NCLEX RN Mental Health and Psychiatric Nursing

NCLEX RN Mental Health and Psychiatric Nursing (Personality and Mood Disorders)

• The community nurse is speaking to a group of new mothers as part of a primary prevention

program. Which self-measures would be most helpful as a strategy to decrease the occurrence of mood disorders?

• Keeping busy, so as not to confront problem areas.
• Medication with antidepressants.
• Use of crisis intervention services.

• Verbalizing rather than internalizing feelings.

Correct Answer: D. Verbalizing rather than internalizing feelings.

Individuals who develop mood disorders often have difficulty expressing feelings, especially feelings of anger toward significant others. Internalizing those feelings can contribute to loss of self-esteem and guilt, and therefore negative cognitions and depression.Option A: Ignoring problems is not a helpful strategy. Recognizing problems and using problem- solving methods will contribute to mental health. The nurse can direct their need for movement into socially acceptable, large motor activities such as arranging chairs for a community meeting or walking.Option B: Antidepressants are certainly necessary in the treatment of the mood disorder of depression; however, they are not used in primary prevention. Decreasing environmental stimulation may assist the client to relax; the nurse must provide a quiet environment without noise, television, and other distractions; finger foods or things the client can eat while moving around are the best options to improve nutrition.Option C: Crisis intervention would be a useful strategy in handling the immediate needs of someone experiencing a crisis; it is not a tool of primary prevention. A primary nursing responsibility is to provide a safe environment for the client and others; for clients who feel out of control, the nurse must establish external controls emphatically and nonjudgmentally.

• A client with antisocial personality disorder was admitted in a unit at Nurseslabs Hospital. The

newly admitted client stole money from an elderly in the unit. Which of the following is the most appropriate for the nurse to say to this client?

• "Why did you take the money?"
• "Let's talk about how you felt when you took the money."

• "The consequences of stealing are a loss of privileges."
• "This client is defenseless against you." 1 / 4

Correct Answer: C. “The consequences of stealing are loss of privileges.”

The most appropriate response is to reinforce the consequences of behavior that disregard the rights of others. Be very clear about the consequences if policies/limits are not adhered to. Client needs to understand the consequences of breaking the rules.Option A: This client is likely to rationalize and excuse the behavior. Approach the client in a consistent manner in all interactions. Enhances feelings of security and provides structure.Exceptions encourage manipulative behavior.Option B: The nurse should not encourage the client to provide excuses or explanations of behaviors that are clearly against the rules. Be clear with the client as to the unit/hospital/clinic policies. Give brief concrete reasons for the rules, if asked, and then move on.Option D: A client with antisocial personality disorder is unlikely to have compassion for others and typically lacks respect for the rights of others. When limits or policies are not followed, enforce the consequences in a matter-of-fact, nonjudgmental manner. Helps minimize manipulations and might help encourage cooperation.

• The client on Haldol has pill rolling tremors and muscle rigidity. He is likely manifesting:
• Tardive dyskinesia

• Pseudoparkinsonism
• Akinesia
• Dystonia

Correct Answer: B. Pseudoparkinsonism

Pseudoparkinsonism is a side effect of antipsychotic drugs characterized by mask-like faces, pill-rolling tremors, muscle rigidity. Patients with this disorder have apraxic slowness, paratonic rigidity, frontal gait disorder, and elements of akinesia that, taken together, may be mistaken for true parkinsonism.Pseudoparkinsonism appears to be common and is most often due to Alzheimer’s disease or vascular dementia.Option A: Tardive dyskinesia is manifested by lip-smacking, wormlike movement of the tongue.Tardive dyskinesia (TD) is a syndrome that includes a group of iatrogenic movement disorders caused due to a blockade of dopamine receptors. The movement disorders include akathisia, dystonia, buccolingual stereotypy, myoclonus, chorea, tics, and other abnormal involuntary movements which are commonly caused by the long-term use of typical antipsychotics.Option C: Akinesia is characterized by a feeling of weakness and muscle fatigue. The term akinesia refers to the inability to perform a clinically perceivable movement. It can present as a delayed response, freezing mid-action, or even total abolition of movement. Akinesia occurs when movement is not perceived either because the amplitude of the movement is small or because the time taken to initiate the reaction is significantly increased. 2 / 4

Option D: Dystonia is manifested by torticollis and rolling back of the eyes. Dystonia is defined by involuntary maintained contraction of agonist and antagonist muscles yielding abnormal posturing, twisting, and repetitive movements or tremulous and can be initiated or worsened by attempted movement.

• The client is concerned about his coming discharge, manifested by being unusually sad. Which is

the most therapeutic approach by the nurse?

• “You are much better than when you were admitted so there’s no reason to worry.”
• “What would you like to do now that you’re about to go home?”

• “You seem to have concerns about going home.”
• “Aren’t you glad that you’re going home soon?”

Correct Answer: C. “You seem to have concerns about going home.”

This statement reflects how the client feels. Showing empathy can encourage the client to talk which is important as an alternative more adaptive way of coping with stressors. Patients often ask nurses for advice about what they should do about particular problems or in specific situations. Nurses can ask patients what they think they should do, which encourages patients to be accountable for their own actions and helps them come up with solutions themselves.Option A: Giving false reassurance is not therapeutic. It’s frequently useful for nurses to summarize what patients have said after the fact. This demonstrates to patients that the nurse was listening and allows the nurse to document conversations. Ending a summary with a phrase like “Does that sound correct?” gives patients explicit permission to make corrections if they’re necessary.Option B: While this technique explores plans after discharge, it does not focus on the expression of feelings. Sometimes during a conversation, patients mention something particularly important.When this happens, nurses can focus on their statement, prompting patients to discuss it further.Patients don’t always have an objective perspective on what is relevant to their case; as impartial observers, nurses can more easily pick out the topics to focus on.Option D: This close-ended question does not encourage verbalization of feelings. Therapeutic communication is often most effective when patients direct the flow of conversation and decide what to talk about. To that end, giving patients a broad opening such as “What’s on your mind today?” or “What would you like to talk about?” can be a good way to allow patients an opportunity to discuss what’s on their mind

• Which is the best indicator of success in the long-term management of the client with a somatic

disorder?

• His symptoms are replaced by indifference to his feelings.
• He participates in diversionary activities. 3 / 4

• He learns to verbalize his feelings and concerns.
• He states that his behavior is irrational.

Incorrect

Correct Answer: C. He learns to verbalize his feelings and concerns.

The client is encouraged to talk about his feelings and concerns instead of using body symptoms to manage his stressors. Teach the client to reframe and dispute cognitive distortions. Disputes need to be strong, specific, and nonjudgmental. Practice and belief in the disputes over time help clients gain a more realistic appraisal of events, the world, and themselves.Option A: The client is encouraged to acknowledge feelings rather than being indifferent to her feelings. Work with the client to recognize cognitive distortions. Encourage the client to keep a log.Cognitive distortions are automatic. Keeping a log helps make automatic, unconscious thinking clear.Option B: Participation in activities diverts the client’s attention away from his bodily concerns but this is not the best indicator of success. Problem solve and role play with client acceptable social skills that will help obtain needs effectively and appropriately.Option D: Help the client recognize that his physical symptoms occur because of or are exacerbated by specific stressor, not as irrational. Give the client honest and genuine feedback regarding your observations as to his or her strengths, and areas that could use additional skills. Feedback helps give clients a more accurate view of self, strengths, areas to work on, as well as a sense that someone is trying to understand them.

• Which of the following interventions is important for a client with paranoid personality disorder

taking olanzapine (Zyprexa)?

• Explain effects of serotonin syndrome.
• Teach the client to watch for extrapyramidal adverse reactions.

• Explain that the drug is less effective if the client smokes.
• Discuss the need to report paradoxical effects such as euphoria.

Correct Answer: C. Explain that the drug is less effective if the client smokes.Olanzapine (Zyprexa) is less effective for clients who smoke cigarettes. Olanzapine doesn’t cause euphoria (damn), and extrapyramidal side effects aren’t a problem. However, the client should be aware of adverse effects such as tardive dyskinesia.Option A: Serotonin syndrome is a potentially life-threatening condition precipitated by the use of serotonergic drugs. It may be a consequence of therapeutic medication use, accidental interactions between medications or recreational drugs, or intentional overdose. Symptoms can range from mild to fatal and classically include altered mental status, autonomic dysfunction, and neuromuscular excitation. Multiple drugs may precipitate serotonin toxicity by a variety of mechanisms. SSRIs such as citalopram, escitalopram, fluoxetine, fluoxetine, paroxetine, and sertraline impair reuptake of serotonin from the synaptic cleft into the presynaptic neuron.

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