NUR 326 MENTAL HEALTH EXAM #2 DUE 10TH JULY 2024/2025

NUR 326 MENTAL HEALTH EXAM #2 DUE 10TH JULY 2024/2025 A community nurse arrives at a patient's home who has been diagnosed with bulimia nervosa. The nurse finds the client unconscious on the floor. The client has a history of abusing laxatives and purging. To what would the nurse attribute the client's symptoms? A. Increased creatinine and blood urea nitrogen (BUN) levels. B. Abnormal electroencephalopgram (EEG). C. Metabolic Acidosis. D. Metabolic Alkalosis. - CORRECT ANSWER-C. Metabolic Acidosis. A client who is 5' 6" tall and weighs 98 lbs is admitted with a medical diagnosis of anorexia nervosa. What is the primary nursing diagnosis at this time? A. Ineffective coping R/T food obession. B. Altered nutrition: less than body requirements R/T inadequate food intake. C. Risk for injury R/T suicidal tendencies. D. Altered body image R/T perceived obesity. - CORRECT ANSWER-B. Altered nutrition: less than body requirements R/T inadequate food intake. Jill is a patient being seen for bulimia nervosa. She just came back to the unit from lunch and her roommate tells you she is throwing up in the bathroom. The nurse should expect to: A. Restrict the patient to the unit for future meals. B. Plan to monitor patient for 1 hour after meals to keep patient from purging. C. Take away phone privileges from the patient until she can demonstrate healthy and compliant behavior. D. Put the patient on 1 to 1 observations for safety. - CORRECT ANSWER-B. Plan to monitor patient for 1 hour after meals to keep patient from purging. The environment in the home can be a major influence in the development of eating disorders. Which home environment could be associated with the development of an eating disorder? A. The home environment places an overemphasis on food. B. The home environment places loose personal boundaries. C. The home environment has the kids in after school activities. D. The home environment is overprotective and demands perfection. - CORRECT ANSWER-D. The home environment is overprotective and demands perfection. ----- - CORRECT ANSWER------- fatigue - CORRECT ANSWER-"a subjective lack of physical and/or mental energy that is perceived by the individual or caregiver to interfere with usual and desired activities" scope of fatigue - CORRECT ANSWER-No fatigue (full functional status), mild fatigue, moderate fatigue, exhaustion (impaired functional status) Markowitz and Rabow three defining characteristics: - CORRECT ANSWER--perception of generalized weakness, resulting in inability to initiate certain activities -easy fatiguability and the reduced capacity to maintain performance -mental fatigue resulting in impaired concentration and loss of memory and emotional stability normal physiological process for fatigue - CORRECT ANSWER--fatigue can be considered an expected symptom experienced by healthy individuals, but it is not considered a normal or expected finding when fatigue is persistent or severe -in healthy individuals, fatigue is received by physical and/or cognitive rest categories of fatigue - CORRECT ANSWER--each classification of fatigue can further be categorized as: *temporary or *chronic=lasting longer than 6 months theoretical links to fatigue - CORRECT ANSWER--there are many models or theories to explain what happens within the body to cause fatigue, but no single theory completely explains this multidimensional concept -three leading theories three leading theories of fatigue - CORRECT ANSWER-*waste product accumulation *insufficient supply of substances *an inflammatory process common occurring physiological consequences of fatigue - CORRECT ANSWER-- significant changes in a persons life that result in the loss of a job, loss of relationships, and inability to care for oneself -significant psychological consequences, particularly depression -mortality from suicide was higher in patients than the general population -poor prognosis for complete long-term resolution of symptoms risk factors for fatigue across various populations - CORRECT ANSWER-all individuals are potentially at risk for fatigue populations at greatest risk for fatigue - CORRECT ANSWER--older adults -women individual risk factors for fatigue - CORRECT ANSWER--underlying conditions -treatment-related factors -nutritional status -lifestyle choices subjective assessment for fatigue (history) - CORRECT ANSWER--personal description of the fatigue -onset and course -duration and daily pattern -factors that alleviate or exacerbate -impact on daily life objective assessment for fatigue (physical examination) - CORRECT ANSWER-- inspection: general appearance, gait, skin -palpation: lymph adenopathy, thyroid nodules, and goiter -auscultation: heart and lungs underlying conditions common diagnostic tests for fatigue - CORRECT ANSWER--there are no specific diagnostic markers for fatigue (diagnostic testing is primarily completed to rule out underlying diseases) -measurement of motor or cognitive function does not show significant correlations with perceived fatigue primary prevention for fatigue - CORRECT ANSWER--primary prevention focuses on maintaining a healthy lifestyle including topics like: *good nutrition *exercise *getting adequate sleep *managing stress *vitamin supplements secondary prevention (screening) for fatigue - CORRECT ANSWER--no populationwide screening efforts with respect to fatigue -high-risk patients or fatigue should be asked additional questions or use a fatigue screening tool collaborative interventions for fatigue - CORRECT ANSWER-*manage physiological fatigue by managing poor lifestyle choices and disease *manage secondary fatigue to treat underlying condition and reduce fatigue -exercise/rest therapy -sleep hygiene -nutrition teaching -stress management -pharmacological treatment -psychological care Chronic Fatigue Syndrome (CFS) - CORRECT ANSWER--also called chronic fatigue and immune dysfunction or myalgic encephalomyelitis -characterized by debilitating fatigue and associated complaints -affects 1 million people in the U.S. -women more than men Chronic Fatigue Syndrome etiology and pathophysiology - CORRECT ANSWER-- precise mechanisms remain unknown -many theories about cause *neuroendocrine abnormalities involving a hypo function of HPA axis and HPG (hypothalamic-pituitary-gonadal) axis -severe microorganisms -changes in CNS chronic fatigue syndorme clinical manifestations - CORRECT ANSWER--difficult to distinguish between CFS and fibromyalgia -onset insidious, intermittent, or sudden -incapacitating fatigue most common -associated symptoms may fluctuate chronic fatigue syndrome diagnostic studies - CORRECT ANSWER--physical examination and diagnostic studies rule out other possibilities -in general, a diagnosis of exclusion -CDC algorithm *major criterion + four or more of minor criteria for 6 months or more *major criterion=fatigue *minor criteria=specific associated symptoms chronic fatigue syndrome nursing and collaborative management - CORRECT ANSWER--supportive care -patient teaching -drug therapy *NSAIDs *antihistamines/decongestants *tricyclic antidepressants *clonazepam (Klonopin) *low-dose hydrocortisone chronic fatigue syndrome nursing and collaborative management cont.... - CORRECT ANSWER--activity -well-balanced diet *fiber *dark-colored fruits and vegetables -behavioral therapy -financial instability/disability *major problem facing CFS patients *cannot work or decreased time working -occupational/psychosocial needs -prognosis variable -financial instability CFS nursing and collaborative management - CORRECT ANSWER--CFS does not process *most patients recover or gradually improve over time *some do not show significant improvement scope of sleep - CORRECT ANSWER-top-->bottom -restorative sleep -intermittent/situational poor sleep -chronic poor sleep/sleep disorder stages of adult sleep - CORRECT ANSWER-pre sleep sleepiness->NREM Stage 1-> NREM Stag 2->NREM Stage 3->NREM Stage 4->NREM Stage 3->NREM Stage 2-> REM sleep *90 min sleep cycle Non-rapid eye movement (NREM) sleep - CORRECT ANSWER-stage 1: transition from wakefulness to sleep stage 2: most of night sleep, HR and Temp decreases stage 3: deep sleep/slow wave stage 4: deep sleep rapid eye movement (REM) sleep - CORRECT ANSWER--begin approximately 90 minutes after the inset of sleep -REM period is short, and may last only 10 minutes -dreaming typically occurs during REM sleep How much sleep is enough for infants? - CORRECT ANSWER-14-16 hours how much sleep is enough for preschool-aged children? - CORRECT ANSWER-11-12 hours how much sleep is enough for school-aged children? - CORRECT ANSWER-9-11 hours how much sleep is enough for teenagers? - CORRECT ANSWER-9 hours how much sleep is enough for adults (including older adults)? - CORRECT ANSWER-7- 9 hours consequences of poor sleep - CORRECT ANSWER--psychological and emotional consequences -physiological consequences psychological and emotional consequences of poor sleep - CORRECT ANSWER-- mood changes -irritability -excessive daytime sleepiness leading to distress physiological consequences of poor sleep - CORRECT ANSWER--hypertension -heart disease and heart failure -stroke -obesity -developmental disorders such as alterations in growth hormone -reproductive disorders due to disruption i hormonal regulation -increased mortality neurologic effects of sleep disorders - CORRECT ANSWER--cognitive impairment -behavioral changes (ex: irritability, moodiness) immune effects of sleep disorders - CORRECT ANSWER--impaired function respiratory effects of sleep disorders - CORRECT ANSWER--asthma exacerbated during sleep cardiovascular effects of sleep disorders - CORRECT ANSWER--heart disease (hypertension, dysrhythmias) -increased blood pressure in people with hypertension -stroke gastrointestinal effects of sleep disorders - CORRECT ANSWER--increased risk for obesity -increased gastroesophageal reflux disease (GERD) endocrine effects of sleep disorders - CORRECT ANSWER--increased risk for type 2 diabetes -increased insulin resistance -decreased growth hormone common conditions that affect sleep - CORRECT ANSWER--Alzheimer's disease -anxiety -arthritis -asthma -cancer -chronic obstructive pulmonary disease (COPD) -chronic kidney disease -depression -diabetes -epilepsy -febrile conditions -fibromyalgia -gastroesophageal reflux disease -heart failure -hyperthyroidism -menopause -pain -parkinson's disease -stroke common pharmaceutical categories that impair sleep - CORRECT ANSWER-- antiarrhythmics -antihistamines -beta-blockers -corticosteroids -diuretics -nicotine products -selective serotonin reuptake inhibitors (SSRIs) -theophyline -thyroid hormone risk factors for sleep - CORRECT ANSWER--every human being is at risk for sleep problems - populations at risk for sleep disorders - CORRECT ANSWER--middle-aged and older adult -women -pregnant and perimenopausal women -men have higher risk for obstructive sleep apnea (OSA) -obesity assessment for sleep problems (history) - CORRECT ANSWER--sleep history *when a sleep problem presents, questions about how the person feels upon awakening are important *a thorough review of systems to identify underlying sleep problems *family history and social history are very helpful assessment for sleep problems (physical examination) - CORRECT ANSWER--few physical findings direct indicate a sleep disorder. some helpful assessments include: *mallampati score *neck circumference *weight/BMI *respiratory and cardiac function *neurological changes diagnostic tests for sleep problems - CORRECT ANSWER--definitive tests for sleep problems measure activity and events related to sleep and wakefulness -actigraph is useful but not a definitive diagnostic tool -polysomnogram (PSG) -sleep journals primary prevention for sleep - CORRECT ANSWER--good sleep hygiene -good sleep environment -reviewing personal behaviors -consistent bedtime and awakening time -good dietary habits -regular exercise secondary prevention (screening) for sleep - CORRECT ANSWER--American Academy of Sleep Medicine screening tool for sleep apnea and bruxism -adapt tools to the developmental level of the patient -subjective answers from patines in response to simple questions help determine sleep issues insomnia - CORRECT ANSWER-common problem experienced by 1 in 3 adults insomnia symptoms - CORRECT ANSWER-include difficulty falling asleep, difficulty staying asleep, waking up too early, or complaints of waking up feeling unrefreshed *acute insomnia *chronic insomnia types of insomnia - CORRECT ANSWER--acute insomnia -chronic insomnia acute insomnia - CORRECT ANSWER--difficulty falling asleep or remaining asleep for at least 3 nights/wk for less than a month chronic insomnia - CORRECT ANSWER--same symptoms as acute -daytime symptoms that persist for 1 month or longer insomnia causes - CORRECT ANSWER--aggravated by inadequate sleep hygiene *stimulants *medications *using alcohol to induce sleep *irregular sleep schedules *nightmare *exercising near bedtime *jet lag chronic insomnia classified as: - CORRECT ANSWER--primary (idiopathic) *lifelong difficulty in initiating and maintaining sleep, resulting in poor daytime functioning -co-morbid *insomnia due to a psychiatric illness, a medical condition, medications, or substance abuse insomnia clinical manifestations - CORRECT ANSWER--difficulty falling asleep (long sleep latency) -frequent awakening (fragmented sleep) -prolonged nighttime awakenings -feeling unrefreshed on awakening (non restorative sleep) insomnia diagnosed through - CORRECT ANSWER--self-report -actigraphy -polysomnography (PSG) insomnia collaborative care - CORRECT ANSWER--education -cognitive-behavioral therapy (CBT) -sleep hygiene -complementary and alternative therapies *melatonin-effective related to jet lag and shift work *valerian-safe but not effective -drug therapy *benzodiazepines *benzodiazepine-receptor agonist *antidepressants *antihistamines insomnia nursing assessment - CORRECT ANSWER--sleep history -assess diet, caffeine and alcohol intake -ask about sleep aids -encourage a sleep diary for 2 weeks -medical history: factors that affect sleep insomnia nursing diagnoses - CORRECT ANSWER--insomnia -sleep deprivation -disturbed sleep pattern -readiness for enhanced sleep insomnia nursing implementation - CORRECT ANSWER-*assume primary role in teaching sleep hygiene -decrease caffeine intake -reduce light and noise *teach patines about sleep medications sleep hygiene/healthy sleep habits: Tips for healthy sleep habits - CORRECT ANSWER--keep a consistent sleep schedule. get up at the same time every day, even on weekends or during vacations -set a bedtime that is early enough for you to get at least 7 hours of sleep -dont go to bed unless you are sleepy -if you don't fall asleep after 20 minutes, get out of bed -establish a relaxing bedtime routine -use your bed only for sleep and sex -make your bedroom quiet and relaxing. keep the room at a comfortable, cool temperature -limit exposure to bright light in the evenings -turn off electronic devices at least 30 minutes before bedtime -dont eat a large meal before bedtime. if you are hungry at high, eat a light, healthy snack. -exercise regularly and maintain a healthy diet -avoid caffeine in the late afternoon or evening -avoid consuming alcohol before bedtime -reduce your fluid intake before bedtime sleep disturbances in the hospital - CORRECT ANSWER--environmental sleep disruptions, medications, acute and critical illness, disruptions in circadian rhythm, and reduced melatonin levels -sleep-disordered breathing is major concern in ICU -decreased sleep duration influences pain and psychologic factors obstructive sleep apnea - CORRECT ANSWER--also called obstructive sleep apneahypopnea syndrome (OSAHS) -partial or complete upper airway obstruction during sleep -apneic period may include hypoxemia and hypercapnia how sleep apnea occurs - CORRECT ANSWER-A: the patient predisposed to obstructive sleep apnea (OSA) has a small pharyngeal airway B: during sleep, the pharyngeal muscles relax, allowing the airway to close. lack of airflow results in repeated apneic episodes C: with CPAP, continuous positive airway pressure splints the airway open, preventing airflow obstruction obstructive sleep apnea clinical manifestations - CORRECT ANSWER--frequent arousal during sleep -insomnia -excessive daytime sleepiness -witnessed apneic episodes -snoring -morning headache -irritability obstructive sleep apnea complications can result in: - CORRECT ANSWER-- hypertension -cardiac changes -poor concentration/memory -impotence -depression *diagnosis is based on PSG sleep apnea nursing and collaborative management: Mild sleep apnea - CORRECT ANSWER--sleeping on ones side -elevating head of bed -avoiding sedatives and alcohol 3 to 4 hours before sleep -weight loss -oral appliance sleep apnea nursing and collaborative management: severe (>15 apnea/hypopnea events/hr) - CORRECT ANSWER--CPAP *poor compliance -BiPAP -surgery *uvulopalatopharyngoplasty (UPPP or UP3) *genioglossal advancement and hyoid myotomy (GAHM) CPAP with nasal mask - CORRECT ANSWER--management of sleep apnea often involves sleeping with a nasal mask in place -the pressure supplied by air coming from the compressor opens the oropharynx and nasopharynx eating disorders - CORRECT ANSWER--anorexia nervosa= food-restricting anorectic *anorexia nervosa & bulimia nervosa=anorectic with bulimic features -bulimia nervosa=bulimic with normal weight *bulimia nervosa & obesity=bulimic with high weight -obesity=overweight without bulimia nervosa *obesity & binge eating disorder or night eating syndrome=binge eating disorder or night eating syndrome with high weight -binge eating disorder or night eating syndrome=binge eating disorder or night eating syndrome with normal weight eating disorders: intro - CORRECT ANSWER--self regulation -adaptive eating responses *balanced eating patterns *appropriate caloric intake *healthy body weight -some people use food to meet other needs