply is "Anything you say about feelings is private, but some things like suicidal thinking must be reported to the treatment team." This response acknowledges the adolescent's concern about confidentiality while also explaining the limitations to confidentiality when it comes to safety concerns such as suicidal thoughts. It shows that the nurse respects the adolescent's privacy but also prioritizes their well-being and safety.

The nurse is assessing the patient's understanding of the concept of abstraction. The saying "You can't judge a book by looking at the cover" implies that one cannot make accurate judgments about something or someone based solely on their outward appearance. This requires the ability to think abstractly and understand that there may be more to a person or situation than what is immediately apparent.

The nurse should ask the question "Are you having difficulty hearing when I speak?" because the patient's vague or unrelated answers, leaning forward, and frowning indicate potential hearing difficulties. By asking this question, the nurse can gather more information about the patient's hearing abilities and adjust their communication approach accordingly.

The nurse has fulfilled the aspect of care coordination known as milieu management. Milieu management refers to creating and maintaining a therapeutic environment for patients. In this scenario, the nurse is taking the patient on a tour, explaining the rules of the unit, and explaining the daily schedule, all of which contribute to creating a structured and supportive environment for the patient's care.

The nurse should respond by assuring the patient that their information will not be shared with their family or friends without their permission, but it will be shared with other staff members. This response respects the patient's privacy while also acknowledging the need for collaboration and communication among the healthcare team. It maintains confidentiality within the boundaries of the therapeutic relationship.

The desirable outcome for the initial stage of a nurse-patient relationship is for the patient to demonstrate behaviors that indicate rapport and trust with the nurse. This is important because establishing a strong rapport and trust is the foundation for effective communication and collaboration between the nurse and patient. It allows the patient to feel comfortable, safe, and supported, which in turn promotes a positive therapeutic relationship and enhances the overall quality of care provided.

In the nurse-patient relationship, the orientation phase is the initial stage where the nurse and patient establish rapport and set goals for the therapeutic relationship. It is important for the nurse to address termination during this phase because it allows the patient to understand that the relationship will eventually come to an end. This helps to prevent any feelings of abandonment or confusion that may arise when the relationship concludes. By discussing termination early on, the nurse can ensure a smooth and gradual transition out of the therapeutic relationship.

During the first session with a new patient, a nurse should introduce the matter of a contract because contracts spell out the participation and responsibilities of both parties. This helps establish clear expectations and boundaries for the therapeutic relationship between the nurse and the patient. By discussing and agreeing upon these terms, both parties can have a mutual understanding of their roles and responsibilities, which can contribute to effective communication and collaboration throughout the treatment process.

The nurse's best response is "I’m glad you’ve made progress and that I helped, but I cannot accept the gift." This response acknowledges the patient's progress and gratitude while also adhering to the agency's policies and procedures regarding accepting gifts. It demonstrates professionalism and ethical behavior on the part of the nurse.

The nurse's best action in this situation is to recognize the patient's thoughtfulness, express appreciation, and accept the card. This response shows gratitude towards the patient for their kind gesture and helps maintain a positive and supportive relationship between the nurse and the patient.

The correct answer is "I’d like to sit with you for a while to help you get comfortable talking to me." This statement demonstrates offering self because the nurse is expressing a willingness to spend time with the patient to establish a comfortable and trusting relationship. By offering to sit with the patient, the nurse is showing support and creating an environment where the patient feels safe to open up and communicate.

Silence provides meaningful moments for reflection during patient interview sessions. This principle suggests that allowing periods of silence can give patients the opportunity to process and reflect on their thoughts and feelings. It can also encourage them to share more information and provide deeper insights into their concerns and experiences. By creating a space for silence, the nurse respects the patient's need for reflection and allows for a more meaningful and therapeutic conversation.

The most appropriate remark would be "You’ve combed your hair and are wearing a new dress." This statement acknowledges the improvement in the patient's personal appearance and reinforces her self-esteem. It shows that the nurse noticed and appreciated the effort the patient put into her appearance, which can help boost her self-esteem and sense of worth.

The patient's symptoms suggest that he is experiencing severe depression, which can lead to weight loss and lack of self-care. Providing the patient with nutrient-dense finger foods and weighing him daily would address the unintentional weight loss and help monitor his nutritional status. This intervention would be important in the initial care plan to ensure the patient's physical health is being addressed.

Cognitive-behavioral therapy would best address a presentation of this type because it focuses on identifying and changing negative thought patterns and beliefs. The student's belief that everything he does is wrong and that nothing he tries ever works is an example of negative thinking. Cognitive-behavioral therapy can help the student challenge and reframe these negative thoughts, leading to more positive and realistic beliefs.

The nurse's response explains that the tricyclic antidepressant can affect the patient's blood pressure and cause dizziness, especially when changing positions. The nurse suggests drinking more fluids and changing position slowly as ways to alleviate this side effect. This response shows the nurse's understanding of the medication's effects and provides practical solutions for the patient's concern.

Imipramine is a tricyclic antidepressant that can cause anticholinergic side effects. Urinary retention is a serious side effect that requires immediate medical attention as it can lead to bladder distention and urinary tract infections. Dry mouth, blurred vision, and nasal congestion are common side effects of imipramine but do not require immediate medical attention.

The priority nursing focus immediately after electroconvulsive therapy treatment should be on assessing the level of consciousness and normal body functions. Electroconvulsive therapy can cause temporary confusion and disorientation, so it is important to monitor the patient's level of consciousness to ensure they are recovering well from the procedure. Additionally, assessing normal body functions such as vital signs and neurological status is crucial to identify any potential complications or adverse reactions to the treatment.

The progress note that suggests the treatment plan has been effective for the severely depressed and withdrawn patient is the one that mentions positive changes in mood and engagement with activities. The note states that the patient slept for 6 hours straight, participated in an activity group by singing, and expressed eagerness to see their grandchild. These behaviors indicate an improvement in mood, increased motivation, and a desire for social interaction, which are positive signs of the treatment plan's effectiveness.

The nurse should inform the patient about the risk of a serious reaction if she starts taking the MAOIs on her own. MAOIs should not be taken concurrently with SSRIs due to the risk of serotonin syndrome, a potentially life-threatening condition. Therefore, it is crucial for the nurse to emphasize the importance of following the prescribed treatment plan and not making any changes without consulting a healthcare professional.

The rationale for counseling the patient not to make a major business decision for a month is that ECT often causes temporary memory impairment.

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The best response would be to inform the patient that without an antidepressant, the depression is more likely to reoccur, but there are other medications that do not interfere as much with sex. This response addresses the patient's concern about the sexual side effects while also emphasizing the importance of continuing medication to prevent a recurrence of depression. It also offers a potential solution by mentioning that there are other medications available that may have fewer sexual side effects.

The patient's symptoms of cold sweats, nausea, rapid heartbeat, and terrible nightmares are consistent with withdrawal symptoms from abruptly stopping amitriptyline. The nurse should explain to the patient that these symptoms are likely due to withdrawal and advise her to take one dose of Elavil and contact her doctor for further guidance. This response acknowledges the patient's concerns, provides a possible explanation for her symptoms, and directs her to seek medical advice for appropriate management.

The nurse should respond by suggesting to the patient to examine one specific bad thing that happened in order to explore other possible explanations. This response encourages the patient to challenge their overgeneralization and consider alternative perspectives. By examining one specific event, the patient may be able to recognize that there are factors outside of their control that contribute to negative outcomes.

A severely depressed patient with psychomotor retardation may benefit from a rest period during the hour block from 11 AM to noon. This can help the patient conserve energy and reduce fatigue, which are common symptoms of depression. Rest periods can also provide an opportunity for the patient to relax and recharge, which may improve their overall well-being and ability to engage in therapy activities later in the day.

In preparing a depressed patient for their first electroconvulsive therapy (ECT) session, it is important to advise the patient that memory loss is usually transient. This is because memory loss is a common side effect of ECT, but it is typically temporary and improves over time. By informing the patient about this potential side effect, they can be mentally prepared and have realistic expectations about the treatment. This can help alleviate any anxiety or concerns they may have about memory loss and increase their overall comfort and readiness for the procedure.

The correct answer is to hold all medications and call 911 for transportation to the hospital. This is because the patient experienced a grand mal seizure, which is a medical emergency. The confusion and hot forehead could be signs of increased intracranial pressure, indicating a potentially serious condition. Holding all medications is important to prevent any potential interactions or adverse effects during transportation to the hospital. Calling 911 ensures that the patient receives immediate medical attention and appropriate care.

The priority concern for this patient's plan of care is hyperactivity, as well as not eating and sleeping. These symptoms suggest a manic episode, which can be indicative of a serious mental health condition such as bipolar disorder. Hyperactivity can lead to potential harm for the patient and others, while not eating and sleeping can have detrimental effects on their physical and mental well-being. Therefore, addressing these symptoms and ensuring the patient's safety and basic needs are met should be the priority in their plan of care.

A patient with mania who has not eaten or slept for 3 days is at high risk for injury. Mania is characterized by hyperactivity, impulsivity, and poor judgment, which can increase the likelihood of accidents or self-harm. The patient's lack of sleep and proper nutrition further exacerbates these risks. Therefore, the priority nursing diagnosis should be "Risk for injury" to ensure the patient's safety and prevent any potential harm.

The appropriate response by the nurse is to acknowledge the patient's behavior and provide support and assistance. This response shows empathy and understanding while also setting clear boundaries. It offers the patient help in controlling their impulses rather than immediately resorting to punishment or confrontation.

The rationale for adding olanzapine to the lithium regime is to bring hyperactivity under rapid control. Olanzapine is an antipsychotic medication that is commonly used to treat manic episodes in bipolar disorder. It works by balancing the levels of certain chemicals in the brain, which helps to reduce symptoms of mania, including hyperactivity. By combining olanzapine with lithium, the healthcare provider can provide a more comprehensive treatment approach that targets both the mood stabilization effects of lithium and the rapid control of hyperactivity provided by olanzapine.

Rapid cycling is a characteristic of bipolar disorder where a person experiences four or more mood episodes (either manic or depressive) within a year. Carbamazepine (Tegretol) is commonly prescribed for rapid cycling bipolar disorder as it has mood-stabilizing properties and can help to reduce the frequency and severity of mood episodes. Clonidine (Catapres) is primarily used for hypertension, Phenytoin (Dilantin) is an anticonvulsant used for seizures, and Chlorpromazine (Thorazine) is an antipsychotic used for various psychiatric conditions but not specifically for rapid cycling bipolar disorder.

The question asks for a drug that belongs to the same group as divalproex (Depakote), carbamazepine (Tegretol), and gabapentin (Neurontin). The correct answer, lamotrigine (Lamictal), is an anticonvulsant medication commonly used to treat epilepsy and bipolar disorder, just like the other drugs mentioned. Clonazepam (Klonopin), risperidone (Risperdal), and aripiprazole (Abilify) are not in the same group and are used to treat different conditions.

The rationale for escorting the patient to their room to dine alone is to reduce environmental stimuli that negatively affect the patient. By removing the patient from the dining room where there is chaos and potential triggers, the staff can create a more calm and controlled environment for the patient. This can help to minimize the patient's hyperactivity, restlessness, and disorganization, and reduce the risk of harm to others.

The best intervention for the nurse in this situation is to invite the patient to sit with the nurse and look at new fashion magazines. This intervention acknowledges the patient's interest in fashion and redirects their focus in a more appropriate and therapeutic way. It provides a distraction from the impulsive desire to make excessive purchases and allows the nurse to engage with the patient in a therapeutic manner.

Lithium is a medication commonly used to treat bipolar disorder. It works by stabilizing mood swings. One of the potential side effects of lithium is dehydration, as it can increase urine output. Therefore, it is important for patients taking lithium to maintain normal salt and fluids in their diet to prevent dehydration. This means they should not restrict their salt intake and should drink an adequate amount of fluids to stay hydrated. The other options mentioned in the question, such as drinking twice the usual daily amount of fluid or avoiding certain foods, are not specifically related to lithium use. Regular laboratory studies of liver function are important for patients taking certain medications, but it is not specifically mentioned in the question stem.

Both patients with depression and acute mania may experience disturbed sleep patterns. Depression can cause insomnia or excessive sleepiness, while acute mania can cause decreased need for sleep. Addressing the disturbed sleep pattern is a priority for both patients as it can negatively impact their overall well-being and exacerbate their symptoms.

The menu option of broiled chicken breast on a roll, ear of corn, and apple is the best suited for a patient with acute mania. This option includes lean protein from the chicken breast, fiber from the roll and corn, and essential vitamins and minerals from the apple. This combination provides a balanced meal that can help stabilize the patient's mood and energy levels.

The given answer indicates that the treatment plan for a patient with acute mania was effective because the patient is able to converse without interrupting, their clothing matches, and they are participating in activities. These behaviors suggest that the patient's irritability and distractibility have decreased, and they are able to engage in social interactions and daily activities more effectively.

The patient is exhibiting symptoms of mania, which may be caused by a subtherapeutic lithium level. By considering the need to measure the serum lithium level, the nurse can determine if the patient is not swallowing the medication or if the dose needs to be adjusted. This action is important in order to ensure the patient's safety and well-being.

The correct answer is to clear the room of all other patients. This intervention is necessary to ensure the safety of both the patient with acute mania and the other patients in the room. By removing the other patients from the room, the nurse reduces the risk of any potential harm or escalation of the situation. This intervention prioritizes the safety and well-being of all individuals involved.

Lithium is a medication commonly used to treat bipolar disorder. It works by stabilizing mood and preventing episodes of mania or depression. However, it can also cause certain side effects. Diaphoresis, which is excessive sweating, weakness, and nausea are common side effects of lithium. Monitoring for these symptoms is important to ensure the patient's safety and to make any necessary adjustments to their medication regimen. The other options listed do not represent common side effects of lithium.

The patient's symptoms, including diarrhea, weakness, unsteadiness, and worsening hand tremor, may indicate lithium toxicity. Lithium toxicity can cause gastrointestinal symptoms, neurologic symptoms, and dehydration. Therefore, it is appropriate for the nurse to instruct the patient to have someone bring them to the clinic immediately for further evaluation and management of their symptoms.