NCLEX-RN PREPARATION PROGRAM. MENTAL HEALTH DISORDERS Module 6, Part 2 of 3. Major Mental Health Disorders. PERSONALITY DISORDERS (PD) Diagnostic criteria (Axis II, DSM-IV): “Enduring pattern of inner experience & behavior that deviates from expectations in 2 or more areas”:
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Module 6, Part 2 of 3
PERSONALITY DISORDERS (PD)
B. Dramatic-Emotionally Erratic
C. Anxious-Fearful Dependent
A profound deficit in the ability to form personal relationships or respond to others in a meaningful way. Appear indifferent, aloof and/or unresponsive to praise or criticism. Typically have no close friends and prefer to be alone. Social detachment and consequent impairment in social & occupational functioning.
Schizoid - Orders home delivery; ingests food through mail slot
Schizotypal - Eats soup using gardening equipment & chop sticks
Paranoid - Sits with back to the wall; spies on food prep area
Antisocial P.D. - Steals tip left by narcissist
Borderline P.D. - When informed her boyfriend plans to go duck hunting, throws a drink at him, then uses glass to cut self
Histrionic - Does a belly dance in the center of the restaurant
Narcissist - Expects best table without a reservation
Avoidant - Tips generously for take-out service
Dependent - Vegetarian non-smoker eats veal in smoking area
to please date
OCPD - Aligns cutlery & dispenses etiquette tips
Decrease impulsivity, mood swings, anxiety
A client recently released from prison for embezzlement has a history of becoming defensive and angry when criticized and blaming others for personal problems. The client has expressed no remorse or emotion about the actions that resulted in the prison term, but instead says that the embezzlement was justifiable because the employer “did not treat me fairly.” The nurse concludes these behaviors are consistent with which of the following mental health problems?
rules should apply.
An unrealistic fear in which the cause may or may not be identified.
anxiety and physical symptoms
Sense of impending doom, helplessness, or being trapped
Peaks within 10 minutes
Occurs unexpectedly and on an intermittent basis
Concern about additional attacks
Avoidance of places or situations in which escape is difficult or help not available in the event of a panic attack (i.e., outside the home alone, being in a crowd…)
A client who is hospitalized for panic disorder is experiencing increased anxiety. The client exhibits selective inattention and tells the nurse, “I’m anxious now.” The nurse determines that the degree of the client’s anxiety is:
During an assessment interview, the client tells the nurse, “I can’t stop worrying about my makeup. I can’t go anywhere or do anything unless my makeup is fresh and perfect. I wash my face and put on fresh makeup at least once and sometimes twice an hour.” The nurse’s priority should be to adjust the client’s plan of care so the client will be:
A. Required to spend daytime hours out of own room
B. Given advance notice of approaching time for all group therapy sessions
C. Asked to keep a diary of feelings experienced if unable to groom self at will
D. Allowed to use own cosmetics and grooming products
A client asks why a beta blocker (Inderal) medication has been prescribed for anxiety. When answering this question, the nurse should explain that this medication class is effective for treatment of which symptoms associated with anxiety?
A. Cognitive dissonance and confusion
B. Depression and suicidal ideations
C. Insomnia and nightmares
D. Palpitations and rapid heart beat
Focus: Physical symptoms with
absence of a pathophysiological problem
Body Dysmorphic Disorder
An older client with chronic low back pain receives cooking and cleaning help from her extended family. The mental health nurse anticipates that this client benefits from which of the following in this situation?
A. Primary gain
B. Secondary gain
A. Abrupt onset of physical symptoms at menopause
B. Episodes of personality dissociation
C. Ignoring physical symptoms until role performance
D. Numerous physical symptoms in many organ areas
A. “I realize that tests and lab results cannot pick up on the seriousness of my illness.”
B. “Once my family realizes how severely ill I am, they will be more understanding.”
C. “I know that I don’t have a serious illness, even though I still worry about my symptoms.”
D. “I realize that exposure to toxins can cause significant organ damage.”
Dissociative Identity Disorder
The spouse of a client who is experiencing a fugue state asks the nurse if the spouse will be able to remember what happened during the time of fugue. What is the nurse’s best response?
A. “Your spouse will probably have no memory for events during the fugue.”
B. “Your spouse will be able to tell you – if you can gently encourage talking.”
C. “It is not possible to predict whether your spouse will remember the fugue state.”
D. “Avoid mentioning it, or your spouse may start alternating old and new identities.”
A mood disorder is characterized by:
Depression Models of Causation
Depression: Signs and Symptoms
Selective Serotonin Reuptake Inhibitors (SSRIs):
hyper-reflexia, diaphoresis, shivering, diarrhea, fever,
Nursing Interventions for Depression:
The nurse has explained to a client the biologic theories of depression. The nurse concludes that the teaching has been effective if the client says, “I now know that my depression may be caused from:
A. Excessive serotonin activity in the central nervous system (CNS).”
B. Insufficient serotonin activity in the CNS.”
C. Excessive norepinephrine in the CNS.”
D. Insufficient acetylcholine activity in the CNS.”
E. A genetic mutation on chromosome 6.”
A 63-year-old male client expresses feelings of hopelessness and helplessness about his spouse’s illness and anticipated death. On which of the following issues should the nurse initially assist the client to focus?
A. The nature of the spouse’s present illness
B. The client’s response to past losses
C. The dying spouse’s feelings about impending loss and death
D. The client’s relationship with the spouse
Bipolar Disorder: Signs and Symptoms of Mania
Bipolar Disorder: Psychotrophics
Bipolar Disorder: Medical Management
Bipolar Disorder: Medical Management
Anticonvulsants as Mood Stabilizers
Bipolar Disorder Nursing Interventions and Goals
The client has bipolar I disorder. Lithium carbonate (Lithium) 300 mg four times a daily has been prescribed. After 3 days of lithium therapy, the client says, “What’s wrong? My hands are shaking a little.” The best response of the nurse is:
A. “Minor hand trembling often happens for a few days after Lithium is started. It usually decreases in 1 to 2 weeks.”
B. “There’s no reason to worry about that. We won’t, unless it lasts longer than a couple of weeks.”
C. “Just in case your blood level is too high, I am not going to give you your next dose of Lithium.”
D. “I wouldn’t worry about it if I were you. It’s a small tremor that doesn’t interfere with your functioning.”
Catatonic stupor, evidenced by extreme psychomotor retardation and posturing, and catatonic excitement, extreme psychomotor agitation with purposeless movements that may harm self or others
Flat or inappropriate affect (such as silliness or giggling), bizarre behavior and social impairment
Paranoid delusions in which the individual falsely believes that others are out to harm him/her. The individual may be hostile, argumentative and aggressive
Bizarre behavior that does not meet the criteria of other types of schizophrenia. Delusions and hallucinations are prominent
Individual who has had one major episode of schizophrenia with prominent psychotic symptoms and who has lingering symptoms
Schizophrenia: Diagnostic Criteria
Positive and Negative Symptoms
Positive Signs and Symptoms
Delusions - Fixed false beliefs (grandiose, persecutory, somatic…)
Thought broadcasting, insertion
Co-Morbid Conditions and Effects
Schizophrenia: Psychotrophic Side Effects
Psychotrophic Side Effects
Schizophrenia: Factors Supporting Compliance
Schizophrenia: Factors Inhibiting Compliance
A patient with schizophrenia tells you that voices in his head are telling him he is in danger, and that he must stay in his room. He asks you, "Do you hear them?" Your best therapeutic response would be:
A. “I know these voices are very real to you, but I don't
B. “You need to get out of your room and get your mind
occupied so you don't hear the voices."
C. “Don't worry. You're safe in the hospital. I won't let
anything happen to you.”
D. “The voices are coming from your imagination.”
Possible long-term effects of chronic alcohol abuse
Accompanied by physiologic/cognitive symptoms from reduction in prolonged substance use
High protein, high vitamin diet (B/C)
Replace fluid/ electrolytes (I/O)
Diuresis with blood alcohol level increase
Fluid retention may occur (overhydration)
MgSO4 to increase body’s response to thiamine/raise seizure threshold
VS q hour x 12 h, then q4h
Pulse good indicator of progress through withdrawalNursing Interventions: Alcohol Dependence
Types of Drugs Frequently Abused
Reasons nurses are at high risk for substance use.
Signs of substance abuse in nurses
perfume, slurred speech
Action plan if you suspect a peer
Report the peer suspected of drug abuse to a manager or supervisor to:
A client says, “I have a very small drink every morning to calm my nerves and stop my hands from trembling.” The nurse concludes that this client is describing which of the following?
A. An anxiety disorder
D. Alcohol abuse
A client asks the nurse to provide information about the detoxification process and withdrawal from a benzodiazepine. The nurse should inform the client that the process will involve which of the following?
A. Rapid reduction in amount and frequency of the drug normally used
B. Abrupt discontinuation of the drug commonly used
C. Gradual downward reduction in dosage of the drug commonly used
D. Planned, progressive addition of an anti-psychotic drug
A. Present psycho-education on the dangers of drug and alcohol use.
B. Encourage the client to develop a relapse prevention plan.
C. Administer anti-craving medications.
D. Provide withdrawal care based on unit protocol.
Photo Acknowledgement:All unmarked photos and clip art contained in this module were obtained from the 2003 Microsoft Office Clip Art Gallery.