A nurse is admitting a new client on the mental health unit. During the conversation the nurse should be aware that countertransference can occur if the nurse display what feeling?
- Countertransference occurs when a health care team member displaces characteristics of people in her past onto a client. The nurse overly identifies with the client, competes with the client, and argues with a client.
A client on the mental health unit is being discharge to a community base program referred to as Assertive Community Treatment. (ACT) What should the nurse explain to the client about this program?
- This programs includes non-traditional case management and treatment by an inter-professional team for clients who have severe mental illness and are noncompliant with traditional treatment. ACT helps to reduce reoccurrences of hospitalization and provide crisis intervention, assistance with independent living and information regarding resources for necessary support services
A nurse is caring for a client who states that he has abused his son because of the stress caused by his son's mental illness. How should the nurse use the communication tool of 'clarifying' when speaking with this client?
- Use techniques such as paraphrasing, reflection, exploring and restarting when communicating with the client ATI Mental Health Questions and Answers
A nurse is caring for a client who is admitted to the unit for self-mutilation. What type of behavioral therapy would the nurse expect to be ordered for this client?
- Dialectical behavior therapy is a cognitive-behavioral therapy used for clients who exhibit self-injurious behavior. It focus on gradual behavioral changes and provides acceptance and validation for these clients.
A community health nurse is leading a support group for clients who have completed a substance use disorder program. What level of prevention is this?
- This level is tertiary prevention
A nurse is caring for a client following a traumatic experience. What manifestations would alert the nurse to the possibility that the client is suffering from post-traumatic stress disorder (PTSD)?
- The client is having flashbacks unwanted memories or dreams and in a depressed mood.
A nurse is caring for a client in the manic phase of bipolar disorder. Identify five (5) clinical manifestations associated with this phase of the bipolar disorder.
- During the manic phase of a bipolar disorder the patient may present with an elevated mood, the decreased need for sleep racing thoughts,
difficulty maintain attention and excessive involvement in pleasurable activities.
A nurse is providing education regarding self-mutilation behaviors. Provide one (1) reason a client might consider performing the act of selfmutilate. Identify three (3) signs of possible self-mutilation?
- The client might self-mutilate to seek relief from negative thoughts and feelings.
- Signs of possible mutilation
- Wearing long sleeve shirts in hot weather
- Hair loss or bald spots
- Fresh cuts, scratches or other new wounds.
A nurse is completing a physical assessment on a child. What are three (3) potential signs of neglect?
- Poor dental health
- No immunizations
- Bruising on child’s abdomen back and buttocks
A nurse is completing a physical assessment on a child. What are three (3) potential signs of neglect?
- Absent from school
- Lacks medical attention
- Dirty body odor
A nurse is facilitating group therapy and the group is currently in the working phase of group development. What is the primary focus during this phase?
- The primary focus during the working phase is to promote problem solving skills in order to facilitate behavioral changes. One should know that power and control issues could dominate during this phase.
A nurse is caring for an adolescent client with Autism Spectrum Disorder. Define Autism Spectrum Disorder. What are common manifestations of Autism Spectrum Disorder?
- Autism spectrum disorder is a neurodevelopment disorder that is genetic with behaviors affecting the Individual’s ability to communicate and interact with others. Cognitive and language development are delayed manifestations of this inability to maintain eye contact repetitive actions and strict observance of routines, Physical difficulties can be experiences such as sensory integration dysfunction, sleep disorders, digestive disorders, feeding disorders, epilepsy and or allergies.
A nurse is caring for a client with delirium. What is the onset and clinical manifestations of this disorder?
- Can have hypo and hyper active symptoms
- Early manifestations: inability to concentrate insomnia loss of appetite, restlessness confusion
- Late manifestations agitation hallucinations and misperception
A nurse is caring for a client with attention seeking behaviors. Describe attention seeking behaviors commonly noted in clients diagnosed with histrionic personality disorder.
- Patients diagnosed with histrionic personality disorder tend to present provocative behavior and influenced easily by others or circumstances.
A nurse is caring for a client with an anger disorder. What medications are commonly prescribed during aggressive/violent episodes? Identify three (3) nursing considerations when administering these medications.
- Benzodiazepines, Antipsychotics, Antidepressants, mood stabilizers, Beta blockers
- Encourage the client to drink lots of water
- Instruct to increase fiber intake and that a stool softener may be needed
- Instruct client to limit sunlight exposure and encourage client to wear sunscreen and sunglasses
A client has been prescribed 50 mg of imipramine for depression. The dose ordered for is 50 mg three times a day. Available is 25 mg/tablet. How many tablets would the nurse instruct the client to take in a day?
- 6 tablets per day
The nurse is administering a benzodiazepine to a client with anxiety IV push. List two (2) adverse effects that this drug can produce.
- Cardiac Arrhythmias
- Blurred vision
A nurse is caring for a client prescribed escitalopram oxalate. Identify the classification of this medication. How does this class of medication take effect?
- Escitalopram is a selective serotonin reuptake inhibitor. The mechanism of antidepressant action is the S-enantiomer or racemic citalopram, which is presumed to be linked to a potentiation of serotonergic activity in the CNS resulting from its inhibition of CNS neuronal reuptake of serotonin
What client teaching will the nurse provide prior to electroconvulsive therapy (ECT) regarding the steps of the procedure?
- Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses.
- The client will have a brief exam
- Iv line will be inserted
- Electrodes will be placed on your head
List three (3) co-morbidities of anorexia nervosa
- Depression
- Substance use disorder
- Anxiety
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