ATI MENTAL HEALTH Exams 2025 Version Questions and Answers.

ATI MENTAL HEALTH Exams 2025 Version Questions and Answers. It is important to ask this during assessment? - Perception of own health/beliefs about illness and wellness - how the client passes time - use of substances/disorders - cultural beliefs and practices -spiritual bliefs Mental Status Exam (MSE) used to describe LOC -alert -lethargy -stupor -coma MSE what is alert? client is responsive and answers questions spontaneously and appropriately MSE what is lethargy? opens eyes and responds but is drowsy and falls asleep readily MSE what is stupor? client requires vigorous or painful stimuli (pinching tendon or rubbing sternum); may not respond verbally coma no response from painful stimuli -decorticate or decerbrate rigidity may occur decorticate rigidity when comatose may have this position: flexion and internal rotation of upper extremity joints and legs decerebrate rigidity when comatose: may have this position: neck and elbow extension, wrist and finger flexion Mood provides info about the emotion they are feeling Affect objective expression of mood How to assess memory: immediate repeat a series of numbers or list of objects assess memory: recent recall recent events (visitors from current day) or purpose of appointment/admission assess memory: remote state a fact from his past that is verifiable (birth date or mom's maiden name) assess ability to calculate count back from 100 by 7 abstract thinking ability to interpret and demonstrate higher level thought process; don't take cliches literally Screening tools Mini mental status exam-assess client's cognitive status Glasgow Coma Scale- level of consciousness Glasgow coma scale eye, verbal, and motor response is evaluated; highest value= 15...higher the better Glasgow= Coma state level 7 or below Why are mental disorders not easily dx in kids? - lack of ability or skills to describe what is happening -a wide variation of "normal" behavior esp during developmental stages in addition to normal assessments also include these for older adults - functional ability: get out of a chair? -economic and social status? - environmental factors -physical assessment For older adults also use these assessment tools: geriatric depression, michigan alcoholism screening test, mini mental status exam, pain assessments (visual analog, Wong-Baker FACES, McGill Pain Questionnaire, PAINAD scale proper way to conduct assessments adequate lighting, introduce, be at client's level, use touch to communicate caring as appropriate, ask about medication hx, summarize and ask for feedback from client Therapeutic strategies in mental health setting: counseling, milieu therapy, promotion of self-care activities, psychobiological interventions (admin meds and teach them about meds and monitor for side effects), cognitive and behavioral therapies, health teaching, health promotion and health maintenance, case management cognitive and behavioral therapies modeling, operant conditioning, systematic desensitization case management coordinating holistic care to include medical, mental health, and social services d. because that assesses immediate memory A charge nurse is discussing mental status exam with a new nurse. which of the following statements indicates a need for further teaching? a. "To assess cognitive ability, I should ask the client to count back from 7" b. "To assess affect, I should look at facial expression" c. "To assess language ability, I should have them write a sentence" d. "To assess remote memory, have the client repeat a list of objects" d. monitor for adverse effects of meds A nurse is planning care for a client who has a mental health disorder. Which of the following is appropriate to include as a psychobiological intervention? a. assist with systemic desensitization therapy b. teach about coping mechanisms c. assess for comorbid conditions d. monitor for adverse effects of meds b. identify client's perception health A nurse in an outpatient mental health clinic is preparing to conduct an initial client interview. When conducting the interview, what is highest priority? a. respect client's need for personal space b. identify client's perception health c. include client's family in interview d. teach the client about current condition a. The client arouses briefly in response to sternal rub What is expected if client is "stuporous" a. The client arouses briefly in response to sternal rub b. client has a Glasgow score less than 7 c. client exhibits decorticate rigidity d. client is alert but disoriented to time and place a. used to identify mental health disorders b. establishes diagnostic criteria d. assists nurses in planning care e. indicates expected assessment findings A nurse is speaking about the Diagnostice and Statistical Manual of Mental Disorders (DSM-5). What is important to include in the discussion? a. used to identify mental health disorders b. establishes diagnostic criteria c. indicates recommended pharmacological treatment d. assists nurses in planning care e. indicates expected assessment findings defense mechanisms used as response to anxiety as a way to manage conflict in response to anxiety; are reversible and can become maladaptive; it is important to use a variety of these maladaptive when coping mechanisms interfere with functioning, relationships, and orientation to reality altruism and sublimation defense mechanisms that are ALWAYS healthy intermediate defense mechanisms repression, reaction formation, displacement, rationalization, undoing immature defense mechanisms projection, dissociation, splitting and denial altruism dealing with anxiety by reaching out to others ex: a nurse who lost a family member in a fire is a volunteer firefighter sublimation dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression ex: mad at sister...but goes and workouts hard at the gym suppression voluntarily denying unpleasant thoughts and feelings ex: someone who has lost his job states the will worry about paying bills next week repression putting unacceptable ideas, thoughts and emotions out of conscious awareness ex: someone with fear of dentist "forgets" his dental appointments displacement shifting feelings related to an object, person, or situation to another less threatening object, person or situation reaction formation overcompensating or demonstrating the opposite behavior of what is felt undoing performing an act to make up for prior behavior dissociation temporarily blocking memories and perceptions from consciousness splitting demonstrating an inability to reconcile negative and positive attributes to self or others projection blaming others for unacceptable thoughts and feelings denial pretending the truth is not reality to manage the anxiety of acknowledging what is real Normal anxiety healthy; motivates people to take action acute (state) anxiety is precipitated by an imminent loss or change that threaten one's sense of security chronic (trait) develops over time, often starting in childhood; may display in physical symptoms: fatigue or frequent headaches Mild anxiety is normal; increases one's ability to perceive reality; there is an identifiable cause; may trigger finger or foot tapping or lip chewing Moderate anxiety slightly reduced perception and selective inattention may occur; ability to think clearly is hampered but problem solving still may occur - difficulty concentrating, tiredness, pacing, change in voice pitch, voice tremors, shakiness, and increased RR and HR, insomnia and urinary urgency - usually benefits from the direction of others Severe anxiety perceptual field= greatly reduced with distorted perceptions -learning and problem solving do not occur -ineffective functioning -confusion, impending doom, hypervent, tachycardia, withdrawal, loud and rapid speech and aimless activity -can't take direction from others Panic level anxiety markedly disturbed behavior - extreme fright and horror -severe hyperactivity or flight -immobility can occur -dyfunction in speech, dilated pupils, severe shakiness, severe withdrawal, insomnia, delusions and hallucinations Interventions for mild to moderate levels of anxiety 1. active listening, ask open ending ?, board openings, exploring and seeking clarification 2. calm presence 3. evaluate past coping mechanisms 4. explore alternatives to problem situations 5. encourage participation in activities (exercise) Interventions for severe to panic levels of anxiety 1. provide environment that meets physical and safety needs of client. 2. Remain with client 3. use meds and restraints only after less invasive methods have been used 4. encourage gross motor activities (walking) 5. set limits by using short, simple statements. 6. Repetition may be necessary 7. direct client to acknowledge reality and focus on what is present in environment denial A nurse is caring for a patient who smokes and has lung cancer. The client reports: "I am coughing bc I have that cold that everyone has been getting" what defense mech is he using? Moderate- hampers ability to understand info A nurse is obtaining informed consent for a client who has just learned she must have a breast biopsy. The client is perspiring and pale and has a RR of 30 breaths/min and says "I do not quite understand what you're trying to tell me" what level of anxiety? d. demonstrate a calm manner while using simple and clear language A nurse is caring for a client who is experiencing moderate anxiety. Which of the following is an appropriate intervention when trying to give necessary info to client? a. reassure the client that everything will be okay b. use a low-pitched voice and speak slowly c. ignore the client's anxiety so that she will not be embarrassed d. demonstrate a calm manner while using simple and clear language TRUE True or false: clients who have been dx with a mental health disorder are guaranteed the same civil rights as any other citizen (ex: right to vote, right to press charges) tort wrongful act or injury committed by an entity or person against another person or another person's property; can be used to decide liability issues, as well as intentional issues (such as abuse of patient) TRUE states laws may vary greatly- true or false? beneficence relates to the quality of doing good and can be described as charity autonomy refers to the client's right to make their own decisions (but must accept the consequences of those decisions); must also respect decisions of others fidelity loyalty and faithfulness to the client and to one's duty veracity refers to being honest when dealing with a client Rule of confidentiality info about client, verbal and in writing, must be shared only with those who are responsible for implementing the client's treatment plan voluntary commitment client or guardian places in facility to get treatment; considered competent involuntary (civil) commitment enters facility against own will due to need for treatment or risk of harm and inability to provide self care; need for commitment could be determined by judge or by another agency emergency involuntary commitment type of involuntary commitment in which patient is hospitalized to prevent harm to self or others; usually temporary (less than 10 days); usually initiated by pcp, police, or mental health providers observational or temporary involuntary commitment involuntary commitment in which client is in need of observation, a dx, and a treatment plan; is controlled by state statute and may be imposed by family member, legal guardian, PC or mental health provider long term or formal involuntary commitment similar to temporary commitment but it MUST be imposed by courts (length usually= 60-180 days) shortest restraints can be chemical or physical but should be used for the _____ amount of time and as a last resort - ordered by physician -specify duration of use -provider must rewrite order stating type of restraint, q 24 hours or frequency of time specified by facility policy restraints must be: emergency An _______ situation must be present for nurse to use seclusion or restraints without first getting provider's written order, and must obtain the written order within 15-30 minutes intentional tort: false imprisonment confining a client to a specific area such as a seclusion room if the reason is that it is convenient for the staff intentional tort: assault making a threat to a client's person, such as approaching the client in a threatening manner (ex: with a syringe in hand) intentional tort: battery touching client in a harmful way or offensive way; if the nurse is threatening with syringe and actually grabs the client and gives the injection c. client with borderline personality disorder Which of the following is an example of a client who requires emergency admission to a mental health facility? a. client with schizo who has frequent hallucinations b. client with symptoms of depression who attempted suicide a year ago c. a client with borderline personality disorder who assaulted a homeless man with a metal rod d. client with bipolar who paces and talks to himself c. A client says: "Don't tell anyone but I hid a knife in my bed to protect myself from my roommate who yells at me." what should nurse do? a. keep the client's communication confidential but talk to client daily to convince him to admit to hiding the knife b. keep client's communication confidential but watch the client closely c. tell the client that this must be reported to health care staff bc it concerns the health and safety of the client and others d. report the incident, but do not inform the client of the intention do so b. tort nurse puts client with psychosis in seclusion overnight bc the unit is very short staffed, and the client frequently fights with other clients. this is: a. beneficence b. a tort c. a facility policy d. justice b. client was offered 8 oz of water q hour c. client shouted at assistive personnel d. client received Thorazine 15 mg PO at 1000 Nurse is caring for client in restraints. Which of the following are appropriate for documentation? a. "client ate most of breakfast" b. client was offered 8 oz of water q hour c. client shouted at assistive personnel d. client received Thorazine 15 mg PO at 1000 e. client acted out after lunch b. tell the nurse to stop discussing behavior a nurse hears a newly licensed nurse discussing a client's hallucinations with another nurse. What should the nurse do first? a. notify the nurse manager b. tell the nurse to stop discussing behavior c. provide an in service program about confidentiality d. complete an incident report Intrapersonal Communication communication within an individual; "self talk" Interpersonal Communication between 2+ people in a small group; most common Public Communication within a large group of people; such as in community setting Transpersonal Communication communication that addresses an individual's spiritual needs and provides interventions to meet those needs Proper vocab use use of medical jargon may decrease client understanding proper use of denotative/conatative meaning when communicating, participants must share similar meanings- words that have multiple meanings may cause miscommunication if interpreted differently clarity/brevity shortest, simpliest communication is most effective client centered and purposeful, planned and goal-directed Therapeutic communication should be: verbal tracking provides feedback by restating or summarizing a client's statements d. intonation A charge nurse is conducting a class on therapeutic communication to a group of newly licensed nurses. Which of the following responses by the newly licensed nurse requires additional teaching regarding nonverbal communication? a. Personal space b. Posture c. Eye Contact d. intonation (tone of voice) d. restating A nurse is communicating with a client on the acute mental health facility and the client states: "I can't sleep, I stay up all night." The nurse responds, "You are having difficulty sleeping?" Which of the following is the nurse utilizing? a. offering general leads b. summarzing c. focusing d. restating a. offering advice- because prevents patient from making own decisions A nurse is communicating with a newly admitted client. Which of the following is a barrier to therapeutic communication? a. offering advice b. reflective meaning c. listening attentively d. giving info c. attending to verbal and nonverbal behaviors A nurse is conducting therapy with several clients and their families. Effective communication with clients and family is based on: a. discussing in-depth topics with which the client feels comfortable b. using silence to avoid unpleasant topics c. attending to verbal and nonverbal behaviors d. requiring the client and family to ask for feedback d. I understand you're concerned. Let's discuss what concerns you specifically When a family asks a nurse for reassurance which of the following is appropriate? a. I think your son is getting better. what have you noticed? b. I'm sure everything will be okay. It takes time to heal. c. I'm not sure what's wrong. Have you asked your doc? d. I understand you're concerned. Let's discuss what concerns you specifically a chronic illness related to absolute or relative deficiency of insulin Diabetes mellitus Types of drugs to treat/manage DM various insulins (differed by onset, peak, duration), oral hypoglycemic or oral anti-diabetic (OAD) drugs to increase insulin or modify carb metabolism, injectable meds (new) cells in the pancreas that make glucagon Alpha cells cells in the pancreas that make insulin Beta cells storage unit for glucose glycogen child/adolescent, usually thin, acute weight loss, polyuria, polyphagia, polydipsia, autoimmune (destroy betas), insulin NEEDED, 5-10% prevalence Type UNO (Eric and I have this) Usually overweight, gradual onset (asymptomatic), due to decreased SENSITIVITY in cell's response to insulin and inappropriate insulin secretion; therapy- lifestyle change to decrease weight, or OAD, 90-95% prevalent Type 2...ewwww (rhymes) Symptoms: weakness, malaise, visual changes, polyuria (frequent urination), polydipsia (thirst), polyphagia (hunger), weight loss Hyperglycemia STARVED: Shakey/Sweaty Tired/weak/fatigue Anxious/ache head Rate Up (fast HR) Vision Impaired Eat (hunger) Dizzy Hypoglycemia What are the factors that reduce blood glucose (4 Ms) Meds (Insulin and OADs), Move (Exercise), Mass (Cancer), Moderate (alcohol) What are the factors that raise da rooffff for blood sugars? (3 Ss) Sweets (foods...shit!), stress, steroids What should the fasting blood sugar be? (before meals?) What about after meals? <110 (72-126 mg/dl)= Before <140= After What should Hgb A1c be? less than or equal to 6.5% What is Hgb A1c? Sugar coated Hgb, indicates 3 month compliance of blood glucose control, gold standard measure of drug expected effect MOA of insulin regulate blood glucose by binding to insulin receptors on the cells to help move glucose into cells for energy, store glucose as glycogen (in liver and muscles) for energy source (glycogenesis), store EXTRA glucose as adipose, move POTASSIUM into cells along with glucose What types of diabetics use insulin therapy? - Type 1 -Gestational -Type 2: IF OADs and lifestyle changes don't help, complications (renal, liver, or painful neuropathy), surgery or dx tests, severe stress (infection/trauma), DKA or hyperosmolar hyperglycemic nonketotic syndrome (HHNS or HHNK), treatment of hyperkalemia What is DKA - ONLY for type 1 -hyperglycemia-->osmotic diuresis-->extracellular and intracellular dehydration -s/s: polyuria/dipsia, a/v, Kussmaul, fruity breath What are the labs for DKA and Tx? Labs= BS>250-300, ketonemia, ketonuria TX= Hydration, correct insulin What is HHNK? HYPERGLYCEMIC NONKETOTIC SYNDROME -only for type 2 - same as DKA: hyperglycemia-->osmotic diuresis-->extracellular and intracellular dehydration -s/s: polyuria, sign of dehydration HHNK Labs and tx? BS>600-1000= LAB Agressive Hydration= TX Expected effects of insulin -maintain bs in normal range -eliminate glucose, acetone from urine -keep blood lipid levels at/close to normal Side effects of insulin and ADE SE: injection site irritation/infection, lipohypertrophy or lipoatrophy ADE: hypoglycemia, brain cells are sensitive to lows and can get insulin shock and die ddi for insulin? -Makes bs drop: OADs, BB, and alcohol -Makes bs go up: thiazide diuretics, steroids, LABA, SABA Why do BB affect insulin negatively? -Make BS go low -masks SNS response to hypoglycemia (tachycardia/tremors), making it difficult to identify hypoglycemia Complication of insulin: Somogyi Hypoglycemic at 3 am, HYPERglycemic at 7 am due to TOO much insulin...REBOUND How do you fix Somogyi? Reduce or omit dose insulin Complication of insulin: Dawn Phenomenon Hyperglycemic at 3 am and 7 am due to to nocturnal desensitizing How do you fix the Dawn Phenomenon? Add or increase bedtime dose of insulin...because body wasn't responding to insulin previously How do you treat hypoglycemia in a person with a bs <70? rule of 15 of carbs and no protein or fatty foods because it decreases absorption how to treat hypogly in an unconscious person or one on NPO? Dextrose 50% (D50) IV push or Glucagon SQ/IM There is NO oral form of what? Insulin a small protein that is destroyed by stomach acids and intestinal enzymes insulin rapid, short, intermediate, long acting and premixed insulins require how many injections per day? 8-10/day long acting requires how many? 1/day 10-15 onset 60-90 peak 4-5 hours duration rapid acting insulin (novolog, humalog, apidra) 30-60 min onset 2-4 hours peak 5-8 hours duration short acting insulin (Humulin R, Novolin R) 1-3 hours onset 5-8 hours peak time 12-18 hours duration Intermediate insulin (Novolin NPH, Humulin NPH) 90 min onset no peak 12-24 hours Long acting Levemir= 12-24 duration Lantus= 24 hour duration If mix, mix what to what of insulin? CLEAR TO CLOUDY Regular or short first then long used for basal (background) insulin Long-acting insulin: lantus/levemir smooth, peak less profile (no ups and downs) and has reproducible and predictable effects Long acting insulin what reduces risk of nocturnal hypoglycemia? Long-acting once-daily administration for convenience Long-acting During pregnancy (gestational) and breastfeeding what is modified? Insulin needs changes (due to hormones) but use insulin because it is safer than drugs Thoughts for oldies (old ppl) using insulin higher risk of hypoglycemia: especially if taking BB or warfarin, harder to recognize lows, bs more difficult to control due to poor eating Diabetes control is especially hard for: peds, pregnant, old ppl As a nurse monitor for s/s of abrupt onset of: ____ and s/s of gradual onset:___ abrupt- SNS: tachycardia, palpitations, diaphoresis, shakiness gradual- PNS: headache, tremors, weakness Store unopened vials where? Refrigerator until expires store open vials where? room temp 73-74 degrees Patient Edu for insulin: - wear med ID - rotate sites and allow 1 inch between injection sites -maintain a daily ROUTINE -carry glucose all the time -use one general area for sites to be consistent -SQ absorption rate increase from thigh to upper arm to abs -Lifestyle modifications Oral Anti-diabetic drugs (OADs) manage type 2, usually with 2+ different types of drugs, might need insulin as well Goal of OAD normal bs, reduced blood fat levels, normal body weight 7 major classes of OAD: 1. sulfonylureas, -zide, -ride 2. meglitinides (-nides)**same class as #1 nides, metformin (Glucophage) 4. alpha-glucosidase inhibirots, acarbose (Precose) 5. Thiazolidinediones (TZD) or Glitazones 6. DPP 4 inhibtors 7. GLP-1 or incretin 8. amylin OADs not recommended for peds: sulfonylureas, alpha-glucosidase inhibitors (AGI), thiazolidinediones (TZD) OADs for those older than 10 years old Metformin, meglitnides oral insulin secretagogoues work how? stimulates organ to produce more of a substance; an insulin booster (secrete more), trigger beta cells in pancreas to boost insulin production Two types of oral insulin secretagogoues? 1. sulfonylureas (long acting) 2. meglitinides (short acting) -zide, -mide, -ride (mean sulfa) sulfonyureas (type of oral insulin secretagogoues) stimulate Beta cells in pancreas to boost insulin production and release insulin (both basal and prandial) Sulfonylureas ONLY for ppl having type 2 diabetes less than 10 years (still need insulin cells for it to work), combo therapy recommended sulfonylureas DONT use sulfonylureas in ppl with: type 1 dm-->because no beta cells to work on sulf allergy cautiously use if pt is NPO or not eating (sick, nausea or sick) SE of sulfonylureas and ADE SE: weight gain (water retention), photosensitivity/blurred vision ADE: anemia, hypoglycemia, liver/renal damage, SJS DDI of sulfonylureas (additive effect) alcohol, NSAIDs, Sulfa abx, H2 blockers NURSING for sulfonylureas: monitor: - liver function: yellow skin, dark urine, pale stool, ALT/AST -renal function: Cr <1.5 BUN <20 When do you take sulfonylureas (long acting oral secretagogues)? MORNING: 30 minutes prior to meal; 1 time a day -nide *not sulfa Meglitnide: short acting secretagogues MOA of meglitnide? stimulate insulin secretion rapidly for a short period (every mealtime) who uses meglitnide? ONLY type 2 having diabetes LESS than 10 years, ppl who have a sulfa allergy CAN take, use with other therapies -take 4x day SE and ADE of meglitinide? SE: weight gain, flulike symptoms (URI) ADE: hypoglycemia, LIVER/renal damage *watch liver function (yellow, dark urine, pale stool, ALT/AST) *renal function: Cr <1.5 BUN <20 For meglitinide: take ___ or ___meals to boost insulin response (if don't eat, ____ take this!!) WITH or RIGHT BEFORE meals - don't eat, don't take MOA for biguanides: Metformin (Glucophage) SENSITIZERS - work everywhere -reduce glucose released from liver (reduces conversion of glycogen into glucose) by inhibiting gluconeogenesis (glucagon secretion) and glycogneolysis -increase cell sensitivity to insulin so glucose is taken up by muscle/tissue easier -reduce absorption of glucose from intestinal tract and suppress appetite -lowers triglycerides and increases HDL Who uses biguanides metformin? - Most common for type 2 (FIRST line) in all age groups and polycystics ovarian syndrome (type 2 linked to this) Don't use Biguanides when? -Before and 48 hours after radiology using dye (increases rate of lactic acidosis), check renal function before and restart SE and ADE of biguanides? SE: GI upset (N/V/D, bloating, gassy), Vit. B12 and folic acid deficiency, weight loss ADE: lactic acidosis (muscle aches), drowsiness, hyperventilation, low BP, and bradycardia Dont take biguanides with...1. ___ 2.___ 1. alcohol (lactic acidosis) 2. iodine (ARF) ***know this: for biguanides teaching/monitor: 1. 2. 3 4. TEACH= risk factors of _____ 1. liver function 2. renal function 3. cardiac output 4. risk factors of lactic acidosis: CHF, renal/liver dysfunction, >80 years, IV dye, very ill drug names: "glitazone" Thiazolidinedione (TZD) or Glitazones MOA of TZD or Glitazone reduce insulin resistance by improving cell response to insulin and increase glucose uptake and suppresses hepatic glucose production use TZD or glitazone for which types of diabetics? diabetics WITHOUT heart failure (because of risk of water gain)...not for CHF III and IV SE and ADE of TZD or Glit? SE: weight gain, edema (fluid retention), URI (flulike), increased LDL ADE: Heart failure/disease, anemia (dilutional), hepatoxicity Monitor for TZD or glitazones? Liver functions, cholesterol, CBC, wt and CO, HF s/s Takes ____-______weeks for TZD or Glitazones to work 4-6 weeeks for full full effect..."loooooooong acting"- Luefi drug name: acarbose (precose) Alpha Glucosidase Inhibitors (AGI) MOA of AGI block enzymes in small intestines to inhibit carb breakdown to glucose (delay and decrease glucose absorption from GI) USE AGI for who? Combo (ALWAYS) with other agents for type 1 and 2 diabetics (it is not a real OAD) Don't use AGI in ppl with what? renal dysfunction, inflammatory bowel disease, colonic ulceration, obstruction or cirrhosis Why don't most ppl use AGI? causes gas...who cut the cheeeese? ERICCCCCC! lolz kidding ;) love you Eric SE/ADE of AGI? GI upset, wt loss, anemia due to iron malabsorption, hepatotoxicity DDI for AGI? additive with other OADs When to take AGI? first bite, hypoglycemic occurred in patient taking this med, use glucose tablets/gel, not soda, sucrose or complex carb..ONLY eat simple sugars What are simple sugars? jelly beans, honey, glucose tabs, corn syrup natural "gut" hormones, produced in GI in response to carb, protein and fat intake incretin glucagon-like peptide-1 (GLP-1), inactivated by the enzyme diepeptidyl peptidase-4 (DPP-4) (T1/2 equal to or less than 2 min) incretins MOA of incretins -increase insulin production in pancreas -inhibit glucagon, a gluconeogenic hormone -decrease glucose absorption by slowing gastric emptying (decrease GI motility and appetite (induce nausea feeling) -Reduce both fasting postprandial glucose levels R/t food, short acting (good for IV), work in many organs, doesn't affect fasting hyperglycemia, only postprandial hyperglycemia Incretins Incretins are ______ drugs; use for type ____ diabetics as _____ injection *Extrinsic *2 *SQ only SE/ADE of Incretins N/V/D, decreased appetite, pancreatitis, weight loss, and hypoglycemia (severe) Incretins are injected SQ before ___ main daily meals not after meals 2 (Ex= breakfast and dinner) side effects of incretins are worse in patient who have any degree of ____ kidney impairment MOA of DPP-4 inhibitors (gliptins) increase incretins (or GLP-1) by inhibiting dipeptidly peptidase-4 (the enzyme inactivative GLP-1) -increases insulin release from pancreas -decreases glucagon (decreases glycogen= less glucose in liver) Who uses DPP-4? Type 2 in combo with other drugs insulin dependent, prandial only DPP-4 is ___ line because _______ SECOND b/c blocks enzymes SE: increases risk for infection and headache, weight gain and/or hypoglycemia if used with sulfonylureas Reduce the dose of DPP-4 for _____ pts who have impaired ___. Monitor ___ function (esp BUN and creatinine) -Elderly -Kidney -Kidney insulin independent, prandial only -A peptide hormone produced by beta cells in the pancreas -is co-secreted with insulin in response to post meal high bs -excreted in kidneys -is deficient in DM I and II pt who are deficient in insulin Amylin MOA of amylin is to collectively reduce the total _____ demand, suppress _____ secretion, slow gastric emptying and inhibit ___ secretion, decrease appetie by promoting ___ insulin glucagon, digestive secretion satiety Amylin and AGI are NOT _____, can work without it INSULIN Pramlintide (Symlin)----AMYLIN type extrinsic drugs (or analog, mimic drugs) Amylin is ____ therapy for type what diabetes? adjunct 1 & 2 Amylin reduces ____ glucose and ____ postprandial fluctations don't use amylin in patients with ____ failure renal Amylin has an additive effect if used with ___ insulin Take Amylin ___ injection ___ main meals, or oral med __ hour(s) before or 2 hours after ____ SQ BEFORE 1 hour before 2 hours after pramlintide Electroconvulsive therapy (ECT), Transcrainal magnetic stimulation, vagus nerve stimulation Brain stimulation therapy includes: 1. 2. 3. ECT uses electrical current to induce brief seizure activity while client is anesthetized; mechanism is still unknown (may enhance effects of neurotransmitters- seretonin, dopamine, and norepinephrine) Major Depressive Disorder, Schizophrenia, acute manic episodes (bipolar) What ECT can be used for bipolar disease These clients need ECT because of rapid cycling (4 episodes of acute mania within a year), very destructive behavior; they require ECT and then a regimen of lithium ECT these place client at higher risk for which therapy? recent MI, hx of cerebrovascular accident, cerebrovascular malformation, intracranial mass lesion, increased intracranial pressure ECT receives this 3x per week for a total of 6-12 treatments ECT meds for seizures must be decreased or d/c several days before ECT procedure; MAOIs and lithium should be D/C 2 weeks before treatment ECT monitor/correct HTN, dysrhythmias, VS, mental status; insert IV line until full recovery atropine sulfate or glycopyrrolate (Robinul) 30 minutes prior to beginning of ECT an IM injection of ____ or _____ is given to decrease secretions and counteract any vagal stimulation ECT prep/procedure care administered early in a.m and after client has fasted, bite guard in place, mechanically ventilated with 100% O2, , short acting anestethic given (methohexital), muscle relaxant, cuff placed on arm/leg to block the muscle relaxant, after seizure activity has ceased the anesthetic is D/C ECT post procedure care client is positioned on his side to facilate drainage and prevent aspiration, gag reflex checked, takes 30-60 minutes to recover ECT complications short term memory loss, confusion and disorientation may occur immediately following procedure; memory loss may persist several weeks 25% ECG changes may occur during ECT. Heart rate is expected to increase by ____ during procedure and early recovery; bp may initially fall and then rise during procedure side effects of ECT Headaches, muscle soreness, and nausea can occur during and following procedure ECT can decrease incidence of relapse but is not a permanent cure transcranial magnetic stimulation (TMS) uses magnetic pulsations to stimulate specific areas fo the brain TMS Used only for depressive disorder TMS prescribed daily for 4-6 weeks; can be down outpatient and lasts 30-40 minutes whie an electromagnet is placed on client's scalp allowing magnetic pulsations to pass through; client is alert during procedure complications of TMS mild discomfort or tingling at site, lightheadedness, seizures (rare) vagus nerve stimulation (VNS) provides electrical stimulation through vagus nerve to the brain through a device that is surgically implanted under the skin on chest; believed to result in an increased level of neurotransmitters Depression and maybe anxiety VNS is used for what? VNS commonly preformed outpatient, delivers around the clock programmed pulsations, can turn off device by placing a special external magnet over the site of implant VNS voice changes, hoarseness, throat or neck pain, dysphagia- usually improve with time, dyspnea (especially with exertion so turn off device during exercise) d. I will recieve a muscle relaxant to protect me from injury during ECT A nurse is providing teaching who is scheduled for ECT. Which indicates an understanding of teaching? a. It is common to treat depression with ECT before trying meds b. I can have my depression cured if I recieve a series of ECT treatments c. I will have seizures lasting 1.5-2 mintes during ECT d. I will recieve a muscle relaxant to protect me from injury during ECT b. I will provide postanesthesia care following TMS A charge nurse is discussing TMS with a new nurse. Which of the following indicates a need for further teaching? a. TMS is indicated for clients whose depression is not relieved by medication b. I will provide postanesthesia care following TMS c. TMS is usually performed as an outpatient procedure d. I will schedule the client for daily TMS treatments for the first several weeks c. memory loss d. nausea e. tachycardia A nurse is assessing a client immediately following an ECT procedure. Which are expected findings? a. hypotension b. paralytic ileus c. memory loss d. nausea e. tachycardia c. bipolar with rapid cycling A nurse is leading a peer group discussion about the indications for ECT. Which of the following is appropriate to include in the discussion? a. borderline personality disorder b. acute withdrawal r/t a substance use disorder c. bipolar with rapid cycling d. dysthymic disorder a. voice changes d. dysphagia e. neck pain A nurse is planning care for a client receiving surgical implantation of VNS device. Monitor for which adverse effects? a. voice changes b. seizure activity c. disorientation d. dysphagia e. neck pain Types of antiemetic drugs: 1. Pheno-thiazine subset or DA antagonists 2. Anticoholinergics-->DRY 3.Anti-histamines 4.Dopamine or D2 antagonists (for GERD) 5. Serotonin or 5HT3 6. Glucocorticoids 7. Substance P/neurokinin, antagonists 8. Cannabinoids promethazine (Phenergan) Antiemetic- Pheno-thiazine subset or DA (D2) antagonist scopolamine (Transderm Scop) Anticholinergic antagonist or muscarinic antagonist--> DRY, 10 can'ts 6 D's Promotility drugs for GERD Dopamine or D2 antagonists ondansetron (Zofran) Serotonin or 5HT3 receptor antagonist----used for chemo induced N/v for elderly used in combination with other antiemetics to treat chemo induced n/v Glucocorticoids (dexaethasone) used in combo with glucocosrticoid or serotonin antagonist for antiemetic Substance P.neurokininin1 antagonists used to control CINV, increase appetite in patients having AIDS (antiemitic drug) Cannabinoids treatment of n/v 1. treat cause FIRST 2. block more than one area 3. cocktail drugs- more than 1 drug side of effect of antiemetic are wet or dry? DRY->anticholinergic (10 cants, 6 Ds) ADE of antemetics: (4 of them) 1. Neuroleptic malignant- FEVER 2. tardive dystkinesia (tongue movements) 3. neutropenia 4. resp depression In older adults watch for ____, _____, and ____ from meds - acute confusion -sedation -balance disturbance Which meds are used and which receptors can be blocked to stop the N/V control centers? AAPD5 1. Anticholinergic- blocks cholinergic receptors 2. Antihistimines- block H1 3. Phenothiazine- block H1 and DA receptors 4. 5HT3 antagonist- serotonin 5.DA antagonist- block DA What center is stimulated by chemo that causes N/V? Chemoreceptor trigger zone (CTZ)- it protects the body but is stimulated during chemo psychoanalysis therapeutic process of assessing unconscious thoughts and feelings, and resolving conflict by talking to a psychoanalyst- lasts months- years - not sole therapy of choice -usually focuses on past relationships psychoanalysis therapeutic tools free association (whatever comes to mind first), dream analysis, transference, use of defense mechanisms psychotherapy ____ requires more verbal therapist to client interaction than classic psychoanalysis psychodynamic psychotherapy focuses more on present state rather than on early life interpersonal psychotherapy assists clients in addressing specific problems; can improve interpersonal relationships, communication, role relationship and bereavement cognitive therapy based on the cognitive model, which focuses on individual thoughts and behaviors to solve current problems; treats depression, anxiety, eating disorders and other issues that can improve by changing a client's attitude toward life experiences behavioral therapy based on the theory that behavior is learned and has consequences- changing abnormal behaviors can occur without discovering the underlying causes - can teach clients ways to decrease anxiety or avoidant behavior behavioral therapy most often used for patients with: phobias, substance or addictive disorders and other issues Dialetical behavior therapy cognitive- behavioral therapy for clients who have a personality disorder and exhibit self injurious behavior; focuses on gradual changes and provides acceptance and validation for these clients Cognitive reframing assists clients to identify negative thoughts that produce anxiety, examine the cause, and develop supportive ideas that replace negative self talk priority restructuring assists clients to identify what requires priority, such as devoting energy to pleasurable activities assertiveness training teaches clients to express feelings and solve problems in a nonaggressive manner monitoring thoughts helps client become aware of negative thoughts Modeling therapist serves as a role model for a client who imitates it to improve behavior operant conditioning client receives positive rewards for positive behavior (positive reinforcement) systematic desensitization is planned, progressive, or graduated exposure to anxiety provoking stimuli in real life situation, or by imagining events that cause anxiety. During exposure the client uses relaxation techniques to suppress anxiety response aversion therapy pairing of a maladaptive behavior punishment or unpleasant stimuli to promote a change in behavior meditation, guided imagery, diaphragmatic breathing, muscle relaxation, and biofeedback uses various techniques to control pain, tension and anxiety ex: a nurse can teach diaphragmatic breathing to a client having a panic attack or to a female client in labor flooding exposing a client while in the company of a therapist to a great deal of an undesirable stimulus in attempt to turn off the anxiety response response prevention preventing a client from performing a compulsive behavior with the intent that anxiety will diminish thought stopping teaching a client when a negative thoughts or compulsive behaviors arise to say or shout "stop" and substitute a positive thought. The goal overtime is to use the command silently. b. The therapist will focus on my past relationships during our sessions A nurse is teaching a client who has an anxiety disorder and is scheduled to begin classical psychoanalysis. Which of the client statements indicates an understanding of this treatment? a. Even if my anxiety improves, I will need to continue this therapy for 6 weeks b. The therapist will focus on my past relationships during our sessions c. Psychoanalysis will help me reduce my anxiety by changing my behaviors d. this therapy will address my conscious feelings about stressful experiences d. I should say the first thing that comes to mind A nurse is discussing free association with a client who has major depression disorder. Which of the following indicates understanding of this technique: a. I will write down my dreams b. I may begin to associate my therapist with important ppl in my life c. I can learn to express myself in a nonaggressive manner d. I should say the first thing that comes to mind a. priority restructuring b. monitoring thoughts d. journal keeping *the others are behavioral strategies A nurse is preparing to implement cognitive reframing techniques for a client who has an anxiety disorder. Which of the following should be in plan of care? a. priority restructuring b. monitoring thoughts c. diaphragmatic breathing d. journal keeping e. meditation a. aversion therapy A patient has a new prescription for disulfiraram (Antabuse) for alcohol use disorder. The nurse tells client that it can cause N/V if he drink alcohol. This form of treatment is what? a. aversion therapy b. flooding c. biofeedback d. dialectical behavioral therapy c. gradually expose the client to an elevator while practicing relaxation techniques A nurse is assisting with systematic desensitization for a client who has extreme fear of elevator. Which of the following is appropriate when implementing this form of therapy? a. demonstrate riding in an elevator and then ask the client to imitate behavior? b. adivese the client to say "stop" out loud every time he begins to feel anxious c. gradually expose the client to an elevator while practicing relaxation techniques d. stay with the client in the elevator until his anxiety response diminishes Acute Care Setting for Mental Health Care provides intensive treatment and supervision in locked units for clients with severe mental illness; helps stabilize illness so they can return to the community Community Settings For Mental Health primary care in clinics, schools, day care centers, partial hospitalization programs, drug and alcohol treatment facilities, forensics, telephone crisis centers and home health care Forensic Nursing a combo of biophysical edu and forensic science; uses sci investigation, collection of evidence, analysis, prevention, and treatment of trauma and/or death of perpetrators and victims of violence and traumatic accidents National Alliance on Mental Illness a grassroots organization with the goals of improving the quality of life for ppl with mental illness and providing research to better treat or eradicate mental illness 1. increase in aging population 2. increase in cultural diversity within the US 3. expansion of technology, which may provide new settings for client care, as well as new ways to rest mental illness more effectively Factors that will affect the future of mental health care include: 1. 2. 3. primary prevention What level of prevention? promotes health and prevents mental health problems from occuring primary prevention A nurse leads a group for parents of toddlers discussing normal behaviors and ways to promote healthy development secondary prevention A nurse screens parents of kids who have developmental disorders secondary prevention What level? focuses on early detection of mental illness tertiary prevention what level? focuses on rehab and prevention of further problems in clients previously diagnosed tertiary a nurse leads a support group for clients who have completed a substance use disorder program partial hospitalization programs intense short stay for clients who can go home; detox assertive community treatment for clients who are noncompliant for traditional treatments; helps reduce reoccurrence of hospitalizations and provides crisis intervention, assistance with independent living and info for resources for support services community mental health centers educational groups, medication dispensing programs, individual counseling programs psychosocial rehab programs provide a structured range of programs for clients in a mental health setting, including: residential services, day programs for older adults home care implemented for most children or older adults and clients with medical conditions a. educational groups b. medication dispensing program c. individual counseling program A nurse working in a community mental health facility uses which of the following for the client? a. educational groups b. medication dispensing program c. individual counseling program d. detox programs e. crisis intervention c. a client who says he is hearing voices that tells him that he is not worthy of living anymore A nurse is caring for several clients who are attending community based mental health programs. Which of the following clients should the nurse plan to visit first? a. client recently burned her arm while using hot iron at home b. client who requests that her anti psychotic meds be changed due to SE c. a client who says he is hearing voices that tells him that he is not worthy of living anymore d. a client who tells the nurse that he experienced symptoms of seer anxiety before and after interview tertiary prevention a nurse is working on promotion of healthy coping skills with older adult clients who have been previously hospitalized for severe depression and are now in facility. This is what level? b. client who lives at home and keeps "forgetting" to come in for monthly injection of schzio med A nurse is caring for a group of clients. Which of the following clients should the nurse consider for referral to an assertive community treatment (ACT) group? a. client in an acute care mental health facility who has fallen several times while running downy the hallway b. client who lives at home and keeps "forgetting" to come in for monthly injection of schzio med c. client in a day program who says he is becoming more anxious during group therapy d. client in a weekly grief support group who says she still misses her deceased husband who has been dead for 3 months c. attending a partial hospitalization program- to provide treatment during the day A nurse in an acute mental health facility is caring for a client with severe mental illness and soon will be ready for discharge but still requires supervision a lot of the time. Client's wife works all day but is home late in afternoon. Which of the following should the nurse suggest as appropriate follow-up care? a. receiving daily care from a home health aide b. having weekly visit from a nurse case worker c. attending a partial hospitalization program d. visiting a community mental health center daily therapeutic relationship *purposeful and goal-directed *well-defined boundaries *structured to meet client's needs *characterized by an interpersonal process that is safe, confidential, reliable and consistent Nurse, as a care manager Who is responsible for structuring and/or implementing aspects of the therapeutic milieu within mental health facility? regular community meetings What is a structure of the therapeutic milieu that includes both the clients and nursing staff? consistent approach, going at client's pace, attentive listening, positive initial impressions, comfort during relationship, self-awareness of own thoughts, consistent availability Factors that positively affect development of therapeutic relationships: orientation phase introduce, set contract, discuss confidentiality, establish boundaries, set goals, explore client's feelings and ideas, explore meaning of testing behaviors, enforce limits on testing or other inappropriate behaviors working phase maintain relationship, ongoing assessments, facilitate client's expression of needs and issues, encourage client to problem solve, promote self esteem, foster positive behavioral change, deal with resistance factors, recognize transference and countertransference issues, reassess client's problems and goals and revise if needed, support new coping methods, remind client about date of termination termination phase provide opportunity for the client to discuss thoughts about ending, previous experiences with separation? summarize goals, review memories of work sessions, express own feelings about sessions to validate with client, discuss ways for the client to incorporate new healthy behaviors into life, maintain limits of final termination blurred boundaries of therapeutic relationship needs begin to meet nurses not the client or if relationship becomes social transference when client views a member of health care team as having characteristics of someone they once knew from personal life countertransference when a health care team member displaces characteristics of people in her past onto a client c. losing someone close to you must be very upsetting A nurse is talking with a client who is at risk for suicide following death of a spouse. Which of the following is most appropriate? a. I feel sorry for the loneliness you must be experiencing b. suicide is not the appropriate way to cope with loss c. losing someone close to you must be very upsetting d. I know how difficult it can be to lose a loved one b. client accuses nurse of telling him what to do just like his ex girlfriend A nurse in the working phase with a client with methamphetamine use disorder. Which infers transference behavior? a. client asks if nurse will go to dinner with him b. client accuses nurse of telling him what to do just like his ex girlfriend c. client reminds the nurse of a friend who died from substance overdose d. client becomes angry and threatens harm to himself c. goal directed behavioral change is encouraged d. termination date is established A charge nurse is discussing the characteristics of a nurse client relationship with a newly licensed nurse. Which of the following is appropriate to include in discussion? a. the needs of both participants are met b. an emotional commitment exists between the participants c. goal directed behavioral change is encouraged d. termination date is established a. discussing ways to use new behaviors A nurse is planning care for the termination phase. Which of the following is appropriate to include in the plan of care? a. discussing ways to use new behaviors b. practicing new problem solving skills c. developing goals d. establishing boundaries c. you and the other clients will meet with staff to discuss common problems A nurse is orienting a client to a new mental health unit. When explaining the unit's community meetings, which of the following is most appropriate? a. you and a group of other clients will meet to discuss your treatment plans b. community meetings have a specific agenda established by the staff c. you and the other clients will meet with staff to discuss common problems d. community meetings are an excellent opportunity to explore your personal mental health issues Stress/stressors can provide interest and purpose to life; however too much can cause distress General adaption syndrome body's response to an increased demand. The first stage is the initial adaptive response, known as fight or flight managing stress in a healthy manner is flexible and uses a variety of coping techniques or mechanisms Standardized Screening Tools for Stress Holmes and Rahe scale to measure Life Changes Units, and Lazarus's Cognitive Appraisal cognitive restructuring The client is helped to look at irrational thoughts in a more realistic light and to restructure those thoughts in a more positive way physical exercise causes release of endorphins that lower anxiety, promote relaxation, and have antidepressant effects journal writing can help the client identify stressors and make specific plans to decrease stressors biofeedback a nurse or other health professional trained in this method uses a sensitive mechanical device to assist the client to gain voluntary control of such autonomic functions as heart rate and blood pressure a. excessive stressors cause the client to experience distress A nurse is preparing to provide an educational seminar on stress to other nursing staff. Which of the following is appropriate to include in the discussion? a. excessive stressors cause the client to experience distress b. the body's initial adaptive response to stress is denial c. the absence of stressors results in homeostasis d. negative, rather than positive, stressors produce a biological response a. decreased appetite b. depressed immune system c. increased blood pressure e. unhappiness A nurse is discussing acute vs. prolonged stress with a client. Which should the nurse see as acute stress? a. decreased appetite b. depressed immune system c. increased blood pressure d. panic attacks e. unhappiness a. "cognitive reframing will help me change my irrational thoughts to something positive" Which of the following client statements indicates understanding about stress reduction techniques a. "cognitive reframing will help me change my irrational thoughts to something positive" b. progressive muscle relaxation uses a mechanical device to help reduce stress c. biofeedback causes my body to release endorphins so that I feel less stress and anxiety d. minfulness allows me to prioritize the stressors that I have in my lfie so that I have less anxiety Types of antidiarrheal drugs (3 A's) 1. Antimotility 2. Adsorbent/absorbent 3. Anti-secretory Loperamide (Imodium) Antimotility Polycarbophil (FiberCon) Adsorbent/absorbent Bismuth subsalicylate (Pepto-Bismol) Anti-secretory...fun fact...DONT GIVE TO KIDS because aspirin is in it! -constipation, bloating, gassy (flatulence), stool color change, dependence if long term use are ____ -Antimotility, adsorbent/absorbent intestinal obstruction and anti-secretory are ______ -SE of antidiarrheals -ADE ______ can cause bleeding and bruising because it contains ASA Pepto-Bismol an ADE of antidiarrheals due to antimotlity....inflated colon with ab distention, symptoms include fever, ab pain, rapid heart rate, dehydration, shock,leading to risk for death Toxic megacolon What drugs treat constipation? (6) 1. Bulk forming laxatives 2. Stool softeners 3.Lubricants 4. Osmotic laxatives 5.Stimulant lax 6. Combos (stool softener and lax) Psyllium (Metamucil) Bulk forming lax Docusate Sodium (Colace) stool softener mineral oil Lubricant Magnesium hydroxide (Milk of Magnesia, polyethylene glycol (PEG or Miralax) Osmotic laxative SE of constipation drugs diarrhea, ab cramps, ab distention, nausea, flatulence, electrolyte imbalances take constipation drugs with ________ for safety and effectiveness 8 oz of fluid constipation drugs are used for ____ term short ________ laxatives are safe for daily use in older adults bulk forming [Psyllium (Metamucil)] Children group therapy in the form of play while talking about a common experience Adolescent group therapy especially valuable, as this group typically has strong peer relationships Older adult group therapy this helps with socialization and sharing of memories Initial phase of group development group leader sets a tone of respect, trust and confidentility among members. Members get to know each other and the group leader. There's a discussion about termination. Working phase of group therapy the group leader uses therapeutic communication to encourage group work toward meeting goals. Members take informal roles within the group, which may interfere with, or favor, group progress toward goals Termination phase of group therapy group members discuss termination issues. The leader summarizes work of the group and individual contributions. Groups in an acute mental health setting focus of the group is on relief. Unit activities will directly impact the group and the leader must provide a higher level of structure Groups in an outpatient setting Members are often consistent, the focus of the group is on growth, external influences are limited, and the leader can allow members an opportunity in determining the group's direction. family management problems child makes decisions in family enmeshed boundaries (dysfunctional family) thoughts, roles and feelings blend so much that the individual roles are unclear in family rigid boundaries (dysfunctional families) rules and roles are completely inflexible. These families tend to have members that isolate themselves triangulation one parent may develop an alliance with a child, leaving the other parent relatively uninvolved with both c. asks for group suggestions of techniques and then supports discussion A nurse wants to use democratic leadership with a group whose purpose is to learn appropriate conflict resolution techniques. The nurse is correct in implementing this form of group leadership when she demonstrates which of the following actions? a. observes group techniques without interfering with the group process b. discusses a technique and then directs members to practice the technique c. asks for group suggestions of techniques and then supports discussion d. suggests technique and asks group members to reflect on their use b. define the purpose of the group c. discuss termination of the group e. establish an expectation of confidentiality within the A nurse is planning group therapy for clients dealing with bereavement. Which of the following should the nurse include in the initial phase? a. encourage the group to work towards goals b. define the purpose of the group c. discuss termination of the group d. identify informal roles of members within the group e. establish an expectation of confidentiality within the group b. manipulation A nurse is conducting a family therapy session. The adolescent son tells the nurse that he plans ways to make his sister look bad so his parents will think he's the better sibling, which he believes will give him more privileges. The nurse should identify this dysfunctional behavior as which of the following? a. placation b. manipulation c. blaming d. distraction d. hidden agenda A nurse working on acute mental health unit forms a group to focus on self-management of medications. At each of the meetings, 2 of the members use the opportunity to discuss their common interest in gambling on sports. This is an example of which of the following? a. triangulation b. group process c. subgroup d. hidden agenda c. a member who brags about accomplishments A nurse is working with an established group and identifies various member roles. Which of the following should the nurse identify as an individual role? a. a member who praises input from other members b. a member who follows the direction of other members c. a member who brags about accomplishments d. a member who evaluates the group's performance toward a standard Overview -emerge in late adolescence -periods of normal functioning alternate with periods of illness -acute phase may need 1:1 supervision in hospital Behaviors Shown -Mania: elevated mood; usually require hospital -Hypomania: less severe mania that lasts at least 4 days; hospital not required -Mixed episode: manic and depressive at same time; hospital to prevent self or other harm -Rapid cycling: four or more episodes of acute mania within 1 year Relapse -use of substance can trigger -sleep disturbances may come before, associated with or be brought on by episode -physiological stressors can trigger Manic Characteristics -labile mood with euphoria -restlessness -grandiosity -impulsitivity -neglect ADL -decreased sleep -denial of illness -poor judgments -LOTS MORE, seems obvious... Depressive Characteristics -flat, blunted, labile affect -crying -lack of energy -anhedonia (lack of pleasure) -decrease in personal hygiene -loss/increase in sleep/appetite -self destructive behavior, suicidal Nursing Care -safety -milieu therapy -assess client regularly -decrease stimulation -frequent rest periods -provide outlets for physical activity -LOTS OF EDUCATION ... precipitating factors of relapse, medications, ADLS, maintaining regular sleep, meal and activity pattern, importance of compliance,etc. Communication -use a calm, matter of fact, specific approach -give concise explanations -provide for consistency with expectations and limit-setting -avoid power struggles, do not react personally -listen and act on legitimate client grievances -reinforce nonmanipulative behaviors Medications -Mood stabilizers = lithium carbonate (l