Exam II - Mental Health

Medical aid in dying

mentally capable adult (as defined by the state) with a medical prognosis of living < 6 months requests a prescription from their provider that they self-ingest without pain or suffering

MMSE (mini-mental state examination)

objectively assesses cognitive status - orientation to time/place - attention span - recalling of objects - lanuage/writing

Sexual Assault Nurse Examiner's (SANE) intervention when caring for clients who have been sexually assaulted

offers clients options about their care and assists them in making informed decisions about their care

Expected findings for someone experiencing normal (uncomplicated) grief

- feeling a sense of loss and emptiness when thinking about the lost loved one - somatic manifestations may occur but decrease over time (usually within a year)

A client becomes agitated. The nurse encourages the client return to their room to calm down. What de-escalation technique did the nurse use?

time out

difference between time out and seclusion

time out - gives client time to regain control of their emotions, calm down, and end the behavior seclusion - involuntary confinement

A nurse is debriefing with staff about a behavioral emergency that resulted in physically restraining a client. What is the purpose of debriefing?

to improve quality of future responses

comatose

unconscious and unable to be aroused

What does a trauma informed approach focus on?

understanding the impact of the trauma and addressing the client needs so as to promote + client outcomes

Eye Movement Desensitization and Reprocessing (EMDR)

uses rapid eye movement during desensitization techniques multiphase process by trained therapist

A nurse tells a client that they will return in 30 minutes with their medication. The nurse returns 30 minutes later with the client's medication. Which of the following ethical principles is the nurse demonstrating?

veracity (honesty)

suppression

voluntary blocking of an unpleasant experience from one's awareness ex. - a student puts off thinking about a fight they had with a friend so they can focus on a test

To assess language ability, the nurse could instruct the client to _______________________________________.

write a sentence

A nurse is caring for a client who is demonstrating aggressive behavior towards others and is not responding to verbal interventions. What medication should the nurse anticipate the being prescribed?

ziprasidone

A nurse is caring for a patient who is speaking in a loud voice and has his fists clenched. What action should the nurse take?

request that the other staff members remain close by

intellectualization

separation of emotions and logical facts when analyzing or coping with a situation or event ex. - a law enforcement officer blocks out the emotional aspect of a crime to objectively focus on the investigation

An excess of what neurotransmitter results in aggressive behavior?

serotonin

displacement

shifting sexual or aggressive impulses toward a more acceptable or less threatening object or person ex. - an adolescent angrily punches a punching bag after losing a game

If a client is experiencing a panic attack, what should the nurse do?

stay with the client and remain calm

regression

sudden use of childlike or primitive behaviors that do not correlate with the person's current developmental level ex. - a child temporarily wets the bed when they find out their pet died

purpose of ethics

provides a system of moral principles or standards for governing conduct

stuporous

requires vigorous stimulation for a response

A client who is experiencing prolonged grief disorder (PGD) is at risk for:

- suicide - social dysfunction

U.S. congressional act that mandates mental health parity

Affordable Care Act of 2010

Sertraline

Antidepressant, SSRI

paroxetine

Antidepressant, SSRI

undoing

Performing an act to make up for prior behavior

Lithium

mood stabilizer

euthanasia

ILLEGAL in the US

Repetitive actions seen in OCD patients are due to what underlying condition?

an attempt to reduce anxiety

A nurse is sitting with a client who is extremely anxious until they fall asleep. The nurse should identify that this is an example of which ethical principles?

beneficence

dissociative identity disorder

display of > 1 distinct personality

A nurse is caring for a client who is actively dying. The client's partner is crying and holding the client's hand. Which of the following responses should the nurse make?

"I know this is difficult. Would you like me to sit with you?" The client's partner is experiencing anticipatory grief. Providing a therapeutic presence will create a safe environment for grieving.

lethargic

can open eyes and respond but is drowsy and falls asleep easily

rationalization

creating reasonable and acceptable explanations for unacceptable behavior

Interpersonal violence

type of trauma where force/power is threatened or enacted against another person physical, sexual, & emotional maltreatment and neglect

Cycle of violence

- Tension-building stage - Acute battering stage - Respite/Honeymoon stage

Antidepressants, such as __________________________________________________________ may be prescribed for patients going through a crisis.

paroxetine bupropion fluoxetine

Positive factors that increase resilience of the effects of stress

physical health strong sense of self religious/spiritual beliefs optimism hobbies/interests satisfying interpersonal relationships strong social support systems humor

medication that can dec. manifestations of hyper-vigilance & insomnia

prazosin

medication that dec. elevated vital signs and manifestations of anxiety, panic, hyper-vigilance, and insomnia

propranolol

What is the role of a forensic nurse?

provide legal testimony on behalf of a client who experienced sexual assault or violence

conversion

responding to stress through physical manifestations not caused by physical illness ex. - a person experiences deafness after their partner says they want a divorce

Which of the following types of medications should the nurse expect to administer for a chemical restraint?

sedative

depersonalization/derealization disorder

temporary changes in awareness observing one's own body from a distance feeling that outside events are unreal/part of a dream objects appear larger or smaller than they actually are

Cognitive Reframing is a nursing technique that can help clients reduce stress. What does it entail?

the client is helped to look at irrational thoughts in a more realistic, light, positive, way "I'm a terrible father" --> "I've made some mistakes in parenting, but I've learned from them and have improved"

reaction formation

unacceptable feelings/behaviors are controlled or kept out of awareness by overcompensating or demonstrating the opposite behavior than what is felt ex. - a married woman who has sexual feelings towards another man begins to hate and resent him

repression

unconsciously pushing unwanted memories out of awareness ex. - a person preparing to give a speech unconsciously forgets about a time when they were young and kids laughed at them while on stage

U.S. congressional acts that sets the standards for client privacy and confidentiality

HIPPA

Common clinical manifestations of a client who has gone through a disaster

- anxiety - sleep disturbance - anger - depression

What are some potential reasons that a client might have recurrent episodes of anger?

- they get an ADRENELINE rush - they want to harm someone they think harmed them - they THINK their anger is JUSTIFIED - they feel POWERFUL when angry - anger boosts their SELF ESTEEM

Steps to handle aggressive behavior

-Respond quickly -Remaining CALM & IN CONTROL -Encouraging the client to EXPRESS feelings VERBALLY, using therapeutic comm techniques (reflection, silence, active) -Allowing the client as much PERSONAL SPACE as possible -Maintaining EYE CONTACT - Sitting or standing at the SAME LEVEL as the client -Communicating w/ honesty, sincerity and nonaggressive stance -AVOID accusatory or threatening statements -Describing options clearly & offering choices -REASSURE the client that STAFF members are present to HELP prevent loss of control -Setting LIMITS for the client (tell the client CALMLY and DIRECTLY what he must do in a particular situation, use physical activity to deescalate anger/behaviors, inform the client of the consequences of his behavior, such as loss of privileges, use pharm interventions if the client doesn't respond to the limit setting, plan for 4-6 staff members to be available and in sight of the client as a "show of force" if approp

Pre-assaultive Assualtive Post-assaultive

1 - becomes angry; exhibits anxiety, tension, hyperactivity, and verbal abuse 2 - commits act of violence; seclusion and physical restraints may be required 3 - staff review incident with client

Phases of a crisis

1 - increasing anxiety from threat activates defense response 2 - anxiety continues increasing as defense responses fail; disorganized function; resorts to trial-and-error 3 - trial-and-error fails; anxiety turns into panic; fight or flight; withdrawal behaviors 4 - overwhelming anxiety that can lead to apprehension, dissociation, confusion, violence

Duloxetine

Antidepressant, SNRI

Escitalopram (Lexapro)

Antidepressant, SSRI

Fluoxetine

Antidepressant, SSRI

Adverse Childhood Events (ACE)

Children exposed to ACE are at an increased risk for developing mental and physical health issues.

A nurse is caring for a client who is speaking loudly and threatening to harm staff and other clients. What medication should the nurse anticipate the provider prescribing for this client?

Chlorpromazine

A nurse is working with an interdisciplinary disaster response team planning care for a coastal community following a category 5 hurricane. What are the steps of disaster management?

DETERMINE THE CHALLENGES the community is facing. ASSESS the client's ability to function and cope with the situation. DETERMINE THE RESOURCES the client has available to them. PARTNER WITH THE CLIENT to develop a plan.

trauma

a broad term that describes an experience of physical, emotional, or psychological adversity can occur as a single event or be the result of multiple adverse events

dissassociation

a disruption in consciousness, memory, identity, or perception of the environment that results in compartmentalization of uncomfortable aspects of self ex. - a person forgets who they are following sexual assault

hypervigilance

a state of high and constant alertness to potential threats in their surroundings sense of being in constant danger

How do you assess remote memory?

ask to state a fact from their past (birth date, mother's maiden name)

identification

assumptions of the characteristics of an individual ex. - a child who observes 1 parent abuse the other becomes a bully at school

Antianxiety medications, such as __________________________________________________________ may be prescribed for patients going through a crisis.

alprazolam diazapam (Lorazepam) oxazopam

Excessive ____________________ reaction and inadequate regulation of the _____________________________________ will increase the likelihood of aggression in the client.

amygdala; prefrontal area The brain's prefrontal cortex, limbic system, and amygdala play in important role in survival, regulating basic emotions, and aggression.

milieu therapy

an environment that is safe and beneficial for recovery

What are expected findings for acute stress (fight or flight)?

apprehension sorrow DECREASED APPETITE INCREASED RR, HR, BP INCREASED METABOLISM and glucose use depressed immune system

What is the difference between Acute Stress Disorder (ASD) and Post Traumatic Stress Disorder (PTSD)?

both disorders occur from trauma; key difference is duration, not severity ASD can progress to PTSD if symptoms last > 1 month

adjustment disorder

changes in mood and/or dysfunction of performing ADL; less severe than ASD or PTSD ex. - a break up

What are expected findings for prolonged stress (maladaptive)?

chronic anxiety/panic attacks depression chronic pain sleep disturbances weight gain/loss increased risk for infection, MI, hypertension, fatigue, irritability decreased concentration

prolonged exposure technique

combines relaxation & exposure of traumatic situation results in dec. anxiety response

anosognosia

condition in which a person with an illness seems unaware of the existence of his or her illness.

Reactive attachment disorder

condition where a child doesn't form healthy emotional bonds with their caretakers (parental figures), often because of emotional neglect or abuse at an early age

altruism

dealing with anxiety by reaching out to others ex. - a nurse who lost a family member in a fire is a volunteer fire fighter

sublimation

dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression ex. - a person who has feelings of anger and hostility toward their work supervisor sublimates those feelings by working out vigorously at the gym during their lunch period

Clients are considered competent until ...

deemed incompetent by a judge and a legal hearing

hostile aggression

deliberate infliction of pain upon an unwilling victim "They made me mad so I hit them."

dissociative fugue

disorder in which one travels away from home and is unable to remember details of his past, including often his identity

beneficience

doing good

Post Traumatic Stress Disorder (PTSD)

duration > 1 month can last years

compensation

emphasizing strengths to make up for weaknesses

justice

equal treatment

Expected findings in a client with GAD

excessive worry for 6 or more months restlessness sleep disturbances

Acute Stress Disorder (ASD)

exposure to severe and life threatening traumatic event with INTRUSIVE REMINDERS of the trauma, DISSOCIATIVE symptoms, and AVOIDANCE behavior duration > 3 days less than 1 month

disenfranchised grief

expression of grief is not socially, culturally, or publicly recognized

A nurse is discussing scope of practice related to mental health with a peer. Which of the following statements by the nurse explains practice focus for a mental health nurse?

"It is important to consider mental health needs related to population health are based on the social determinants of health"

A nurse is caring for a client who has depression, diabetic polyneuropathy, and significant neuropathic pain. The nurse hears an assistive personal say, "They are admitted frequently and always report being in pain. I think they are just a drug seeker." What is a good response?

"It is not appropriate to stereotype clients. It seems like you may have bias which could affect client care."

A nurse is preparing educational material for guardians on trauma prevention and developing childhood resilience. What techniques should the nurse include?

- Foster a hopeful perspective of the future. - Encourage development of thinking and learning. - Provide secure and supportive relationships.

Expected findings in a client exhibiting anger

- Hyperactivity (pacing, restlessness) - Hypersensitivity (easily offended) - No eye contact OR intense eye contact - Body language (clenching fists, waving arms) - Rapid breathing - Aggressive postures (leaning forward, tense appearance) - Drug/alcohol intoxication

Nursing responsibilities in milieu therapy

- Explain UNIT RULES, including EXPECTATIONS and client rights. - Provide ORIENTATION, including a tour of the unit, rules, and expectations. -Ensure that CULTURALLY SENSITIVE care is provided. - Use a TRAUMA INFORMED APPROACH to client care.

A nurse is caring for a client with has recently experienced a death of a partner who died 3 weeks ago. Client verbalizes sadness and loneliness, states they cry every day several times a day, has nightmares, has no appetite and has lost 4.5 kg (10 pounds) since. Frequently asks for sleep medication. What actions should the nurse take?

- Perform an ongoing assessment. - Encourage client to discuss their current daily routine. - Encourage client to talk about the death.

What factors reduce risk for developing complicated grief?

- Religious/spiritual practices/beliefs - Sense of personal health and well-being - Having a reliable support system Previous experience with the loss of a loved one and having a history of substance abuse are risk factors.

When caring for a client who is becoming aggressive, what de-escalation techniques should be used?

- approach client with respect - respond to the client's concerns right away - address client in a soft voice DO NOT - block the door way (can make them feel trapped) - stand in front of them (too confrontational)

Comorbidities of anger include which disorders?

- binge eating disorder - PTSD - substance abuse disorder - conduct disorder - ADHD NOT OCD

Nursing implications for after an aggressive/violent episode

- discuss ways client can keep control during aggression cycle - reassure milieu and identify stressors - encourage client to talk about incident and what triggered it - debrief w staff to evaluate effectiveness of situation - document

factors that increase risk for developing a trauma-related disorder

- history of physical abuse - member of a marginalized group - previous active military during war

Risk factors for potential (future) violent behavior:

- history of violent behavior - being a target of a crime - history of abuse/violence - a comorbidity of abuse - aggression - low self-esteem - inadequate coping mechanisms - lack of a + role model - presence of adverse childhood experiences

What symptoms are consistent with a trauma response involved the sympathetic nervous system?

- increased HR - shallow breathing - muscle tension - anxiety

Signs a child is experiencing traumatic grief

- nightmares - decreased ability to concentrate - somatic responses (stomachaches)

Potential findings for someone experiencing maladaptive grief

- onset of back pain > a year after the loss - disheveled unclean appearance - new onset of somatic manifestations - poor hygiene

What are early signs of potential aggression?

- refusing to eat - pacing the floor - destroying items - attempting to leave before discharge

A nurse is caring for a client who recently lost their partner in a car accident. Which of the following should the nurse take to provide supportive grief-informed care? - Provide the client with a list of local grief support groups. - Place the client's personal items within reach. - Have the client complete their menu request. - Ask the client how they met their partner.

Ask the client how they met their partner. This allows for reminiscing, which allows person to talk about the person who died. It's a way to show compassion and normalize grief

Client: "No matter what I do, I just can't stop crying. It feels like I am in the grave." What action should the nurse take first?

Ask the client what they mean by "in the grave." This is an example of using therapeutic communication, a clarification strategy assists the client to express their thoughts and feelings. This will aid in understanding what the client is thinking and feeling, including consideration of self-harm and safety.

An adolescent client's parent died 4 years ago. The other parent states that the client has been coming home drunk, lost their driver's license due to reckless driving, and has been skipping school. What is the nurse's priority action?

Assess for risk of suicide. The client is experiencing complicated grief; safety is the priority.

A client reports to the emergency room who witnessed the death of a spouse in a vehicle accident. Day 1: All vital signs within expected range. Day 2: Client stays in room, refuses to eat/drink and socialize. What are some expected, nonessential and contraindicated nursing implications?

EXPECTED: - Assess environment for safety risks. NONESSENTIAL: - Repeat vital signs every hour CONTRAINDICATED: - Rotate staff as often as possible - Ask closed ended questions - Encourage client to share details regarding trauma

A nurse encourages each client in a group session to speak and be heard. The nurse should identify that this is an example of which ethical principle?

Justice Justice involves caring for all clients equally and with the same level of fairness

... is the most common unintentional tort.

Negligence (and malpractice, which is a type of negligence specific to health care providers)

U.S. congressional act that requires providers to inform their clients of the cost of treatment and whether their insurance will cover it

No Surprise Act

organization that provides oversight for nurses regarding work place violence

Occupational Safety and Health Administration

Medications typically used to control aggressive and impulsive behaviors

Olanzapine Ziprasidone Haloperidol (severe adverse effects, not the first choice)

What complications can result from inadequate monitoring of a client on physical restraints?

Positional asphyxia Food aspiration Cardiac arrest

Strategies for a nurse to reduce burnout.

Self-scheduling work shifts

Why is setting boundaries with clients on a pediatric mental health unit so important?

Setting boundaries INCREASES a child's sense of SECURING through knowing the CONSEQUENCES of behaviors

A nurse is preparing to begin caring for a client and discovers that the client's adult children were recently killed as a result of gun violence. What action should the nurse first take?

Spend time reflecting and planning to avoid imposing any personal bias.

A nurse is leading a group session when a client begins cursing and running around the room shouting. Which of the following actions should the nurse take?

Suggest the client go someplace quiet and compose themselves.

A newly hired nurse confides in another nurse that despite trying to be hopeful, they feel very depressed. What should the nurse do?

Suggest the newly hired nurse contact a mental health professional.

Most states require 2 providers to assess a client and confirm the need for an involuntary admission T or F

T

A nurse overhears unit staff workers making jokes about a nursing student. This is an example of which of the following?

incivility

fidelity

loyalty, faithfulness

How do you assess recent memory?

ask to recall recent events (who came visit them today, what did you eat for breakfast)

How do you assess immediate memory?

ask to repeat a series of numbers or list of objects

projection

attributing one's own threatening feelings, motives, or impulses to another person or group ex. - a married client who is attracted to another person accuses their partner of having an affair

To assess affect, the nurse should observe _________________________________.

facial expressions

psychodynamic psychotherapy

getting in touch with conscious and unconscious thought processes

A client has sustained life-threatening injuries. The healthcare team is discussing withdrawal of life-sustaining treatment. The decision to withdraw life-sustaining care is the responsibility of who?

health care team & family

veracity

honesty

A client has schizophrenia and has been diagnosed with a terminal illness/ The inter professional team should recommend...

hospice care

anhedonia

inability to find pleasure in a situation or life

dissociative amnesia

inability to recall important personal information r/t traumatic event

splitting

inability to reconcile positive and negative aspects of self and others resulting in sudden shifts between positive and negative feelings

A nurse overhears a coworker say, "I get that some people have a hard childhood, but eventually they need to get over it. What is an appropriate response?

"People who experience adverse childhood events are changed biologically and genetically."

antidepressant medications that can dec. depression and relieve ASD or PTSD

paroxetine setraline venafaxine mirtazapine amitriptyline

A nurse is caring for a client who was diagnosed with adjustment disorder after losing their job 2 months ago. What manifestation should the nurse monitor? - persistent avoidance - psychosis - dissociative amnesia - suicidal ideation

suicidal ideation Adjustment disorders can severely affect a person's ability to function. They may find it difficult to adjust to the changes caused by the stressor, leaving them at high risk for attempted or completed suicide.