Deck 57: Nursing Care of Patients With Mental Health Disorders

Question 1

Tommy
Tommy has come to the clinic with numerous cracks on his hands. They are bleeding and very sore. Tommy tells you that he has to wash his hands all the time. His mother says he washes for 2 to 3 hours at a time, and he will not stop when she tells him to. The doctor has diagnosed Tommy with obsessive-compulsive disorder and has explained the illness to Tommy and his mother. When the doctor leaves the room, Tommy's mother begins to cry. "What did he just say? What am I supposed to do? What did I do wrong that Tommy got this illness?"
1. How can you respond therapeutically?
2. What team member would you use as a resource?

Answer 1

You need to first assure Tommy's mother that her son's obsessive compulsive disorder (OCD) is not her mistake. Medications and therapies are available to control the symptoms of OCD, which needs the family support as well. Tommy's mother can be encouraged to attend the supportive groups, which would greatly helps to build positive communication with Tommy.
Tommy's mother must be advised to meet the behavioural therapist to know more about the etiology of the disease and possible suitable treatment options available.

Question 2

Identify etiological theories for common mental health disorders.

Answer 2

Etiological theories for the common mental health disorders:
The As per the analysis of "psychoanalytical theorists," the anxiety is a conflict between the conscience (superego) and the id (identity of the personality). This behaviour is oppressed during the early developmental stage but become apparent during the adulthood.
According to the "biological theorists," anxiety is the sympatho-adrenal response (fight or flight response) towards stress. The signs and symptoms of increased sympathetic response and anxiety are correlated that includes constriction of blood vessels, raise in blood pressure, etc. Another biological theory implicates the lack of or decreased levels of inhibitory neurotransmitter GABA (gamma aminobutyric acid) as the causes of anxiety.

Question 3

Which statement by a depressed patient causes the LPN to contact the RN or HCP immediately?
1) "Everyone is out to get me."
2) "I have tried to kill myself three times."
3) "I feel so hopeless."
4) "My friend is bringing me a gun."

Answer 3

The patients suffering from depression often express their thoughts regarding their death. The patient must be closely observed under such conditions till the improvements are observed, which situation needs immediate attention.
Thus, the options (3), (4), and (5) are incorrect.
Depression is a psychological illness in which the person exhibits low mood and lack of interest in any activities. It affects the person's psychological behaviour and physical wellbeing. People suffering from depression are more prone to attempt suicide. Thus, if anybody speaks frequently about their death, careful observation is needed, the LPN (licensed practice nurse) must immediately contact the RN (registered nurse).
Thus, the correct option is .

Question 4

Zenz
Mr. Zenz is the manager of a busy office. His usual behavior is rather sullen, and he comes across as quiet or sad to various members of the staff. He is in his 40s and married, with three children, ages 4, 5, and 7. He speaks of them proudly but always comments that they take after their mother." His management style in the office is to let people do their jobs; he rarely interferes, although his door is always open and staff members are told they are welcome any time. Recently, however, staff members have noticed a change in Mr. Zenz. He moves quickly, speaks quickly, and has set unrealistic goals for the staff. He frequently says he has called the president of the company to tell him of his new ideas. He says he has not slept in several days and he feels terrific. He has changed his wardrobe and has begun pointing out specific performance issues to staff. He jokes with staff. Staff members are made aware that he has bipolar disorder and has quit taking his medications. His wife has asked for the staff's help. Remember: He is your boss.
1. How do you respond to Mrs. Zenz?
2. How do you approach Mr. Zenz?

Question 5

Describe signs and symptoms of common mental health disorders.

Question 6

A patient states, "My doctor says I have obsessivecompulsive disorder. What does that mean?" Which response by the nurse is best?
1) "It means that you have experienced a major life stress and will need therapy to help you manage the symptoms."
2) "You can expect to experience periods of high energy and anxiety, alternating with periods of feeling very low."
3) "You may experience involuntary, intrusive thoughts, and feel compelled to respond with seemingly meaningless actions."
4) "People with obsessive-compulsive disorder are very organized. This is a good disorder to have."

Question 7

Anne
While preparing to invite Anne, a young woman receiving chemotherapy on your oncology unit, to a movie in the day room, you observe her standing in the corner of her room trembling. You ask her what's wrong, and she responds that she's talking to the woman in the wall. Your first instinct is to giggle, but you ask her, "What woman?" She tells you that you wouldn't understand and says, "You helped put her there, and you told me that it is my job to be sure she can't get out." You report this to the charge nurse, who calls the physician. Tests are run, and it is determined that Anne is not experiencing side effects from the chemotherapy. Further workup delivers the diagnosis of schizophrenia for Anne.
1. What therapeutic responses are appropriate for this situation?
2. What special needs might Anne now experience relating to her chemotherapy, if any?
3. How will you get Anne to the movie or to participate in other care activities?
4. What actions can team members take to promote trust with Anne?

Question 8

Describe therapeutic management for each of the disorders.

Question 9

A patient is experiencing extrapyramidal side effects while taking antipsychotic medication. Which medication on the patient's orders will help reduce these effects?
1) benztropine (Cogentin)2. chlorpromazine (Thorazine)3. haloperidol (Haldol)4. lithium (Eskalith)

Question 10

Maria
You are a school nurse in your local high school. Younotice that Maria, a 17-year-old student, is behaving oddly. She has always been rather loud and even has been referred to as "obnoxious" by several of her peers. Lately you have observed her sitting alone, as if waiting for someone, but when you approach her, she barely greets you and then moves away.
1. What are your concerns about Maria?
2. What are some of the possibilities that might be affecting her?
3. How can you approach her more effectively the next time you see her?

Question 11

Identify actions, side effects, and nursing considerations for selected classifications of psychoactive medications.

Question 12

A patient who is a veteran of the Gulf War hears the hospital fire alarm go off during a drill and cries, "There are people hiding behind the pillars! They have guns! Be careful!" What action should the nurse take first?
1) Tell the patient that his behavior is inappropriate and that he is frightening the other patients.
2) Administer an as-needed (prn) antipsychotic medication as ordered.
3) Ask him if he is afraid of the guns.
4) Stay with the patient while calmly reorienting him.

Question 13

Plan nursing interventions for patients with mental health disorders.

Question 14

A patient is being treated on the mental health unit for an anxiety disorder. The patient approaches the nurse and reports feeling dizzy and weak, with a sensation of a\ racing heart. The nursing care plan includes interventions of imagery exercises and prn lorazepam (Ativan) for symptoms of anxiety. What should the nurse do first?
1) Instruct the patient to sit and breathe deeply.
2) Give the patient the prescribed prn lorazepam.
3) Obtain the patient's vital signs.
4) Instruct the patient in an imagery exercise.

Question 15

Discuss the role of the LPN/LVN in the care of patients with mental health disorders.

Question 16

A patient reports seeing children playing on the floor in the hallway of the mental health unit. There are no children anywhere on the unit. Which response by the nurse is best?
1) "The children are fine there; they are just playing."
2) "I don't see any children, and there haven't been any children on the unit today. Would you like to walk with me?"
3) "Children are not allowed on this unit. I will ask them to leave."
4) "You know there are no children here. It must be time for your medication."