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Flat affect Social withdrawal Disorganized thoughts Auditory hallucinations Positive symptoms, referred to as florid psychotic symptoms, reflect an excess or distortion of function and include delusions, hallucinations, increased speech production with associations, and bizarre behavior. Disorganized thoughts (e.g., derailment, tangentiality, illogicality, incoherence, and circumstantiality) are positive signs of schizophrenia. Positive
symptoms usually respond to antipsychotic medications. French fries Pepperoni pizza Bologna sandwich Hamburger on a bun Hash brown potatoes Cheese and processed meats contain tyramine, which is contraindicated when MAOIs are taken. Tyramine, a precursor in the synthesis of norepinephrine, taken in the presence of MAOIs can lead to a sharp increase in norepinephrine and a potentially fatal hypertensive crisis. Although bread does not contain tyramine, bologna does; delicatessen meats (e.g., bologna and sausage), meat extracts, and liver are high in tyramine and should be avoided. French-fried potatoes, hamburgers, bread, and hash brown potatoes do not contain tyramine and are not contraindicated when a client is taking an MAOI. Continuous involuntary movement of the tongue and jaw Extremely high blood pressure with headache and flushing Blurred vision, urine retention, dry mouth, and constipation Restlessness, tachycardia, fever, diarrhea, and altered mental status Restlessness, tachycardia, fever, diarrhea, and altered mental status are related to serotonin syndrome, an excessive accumulation of serotonin that can lead to death if not identified and treated quickly. Continuous involuntary movement of the tongue and jaw is related to tardive dyskinesia, which results from long-term use of an antipsychotic medication. Extremely high blood pressure with headache and flushing indicate a possible hypertensive crisis from the intake of tyramine-containing foods by a client receiving a monoamine oxidase inhibitor antidepressant. Blurred vision, urine retention, dry mouth, and constipation are common anticholinergic side effects of tricyclic antidepressants and some antipsychotic medications. Provide an unstructured environment to promote self-expression. Be firm, consistent, and understanding while focusing on specific target behaviors. Use an authoritarian approach, because this type of client needs to learn to conform to the rules of society. Record but ignore marked shifts in mood, suicidal threats, and temper displays because these are attention-seeking behaviors. The nurse would be firm, consistent, and understanding while focusing on specific target behaviors. Consistency, limit-setting, and supportive confrontation are essential nursing interventions designed to provide a secure, therapeutic environment for clients with borderline personality disorder. To be therapeutic, the environment needs structure, and the staff must help the client set short-term goals for behavioral changes. The use of an authoritarian approach will increase anxiety in this type of client, resulting in feelings of rejection and withdrawal. Ignoring the client's behavior is nontherapeutic and may reinforce underlying fears of abandonment. Recommended textbook solutions The Language of Composition: Reading, Writing, Rhetoric2nd EditionLawrence Scanlon, Renee H. Shea, Robin Dissin Aufses 661 solutions Edge Reading, Writing and Language: Level CDavid W. Moore, Deborah Short, Michael W. Smith 304 solutions Literature and Composition: Reading, Writing,Thinking1st EditionCarol Jago, Lawrence Scanlon, Renee H. Shea, Robin Dissin Aufses 1,697 solutions Technical Writing for Success3rd EditionDarlene Smith-Worthington, Sue Jefferson 468 solutions Conney with borderline personality disorder who is to be discharge soon threatens to “do something” to herself if discharged. Which of the following actions by the nurse would be most important?Discuss the meaning of the client’s statement with her Request an immediate extension for the client Ignore the client’s statement because it’s a sign of manipulation Ask a family member to stay with the client at home temporarily Correct! Wrong! Any suicidal statement must be assessed by the nurse. The nurse should discuss the client’s statement with her to determine its meaning in terms of suicide. Nurse Pat is aware that the major health complication associated with intractable anorexia nervosa would be?Endocrine imbalance causing cold amenorrhea Glucose intolerance resulting in protracted hypoglycemia Cardiac dysrhythmias resulting to cardiac arrest Decreased metabolism causing cold intolerance Correct! Wrong! These clients have severely depleted levels of sodium and potassium because of their starvation diet and energy expenditure, these electrolytes are necessary for cardiac functioning. Nurse Anna can minimize agitation in a disturbed client by?Increasing stimulation ensuring constant client and staff contact increasing appropriate sensory perception limiting unnecessary interaction Correct! Wrong! Limiting unnecessary interaction will decrease stimulation and agitation. Which of the following approaches would be most appropriate to use with a client suffering from narcissistic personality disorder when discrepancies exist between what the client states and what actually exist?Limit setting Consistency Rationalization Supportive confrontation Correct! Wrong! The nurse would specifically use supportive confrontation with the client to point out discrepancies between what the client states and what actually exists to increase responsibility for self. Mario is complaining to other clients about not being allowed by staff to keep food in his room. Which of the following interventions would be most appropriate?Setting limits on the behavior Reprimanding the client Allowing a snack to be kept in his room Ignoring the clients behavior Correct! Wrong! The nurse needs to set limits in the client’s manipulative behavior to help the client control dysfunctional behavior. A consistent approach by the staff is necessary to decrease manipulation. Joey a client with antisocial personality disorder belches loudly. A staff member asks Joey, “Do you know why people find you repulsive?” this statement most likely would elicit which of the following client reaction?Remorsefulness Shame Embarrassment Defensiveness Correct! Wrong! When the staff member ask the client if he wonders why others find him repulsive, the client is likely to feel defensive because the question is belittling. The natural tendency is to counterattack the threat to self image. Nurse Trish is working in a mental health facility; the nurse priority nursing intervention for a newly admitted client with bulimia nervosa would be to?Monitor client continuously Teach client to measure I & O Involve client in planning daily meal Observe client during meals Correct! Wrong! These clients often hide food or force vomiting; therefore they must be carefully monitored. A 39 year old mother with obsessive-compulsive disorder has become immobilized by her elaborate hand washing and walking rituals. Nurse Trish recognizes that the basis of O.C. disorder is often:
Feeling of unworthiness and hopelessness Problems with being too conscientious Problems with anger and remorse Feelings of guilt and inadequacy Correct! Wrong! Ritualistic behavior seen in this disorder is aimed at controlling guilt and inadequacy by maintaining an absolute set pattern of behavior. A neuromuscular blocking agent is administered to a client before ECT therapy. The Nurse should carefully observe the client for?Nausea and vomiting Seizures Respiratory difficulties Dizziness Correct! Wrong! Neuromuscular Blocker, such as SUCCINYLCHOLINE (Anectine) produces respiratory depression because it inhibits contractions of respiratory muscles. A 75 year old client is admitted to the hospital with the diagnosis of dementia of the Alzheimer’s type and depression. The symptom that is unrelated to depression would be?Neglect of personal hygiene Shallow of labile effect “I don’t know” answer to questions Apathetic response to the environment Correct! Wrong! With depression, there is little or no emotional involvement therefore little alteration in affect. Which nursing intervention would be indicated for a client with an anxiety disorder?The nursing interventions for anxiety disorders are: Stay calm and be nonthreatening. Maintain a calm, nonthreatening manner while working with client; anxiety is contagious and may be transferred from staff to client or vice versa.
Which defense mechanism would be exhibited when a client with alcohol use disorder States?Rationalization. In those with substance use disorder, rationalization is providing good reasons for the use of drugs or alcohol, instead of the real and true reasons. It is used to defend oneself against feelings of guilt, as well as to protect oneself against criticism and maintain self-respect.
Which activity would be most appropriate for a severely withdrawn client?Which activity would be most appropriate for a severely withdrawn client? Question 1 Explanation: The best approach with a withdrawn client is to initiate brief, nondemanding activities on a one-to-one basis. This approach gives the nurse an opportunity to establish a trusting relationship with the client.
Which signs would a client with schizotypal personality disorder exhibit during a social situation?Schizotypal personality disorder typically includes five or more of these signs and symptoms: Being a loner and lacking close friends outside of the immediate family. Flat emotions or limited or inappropriate emotional responses. Persistent and excessive social anxiety.
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Which action would the nurse take to minimize agitation in a disturbed client Quizlet
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