NUR 2459 / NUR2459 Exam 2: Mental and Behavioral Health Nursing Exam 2 Questions and Answe, Exams of Nursing

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NUR 2459 / NUR2459 Exam 2: Mental and

Behavioral Health Nursing Exam 2 Questions and

Answers 100% Correct with Rationales

A .patient .with .schizophrenia .begins .to .talks .about ."volmers" .hiding .in .the .warehouse .at .work. .The .term ."volmers" .should .be .documented .as:

a. neologism b. concrete .thinking c. thought .insertion d. idea .of .reference ANS: .A

• A .neologism .is .a .newly .coined .word .having .special .meaning .to .the .patient. ."Volmer" .is .not .a .known .common .noun.
• Concrete .thinking .refers .to .the .inability .to .think .abstractly.
• Thought .insertion .refers .to .thoughts .of .others .that .are .implanted .in .one's .mind.
• An .idea .of .reference .is .a .type .of .delusion .in .which .trivial .events .are .given .personal .significance.  A .patient .with .suicidal .impulses .is .placed .on .the .highest .level .of .suicide .precautions. .Which .measures .should .be .incorporated .into .the .plan .of .care .by .the .nurse .caring .for .the .patient? .(More .than .one .answer .is .correct.)

a. Maintain .arm's-length, .one-on-one .nursing .observation .around .the .clock. b. Allow .no .glass .or .metal .on .meal .trays. c. Keep .patient .within .visual .range .while .awake. .Check .every. 15 .to. 30 .minutes .while .the .patient .is .sleeping. d. Check .the .patient's .whereabouts .every. 15 .minutes .and .make .frequent .verbal .contacts. e. Check .whereabouts .every .hour. .Make .verbal .contact .at .least .three .times .each .shift. f. Remove .all .potentially .harmful .objects .from .the .patient's .possession. ANS: .A, .B, .F

One-on-one .observation .is .necessary .for .anyone .who .has .limited .control .over .suicidal .impulses.

• Plastic .dishes .on .trays .and .the .removal .of .potentially .harmful .objects .from .the .patient's .possession .are .measures .included .in .any-level .suicide .precautions.

The .remaining .options .are .used .in .less .stringent .levels .of .suicide .precautions.  A .patient .diagnosed .with .schizophrenia .anxiously .says, ."I .can .see .the .left .side

of .my .body .merging .with .the .wall, .then .my .face .appears .and .disappears .in .the .mirror." .While .listening, .the .nurse .should:

a. sit .close .to .the .patient. b. place .an .arm .protectively .around .the .patient's .shoulders. c. place .a .hand .on .the .patient's .arm .and .exert .light .pressure. d. maintain .a .normal .social .interaction .distance .from .the .patient.

c. Denial d. Projection ANS: .C

Denial .is .an .unconscious .blocking .of .threatening .or .painful .information .or .feelings. .Regression .involves .using .behaviors .appropriate .at .an .earlier .stage .of .psychosexual .development. .Displacement .shifts .feelings .to .a .more .neutral .person .or .object. .Projection .attributes .one's .own .unacceptable .thoughts .or .feelings .to .another  A .cab .driver, .stuck .in .traffic, .becomes .lightheaded, .tremulous, .diaphoretic, .tachycardia .and .dyspneic. .A .workup .in .an .emergency .department .reveals .no .pathology. .Which .medical .diagnosis .should .a .nurse .suspect, .and .what .nursing .diagnosis .should .be .the .nurse's .first .priority?

1. Generalized .anxiety .disorder .and .a .nursing .diagnosis .of .fear
2. Altered .sensory .perception .and .a .nursing .diagnosis .of .panic .disorder
3. Pain .disorder .and .a .nursing .diagnosis .of .altered .role .performance
4. Panic .disorder .and .a .nursing .diagnosis .of .anxiety ANS: .D

The .nurse .should .suspect .that .the .client .has .exhibited .signs/symptoms .of .a .panic .disorder. .The .priority .nursing .diagnosis .should .be .anxiety. .Panic .disorder .is .characterized .by .recurrent, .sudden .onset .panic .attacks .in .which .the .person .feels .intense .fear, .apprehension, .or .terror.  The .nurse .is .providing .health .teaching .for .a .patient .who .has .been .prescribed .Phenelzine .(Nardil) .for .depression .and .provides .a .written .list .of .foods .that .should .not .be .eaten .while .taking .this .medication. .What .is .the .potential .problem .if .the .patient .is .not .compliant .with .these .dietary .restrictions? hypertensive .crisis foods .with .tyramine .in .it Aged .meats .or .aged .cheeses, .protein .extracts, .sour .cream, .alcohol, .anchovies, .liver, .sausages, .overripe .figs, .bananas, .avocados, .chocolate, .soy .sauce, .bean .curd, .natural .yogurt, .fava .beans—tyramine-containing .foods—may .precipitate .hypertensive .crisis. Avoid .chocolate .or .caffeine. Herbal: .Ginseng, .ephedra, .ma .huang, .St. .John's .wort .may .cause .hypertensive .crisis. For .depression .that .is .refractory .to .TCAs. .Avoid .certain .foods .such .as cheese, .sour .cream, .wine, .beer, .figs, .anchovies, .shrimp, .bananas, .and .chocolate, .and .avoid .drugs .(e.g., .TCAs). Risk .for .hypertensive .crisis: Avoid .self-medication. .WHY? OTC .preparations .containing .dextromethorphan, .sympathomimetic .agents, .or .antihistamines .(e.g., .cough, .cold, .and .hay .fever .remedies, .appetite .suppressants) .can .precipitate .severe .hypertensive .reactions .if .taken .during .therapy .or .within .2-3 .wk .after .discontinuation .of .an .MAO .inhibitor.  Which .piece .of .subjective .data .obtained .during .the .nurse's .psychosocial .assessment .of .a .client .experiencing .severe .anxiety .would .indicate .the .possibility .of .obsessive-compulsive .disorder?

a. "I .have .to .keep .checking .to .see .where .my .car .keys .are." b. "My .legs .feel .weak .most .of .the .time." c. "I'm .afraid .to .go .out .in .public." d. "I .keep .reliving .the .rape." ANS: .A

Recurring .doubt .(obsessive .thinking) .and .the .need .to .check .(compulsive .behavior) .suggest .obsessive-compulsive .disorder. .The .repetitive .behavior .is .designed .to .decrease .anxiety .but .fails .and .must .be .repeated. .Option .B .is .more .in .keeping .with .a .somatoform .disorder. .Option .C .is .associated .with .agoraphobia .and .option .D .with .posttraumatic .stress .disorder.  The .nurse .is .evaluating .the .effectiveness .of .psychotropic .medication .on .negative .symptoms .of .psychosis. .The .nurse .looks .for .a .decrease .in .which .of .the .following?

A: .Affective .flattening. .B: .Bizarre .behavior. C: .Illogicality. D: .Somatic .delusions. A: .Affective .flattening.

Reason: Negative .symptoms .of .psychosis .involve .a .diminution .or .loss .of .normal .functioning. .They .include .affective .flattening, .alogia .(restricted .thought .and .speech), .avolution/apathy .(lack .of .behavior .initiation), .and .anhedonia/asociality .(inability .to .experience .pleasure .or .maintain .social .contacts). .Positive .symptoms .of .psychosis .involve .an .excess .or .distortion .of .normal .functioning. .These .include .psychotic .disorders .of .thinking .(delusions) .and .disorganization .of .speech .(illogicality) .and .behavior.

11. The .nurse .is .evaluating .the .effectiveness .of .an .antipsychotic .on .negative .symptoms .of .psychosis. .Which .of .the .following .symptoms .would .be .classified .as .negative .symptoms .of .psychosis? Blunted .affect .Poverty .of .thought .Loss .of .motivation Inability .to .experience .pleasure .or .joy
12. A .39-year-old .woman .is .recently .divorced .and .is .learning .to .cope .with .additional .stressors. .Which .of .the .following .best .demonstrate(s) .that .she .is .utilizing .positive .coping .strategies .to .manage .her .stress? .(Select .all .that .apply).

1. alter .her .general .lifestyle .by .moving .to .another .area.
2. arrange .to .increase .her .job .hours, .to .avoid .home .life.
3. control .stress .by .increased .physical .activity.
4. change .her .reactions .to .stress .with .cognitive .behavioral .therapy.

diabetes d. A .79-year-old .single .white .man .with .cancer .of .the .prostate .gland ANS: .D

High-risk .factors .include .being .an .older .adult, .single, .and .male .and .having .a .co- .occurring .medical .illness. .Cancer .is .one .of .the .somatic .conditions .associated .with .increased .suicide .risk. .Protective .factors .for .African-American .women .and .Hispanic .individuals .include .strong .religious .and .family .ties. .Asian .Americans .have .a .suicide .rate .that .increases .with .age.

16. The .nurse .is .caring .for .a .patient .who .takes .antipsychotic .medications .and .has .developed .muscle .rigidity, .hyperpyrexia, .diaphoresis, .and .drooling. .Which .of .the .following .adverse .effects .of .antipsychotic .educations .is .most .likely .causing .these .symptoms? Neuroleptic .malignant .syndrome
17. A .patient .with .catatonic .schizophrenia .exhibits .little .spontaneous .movement .and .demonstrates .waxy .flexibility. .Which .patient .needs .are .of .priority .importance?

a. Self-esteem. c. .Physiological b. Psychosocial. d. .Self-actualization ANS: .C. .Physiologic

Physiological .needs .must .be .met .to .preserve .life. .A .patient .with .waxy .flexibility .must .be .fed .by .hand .or .tube, .toileted, .given .range-of-motion .exercises, .and .so .forth .to .preserve .physiological .integrity. .Higher .level .needs .are .of .lesser .concern.

18. A .nurse .works .with .a .patient .with .paranoid .schizophrenia .regarding .the .importance .of .medication .management. .The .patient .repeatedly .says, ."I .don't .like .taking .pills." .Family .members .say .they .feel .helpless .to .foster .compliance. .Which .treatment .strategy .should .the .nurse .discuss .with .the .health .care .provider?

a. Use .of .a .long-acting .antipsychotic .preparation b. Addition .of .a .benzodiazepine, .such .as .lorazepam .(Ativan) c. Adjunctive .use .of .an .antidepressant, .such .as .amitriptyline .(Elavil) d. Prolonged .hospitalization; .this .patient .is .not .ready .for .discharge ANS: .A. Use .of .a .long-acting .antipsychotic .preparation

Medications .such .as .fluphenazine .decanoate .and .haloperidol .decanoate .are .long- acting .forms .of .antipsychotic .medications. .They .are .administered .by .depot .injection .every. 2 .to. 4 .weeks, .thus .reducing .daily .opportunities .for .noncompliance. .The .other .options .do .not .address .the .patient's .dislike .of .taking .pills.

19. Which .documentation .indicates .that .the .treatment .plan .for .a .patient .diagnosed .with .acute .mania .has .been .effective?

a. "Converses .with .few .interruptions; .clothing .matches; .participates .in .activities." b. "Irritable, .suggestible, .distractible; .napped .for. 10 .minutes .in .afternoon." c. "Attention .span .short; .writing .copious .notes; .intrudes .in .conversations." d. "Heavy .makeup; .seductive .toward .staff; .pressured .speech." ANS: .A

The .descriptors .given .indicate .the .patient .is .functioning .at .an .optimal .level, .using .appropriate .behavior, .and .thinking .without .becoming .overstimulated .by .unit .activities. .The .incorrect .options .reflect .manic .behavior.

20. A .priority .nursing .intervention .for .a .patient .diagnosed .with .major .depressive .disorder .is:

a. distracting .the .patient .from .self-absorption. b. carefully .and .inconspicuously .observing .the .patient .around .the .clock. c. allowing .the .patient .to .spend .long .periods .alone .in .self-reflection. d. offering .opportunities .for .the .patient .to .assume .a .leadership .role .in .the .therapeutic .milieu. ANS: .B

Approximately .two .thirds .of .people .with .depression .contemplate .suicide. .Patients .with .depression .who .exhibit .feelings .of .worthlessness .are .at .higher .risk. .Regularly .planned .observations .of .the .patient .with .depression .may .prevent .a .suicide .attempt .on .the .unit.

21. A .nurse .plans .health .teaching .for .a .patient .with .generalized .anxiety .disorder .who .begins .a .new .prescription .for .lorazepam .(Ativan). .What .information .should .be .included? .(Select .all .that .apply).

a. Caution .in .use .of .machinery b. Foods .allowed .on .a .tyramine-free .diet c. The .importance .of .caffeine .restriction d. Avoidance .of .alcohol .and .other .sedatives e. Take .the .medication .on .an .empty .stomach ANS: .A, .C, .D

a. Caution .in .use .of .machinery c. .The .importance .of .caffeine .restriction d. .Avoidance .of .alcohol .and .other .sedatives

22. A .patient .is .experiencing .moderate .anxiety. .The .nurse .encourages .the .patient .to .talk .about .feelings .and .concerns. .What .is .the .rationale .for .this .intervention?

a. Offering .hope .allays .and .defuses .the .patient's .anxiety. b. Concerns .stated .aloud .become .less .overwhelming .and .help .problem .solving .begin. c. Anxiety .is .reduced .by .focusing .on .and .validating .what .is .occurring .in .the .environment. d. Encouraging .patients .to .explore .alternatives .increases .the .sense .of .control .and .lessens .anxiety.

c. can .be .administered .as .needed. d. is .faster .acting .than .diazepam. ANS: .B

Buspirone .is .considered .effective .in .the .long-term .management .of .anxiety .because .it .is .not .habituating. .Because .it .is .long .acting, .buspirone .is .not .valuable .as .an .as- needed .or .as .a .fast- .acting .medication. .The .fact .that .buspirone .does .not .produce .blood .dyscrasias .is .less .relevant .in .the .decision .to .prescribe .buspirone

27. A .client .with .generalized .anxiety .disorder .and .depression .comes .to .the .anxiety .disorders .clinic .displaying .severe .anxiety. .Of .the .medications .listed .in .the .client's .medical .record, .which .one, .with .an .appropriate .order, .can .be .given .as .a .prn .anxiolytic?

a. Buspirone .(BuSpar) b. Lorazepam .(Ativan) c. Phenytoin .(Dilantin) d. Fluoxetine .(Paxil) ANS: .B

Lorazepam .is .a .benzodiazepine .used .to .treat .anxiety. .It .may .be .given .as .a .prn .medication. .Option .A: .Buspirone .has .a .long .action .and .is .not .useful .as .a .prn .drug. .Option .C: .Phenytoin .is .an .anticonvulsant. .Option .D: .Fluoxetine .is .a .selective .serotonin .reuptake .inhibitor .used .to .treat .the .client's .depression.

28. The .nurse .is .caring .for .a .female .patient .diagnosed .with .schizophrenia .who .believes .that .her .thoughts .are .broadcast .from .her .head. .The .nurse .identifies .which .of .the .following .as .the .most .appropriate .nursing .diagnosis .for .this .patient?

A) Risk .self-directive .violence B) Disturbed .sensory .perception C) Impaired .verbal .communication D) Disturbed .thought .processes ANS: .D

Thought .broadcasting .and .thought .withdrawal .are .disturbed .thought .processes.

29. What .is .the .best .intervention .when .a .pt .is .responding .to .an .auditory .hallucination? ANS: ."Can .you .tell .me .what .you .are .hearing?"

Knowing .what .the .patient .is .hearing .is .important. .A .command .hallucination .could .result .in .injury .to .self .or .others. .For .example: .the .voice .could .be .telling .the .pt .to .self .mutilate

30. A .patient .with .depression .is .evaluated .at .the .clinic .and .started .on .citalopram. .The .patient .tells .the .nurse, ."l .have .some .pills .I .previously .took .for .depression. .They're .called .MAOIs. .I .think .I .should .take .them .along .with .this .new .medication." .What .information .is .essential .for .the .nurse .to .communicate .regarding .her .statements?

Make .sure .to .educate .your .patients .about .the .expected .side .effects .of .MAOI .inhibitors, .which .are:

• Dizziness
• Weakness/fainting .resulting .from .an .abrupt .positional .change
• Drowsiness
• Blurred .vision .(reversible)
• Nausea .and .vomiting
• Loss .of .appetite
• Emotional .or .mental .changes
• Irritability/ .nervousness

Patients .should .be .informed .about .the .warning .signs .that .warrant .immediate .physician/nurse .attention .as .well. .They .include:

• A .headache
• Rashes
• Darkened .urine
• Pale .stools
• Eye/skin .yellowing
• Chills .and .fever
• A .sore .throat

31. The .nurse .is .caring .for .a .patient .who .experiences .orthostatic .hypotension .related .to .taking .chlorpromazine .(Thorazine). .The .nurse .should .suggest .which .of .the .following .interventions .for .managing .this .side .effect?

A. Stay .in .bed .for .an .hour .after .taking .the .medication. B. Stand .quickly, .then .wait .a .moment .before .walking. C. Rise .slowly .when .getting .out .of .bed. D. Rise .from .your .left .side .when .getting .out .of .bed. ANS: .C

Sudden .position .changes .lead .to .dizziness .associated .with .postural .hypotension.

32. An .adult .says, ."When .I .was .a .child, .I .took .medication .because .I .couldn't .follow .my .teachers' .directions. .I .stopped .taking .it .when .I .was .about .13. .I .still .have .trouble .getting .organized, .which .causes .difficulty .doing .my .job." .Which .clinical .disorder .does .this .scenario .suggest?

a. Stress .intolerance .disorder b. Generalized .anxiety .disorder c. Borderline .personality .disorder d. Adult .attention .deficit .hyperactivity .disorder .(AADHD) ANS: .d. Adult .attention .deficit .hyperactivity .disorder .(AADHD)

33. lf .a .cruel .and .abusive .person .rationalizes .the .behavior, .which .comment .would .be .most .characteristic .of .rationalization .as .a .defense .mechanism?

34. If .a .cruel .and .abusive .person .rationalizes .the .behavior, .which .comment .would

C. amenorrhea D. breast .secretion E. dyskinesia F. Parkinsonism G. Sexual .dysfunction ANS: .A,B,E,F

Extrapyramidal .side .effects .of .the .central .nervous .system .are .involved .in .the .production .and .control .of .involuntary .and .gross .motor .movements .producing .acute .dystonia, .akathisia, .dyskinesia .and .Parkinsonism. .Amenorrhea, .breast .secretion, .and .sexual .dysfunction .are .endocrine-related .side .effects .of .the .drug.

38. A .nurse .answers .a .suicide .crisis .line. .A .caller .says, ."I .live .alone .in .a .home .several .miles .from .my .nearest .neighbors. .I .have .been .considering .suicide .for. 2 .months. .I .have .had .several .drinks .and .now .my .gun .is .loaded. .I'm .going .to .shoot .myself .in .the .heart." .How .would .the .nurse .assess .the .lethality .of .this .plan?

a. No .risk b. Low .level c. Moderate .level d. High .level ANS: .D

The .patient .has .a .highly .detailed .plan, .a .highly .lethal .method, .the .means .to .carry .it .out, .lowered .impulse .control .because .of .alcohol .ingestion, .and .a .low .potential .for .rescue.

39. A .nurse .provided .medication .education .for .a .patient .who .takes .phenelzine .(Nardil) .for .depression. .Which .behavior .indicates .effective .learning? .The .patient:

a. monitors .sodium .intake .and .weight .daily. b. wears .support .stockings .and .elevates .the .legs .when .sitting. c. consults .the .pharmacist .when .selecting .over-the-counter .medications. d. can .identify .foods .with .high .selenium .content, .which .should .be .avoided. ANS: .C

Over-the-counter .medicines .may .contain .vasopressor .agents .or .tyramine, .a .substance .that .must .be .avoided .when .the .patient .takes .MAOI .antidepressants. .Medications .for .colds, .allergies, .or .congestion .or .any .preparation .that .contains .ephedrine .or .phenylpropanolamine .may .precipitate .a .hypertensive .crisis. MAOI .antidepressant .therapy .is .unrelated .to .the .need .for .sodium .limitation, .support .stockings, .or .leg .elevation. .MAOIs .interact .with .tyramine-containing .foods, .not .selenium, .to .produce .dangerously .high .blood .pressure.

40. Which .statement .by .a .patient .in .the .continuation .phase .of .treatment .for .bipolar .disorder .indicates .that .a .referral .may .still .be .needed?

41. Your .patient .is .very .stressed .about .work, .and .has .started .taking .yoga .classes. .Which .comment .would .indicate .that .this .physical .activity .has .been .successful?

42. When .assessing .a .patient's .plan .for .suicide, .what .aspect .has .priority?

a. Patient's .financial .and .educational .status b. Patient's .insight .into .suicidal .motivation c. Availability .of .means .and .lethality .of .method d. Quality .and .availability .of .patient's .social .support ANS: .C

c. .Availability .of .means .and .lethality .of .method If .a .person .has .plans .that .include .choosing .a .method .of .suicide .readily .available .and .if .the .method .is .one .that .is .lethal .(i.e., .will .cause .the .person .to .die .with .little .probability .for .intervention), .the .suicide .risk .is .high.

43. A .nurse .receives .this .laboratory .result: .lithium .level .1.7 .mEq/L. .How .should .the .nurse .interpret .this .lab .value?

44. A .nurse .receives .this .laboratory .result .for .a .patient .diagnosed .with .bipolar .disorder: .lithium .level. 1 .mEq/L. .This .result .is:

a. within .therapeutic .limits b. below .therapeutic .limits c. above .therapeutic .limits d. incorrect .because .of .inaccurate .testing ANS:A

The .normal .range .for .a .blood .sample .taken. 8 .to. 12 .hours .after .the .last .dose .of .lithium .is 0.4 .to. 1 .mEq/L.

44. A .patient .diagnosed .with .major .depression .refuses .solid .foods. .In .order .to .meet .nutritional .needs, .which .beverage .will .the .nurse .offer .to .this .patient?

a. Tomato .juice c. .Hot .tea b. Orange .juice d. .Milk ANS: .D

Milk .is .the .only .beverage .listed .that .provides .protein, .fat, .and .carbohydrates. .In .addition, .milk .is .fortified .with .vitamins.

45. A .patient .says .to .the .nurse, ."My .life .doesn't .have .any .happiness .in .it .anymore. .I .once .enjoyed .going .out .with .friends, .but .now .I .don't .care .if .they .even .invite .me." .Which .term .best .describes .this .patient's .feelings?

46. A .patient .says .to .the .nurse, ."My .life .doesn't .have .any .happiness .in .it .anymore. .I .once .enjoyed .holidays, .but .now .they're .just .another .day." .The .nurse .documents .this .report .as .an .example .of:

a. dysthymia.

Limit .setting .and .honest .feedback .may .seem .heavy-handed .to .a .labile .patient .and .may .incite .anger.

49. Which .statement .made .by .a .client .who .has .agoraphobia .and .does .not .leave .her .home .identifies .the .thinking .typical .of .a .client .with .this .disorder?

a. "I .know .I'll .get .over .not .wanting .to .leave .home .soon; .it .just .takes .time." b. "When .I .have .a .good .incentive .to .go .out, .I'll .be .able .to .do .it." c. "My .husband .and .kids .tell .me .they .like .it .now .that .I .stay .home." d. "Being .afraid .to .go .out .seems .ridiculous, .but .I .can't .go .out .the .door." ANS: .D

The .individual .who .is .agoraphobic .generally .acknowledges .that .the .behavior .is .not .constructive .and .that .he .or .she .does .not .really .like .it. .The .symptom .is .ego .dystonic. .However, .the .client .will .state .he .or .she .is .unable .to .change .the .behavior. .Options .A .and .B: .Agoraphobics .are .not .optimistic .about .change. .Option .C: .Most .families .are .dissatisfied .with .the .behavior.

50. An .adult .with .depression .has .been .treated .with .medication .and .cognitive .behavioral .therapy. .The .patient .now .verbalizes .that .being .passive .and .letting .others .make .decisions .for .her .contributed .to .the .depression. .What .referrals .could .the .nurse .make .to .help .this .patient .prevent .recurrence .of .depression?

51. .An .adult .diagnosed .with .major .depressive .disorder .was .treated .with .medication .and .cognitive .behavioral .therapy. .The .patient .now .recognizes .how .passivity .contributed .to .the .depression. .Which .intervention .should .the .nurse .suggest?

a. Social .skills .training b. Relaxation .training .classes c. Use .of .complementary .therapy d. Learning .desensitization .techniques ANS: .A

Social .skills .training .is .helpful .in .treating .and .preventing .the .recurrence .of .depression. .Training .focuses .on .assertiveness .and .coping .skills .that .lead .to .positive .reinforcement .from .others .and .the .development .of .a .patient's .support .system. .The .use .of .complementary .therapy .refers .to .adjunctive .therapies .such .as .herbals. .Assertiveness .would .be .of .greater .value .than .relaxation .training .because .passivity .is .a .concern. Desensitization .is .used .in .the .treatment .of .phobias.

Immature .defenses .Beck's .Cognitive .Triad o Beck .proposed .that .people .acquire .a .psychological .predisposition .to .depression .through .early .life .experiences o Three .autonomic .(uncontrollable .and .repetitive) .negative .thoughts .(triad) .are .responsible .for .development .of .depression

Three .autonomic .(uncontrollable .and .repetitive) .negative .thoughts .(triad) .are .responsible .for .development .of .depression ▪ Negative, .self-deprecating .view .of .self

• "I .really .never .do .anything .well; .everyone .else .seems .smarter." ▪ Pessimistic .view .of .the .world
• "Once .you're .down, .you .can't .get .up." .• ."Bad .things .everywhere .you .look." ▪ Belief .that .negative .reinforcement .(no .validation .for .the .self) .will .continue
• "It .doesn't .matter .what .you .do, .nothing .will .get .better."
• "I'll .be .at .this .stupid .job .for .the .rest .of .my .life." Risk .for .suicide; .Questions ▪ SADPERSONS .scale
• S- .sex-. 1 .male
• A- .age-. 1 .if .<19 .or .>
• D- .depression/hopelessness-. 2
• P- .previous .attempts/psychiatric .care-. 1
• E- .excessive .alcohol .or .drug .use-. 1
• R- .rational .thinking .loss .(psychotic .or .organic .illness-. 1
• S- .separated/widowed/divorced-. 1
• O- .organized .plan .or .serious .attempt-. 2
• N- .no .social .support-. 1
• S- .stated .future .intent-. 1
• Guidelines o 0-5: .may .be .safe .to .discharge- .discharge .with .family .or .friend o 6-8: .probably .requires .psych .consult o >8: .probably .requires .hospital .admission, .voluntary .or .involuntary Overt .statements- .RISK .FOR .SUICIDE
• I .can't .take .it .anymore
• Life .isn't .worth .living .anymore
• I .wish .I .were .dead
• Everyone .would .be .better .off .if .I .were .dead Covert .statements- .RISK .FOR .SUICIDE
• It's .okay .now. .Everything .will .be .fine
• Things .will .never .work .out
• I .won't .be .a .problem .much .longer
• Nothing .feels .good .to .me .anymore .and .probably .never .will
• How .can .I .give .my .body .to .medical .science? Behaviors: .RISK .FOR .SUICIDE ▪ Giving .away .possessions ▪ Writing .farewell .notes ▪ Making .out .a .will ▪ Putting .personal .affairs .in .order ▪ Having .global .insomnia ▪ Sudden .improvements .in .mood .after .being .depressed .or .withdrawn ▪ Neglecting .personal .hygiene Protective .factors .from .suicide: .Internal

• Minimizing .sleep .during .the .day .increases .the .likelihood .of .sleep .at .night ▪ Encourage .use .of .relaxation .measures .in .evening
• Induce .relaxation .and .sleep ▪ Reduce .environmental .and .physical .stimulants- .decaf .coffee, .soft ./music
• Increases .possibility .of .sleep Self-care .deficits .INTERVENTIONS ▪ Encourage .use .of .toothbrush, .washcloth, .soap, .makeup, .shaving .equipment, .and .so .forth
  • Being .clean .and .well-groomed .can .temporarily .increase .self-esteem ▪ Give .step .by .step .reminders .where .appropriate
• Slowed .thinking .and .difficulty .concentrating .make .organizing .simple .tasks .difficult SSRI .(MOST .POPULAR) Citalopram .(Celexa) .escitalopram .(Lexapro) .fluoxetine .(Prozac) .fluvoxamine .(Luvox) .paroxetine .(Paxil) .sertraline .(Zoloft) SSRI .Side .effects
• Headache, .nausea, .sleeplessness .and/or .drowsiness .during .the .day .(usually .short .lasting)
• Sexual .dysfunction, .tremors, .dizziness, .agitation, .nervousness/jittery
• Rare: .serotonin .syndrome, .suicidal .ideation NDRI Bupropion .(Welbutrin) NDRI .Side .Effects
• Anxiety, .insomnia, .nausea, .headache, .dizziness, .anorexia
• Rare: .seizures, .increased .anxiety/insomnia .Serotonin .antagonist .and .reuptake .inhibitors .Buspirone .(BuSpar) LONG .TERM .THERAPY Serotonin .antagonist .and .reuptake .inhibitors .Side .Effects
• Anxiety, .nausea, .headache, .dizziness
• Useful .augmenting .drug .for .antidepressants; .mainly .used .to .treat .anxiety SNRIs- .severe .depression, .MDD .Duloxetine. (Cymbalta) .venlafaxine .(Effexor) .desvenlafaxine .(Pristiq) TCA .(Tricyclic's) .Amitriptyline .(Elavil) .clomipramine .(Anafranil) .desipramine .(Norpramin) .doxepin .(Sinequan) .imipramine .(Tofranil) .maprotiline .(Ludiomil) .nortriptyline .(Pamelor)

protriptyline .(Vivactil) .trimipramine .(Surmontil) .amoxapine .(Asendin) .TCA .Side .Effects Dry .mouth, .constipation, .bladder .problems, .sexual .problems, .blurred .vision, .drowsiness .MAOIs- .second .line .treatment .and .only .to .depressions .that .are .resistant .to .other .medications .and .treatments Isocarboxazid .(Marplan), .phenelzine .(Nardil) .tranylcypromine .(Parnate) .selegiline

. (Eldepryl) .MAOI .Side .Effects High .risk .of .hypertensive .crisis; .cerebral .hemorrhage .or .death .if .take .with .food .high .in .tyramine TCA .teachings o Improvement .in .mood .may .take .7-28 .days; .6-8 .weeks .for .full .effect o Drowsiness, .dizziness, .and .hypotension .usually .subside .after .few .weeks o Alcohol .can .block .effects .o .Take .full .dose .at .bedtime .if .possible o Suddenly .stopping .can .cause .nausea, .altered .heartbeat, .nightmares, .cold .sweats .(in .2-4 .days) symptoms .and .interventions .for .serotonin .syndrome ▪ Hyperactivity/restlessness ▪ Tachycardia .(CV .shock) ▪ Fever .(hyperpyrexia) .▪ .Elevated .blood .pressure .▪ .Altered .mental .status .(delirium) ▪ Irrationality/mood .swings/hostility ▪ Seizures .(status .epilepticus) ▪ Myoclonus/incoordination/tonic. rigidity ▪ Abdominal .pain/bloating/diarrhea ▪ Apnea .(death) SSRI .teaching o May .cause .sexual .dysfunction .or .lack .of .sex .drive o Many .cause .insomnia, .anxiety, .nervousness o No .OTC .without .notifying .HCP o Avoid .alcohol .o .Liver .and .renal .function .tests .performed .routinely, .blood .counts .periodically o Report .to .a .physician: ▪ Increase .in .depression .or .suicidal .thoughts, .rash .or .hives, .rapid .heartbeat, .sore .throat, .difficulty .urinating, .fever/malaise, .anorexia/weight .loss, .unusual .bleeding, .initiation .of .hyperactive .behavior, .severe .headache Drugs .that .interact .with .MAOI o OTC .for .cold, .allergies, .congestion o TCAs .o .Narcotics o Anti-hypertensives o Amine .precursors .(levodopa) o Sedatives