NSG 221 HESI Final Exam - Questions and Answers

NSG 221 HESI Final Exam - Questions and Answers Countertransference Countertransference occurs when the therapist displaces onto the client attitudes or feelings from his or her past. For example, a female nurse who has teenage children and who is experiencing extreme frustration with an adolescent client may respond by adopting a parental or chastising tone. The nurse is countertransfering her own attitudes and feelings toward her children onto the client. Nurses can deal with countertransference by examining their own feelings and responses, using self-awareness, and talking with colleagues. Tardive Dyskinesia Tardive dyskinesia (TD), a syndrome of permanent involuntary movements, is most commonly caused by the long-term use of conventional antipsychotic drugs. Tongue thrusting and protruding, lip smacking, blinking, grimacing, and other excessive unnecessary facial movements are characteristic. After it has developed, TD is irreversible, although decreasing or discontinuing antipsychotic medications can arrest its progression Civil Rights-Psychiatric Clients Clients receiving mental health care retain all civil rights afforded to all people except the right to leave the hospital in the case of involuntary commitment. Any restrictions (e.g., mail, visitors, clothing) must be made for a verifiable, documented reason. These decisions can be made by a court or a designated decision-making person or persons, for example, a primary nurse or treatment team, depending on local laws or regulations. Group Therapy In group therapy, clients participate in sessions with a group of people. The members share a common purpose and are expected to contribute to the group to benefit others and receive benefit from others in return. Group rules are established, which all members must observe. These rules vary according to the type of group. Being a member of a group allows the client to learn new ways of looking at a problem or ways of coping with or solving problems and also helps him or her learn important interpersonal skills. Crisis Intervention-Empathy Empathy is the ability to place oneself into the experience of another for a moment in time. Nurses develop empathy by gathering as much information about an issue as possible directly from the client to avoid interjecting their personal experiences and interpretations of the situation. The nurse asks as many questions as needed to gain a clear understanding of the client's perceptions of an event or issue. Clarification Communication Understanding the context of communication is extremely important in accurately identifying the meaning of a message. To clarify context, the nurse must gather information from verbal and nonverbal sources and validate findings with the client. Depressed Adolescent Rapport (use of self disclosure) Self-disclosure means revealing personal information such as biographical information and personal ideas, thoughts, and feelings about oneself to clients. Now, however, it is believed that some purposeful, well-planned self-disclosure can improve rapport between the nurse and the client. The nurse can use self-disclosure to convey support, educate clients, and demonstrate that a client's anxiety is normal and that many people deal with stress and problems in their lives. Depressed Adolescent Rapport (Establishing Rapport) When assessing a new patient, establish rapport first. If not much time is available to establish rapport, or if the patient is guarded or suspicious, you can say, "The questions I am about to ask you I ask all of my patients," and then proceed. Some other tips include the following: Establish rapport and connection by showing interest in the patient and by listening. Codependent Behaviors & Alcohol Abuse Codependence is a maladaptive coping pattern on the part of family members or others resulting from a prolonged relationship with the person who uses substances. Characteristics of codependence are poor relationship skills, excessive anxiety and worry, compulsive behaviors, and resistance to change. Family members learn these dysfunctional behavior patterns as they try to adjust to the behavior of the substance user. One type of codependent behavior is called enabling, which is a behavior that seems helpful on the surface but actually perpetuates the substance use. Clonidine (Catapress) Suppresses opiate withdrawal symptoms It is given to clients with opiate dependence to suppress some effects of withdrawal or abstinence. It is most effective against nausea, vomiting, and diarrhea, but produces modest relief from muscle aches, anxiety, and restlessness is an alpha-2-adrenergic agonist used to treat hypertension. It is given to clients with opiate dependence to suppress some effects of withdrawal or abstinence. It is most effective against nausea, vomiting, and diarrhea, but produces modest relief from muscle aches, anxiety, and restlessness Disulfiram (Antabuse) Maintains abstinence from alcohol Disulfiram (Antabuse) may be prescribed to help deter clients from drinking. If a client taking disulfiram drinks alcohol, a severe adverse reaction occurs with flushing, a throbbing headache, sweating, nausea, and vomiting. In severe cases, severe hypotension, confusion, coma, and even death may result. Alcohol Detoxification Alcohol detoxification through pharmacologic means generally takes place in a hospital setting but may occur in the home. The home care nurse shares the responsibility for teaching patients how to use chlordiazepoxide effectively and how to recognize medication responses that should be reported to the health care provider. The nurse instructs the patient and/or caregivers to recognize signs and symptoms of alcohol withdrawal and reviews the pharmacologic treatment regimen with them. Anxiety Cognitive Behavioral Techniques Cognitive-behavioral therapy (CBT) is used successfully to treat anxiety disorders. Positive reframing means turning negative messages into positive messages Decatastrophizing involves the therapist's use of questions to more realistically appraise the situation. Assertiveness training helps the person take more control over life situations. These techniques help the person negotiate interpersonal situations and foster self-assurance. They involve using "I" statements to identify feelings and to communicate concerns or needs to others. Valproic Acid (Depakote) Monitoring Lab Valproic acid (Depakote), also known as divalproex sodium or sodium valproate, is an anticonvulsant used for simple absence and mixed seizures, migraine prophylaxis, and mania. The mechanism of action is unclear. Therapeutic levels are monitored periodically to remain at 50 to 125 μg/mL, as are baseline and ongoing liver function tests, including serum ammonia levels and platelet and bleeding times. Antisocial Personality Disorder Disregard for rights of others, rules, and laws. People with antisocial personality disorder generally do not seek treatment voluntarily unless they perceive some personal gain from doing so. Clients with antisocial personality disorder have an established pattern of reacting impulsively when confronted with problems. The nurse can teach problem-solving skills and help clients practice them Clozapine Labs Prior to beginning the administration of clozapine, it is necessary to obtain a baseline white blood cell count and neutrophil count. Also, it is important to monitor the blood glucose level regularly for hyperglycemia, especially if signs and symptoms of diabetes mellitus or risk factors are present. May cause agranulocytosis, a potentially life-threatening event. Clients who are being treated with clozapine must have a baseline WBC count and differential before initiation of treatment and a WBC count every week throughout treatment and for 4 weeks after discontinuation of clozapine.