N340 Exam 3 Flashcards Combined

what STI is known as the silent disease?

chlamydia

Name the 3 cluster C personality disorders. **anxious

○ Avoidant ○ Dependent ○ Obsessive-compulsive (worsens with age)`

What is the incubation period for genital herpes (herpes simplex 2)?

2-20 days

For anorexia nervosa, a weight gain of _____-____ Ib./week is medically acceptable. Weight gain of more than _____ Ib. in 1 week may result in pulmonary edema ABSOLUTELY NEED TO KNOW.

2-3; 5

What is the incubation period for hepatitis A?

30 days

What is the incubation period for HPV?

4-6 weeks; can be up to 9 months

what is the primary treatment for chlamydia? ● Expensive ● One time dose, can ensure compliance ● Most common form ● Very effective since you only have to take 1 dose

Azithromycin 1g PO x 1 dose

28. A nurse wants to research epidemiology, assessment techniques, and best practices regarding persons with addictions. Which resource will provide the most comprehensive information? a.Substance Abuse and Mental Health Services Administration (SAMHSA) b.Institute of Medicine (IOM)-National Research Council c.National Council of State Boards of Nursing (NCSBN) d.American Society of Addictions Medicine

A

A 7-year-old child was diagnosed with pica. Which assessment finding would the nurse expect associated with this diagnosis? a.The child frequently eats newspapers and magazines. b.The child refuses to eat peanut butter and jelly sandwiches. c.The child often rechews and reswallows foods at mealtimes. d.The parents feed the child clay because of concerns about anemia.

A

A male client visits the clinic office complaining of a yellow, green discharge from his penis. Which of the following STDs has the client most likely contracted? a.Gonorrhea b.Syphilis c.Herpes simplex virus 2 d.Human papillomavirus

A

What disorder is described below: ● Both occur more in children; linked to OCD ● ____1______ - hair pulling disorder - 1 of the oldest recorded psychiatric problems (tendency of a person to pull out own hair) ○ "I was so annoyed that I wanted to pull my hair out." ● Typically hair on head, but can be any body hair ○ Small patches - baldness ● Pain - eases anxiety - similar to cutting ● _____2_____ - secretly swallowing the pulled hair ○ Can lead to hair masses or trichobezoar in the GI system ○ Rapunzel syndrome ● Females more affected - ratio of 10:1

1. trichotillomania 2. trichophagia

What is the incubation period for stage 1: primary syphilis?

10-90 days

what ages are known to suffer from inhalant use disorder?

12-17

With alcohol withdrawal, withdrawal seizures may occur within ____-___ hours AFTER ALCOHOL CESSATION. ○ Diazepam IV → common treatment for withdrawal seizures ○ If freestanding hospital doesn't have IV fluids, may have to transfer patient to a hospital that does

12-24 hours

In the US, a standard drink contains ____ grams of pure alcohol. **alcohol intoxication

14

For binge eating disorder, the DSM-5 criteria for this disorder and qualifies as follows: Extreme--> how many binge eating episodes per week?

14 or more

For anorexia nervosa, a severe BMI is?

15- 15.99

Physical assessment of a patient diagnosed with bulimia often reveals a.prominent parotid glands. b.peripheral edema. c.thin, brittle hair. d.25% underweight.

A

T or F. With HIV, EARLY DETECTION AND SCREENING IS IMPORTANT.

T

does hepatitis A and B have a vaccine?

yes

With accurate records of vulnerable persons, use _____ ____ which includes size, color, shape, and descriptions of the injuries.

body map

With inhalant use disorder, ____ ____ are toxic gases inhaled through the nose or mouth to enter the bloodstream.

volatile hydrocarbons

What is the treatment for trichomoniasis?

******○ Metronidazole (Flagyl) 2g in single dose ■ To ensure the compliance of the medication through single dose is why it is the most common treatment******** OR ○ Metronidazole (Flagyl) 500 mg BID x 7 days

What if victim doesn't want to leave at this time? ○ Would not report the abuse ○ Still should be given the phone numbers to community resources that are pertinent for their situation ○ Lafayette: Faith House ○ Hearts of Hope—children and adults of sexual assault—911 General Mouton ○ Family Justice Center—works closely with Faith House

...

For binge eating disorder, the DSM-5 criteria for this disorder and qualifies as follows: Mild--> how many binge eating episodes per week?

1-3

What are the 4 symptoms/categories for the DMS-5 Criteria for substance use disorders?

1. Impaired Control 2. Social Impairment 3. Risky Use ■ Spill over into risky behavior that has consequences ■ On the job 4. Physical effects (Intoxication, tolerance, withdrawal)

When talking about the difference between obsessive-compulsive disorder and obsessive-compulsive personality disorder, ● Obsessive-Compulsive Disorder → obsessive thoughts & rituals; they are ____1____ that these thoughts & actions are unreasonable ● Obsessive-compulsive personality disorder → characterized more by the ____2_____ focus on perfectionism - think their actions are right & feel comfortable with such self-imposed rules ○ **the preoccupation with all of these rules and perfectionism means that it can often result in losing the major point of the activity and projects are incomplete due to these overly strict standards

1. aware 2. unhealthy

1. What 2 2nd generation antipsychotics are used for violent patients and have an orally disintegrating tablet available? 2. Which one is the choice when someone is becoming aggressive or escalating??

1. risperidone and olanzapine 2. Olanzapine

With treatment for cluster A paranoid personality disorder, you can counteract mistrust by (a) adhering to ______1____ and (b) avoiding being overly ______2____ and (c) projecting a neutral but _____3____ affect. Being too nice or _____b______ may be met with suspiciousness.

1. schedules 2. friendly 3. kind

With alcohol use disorder we have alcohol intoxication. ____mg/dL includes: · 6 alcoholic drinks: vomiting, (unless high tolerance) & major loss of balance

150 (0.15 g/dL)

For anorexia nervosa, a moderate BMI is?

16- 16.99

What pharmacological intervention for a violent patient is described below: ○ Haloperidol → keep in mind EPS! ■ Most widely used ____ ____ ______ ○ Chlorpromazine → EPS, sedating!

1st generation antipsychotics

What pharmacological intervention for a violent patient is described below: ○ Risperidone → orally disintegrating tablet available ○ Olanzapine → orally disintegrating tablet available ■ Choice when someone is becoming aggressive or escalating ○ Ziprasidone → cautiously with QT elongation!

2nd generation antipsychotics

What is the incubation period for gonorrhea?

3-21 days

What is the incubation period for chlamydia?

3-21 days (people are unaware of infection and can still spread it)

With alcohol use disorder we have alcohol intoxication. ____mg/dL includes: · ) more than 10 drinks: reduction of body temperature, blood pressure, respirations, sleepiness, amnesia

300 (0.30 g/dL)

There are how many phases of crisis?

4

For binge eating disorder, the DSM-5 criteria for this disorder and qualifies as follows: Moderate--> how many binge eating episodes per week?

4-7

With alcohol use disorder we have alcohol intoxication. ____mg/dL includes: - impaired vital signs & possible death

400 (0.40 g/dL)

What is the incubation period for hepatitis C?

45 days

What is the incubation period for stage 2: secondary syphilis?

6 weeks to 6 months

what is the incubation period for hepatitis B?

75 days

with alcohol withdrawal, psychotic and perceptual symptoms may begin in how many hours? *psychotic state can last 3-4 days

8-10 hours

For binge eating disorder, the DSM-5 criteria for this disorder and qualifies as follows: Severe--> how many binge eating episodes per week?

8-13

With alcohol use disorder we have alcohol intoxication. ____mg/dL includes: · - 4 alcoholic drinks - poor muscle coordination, altered speech & hearing, difficulty danger, impaired judgment, poor self-control, decreased reasoning

80 (0.08 mg/dL)

For anorexia nervosa, an extreme BMI is?

< 15

For anorexia nervosa, a mild BMI is?

> 17 kg/m2

A nurse assesses an individual who commonly experiences anxiety. Which comment by this person indicates the possibility of obsessive-compulsive disorder? a."I check where my car keys are eight times." b."My legs often feel weak and spastic." c."I'm embarrassed to go out in public." d."I keep reliving a car accident."

A

A nurse explained to a new mother that because she had tested positive for the hepatitis B virus, her newborn son would need the hepatitis B vaccine immediately and then also an immune globulin injection. "Wait," said the new mother. "Why is my son getting two shots?" Which of the following statements would be the best response by the nurse? a."One injection protects your son, while the other encourages his body to build up immunity." b."One shot keeps your son from getting sick, while the other is a typical vaccine to prevent you from accidentally infecting him." c."Since you've already been infected with the virus, your son needs twice as much protection." d."The second shot is just to make sure the first one works."

A

A nurse provides care for an adolescent patient diagnosed with an eating disorder. Which behavior by this nurse indicates that additional clinical supervision is needed? a.The nurse interacts with the patient in a protective fashion. b.The nurse's comments to the patient are compassionate and nonjudgmental. c.The nurse teaches the patient to recognize signs of increasing anxiety and ways to intervene. d.The nurse refers the patient to a self-help group for individuals with eating disorders.

A

A patient admitted to an alcohol rehabilitation program tells the nurse, "I'm actually just a social drinker. I usually have a drink at lunch, two in the afternoon, wine with dinner, and a few drinks during the evening." The patient is using which defense mechanism? a.Denial b.Projection c.Introjection d.Rationalization

A

A patient diagnosed with anorexia nervosa virtually stopped eating 5 months ago and lost 25% of body weight. A nurse asks, "Describe what you think about your present weight and how you look." Which response by the patient is most consistent with the diagnosis? a."I am fat and ugly." b."What I think about myself is my business." c."I'm grossly underweight, but that's what I want." d."I'm a few pounds' overweight, but I can live with it."

A

A patient diagnosed with borderline personality disorder was hospitalized several times after multiple episodes of head banging and carving on both wrists. The patient remains impulsive. Which nursing diagnosis is the initial focus of this patient's care? a.Self-mutilation b.Impaired skin integrity c.Risk for injury d.Powerlessness

A

A patient fearfully runs from chair to chair crying, "They're coming! They're coming!" The patient does not follow the staff's directions or respond to verbal interventions. The initial nursing intervention of highest priority is to a.provide for the patient's safety. b.encourage clarification of feelings. c.respect the patient's personal space. d.offer an outlet for the patient's energy.

A

A patient in the emergency department shows disorganized behavior and incoherence after a friend suggested a homosexual encounter. In which room should the nurse place the patient? a.An interview room furnished with a desk and two chairs b.A small, empty storage room with no windows or furniture c.A room with an examining table, instrument cabinets, desk, and chair d.The nurse's office, furnished with chairs, files, magazines, and bookcases

A

An outpatient diagnosed with anorexia nervosa has begun refeeding. Between the first and second appointments, the patient gained 8 pounds. The nurse should a.assess lung sounds and extremities. b.suggest use of an aerobic exercise program. c.positively reinforce the patient for the weight gain. d.establish a higher goal for weight gain the next week.

A

A patient says, "I get in trouble sometimes because I make quick decisions and act on them." Select the nurse's most therapeutic response. a."Let's consider the advantages of being able to stop and think before acting." b."It sounds as though you've developed some insight into your situation." c."I bet you have some interesting stories to share about overreacting." d."It's good that you're showing readiness for behavioral change."

A

A patient tells the nurse, "My husband lost his job. He's abusive only when he drinks too much. His family was like that when he was growing up. He always apologizes and regrets hurting me." What risk factor was most predictive for the husband to become abusive? a.History of family violence b.Loss of employment c.Abuse of alcohol d.Poverty

A

A patient who was responding to auditory hallucinations earlier in the morning now approaches the nurse shaking a fist and shouts, "Back off!" and then goes to the dayroom. While following the patient into the dayroom, the nurse should a.make sure there is adequate physical space between the nurse and patient. b.move into a position that places thepatient close to the door. c.maintain one arm's length distance from the patient. d.begin talking to the patient about appropriate behavior.

A

A person speaking about a rival for a significant other's affection says in an emotional, syrupy voice, "What a lovely person. That's someone I simply adore." The individual is demonstrating a.reaction formation. b.repression. c.projection. d.denial.

A

A rape victim says to the nurse, "I always try to be so careful. I know I should not have walked to my car alone. Was this attack my fault?" Which communication by the nurse is most therapeutic? a.Support the victim to separate issues of vulnerability from blame. b.Emphasize the importance of using a buddy system in public places. c.Reassure the victim that the outcome of the situation will be positive. d.Pose questions about the rape and help the patient explore why it happened.

A

A school nurse asks a class about the ways HIV can be transmitted. Which of the following comments by a student indicates a need for additional teaching? a."I wouldn't sit next to someone with HIV." b."Having unprotected sex with someone who is infected spreads HIV." c."Sharing needles when shooting up drugs spreads HIV." d."Transfusions of blood products that are contaminated can spread HIV."

A

A soldier in a combat zone tells the nurse, "I saw a child get blown up over a year ago, and I still keep seeing bits of flesh everywhere. I see something red, and the visions race back to my mind." Which phenomenon associated with PTSD is the soldier describing? a.Reexperiencing b.Hyperarousal c.Avoidance d.Psychosis

A

A student says, "Before taking a test, I feel very alert and a little restless." Which nursing intervention is most appropriate to assist the student? a.Explain that the symptoms result from mild anxiety and discuss the helpful aspects. b.Advise the student to discuss this experience with a health care provider. c.Encourage the student to begin antioxidant vitamin supplements. d.Listen attentively, using silence in a therapeutic way.

A

A victim of a sexual assault who sits in the emergency department is rocking back and forth and repeatedly saying, "I can't believe I've been raped." This behavior is characteristic of which stage of rape-trauma syndrome? a.The acute phase reaction b.The long-term phase c.A delayed reaction d.The angry stage

A

A victim of intimate partner violence comes to the crisis center seeking help. Crisis intervention strategies the nurse applies will focus on a.supporting emotional security and reestablishing equilibrium. b.long-term resolution of issues precipitating the crisis. c.promoting growth of the individual. d.providing legal assistance.

A

A wife received news that her husband died of heart failure and called her family to come to the hospital. She angrily tells the nurse who cared for him, "He would still be alive if you had given him your undivided attention." Select the nurse's best intervention. a.Say to the wife, "I understand you are feeling upset. I will stay with you until your family comes." b.Say to the wife, "Your husband's heart was so severely damaged that it could no longer pump." c.Say to the wife, "I will call the health care provider to discuss this matter with you." d.Hold the wife's hand in silence until the family arrives.

A

After major reconstructive surgery, a patient's wounds dehisced. Extensive wound care was required for 6 months, causing the patient to miss work and social activities. Which physiological response would be expected for this patient? a.Vital signs return to normal. b.Release of endogenous opioids would cease. c.Pulse and blood pressure readings are elevated. d.Psychomotor abilities of the right brain become limited.

A

After treatment for a detached retina, a survivor of intimate partner abuse says, "My partner only abuses mewhen I make mistakes. I've considered leaving, but I was brought up to believe you stay together, no matter what happens." Which diagnosis should be the focus of the nurse's initial actions? a.Risk for injury related to physical abuse from partner b.Social isolation related to lack of a community support system c.Ineffective coping related to uneven distribution of power within a relationship d.Deficient knowledge related to resources for escape from an abusive relationship

A

An 11-year-old says, "My parents don't like me. They call me stupid and say they wish I were never born. It doesn't matter what they think because I already know I'm dumb." Which nursing diagnosis applies to this child? a.Chronic low self-esteem related to negative feedback from parents b.Deficient knowledge related to interpersonal skills with parents c.Disturbed personal identity related to negative self-evaluation d.Complicated grieving related to poor academic performance

A

An adult has cared for a debilitated parent for 10 years. The health care provider recently recommended transfer of the parent to a skilled nursing facility. The adult says, "I've always been able to care for my parents. Nursing home placement goes against everything I believe." Successful resolution of this adult's crisis will most closely relate to a.resolving the feelings associated with the threat to the person's self-concept. b. ability of the person to identify situational supports in the community. c.reliance on assistance from role models within the person's culture. d.mobilization of automatic relief behaviors by the person.

A

An individual experiences sexual dysfunction and blames it on a partner by calling the person unattractive and unromantic. Which defense mechanism is evident? a.Rationalization b.Compensation c.Introjection d.Regression

A

At a meeting for family members of alcoholics, a spouse says, "I did everything I could to help. I even requested sick leave when my partner was too drunk to go to work." The nurse assesses these comments as a.codependence. b.assertiveness. c.role reversal. d.homeostasis.

A

During the initial interview at the crisis center, a patient says, "I've been served with divorce papers. I'm so upset and anxious that I can't think clearly." Which comment should the nurse use to assess personal coping skills? a."In the past, how have you handled difficult or stressful situations?" b."What would you like us to do to help you feel more relaxed?" c."Tell me more about how it feels to be anxious and upset." d."Can you describe your role in the marital relationship?"

A

During the third week of treatment, the spouse of a patient in a rehabilitation program for substance abuse says, "After this treatment program, I think everything will be all right." Which remark by the nurse will be most helpful to the spouse? a."While sobriety solves some problems, new ones may emerge as one adjusts to living without drugs and alcohol." b."It will be important for you to structure life to avoid as much stress as you can and provide social protection." c."Addiction is a lifelong disease of self-destruction. You will need to observe your spouse's behavior carefully." d."It is good that you are supportive of your spouse's sobriety and want to help maintain it."

A

Emergency response workers arrive in a community after a large-scale natural disaster. What is the workers' first action? a.Report to the incident command system (ICS) center. b.Determine whether the community is safe. c.Establish teams of workers with varied skills. d.Evaluate actions completed by local law enforcement.

A

One bed is available on the inpatient eating-disorder unit. Which patient should be admitted to this bed? The patient whose weight decreased from a.150 to 100 pounds over a 4-month period. Vital signs are temperature, 35.9° C; pulse, 38 beats/min; blood pressure 60/40 mm Hg b.120 to 90 pounds over a 3-month period. Vital signs are temperature, 36° C; pulse, 50 beats/min; blood pressure 70/50 mm Hg c.110 to 70 pounds over a 4-month period. Vital signs are temperature 36.5° C; pulse, 60 beats/min; blood pressure 80/66 mm Hg d.90 to 78 pounds over a 5-month period. Vital signs are temperature, 36.7° C; pulse, 62 beats/min; blood pressure 74/48 mm Hg

A

Relaxation techniques help patients who have experienced major traumas because they a.engage the parasympathetic nervous system. b.increase sympathetic stimulation. c.increase the metabolic rate. d.release hormones.

A

Select the most therapeutic manner for a nurse working with a patient beginning treatment for alcohol addiction. a.Empathetic, supportive b.Skeptical, guarded c.Cool, distant d.Confrontational

A

Select the priority nursing intervention when caring for a patient after an overdose of amphetamines. a.Monitor vital signs. b.Observe for depression. c.Awaken the patient every 15 minutes. d.Use warmers to maintain body temperature.

A

Select the priority outcome for a patient completing the fourth alcohol detoxification program in the past year. Prior to discharge, the patient will a.state, "I know I need long-term treatment." b.use denial and rationalization in healthy ways. c.identify constructive outlets for expression of anger. d.develop a trusting relationship with one staff member.

A

The nurse who is counseling a patient with dissociative identity disorder should understand that the assessment of highest priority is a.risk for self-harm. b.cognitive function. c.memory impairment. d.condition of self-esteem.

A

The parents of a 15-year-old seek to have this teen declared a delinquent because of excessive drinking, habitually running away, and prostitution. The nurse interviewing the patient should recognize these behaviors often occurin adolescents who a.have been abused. b.are attention seeking. c.have eating disorders. d.are developmentally delayed.

A

The principle most useful to a nurse planning crisis intervention for any patient is that the patient a. is experiencing a state of disequilibrium. b.is experiencing a type of mental illness. c.poses a threat of violence to others. d.has high potential for self-injury.

A

The treatment team discusses adding a new prescription for lisdexamfetamine dimesylate to the plan of care for a patient diagnosed with binge eating disorder. Which finding from the nursing assessment is most important for the nurse to share with the team? a.The patient's history of poly-substance abuse b.The patient's preference for homeopathic remedies c.The patient's family history of autoimmune disorders d.The patient's comorbid diagnosis of a learning disability

A

Two staff nurses applied for promotion to nurse manager. The nurse not promoted initially had feelings of loss but then became supportive of the new manager by helping make the transition smooth and encouraging others. Which term best describes the nurse's response? a.Altruism b.Suppression c.Intellectualization d.Reaction formation

A

What cluster of personality disorders is described below: ● Behaviors are described as ***odd or eccentric**** 1. Paranoid - symptoms evident in young people 2. Schizoid 3. Schizotypal

A

What is the priority intervention for a nurse beginning to work with a patient diagnosed with a schizotypal personality disorder? a.Respect the patient's need for periods of social isolation. b.Prevent the patient from violating the nurse's rights. c.Teach the patient how to select clothing for outings. d.Engage the patient in community activities.

A

What is the priority nursing diagnosis for a patient diagnosed with antisocial personality disorder who has made threats against staff, ripped art off the walls, and thrown objects? a.Risk for other-directed violence b.Risk for self-directed violence c.Impaired social interaction d.Ineffective denial

A

When a patient first began using alcohol, two drinks produced relaxation and drowsiness. After 1 year, four drinks are needed to achieve the same response. Why has this change occurred? a.Tolerance has developed. b.Antagonistic effects are evident. c.Metabolism of the alcohol is now delayed. d.Pharmacokinetics of the alcohol have changed.

A

What STI is described below: ● Causes inflammation of the liver, and sometimes death ● S&S: ○ Anorexia ○ Malaise ○ Nausea and vomiting ○ Abdominal pain ○ Dark urine ○ Jaundice ○ Occasionally rash or joint pain

Hepatitis

Which assessment finding best supports dissociative fugue? The patient states a."I cannot recall why I'm living in this town." b."I feel as if I'm living in a fuzzy dream state." c."I feel like different parts of my body are at war." d."I feel very anxious and worried about my problems."

A

Which behavior best demonstrates aggression? a.Stomping away from the nurses' station, going to the hallway, and grabbing a tray from the meal cart. b.Bursting into tears, leaving the community meeting, and sitting on a bed hugging a pillow and sobbing. c.Telling the primary nurse, "I felt angry when you said I could not have a second helping at lunch." d.Telling the medication nurse, "I am not going to take that, or any other, medication you try to give me."

A

Which comment by the nurse would best support relationship building with a survivor of intimate partner abuse? a."You are feeling violated because you thought you could trust your partner." b."I'm here for you. I want you to tell me about the bad things that happened to you." c."I was very worried about you. I knew you were living in a potentially violent situation." d."Abusers often target people who are passive. I will refer you to an assertiveness class."

A

Which features should be present in a therapeutic milieu for a patient experiencing a hallucinogen overdose? a.Simple and safe b.Active and bright c.Stimulating and colorful d.Confrontational and challenging

A

Which intervention is appropriate for an individual diagnosed with an antisocial personality disorder who frequently manipulates others? a.Refer requests and questions related to care to the case manager. b.Encourage the patient to discuss feelings of fear and inferiority. c.Provide negative reinforcement for acting-out behavior. d.Ignore, rather than confront, inappropriate behavior.

A

Which nursing intervention has the highest priority for a patient diagnosed with bulimia nervosa? a.Assist the patient to identify triggers to binge eating. b.Provide corrective consequences for weight loss. c.Assess for signs of impulsive eating. d.Explore needs for health teaching.

A

Which of the following statements best explains why HSV-2 infection is more challenging for a client than gonorrhea infection? a.HSV-2 is a viral infection that is both chronic and incurable. b.HSV-2 is extremely expensive to treat. c.HSV-2, like HIV, is almost impossible to diagnosis in the early stages. d.Once a person has been treated for HSV-2, the person is immune to further outbreaks.

A

Which scenario demonstrates a dissociative fugue? a.After being caught in an extramarital affair, a man disappeared but then reappeared months later with no memory of what occurred while he was missing. b.A man is extremely anxious about his problems and sometimes experiences dazed periods of several minutes passing without conscious awareness of them. c.A woman finds unfamiliar clothes in her closet, is recognized when she goes to new restaurants, and complains of "blackouts" despite not drinking. d.A woman reports that when she feels tired or stressed, it seems like her body is not real and is somehow growing smaller.

A

While conducting the initial interview with a patient in crisis, the nurse should a.speak in short, concise sentences. b.convey a sense of urgency to the patient. c.be forthright about time limits of the interview. d.let the patient know the nurse controls theinterview.

A

A woman and man who have come to the health clinic begin to argue loudly. "You gave me an STD!" the man yells. The woman screams back, "Not me. I don't have an STD!" Which of the following statements would be most appropriate for the nurse to say to them? (Select all that apply.) a."Actually, you're very fortunate to have been tested so you and your partner can begin treatment before more serious damage is done." b."Some STDs may not have any symptoms, so you need to be tested for other conditions and treated if necessary." c."Sometimes the test is inaccurate, so before getting too upset, you should ask to be tested again." d."You may be able to get treatment from your pharmacist so you won't have to be embarrassed like this again."

A,B,C

A patient tells a nurse, "My best friend is a perfect person. She is kind, considerate, good-looking, and successful with every task. I could have been like her if I had the opportunities, luck, and money she's had." This patient is demonstrating a.denial. b.projection. c.rationalization. d.compensation.

C

A 10-year-old child was placed in a foster home after being removed from parental contact because of abuse. The child has apprehension, tremulousness, and impaired concentration. The foster parent also reports the child has an upset stomach, urinates frequently, and does not understand what has happened. What helpful measures should the nurse suggest to the foster parents? The nurse should recommend (Select all that apply) a.conveying empathy and acknowledging the child's distress. b.explaining and reinforcing reality to avoid distortions. c.using a calm manner and low, comforting voice. d.avoiding repetition in what is said to the child. e.staying with the child until the anxiety decreases. f.minimizing opportunities for exercise and play.

A,B,C,E

The nurse interviewing a patient with suspected PTSD should be alert to findings indicating the patient (Select all that apply) a.avoids people and places that arouse painful memories. b.experiences flashbacks or re-experiences the trauma. c.experiences symptoms suggestive of a heart attack. d.feels compelled to repeat selected ritualistic behaviors. e.demonstrates hypervigilance or distrusts others. f.feels detached, estranged, or empty inside.

A,B,C,E,F

A young adult says, "I was sexually abused by my older brother. During those assaults, I went somewhere else in my mind. I don't remember the details. Now, I often feel numb or unreal in romantic relationships, so I just avoid them." Which disorders should the nurse suspect based on this history? (Select all that apply.) a.Acute stress disorder b.Depersonalization disorder c.Generalized anxiety disorder d.PTSD e.Reactive attachment disorder f.Disinhibited social engagement disorder

A,B,D

A child was placed in a foster home after being removed from abusive parents. The child is apprehensive and overreacts to environmental stimuli. The foster parents ask the nurse how to help the child. Which interventions should the nurse suggest? (Select all that apply.) a.Use a calm manner and low voice. b.Maintain simplicity in the environment. c.Avoid repetition in what is said to the child. d.Minimize opportunities for exercise and play. e.Explain and reinforce reality to avoid distortions.

A,B,E

A nurse plans health teaching for a patient diagnosed with generalized anxiety disorder who begins a new prescription for lorazepam. 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

A,C,D

The nurse assesses an adult who is socially withdrawn and hoards. Which nursing diagnoses most likely apply to this individual? (Select all that apply.) a.Ineffective home maintenance b.Situational low self-esteem c.Chronic low self-esteem d.Disturbed body image e.Risk for injury

A,C,E

The nurse can assist a patient to prevent substance abuse relapse by (Select all that apply) a.rehearsing techniques to handle anticipated stressful situations. b.advising the patient to accept residential treatment if relapse occurs. c.assisting the patient to identify life skills needed for effective coping. d.advising isolating self from significant others until sobriety is established. e.informing the patient of physical changes to expect as the body adapts to functioning without substances.

A,C,E

After discovering discrepancies and missing controlled substances, the nursing supervisor determines that a valued, experienced staff nurse is responsible. Which actions should the nursing supervisor take? (Select all that apply.) a.Refer the nurse to a peer assistance program. b.Confront the nurse in the presence of a witness. c.Immediately terminate the nurse's employment. d.Relieve the nurse of responsibilities for patient care. e.Require the nurse to undergo immediate drug testing.

A,D

While _____ is recommended for all patients, the following are conditions that increase the urgency to initiate therapy: · Pregnancy · AIDS-defining conditions including HIV-associated dementia (HAD) and AIDS-associated malignancies · Acute opportunistic infections (Ois) · Lower CD4 counts (less than 200) · HIV-associated nephropathy · Acute/early infection · HIV/Hepatitis B virus coinfection · HIV/Hepatitis C virus coinfection

ART

What medications for withdrawal of substance use disorders is described below: Begin taking on the 5th day of abstinence from alcohol; reduces craving for alcohol; helps in relapse prevention

Acamprosate

A client with tuberculosis (TB) asks why the nurse is required to watch the client swallow the medication each day. Which of the following statements is the best response by the nurse? a."Clients with TB are often noncompliant, so if I directly observe, you will be sure to take the drugs that have been ordered." b."This therapy is recommended to make sure that you receive the treatment you need and the infection doesn't become resistant to the drugs." c."This is to make sure you take your medication if your condition becomes so advanced that you do not have enough cerebral oxygenation to remember." d."Tuberculosis medications are very expensive so this method ensures that government money doesn't get wasted on those who will not take the drugs."

B

A hospitalized patient diagnosed with alcohol use disorder believes spiders are spinning entrapping webs in the room. The patient is fearful, agitated, and diaphoretic. Which nursing intervention is indicated? a.Check the patient every 15 minutes b.One-on-one supervision c.Keep the room dimly lit d.Force fluids

B

A hospitalized patient diagnosed with alcohol use disorder believes the window blinds are snakes trying to get in the room. The patient is anxious, agitated, and diaphoretic. The nurse can anticipate the health care provider will prescribe a(n) a.narcotic analgesic, such as hydromorphone. b.sedative, such as lorazepam or chlordiazepoxide. c.antipsychotic, such as olanzapine or thioridazine. d.monoamine oxidase inhibitor antidepressant, such as phenelzine.

B

A mother felt very guilty that her baby was born HIV positive. When the nurse suggested the usual DPT and MMR immunizations, the mother was extremely upset. "Don't you know HIV children are immunosuppressed?" she exclaimed. Which of the following would be the nurse's best response? a."All children have to have these immunizations before they can attend school." b."Being HIV positive, your child is more likely to catch an infection and be very ill if not immunized." c."I'm so sorry; I forgot for a moment your child was HIV positive." d."The American Pediatric Association requires all health care providers to offer these immunizations to all parents; it is your choice whether or not to accept them."

B

A new patient acts out so aggressively that seclusion is required before the admission assessment is completed or orders written. Immediately after safely secluding the patient, which action is the nurse's priority? a.Complete the physical assessment. b.Notify the health care provider to obtain a seclusion order. c.Document the incident objectively in the patient's medical record. d.Explain to the patient that seclusion will be discontinued when self-control is regained.

B

A nurse assesses a patient in crisis. Select the most appropriate question for the nurse to ask to assess this patient's situational support. a."Has anything upsetting occurred in the past few days?" b."Who can be helpful to you during this time?" c."How does this problem affect your life?" d."What led you to seek help at this time?"

B

A nurse cares for a patient experiencing an opioid overdose. Which focused assessment has the highest priority? a.Cardiovascular b.Respiratory c.Neurological d.Hepatic

B

A nurse in the emergency department assesses an unresponsive victim of rape. The victim's friend reports, "That guy gave her salty water before he raped her." Which question is most important for the nurse to ask of the victim'sfriend? a."Does the victim have any kidney disease?" b."Has the victim consumed any alcohol?" c."What time was she given salty water?" d."Did you witness the rape?"

B

A nurse interviews a patient abducted and raped at gunpoint by an unknown assailant. The patient says, "I shouldn't have been there alone. I knew it was a dangerous area." What is the patient's present coping strategy? a.Projection b.Self-blame c.Suppression d.Rationalization

B

A nurse is concerned about the prevalence of tuberculosis among migrant farmworkers. Which of the following activities would be best to use when implementing tertiary prevention? a.Administer purified protein derivative (PPD) to contacts of those with tuberculosis. b.Initiate directly observed therapy (DOT) for tuberculosis treatment. c.Provide education about the prevention of tuberculosis to members of the migrant community. d.Use skin tests to screen migrant health workers for tuberculosis infection.

B

A nurse reviews vital signs for a patient admitted with an injury sustained while intoxicated. The medical record shows these blood pressure and pulse readings at the times listed: 0200: 118/78 mm Hg and 72 beats/minute 0400: 126/80 mm Hg and 76 beats/minute 0600: 128/82 mm Hg and 72 beats/minute 0800: 132/88 mm Hg and 80 beats/minute 1000: 148/94 mm Hg and 96 beats/minute What is the nurse's priority action? a.Force fluids. b.Begin the detox protocol. c.Obtain a clean-catch urine sample. d.Place the patient in a vest-type restraint.

B

A nurse set limits while interacting with a patient demonstrating behaviors associated with borderline personality disorder. The patient tells the nurse, "You used to care about me. I thought you were wonderful. Now I can see I was wrong. You're evil." This outburst can be assessed as a.denial. b.splitting. c.defensive. d.reaction formation.

B

A nurse wants to teach alternative coping strategies to a patient experiencing severe anxiety. Which action should the nurse perform first? a.Verify the patient's learning style. b.Lower the patient's current anxiety. c.Create outcomes and a teaching plan. d.Assess how the patient uses defense mechanisms.

B

A nurse works with a patient diagnosed with posttraumatic stress disorder (PTSD) who has frequent flashbacks as well as persistent symptoms of arousal. Which intervention should be included in the plan of care? a.Trigger flashbacks intentionally in order to help the patient learn to cope with them. b.Explain that the physical symptoms are related to the psychological state. c.Encourage repression of memories associated with the traumatic event. d.Support "numbing" as a temporary way to manage intolerable feelings.

B

A nursing diagnosis appropriate to consider for a patient diagnosed with any of the personality disorders is a.nonadherence. b.impaired social interaction. c.disturbed personal identity. d.diversional activity deficit.

B

A patient asks for information about AA. Select the nurse's best response. "AA is a a.form of group therapy led by a psychiatrist." b.self-help group for which the goal is sobriety." c.group that learns about drinking from a group leader." d.network that advocates strong punishment for drunk drivers."

B

A patient comes to the crisis center saying, "I'm in a terrible situation. I don't know what to do." The triage nurse can initially assume that the patient is a.suicidal. b.anxious and fearful. c.misperceiving reality. d.potentially homicidal.

B

A patient comes to the crisis clinic after an unexpected job termination. The patient paces, sobs, cringes when approached, and responds to questions with only shrugs or monosyllables. Choose the nurse's best initial comment to this patient. a."Everything is going to be all right. You are here at the clinic and the staff will keep you safe." b."I see you are feeling upset. I'm going to stay and talk with you to help you feel better." c."You need to try to stop crying and pacing so we can talk about your problems." d."Let's set some guidelines and goals for your visit here."

B

A patient who is visiting the crisis clinic for the first time asks, "How long will I be coming here?" The nurse's reply should consider that the usual duration of crisis intervention is a.1 to 2 weeks. b.3 to 4 weeks. c.4 to 6 weeks. d.8 to 12 weeks.

C

A patient diagnosed with alcohol use disorder asks, "How will Alcoholics Anonymous (AA) help me?" Select the nurse's best response. a."The goal of AA is for members to learn controlled drinking with the support of a higher power." b."An individual is supported by peers while striving for abstinence one day at a time." c."You must make a commitment to permanently abstain from alcohol and other drugs." d."You will be assigned a sponsor who will plan your treatment program."

B

A patient diagnosed with anorexia nervosa is resistant to weight gain. What is the rationale for establishing a contract with the patient to participate in measures designed to produce a specified weekly weight gain? a.Because severe anxiety concerning eating is expected, objective and subjective data may be unreliable. b.Patient involvement in decision making increases sense of control and promotes adherence to the plan of care. c.Because of increased risk of physical problems with refeeding, the patient's permission is needed. d.A team approach to planning the diet ensures that physical and emotional needs will be met.

B

A patient diagnosed with borderline personality disorder has a history of self-mutilation and suicide attempts. The patient reveals feelings of depression and anger with life. Which type of medication would the nurse expect to be prescribed? a.Benzodiazepine b.Mood stabilizing medication c.Monoamine oxidase inhibitor (MAOI) d.Cholinesterase inhibitor

B

A patient diagnosed with borderline personality disorder has self-inflicted wrist lacerations. The health care provider prescribes daily dressing changes. The nurse performing this care should a.maintain a stern and authoritarian affect. b.provide care in a matter-of-fact manner. c.encourage the patient to express anger. d.be very rigid and challenging.

B

A patient diagnosed with depersonalization disorder tells the nurse, "It's starting again. I feel as though I'm going to float away." Which intervention would be most appropriate at this point? a.Notify the health care provider of this change in the patient's behavior. b.Engage the patient in a physical activity such as exercise. c.Isolate the patient until the sensation has diminished. d.Administer a prn dose of antianxiety medication.

B

A patient experiences a sudden episode of severe anxiety. Of these medications in the patient's medical record, which is most appropriate to give as a prn anxiolytic? a.buspirone b.lorazepam c.amitriptyline d.desipramine

B

A patient fearfully runs from chair to chair crying, "They're coming! They're coming!" The patient does not follow the staff's directions or respond to verbal interventions. Which nursing diagnosis has the highest priority? a.Fear b.Risk for injury c.Self-care deficit d.Disturbed thought processes

B

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.

B

A patient performs ritualistic hand washing. Which action should the nurse implement to help the patient develop more effective coping? a.Allow the patient to set a hand-washing schedule. b.Encourage the patient to participate in social activities. c.Encourage the patient to discuss hand-washing routines. d.Focus on the patient's symptoms rather than on the patient.

B

A patient preparing for surgery has moderate anxiety and is unable to understand preoperative information. Which nursing intervention is most appropriate? a.Reassure the patient that all nurses are skilled in providing postoperative care. b.Present the information again in a calm manner using simple language. c.Tell the patient that staff is prepared to promote recovery. d.Encourage the patient to express feelings to family.

B

A patient says, "The other nurses won't give me my medication early, but you know what it's like to be in pain and don't let your patients suffer. Could you get me my pill now? I won't tell anyone." Which response by the nurse would be most therapeutic? a."I'm not comfortable doing that," and then ignore subsequent requests for early medication. b."I understand that you have pain, but giving medicine too soon would not be safe." c."I'll have to check with your doctor about that; I will get back to you after I do." d."It would be unsafe to give the medicine early; none of us will do that."

B

A patient with an abdominal mass is scheduled for a biopsy. The patient has difficulty understanding the nurse's comments and asks, "What do you mean? What are they going to do?" Assessment findings include tremulous voice, respirations 28, and pulse 110. What is the patient's level of anxiety? a.Mild b.Moderate c.Severe d.Panic

B

A soldier returned home from active duty in a combat zone and was diagnosed with PTSD. The soldier says, "If there's a loud noise at night, I get under my bed because I think we're getting bombed." What type of experience has the soldier described? a.Illusion b.Flashback c.Nightmare d.Auditory hallucination

B

A survivor of physical spousal abuse was treated in the emergency department for a broken wrist. This patient said, "I've considered leaving, but I made a vow and I must keep it no matter what happens." Which outcome should be met before discharge? The patient will a.facilitate counseling for the abuser. b.name two community resources for help. c.demonstrate insight into the abusive relationship. d.reexamine cultural beliefs about marital commitment.

B

A woman is 5'7", 160 lbs. and wears a size 8 shoe. She says, "My feet are huge. I've asked three orthopedists to surgically reduce my feet." This person tries to buy shoes to make her feet look smaller and, in social settings, conceals both feet under a table or chair. Which health problem is likely? a.Social anxiety disorder b.Body dysmorphic disorder c.Separation anxiety disorder d.Obsessive-compulsive disorder due to a medical condition

B

After an abduction and rape at gunpoint by an unknown assailant, which assessment finding best indicates that a patient is in the acute phase of the rape-trauma syndrome? a.Decreased motor activity b.Confusion and disbelief c.Flashbacks and dreams d.Fears and phobias

B

After the sudden death of his wife, a man says, "I can't live without her ... she was my whole life." Select the nurse's most therapeutic reply. a."Each day will get a little better." b."Her death is a terrible loss for you." c."It's important to recognize that she is no longer suffering." d."Your friends will help you cope with this change in your life."

B

An adult comes to the crisis clinic after termination from a job of 15 years. The patient says, "I don't know what to do. How can I get another job? Who will pay the bills? How will I feed my family?" Which nursing diagnosis applies? a.Hopelessness b.Powerlessness c.Chronic low self-esteem d. Interrupted family processes

B

An adult in the emergency department states, "Everything I see appears to be waving. I am outside my body looking at myself. I think I'm losing my mind." Vital signs are slightly elevated. The nurse should suspect a.a schizophrenic episode. b.hallucinogen ingestion. c.opium intoxication. d.cocaine overdose.

B

An appropriate intervention for a patient diagnosed with bulimia nervosa who binges and purges is to teach the patient a.to eat a small meal after purging. b.not to skip meals or restrict food. c.to increase oral intake after 4 PM daily. d.the value of reading journal entries aloud to others.

B

An emergency department nurse prepares to assist with evidence collection for a sexual assault victim. Prior to photographs and pelvic examination, what documentation is important? a.The patient's vital signs b.Consent signed by the patient c.Supervision and credentials of the examiner d.Storage location of the patient's personal effects

B

An older adult diagnosed with Alzheimer's disease lives with family in a rural area. During the week, this adult attends a day care center while the family is at work. In the evenings, members of the family provide care. Which factor makes this adult most vulnerable to abuse? a.Multiple caregivers b.Alzheimer's disease c.Living in a rural area d.Being part of a busy family

B

In the emergency department, a patient's vital signs are BP 66/40 mm Hg; pulse 140 beats/minute; respirations 8 breaths/minute and shallow. The nursing diagnosis is Ineffective breathing pattern related to depression of respiratory center secondary to opioid intoxication. Select the priority outcome. a.The patient will demonstrate effective coping skills and identify community resources for treatment of substance abuse within 1 week of hospitalization. b.Within 4 hours, vital signs will stabilize, with BP above 90/60 mm Hg, pulse less than 100 beats/minute, and respirations at or above 12 breaths/minute. c.The patient will correctly describe a plan for home care and achieving a drug-free state before release from the emergency department. d.Within 6 hours, the patient's breath sounds will be clear bilaterally and throughout lung fields.

B

Personality traits most likely to be documented regarding a patient demonstrating characteristics of an obsessive-compulsive personality disorder are a.affable, generous. b.perfectionist, inflexible. c.suspicious, holds grudges. d.dramatic speech, impulsive.

B

Police bring a patient to the emergency department after an automobile accident. The patient demonstrates poor coordination and slurred speech but the vital signs are normal. The blood alcohol level is 300 mg/dL (0.30 g/dL). Considering the relationship between the assessment findings and blood alcohol level, which conclusion is most probable? The patient a.rarely drinks alcohol. b.has a high tolerance to alcohol. c.has been treated with disulfiram (Antabuse). d.has ingested both alcohol and sedative drugs recently.

B

Six months ago, a woman had a prophylactic double mastectomy because of a family history of breast cancer. One week ago, this woman learned her husband was involved in an extramarital affair. The woman says tearfully, "What else can happen?" If the woman's immediate family is unable to provide sufficient support, the nurse should a.suggest hospitalization for a short period. b.ask what other relatives or friends are available for support. c.tell the patient, "You are a strong person. You can get through this crisis." d. foster insight by relating the present situation to earlier situations involving loss.

B

Symptoms of withdrawal from opioids for which the nurse should assess include a.dilated pupils, tachycardia, elevated blood pressure, and elation. b.nausea, vomiting, diaphoresis, anxiety, and hyperreflexia. c.mood lability, incoordination, fever, and drowsiness. d.excessive eating, constipation, and headache.

B

The following are cluster ____ personality disorders: (Erratic/Dramatic/Emotional) ● Histrionic ● Narcissistic ● Antisocial ● Borderline

B

The gas pedal on a person's car became stuck on a busy interstate highway, causing the car to accelerate rapidly. For 20 minutes, the car was very difficult to control. In the months after this experience, afterward, which assessment finding would the nurse expect? a.Weight gain b.Flashbacks c.Headache d.Diuresis

B

The nurse assesses a patient who complains of loneliness and episodes of anxiety. Which statement by the patient is mostly likely if this patient also has agoraphobia? a."I'm sure I will get over not wanting to leave home soon. It takes time." b."Being afraid to go out seems ridiculous, but I can't go out the door." c."My family says they like it now that I stay home most of the time." d."When I have a good incentive to go out, I can do it."

B

The unlicensed assistive personnel (UAP) says to the nurse, "That patient with amnesia looks fine, but when I talk to her, she seems vague. What should I be doing for her?" Select the nurse's best reply. a."Spend as much time with her as you can and ask questions about her life." b."Use short, simple sentences and keep the environment calm and protective." c."Provide more information about her past to reduce the mysteries that are causing anxiety." d."Structure her time with activities to keep her busy, stimulated, and regaining concentration."

B

Two weeks ago, a soldier returned to the United States from active duty in a combat zone. The soldier was diagnosed with PTSD. Which comment by the soldier requires the nurse's immediate attention? a."It's good to be home. I missed my home, family, and friends." b."I saw my best friend get killed by a roadside bomb. I don't understand why it wasn't me." c."Sometimes I think I hear bombs exploding, but it's just the noise of traffic in my hometown." d."I want to continue my education, but I'm not sure how I will fit in with other college students."

B

What feelings are most commonly experienced by nurses working with abusive families? a.Outrage toward the victim and discouragement regarding the abuser b.Helplessness regarding the victim and anger toward the abuser c.Unconcern for the victim and dislike for the abuser d.Vulnerability for self and empathy with the abuser

B

What is the most challenging nursing intervention with patients diagnosed with personality disorders who use manipulation? a.Supporting behavioral change b.Maintaining consistent limits c.Monitoring suicide attempts d.Using aversive therapy

B

When a nurse discovers that a woman has been treated for cervical cancer, the nurse asks the woman whether she has ever been tested for HIV or other STDs. The woman is offended and asks why the nurse would ask her such a thing. Which of the following statements would be the best response from the nurse? a."Cervical cancer treatments may decrease immunity, so that it is easier to acquire STDs." b."Cervical cancer usually is caused by HPV, and often the presence of one STD is accompanied by other STDs." c."The presence of an STD in women with cervical cancer may lead to congenital defects in offspring." d."The presence of an STD in a woman with a history of cervical cancer has been associated with a relapse of the cancer after treatment."

B

Which assessment finding presents the greatest risk for violent behavior directed at others? a.Severe agoraphobia b.History of spousal abuse c.Bizarre somatic delusions d.Verbalized hopelessness and powerlessness

B

Which comment by the parents of young children best demonstrates support of development of resilience and effective stress management? a."Our children will be stronger if they make their own decisions." b."We spend daily family time talking about experiences and feelings." c."We use three different babysitters. All of them have college degrees." d."Our parenting strategies are different from those our own parents used."

B

Which communication technique will the nurse use more in crisis intervention than traditional counseling? a.Role modeling b.Giving direction c.Information giving d.Empathic listening

B

Which nursing intervention has the highest priority as a patient diagnosed with anorexia nervosa begins to gain weight? a.Assess for depression and anxiety. b.Observe for adverse effects of refeeding. c.Communicate empathy for the patient's feelings. d.Help the patient balance energy expenditures with caloric intake.

B

Which of the following best describes the characteristic appearance of lesions of human papillomavirus (HPV)? a.Solitary growth with elevated borders and a central depression b.Elevated growths with a "cauliflower" appearance c.Thin-walled pustules that rupture to form honey-colored crusts d.Vesicles that ulcerate and crust within 1 to 4 days

B

Which of the following best explains why chlamydia is a major focus of public health efforts? a.It has more serious long-term outcomes than other STDs b.It can cause problems in infants born to infected mothers c.It is not frequently seen in the United States d.It is so difficult and expensive to treat

B

Which of the following best explains why some health clinics allow clients to be tested for HIV anonymously with no record of the client's name, address, or contact information? a.Client doesn't actually ever have to be told the results of the test. b.Client may be engaged in illegal activities (drug use). c.Client plans on not paying for the test and collection agencies will not be able to harass them. d.Client wants to be sure care providers don't share results with their family.

B

Which personality characteristic is a nurse most likely to assess in a patient diagnosed with anorexia nervosa? a.Carefree flexibility b.Rigidity, perfectionism c.Open displays of emotion d.High spirits and optimism

B

Which rationale best explains why a nurse should be aware of personal feelings while working with a family experiencing family violence? a.Self-awareness enhances the nurse's advocacy role. b.Strong negative feelings interfere with assessment and judgment. c.Strong positive feelings lead to healthy transference with the victim. d.Positive feelings promote the development of sympathy for patients.

B

Which situation demonstrates use of primary intervention related to crisis? a.Implementation of suicide precautions for a depressed patient b.Teaching stress-reduction techniques to a first-year college student c.Assessing coping strategies used by a patient who attempted suicide d.Referring a patient diagnosed with schizophrenia to a partial hospitalization program

B

A person has minor physical injuries after an auto accident. The person is unable to focus and says, "I feel like something awful is going to happen." This person has nausea, dizziness, tachycardia, and hyperventilation. What is the person's level of anxiety? a.Mild b.Moderate c.Severe d.Panic

C

The public health nurse comes to the hospital to see a client just diagnosed with hepatitis A. The nurse says, "I'm sorry to bother you when you're not feeling well, but I need to ask you a few questions." Which of the following questions would be most appropriate for the nurse to ask the client? (Select all that apply.) a."Do you know how you got this infection?" b."Who lives with you?" c."Where are you employed?" d."Where do you usually eat?"

B,C

A patient undergoing alcohol rehabilitation decides to begin disulfiram therapy. Patient teaching should include the need to (Select all that apply) a.avoid aged cheeses. b.avoid alcohol-based skin products. c.read labels of all liquid medications. d.wear sunscreen and avoid bright sunlight. e.maintain an adequate dietary intake of sodium. f.avoid breathing fumes of paints, stains, and stripping compounds.

B,C,F

In which of the following cases would the school nurse be correct to advise the parents of an HIV-infected child to keep the child home from school? (Select all that apply.) a.The child develops allergies with sneezing. b.The child persists in biting behavior or is unable to control body secretions. c.The nurse is not comfortable with being responsible for the child. d.There is an outbreak of chickenpox in the school.

B,D

Which assessment questions would be most appropriate for the nurse to ask a patient with possible obsessive-compulsive disorder? (Select all that apply.) a."Are there certain social situations that cause you to feel especially uncomfortable?" b."Are there others in your family who must do things in a certain way to feel comfortable?" c."Have you been a victim of a crime or seen someone badly injured or killed?" d."Is it difficult to keep certain thoughts out of your awareness?" e."Do you do certain things over and over again?"

B,D,E

What is the treatment for late latent (> 1 year) syphilis?

Benzathine penicillin G (Bicillin at a larger dose) 7.2 million units total over 3 weeks, 1 dose per week

What is the treatment for primary, secondary, and early latent (<1 year) syphilis? **VERY IMPORTANT THAT YOU KNOW THIS.

Benzathine penicillin G (Bicillin) 2.4 million units IM x1 dose (2 injections, one in each hip)

A patient states, "I feel detached and weird all the time. It is as though I am looking at life through a cloudy window. Everything seems unreal. It really messes up things at work and school." This scenario is most suggestive of which health problem? a.Acute stress disorder b.Dissociative amnesia c.Depersonalization disorder d.Disinhibited social engagement disorder

C

What general treatment for opioid use disorders is described below: ● used to help people reduce/quit use of heroin or other opiates such as morphine ○ Sometimes people get addicted to this med; may bring problems - ****this drug is only used 12-24 hours after abstaining from opioids******* ○ Side effects: Nausea, vomiting, constipation, muscle aches, cramps, insomnia, irritability, fever

Buprenophine

What pharmacological intervention for anxiety disorders are described below: -- Alternative anti-anxiety medication that does not cause dependence - Good to use instead of benzodiazepines -- 2-4 weeks required to reach full effects -- Can be used for long term treatment -- Not recommended if have impaired hepatic and renal function

Buspirone

A cruel and abusive person often uses rationalization to explain the behavior. Which comment demonstrates use of this defense mechanism? a."I don't know why I do mean things." b."I have always had poor impulse control." c."That person should not have provoked me." d."I'm really a coward who is afraid of being hurt."

C

A new psychiatric technician says, "Schizophrenia ... schizotypal! What's the difference?" The nurse's response should include which information? a.A patient diagnosed with schizophrenia is not usually overtly psychotic. b.In schizotypal personality disorder, the patient remains psychotic much longer. c.With schizotypal personality disorder, the person can be made aware of misinterpretations of reality. d.Schizotypal personality disorder causes more frequent and more prolonged hospitalizations than schizophrenia.

C

A nurse conducting group therapy on the eating-disorder unit schedules the sessions immediately after meals for the primary purpose of a.maintaining patients' concentration and attention. b.shifting the patients' focus from food to psychotherapy. c.promoting processing of anxiety associated with eating. d.focusing on weight control mechanisms and food preparation.

C

A nurse is providing education to a client about the use of PrEP. Which of the following statements would the nurse include as part of this teaching? a."Side effects of PrEP include extreme lethargy and joint pain." b."PrEP has been shown to be effective in preventing transmission of the disease from sharing needles." c."The effectiveness of PrEP will depend on your adherence to the medication regimen." d."PrEP will prevent you from contracting HIV and Hepatitis B."

C

A nurse prepares for an initial interaction with a patient with a long history of methamphetamine abuse. Which is the nurse's best first action? a.Perform a thorough assessment of the patient. b.Verify that security services are immediately available. c.Self-assess personal attitude, values, and beliefs about this health problem. d.Obtain a face shield because oral hygiene is poor in methamphetamine abusers.

C

A nurse provides health teaching for a patient diagnosed with bulimia nervosa. Priority information the nurse should provide relates to a.self-monitoring of daily food and fluid intake. b.establishing the desired daily weight gain. c.how to recognize hypokalemia. d.self-esteem maintenance.

C

A nurse reports to the treatment team that a patient diagnosed with an antisocial personality disorder has displayed the behaviors below. This patient is detached and superficial during counseling sessions. Which behavior by the patient most clearly warrants limit setting? a.Flattering the nurse b.Lying to other patients c.Verbal abuse of another patient d.Detached superficiality during counseling

C

A patient admitted for injuries sustained while intoxicated has been hospitalized for 48 hours. The patient is now shaky, irritable, anxious, diaphoretic, and reports nightmares. The pulse rate is 130 beats/minute. The patient shouts, "Bugs are crawling on my bed. I've got to get out of here." Select the most accurate assessment of this situation. The patient a.is attempting to obtain attention by manipulating staff. b.may have sustained a head injury before admission. c.has symptoms of alcohol withdrawal delirium. d.is having an acute psychosis.

C

A patient diagnosed with obsessive-compulsive disorder has this nursing diagnosis: Anxiety related to __________ as evidenced by inability to control compulsive cleaning. Which phrase correctly completes the etiological portion of the diagnosis? a.feelings of responsibility for the health of family members b.approval-seeking behavior from friends and family c.persistent thoughts about bacteria, germs, and dirt d.needs to avoid interactions with others

C

A patient experiencing moderate anxiety says, "I feel undone." An appropriate response for the nurse would be: a."What would you like me to do to help you?" b."Why do you suppose you are feeling anxious?" c."I'm not sure I understand. Give me an example." d."You must get your feelings under control before we can continue."

C

A patient experiencing panic suddenly began running and shouting, "I'm going to explode!" Select the nurse's best action. a.Ask, "I'm not sure what you mean. Give me an example." b.Capture the patient in a basket-hold to increase feelings of control. c.Tell the patient, "Stop running and take a deep breath. I will help you." d.Assemble several staff members and say, "We will take you to seclusion to help you regain control."

C

A patient has smoked two packs of cigarettes daily for many years. When the patient tries to reduce smoking, anxiety, craving, poor concentration, and headache occur. This scenario describes a.cross-tolerance. b.substance abuse. c.substance addiction. d.substance intoxication.

C

A patient referred to the eating disorders clinic has lost 35 pounds during the past 3 months. To assess eating patterns, the nurse should ask the patient: a."Do you often feel fat?" b."Who plans the family meals?" c."What do you eat in a typical day?" d."What do you think about your present weight?"

C

A person runs from a crowded nightclub after a pyrotechnics show causes the building to catch fire. Which division of the autonomic nervous system will be stimulated in response to this experience? a.Limbic system b.Peripheral nervous system c.Sympathetic nervous system d.Parasympathetic nervous system

C

A rape victim visited a rape crisis counselor weekly for 8 weeks. At the end of this counseling period, which comment by the victim best demonstrates that reorganization was successful and the victim is now in recovery? a."I have a rash on my buttocks. It itches all the time." b."Now I know what I did that triggered the attack on me." c."I'm sleeping better although I still have an occasional nightmare." d."I have lost 8 pounds since the attack, but I needed to lose some weight."

C

A soldier returns to the United States from active duty in a combat zone. The soldier is diagnosed with PTSD. The nurse's highest priority is to screen this soldier for a.bipolar disorder. b.schizophrenia. c.depression. d.dementia.

C

A soldier who served in a combat zone returned to the United States. The soldier's spouse complains to the nurse, "We had planned to start a family, but now he won't talk about it. He won't even look at children." The spouse is describing which symptom associated with PTSD? a.Reexperiencing b.Hyperarousal c.Avoidance d.Psychosis

C

A woman just received notification that her husband died. She approaches the nurse who cared for him during his last hours and says angrily, "If you had given him your undivided attention, he would still be alive." How should the nurse analyze this behavior? a.The comment suggests potential allegations of malpractice. b.In some cultures, grief is expressed solely through anger. c.Anger is an expected emotion in an adjustment disorder. d.The patient had ambivalent feelings about her husband.

C

After celebrating the fortieth birthday, an individual becomes concerned with the loss of youthful appearance. What type of crisis has occurred? a.Reactive b.Situational c.Maturational d.Body image

C

An 11-year-old reluctantly tells the nurse, "My parents don't like me. They said they wish I was never born." Which type of abuse is likely? a.Sexual b.Physical c.Emotional d.Economic

C

An adolescent comes to the crisis clinic and reports sexual abuse by an uncle. The adolescent told both parents about the uncle's behavior, but the parents did not believe the adolescent. What type of crisis exists? a.Maturational b.Tertiary c.Situational d.Organic

C

An adult tells the nurse, "My partner abuses me when I make mistakes, but I always get an apology and a gift afterward. I've considered leaving but haven't been able to bring myself to actually do it." Which phase in the cycle of violence prevents this adult from leaving? a.Tension-building b.Acute battering c.Honeymoon d.Stabilization

C

An older adult with Lewy body dementia lives with family and attends a day care center. A nurse at the day care center noticed the adult had a disheveled appearance, strong odor of urine, and bruises on the limbs and back. Whattype of abuse might be occurring? a.Psychological b.Financial c.Physical d.Sexual

C

As a nurse prepares to administer medication to a patient diagnosed with a borderline personality disorder, the patient says, "Just leave it on the table. I'll take it when I finish combing my hair." What is the nurse's best response? a.Reinforce this assertive action by the patient. Leave the medication on the table as requested. b.Respond to the patient, "I'm worried that you might not take it. I'll come back later." c.Say to the patient, "I must watch you take the medication. Please take it now." d.Ask the patient, "Why don't you want to take your medication now?"

C

As a patient admitted to the eating-disorder unit undresses, a nurse observes that the patient's body is covered by fine, downy hair. The patient weighs 70 pounds and is 5'4" tall. Which term should be documented? a.Amenorrhea b.Alopecia c.Lanugo d.Stupor

C

At the last contracted visit in the crisis intervention clinic, an adult says, "I've emerged from this a stronger person. You helped me get my life back in balance." The nurse responds, "I think we should have two more sessions to explore why your reactions were so intense." Which analysis applies? a.The patient is experiencing transference. b.The patient demonstrates need for continuing support. c.The nurse is having difficulty terminating the relationship. d.The nurse is empathizing with the patient's feelings of dependency.

C

Consider this comment to three different nurses by a patient diagnosed with an antisocial personality disorder, "Another nurse said you don't do your job right." Collectively, these interactions can be assessed as a.seductive. b.detached. c.manipulative. d.guilt-producing.

C

In the United States, which demographic group has the highest risk for HIV infection? a.African-American homosexual men b.Hispanic IV drug abusers c.White homosexual men d.White lesbians

C

One month ago, a patient diagnosed with borderline personality disorder and a history of self-mutilation began dialectical behavior therapy. Today the patient phones to say, "I feel empty and want to hurt myself." The nurse should a.arrange for emergency inpatient hospitalization. b.send the patient to the crisis intervention unit for 8 to 12 hours. c.assist the patient to choose coping strategies for triggering situations. d.advise the patient to take an antianxiety medication to decrease the anxiety level.

C

Others describe a worker as very shy and lacking in self-confidence. This worker stays in an office cubicle all day, never coming out for breaks or lunch. Which term best describes this behavior? a.Narcissistic b.Histrionic c.Avoidant d.Paranoid

C

Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. This person wears layered loose clothing. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely? a.Binge eating b.Bulimia nervosa c.Anorexia nervosa d.Eating disorder not otherwise specified

C

Several children are seen in the emergency department for treatment of various illnesses and injuries. Which assessment finding would create the most suspicion for child abuse? The child who has a.complaints of abdominal pain. b.repeated middle ear infections. c.bruises on extremities. d.diarrhea.

C

Six months ago, a woman had a prophylactic double mastectomy because of a family history of breast cancer. One week ago, this woman learned her husband was involved in an extramarital affair. The woman tearfully says to the nurse, "What else can happen?" What type of crisis is this person experiencing? a.Maturational b.Mitigation c.Situational d.Recurring

C

The following are cluster ____ personality disorders: (Anxious or Fearful) ● Avoidant ● Dependent ● Obsessive-compulsive

C

The history shows that a newly admitted patient is impulsive. The nurse would expect behavior characterized by a.adherence to a strict moral code. b.manipulative, controlling strategies. c.acting without thought on urges or desires. d.postponing gratification to an appropriate time.

C

The treatment team discusses the plan of care for a patient diagnosed with schizophrenia and daily cannabis abuse who is having increased hallucinations and delusions. To plan effective treatment, the team should a.provide long-term care for the patient in a residential facility. b.withdraw the patient from cannabis, then treat the schizophrenia. c.consider each diagnosis primary and provide simultaneous treatment. d.first treat the schizophrenia, then establish goals for substance abuse treatment.

C

Two staff nurses applied for a charge nurse position. After the promotion was announced, the nurse who was not promoted said, "The nurse manager had a headache the day I was interviewed." Which defense mechanism is evident? a.Introjection b.Conversion c.Projection d.Splitting

C

What is a nurse's legal responsibility if child abuse or neglect is suspected? a.Discuss the findings with the child's parent and health care provider. b.Document the observation and suspicion In the medical record. c.Report the suspicion according to state regulations. d.Continue the assessment.

C

What is an appropriate initial outcome for a patient diagnosed with a personality disorder who frequently manipulates others? The patient will a.identify when feeling angry. b.use manipulation only to get legitimate needs met. c.acknowledge manipulative behavior when it is called to his or her attention. d.accept fulfillment of his or her requests within an hour rather than immediately.

C

When a patient diagnosed with a personality disorder uses manipulation to get needs met, the staff applies limit-setting interventions. What is the correct rationale for this action? a.It provides an outlet for feelings of anger and frustration. b.It respects the patient's wishes, so assertiveness will develop. c.External controls are necessary due to failure of internal control. d.Anxiety is reduced when staff assumes responsibility for the patient's behavior.

C

When alprazolam is prescribed for a patient who experiences acute anxiety, health teaching should include instructions to a.report drowsiness. b.eat a tyramine-free diet. c.avoid alcoholic beverages. d.adjust dose and frequency based on anxiety level.

C

Which agency provides coordination in the event of a terrorist attack? a.Food and Drug Administration (FDA) b.Environmental Protection Agency (EPA) c.National Incident Management System (NIMS) d.Federal Emergency Management Agency (FEMA)

C

Which characteristic of personality disorders makes it most necessary for staff to schedule frequent team meetings in order to address the patient's needs and maintain a therapeutic milieu? a.Ability to achieve true intimacy b.Flexibility and adaptability to stress c.Ability to provoke interpersonal conflict d.Inability to develop trusting relationships

C

Which clinical scenario predicts the highest risk for directing violent behavior toward others? a.Major depressive disorder with delusions of worthlessness b.Obsessive-compulsive disorder; performs many rituals c.Paranoid delusions of being followed by alien monsters d.Completed alcohol withdrawal; beginning a rehabilitation program

C

Which medication from the medication administration record should a nurse administer to provide immediate intervention for a psychotic patient whose aggressive behavior continues to escalate despite verbalintervention? a.Lithium b.Trazodone c.Olanzapine d.Valproic acid

C

Which of the following provides the best explanation as to why people do not immediately seek medical treatment when they first become ill with HIV? a.They are afraid to get tested for fear results will be positive. b.They avoid the problem (maybe it will go away). c.They don't recognize their symptoms as possibly being due to HIV. d.It is too expensive to get an HIV test.

C

Which of the following sexually transmitted diseases can be prevented through immunization? a.Chlamydia b.Gonorrhea c.Hepatitis B d.Herpes

C

Which referral will be most helpful for a woman who was severely beaten by intimate partner, has no relatives or friends in the community, is afraid to return home, and has limited financial resources? a.A support group b.A mental health center c.A women's shelter d.Vocational counseling

C

Which statement made by a patient diagnosed with borderline personality disorder indicates the treatment plan is effective? a."I think you are the best nurse on the unit." b."I'm never going to get high on drugs again." c."I felt empty and wanted to hurt myself, so I called you." d."I hate my mother. I called her today, and she wasn't home."

C

A new patient beginning an alcohol rehabilitation program says, "I'm just a social drinker. I usually have one drink at lunch, two in the afternoon, wine at dinner, and a few drinks during the evening." Which responses by the nurse will be most therapeutic? (Select all that apply.) a."I see," and use interested silence. b."I think you are drinking more than you report." c."Social drinkers have one or two drinks, once or twice a week." d."You describe drinking steadily throughout the day and evening." e."Your comments show denial of the seriousness of your problem."

C,D

Which experiences are most likely to precipitate PTSD? (Select all that apply). a.A young adult bungee jumped from a bridge with a best friend. b.An 8-year-old child watched an R-rated movie with both parents. c.An adolescent was kidnapped and held for 2 years in the home of a sexual predator. d.A passenger was in a bus that overturned on a sharp curve and tumbled down an embankment. e.An adult was trapped for 3 hours at an angle in an elevator after a portion of the supporting cable breaks.

C,D,E

What assessment tool for substance use disorders is described below: · Review the categories for this assessment tool · There are actual questions in each box to assist in the assessment o 1)Nausea & Vomiting o 2)Tactile Disturbance o 3)Tremor o 4)Auditory Disturbances o 5)Paroxysmal Sweats o 6)Visual Disturbances o 7)Anxiety - "Do you feel nervous?" o 8)Headache, Fullness in head o 9)Agitation o 10)Orientation; Clouding of Sensorium - "What day is this? Where are you? Who am I?"

CIWA-Ar (clinical institute withdrawal assessment for alcohol, revised)

what assessment tool do we use to assess opioid withdrawal?

COWS (clinical opiate withdrawal scale)

What is the primary treatment of gonorrhea?

Ceftriaxone (Rocephin) 250mg IM x 1 dose

What drug is a benzo used in alcohol detox protocols? *older medications: "old fashioned Librium" **alcohol withdrawal

Chlordiazepoxide

What 1st generation antipsychotic drug is used for violent patients and you need to keep in mind the EPS side effects and it is SEDATING effefts?

Chlorpromazine

what medication to treat PTSD is described below: addresses hyperarousal & intrusive symptoms

Clonidine (Catapres)

For a patient experiencing panic, which nursing intervention should be implemented first? a.Teach relaxation techniques. b.Administer an anxiolytic medication. c.Prepare to implement physical controls. d.Provide calm, brief, directive communication.

D

22. A soldier returned home last year after deployment to a war zone. The soldier's spouse complains, "We were going to start a family, but now he won't talk about it. He will not look at children. I wonder if we're going to make it as a couple." Select the nurse's best response. a."Posttraumatic stress disorder (PTSD) often changes a person's sexual functioning." b."I encourage you to continue to participate in social activities where children are present." c."Have you talked with your spouse about these reactions? Sometimes we just need to confront behavior." d."Posttraumatic stress disorder often strains relationships. Here are some community resources for help and support."

D

A child drowned while swimming in a local lake 2 years ago. Which behavior indicates the child's parents have adapted to their loss? The parents a.visit their child's grave daily. b.maintain their child's room as the child left it 2 years ago. c.keep a place set for the dead child at the family dinner table. d.throw flowers on the lake at each anniversary date of the accident.

D

A client is being treated for secondary syphilis. Which of the following signs and symptoms would the nurse anticipate the client would exhibit? a.Chancre at the site of entry b.Jaundice c.Difficulty coordinating muscle movements d.Skin rash without itching

D

A client was clearly very relieved when an HIV test came back negative. "Thank goodness. I've had sex several times without a condom, and when one of my friends said he was sick, I think I panicked." Which of the following would be most important to emphasize to the client immediately? a.Abstinence is the only way to be certain you are HIV-free. b.Sex should be restricted to one partner. c.The test could be wrong and the client might still have an HIV infection. d.The test would not cover any recent infection, so if the client has had recent unprotected sex, the test should be repeated in 3 months.

D

A client who is very upset says to the nurse, "But we always used a condom! How could I have genital warts?" Which of the following would be the best response by the nurse? a."Are you positive you always used a condom?" b."Condoms don't always work." c."The condom might have had a tear in the latex." d."Skin to skin contact to a wart may have occurred outside the area that the condom covers."

D

A health care provider recently convicted of Medicare fraud says to a nurse, "Sure I overbilled. Everyone takes advantage of the government. There are too many rules to follow and I deserve the money." These statements show a.shame. b.suspiciousness. c.superficial remorse. d.lack of guilt feelings.

D

A high school student is planning to volunteer at the hospital after school, so she needs to have a Mantoux test before beginning. Which of the following information should the nurse provide to the new volunteer? a."I will be using tiny tines to administer the TB antigen to the skin on your arm." b."Notify the clinic immediately if you experience any redness or itching at the test site." c."The areas should be kept dry until you return; cover it with plastic wrap when bathing." d."You will need to return in 2 to 3 days to have any reaction interpreted."

D

A nurse assesses a patient with a tentative diagnosis of generalized anxiety disorder. Which question would be most appropriate for the nurse to ask? a."Have you been a victim of a crime or seen someone badly injured or killed?" b."Do you feel especially uncomfortable in social situations involving people?" c."Do you repeatedly do certain things over and over again?" d."Do you find it difficult to control your worrying?"

D

A nurse determines desired outcomes for a patient diagnosed with schizotypal personality disorder. Select the best outcome. The patient will a.adhere willingly to unit norms. b.report decreased incidence of self-mutilative thoughts. c.demonstrate fewer attempts at splitting or manipulating staff. d.demonstrate ability to introduce self to a stranger in a social situation.

D

A nurse finds a patient diagnosed with anorexia nervosa vigorously exercising before gaining the agreed-upon weekly weight. Which response by the nurse is appropriate? a."You and I will have to sit down and discuss this problem." b."It bothers me to see you exercising. I am afraid you will lose more weight." c."Let's discuss the relationship between exercise, weight loss, and the effects on your body." d."According to our agreement, no exercising is permitted until you have gained a specific amount of weight."

D

A nurse was reading PPD tests 24 hours after another nurse had administered them. Which of the following findings would cause the nurse to interpret the test as positive? a.15 mm of erythema in a client with HIV infection b.5 mm of induration in an immigrant from a country where TB is endemic c.A 5-mm ruptured pustule with purulent drainage in a homeless client d.10 mm of swelling and increased firmness in a client recently released from a correctional facility

D

A nursing diagnosis for a patient diagnosed with bulimia nervosa is Ineffective coping related to feelings of loneliness as evidenced by overeating to comfort self, followed by self-induced vomiting. The best outcome related to this diagnosis is that within 2 weeks the patient will a.appropriately express angry feelings. b.verbalize two positive things about self. c.verbalize the importance of eating a balanced diet. d.identify two alternative methods of coping with loneliness.

D

A patient admitted yesterday for injuries sustained while intoxicated believes insects are crawling on the bed. The patient is anxious, agitated, and diaphoretic. What is the priority nursing diagnosis? a.Disturbed sensory perception b.Ineffective coping c.Ineffective denial d.Risk for injury

D

A patient being admitted to the eating-disorder unit has a yellow cast to the skin and fine, downy hair over the trunk. The patient weighs 70 pounds; height is 5'4". The patient says, "I won't eat until I look thin." Select the priority initial nursing diagnosis. a.Anxiety related to fear of weight gain b.Disturbed body image related to weight loss c.Ineffective coping related to lack of conflict resolution skills d.Imbalanced nutrition: less than body requirements related to self-starvation

D

A patient checks and rechecks electrical cords related to an obsessive thought that the house may burn down. The nurse and patient explore the likelihood of an actual fire. The patient states this event is not likely. This counseling demonstrates principles of a.flooding. b.desensitization. c.relaxation technique. d.cognitive restructuring.

D

With cluster C obsessive-compulsive personality disorder, treatment includes ______ or _____ for obsessions, anxiety, or depression.

clomipramine; fluoxetine

A patient diagnosed with alcohol use disorder says, "Drinking helps me cope with being a single parent." Which therapeutic response by the nurse would help the patient conceptualize the drinking objectively? a."Sooner or later, alcohol will kill you. Then what will happen to your children?" b."I hear a lot of defensiveness in your voice. Do you really believe this?" c."If you were coping so well, why were you hospitalized again?" d."Tell me what happened the last time you drank."

D

A patient diagnosed with an antisocial personality disorder was treated several times for substance abuse, but each time the patient relapsed. Which treatment approach is most appropriate? a.1-week detoxification program b.Long-term outpatient therapy c.12-step self-help program d.Residential program

D

A patient diagnosed with borderline personality disorder self-inflicted wrist lacerations after gaining new privileges on the unit. In this case, the self-mutilation may have been due to a.an inherited disorder that manifests itself as an incapacity to tolerate stress. b.use of projective identification and splitting to bring anxiety to manageable levels. c.a constitutional inability to regulate affect, predisposing to psychic disorganization. d.fear of abandonment associated with progress toward autonomy and independence.

D

A patient is seen in the clinic for superficial cuts on both wrists. Initially the patient paces and sobs but after a few minutes, the patient is calmer. The nurse attempts to determine the patient's perception of the precipitating event byasking: a."Tell me why you were crying." b."How did your wrists get injured?" c."How can I help you feel more comfortable?" d."What was happening when you started feeling this way?"

D

A patient is thin, tense, jittery, and has dilated pupils. The patient says, "My heart is pounding in my chest. I need help." The patient allows vital signs to be taken but then becomes suspicious and says, "You could be trying to kill me." The patient refuses further examination. Abuse of which substance is most likely? a.PCP b.Heroin c.Barbiturates d.Amphetamines

D

A patient sat in silence for 20 minutes after a therapy appointment, appearing tense and vigilant. The patient abruptly stood, paced back and forth, clenched and unclenched fists, and then stopped and stared in the face of a staff member. The patient is a.demonstrating withdrawal. b.working though angry feelings. c.attempting to use relaxation strategies. d.exhibiting clues to potential aggression.

D

A patient undergoing diagnostic tests says, "Nothing is wrong with me except a stubborn chest cold." The spouse reports the patient smokes, coughs daily, lost 15 pounds, and is easily fatigued. Which defense mechanism is the patient using? a.Displacement b.Regression c.Projection d.Denial

D

A patient was arrested for breaking windows in the home of a former domestic partner. The patient's history also reveals childhood abuse by a punitive parent, torturing family pets, and an arrest for disorderly conduct. Which nursing diagnosis has priority? a.Risk for injury b.Ineffective coping c. Impaired social interaction d. Risk for other-directed violence

D

A patient was diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and lost 25% of body weight. The serum potassium is currently 2.7 mg/dL. Which nursing diagnosis applies? a.Adult failure to thrive related to abuse of laxatives as evidenced by electrolyte imbalances and weight loss b.Disturbed energy field related to physical exertion in excess of energy produced through caloric intake as evidenced by weight loss and hyperkalemia c.Ineffective health maintenance related to self-induced vomiting as evidenced by swollen parotid glands and hyperkalemia d.Imbalanced nutrition: less than body requirements related to reduced oral intake as evidenced by loss of 25% of body weight and hypokalemia

D

A person who feels unattractive repeatedly says, "Although I'm not beautiful, I am smart." This is an example of a.repression. b.devaluation. c.identification. d.compensation.

D

A person who has been unable to leave home for more than a week because of severe anxiety says, "I know it does not make sense, but I just can't bring myself to leave my apartment alone." Which nursing intervention is appropriate? a.Help the person use online video calls to provide interaction with others. b.Advise the person to accept the situation and use a companion. c.Ask the person to explain why the fear is so disabling. d.Teach the person to use positive self-talk techniques.

D

A person's spouse filed charges after repeatedly being battered. The person sarcastically says, "I'm sorry for what I did. I need psychiatric help." Which statement by this person supports an antisocial personality disorder? a."I have a quick temper, but I can usually keep it under control." b."I've done some stupid things in my life, but I've learned a lesson." c."I'm feeling terrible about the way my behavior has hurt my family." d."I hit because I am tired of being nagged. My spouse deserves the beating."

D

A psychiatric clinical nurse specialist uses cognitive-behavioral therapy for a patient diagnosed with anorexia nervosa. Which statement by the staff nurse supports this type of therapy? a."What are your feelings about not eating foods that you prepare?" b."You seem to feel much better about yourself when you eat something." c."It must be difficult to talk about private matters to someone you just met." d."Being thin doesn't seem to solve your problems. You are thin now but still unhappy."

D

A rape victim tells the nurse, "I should not have been out on the street alone." Select the nurse's most therapeutic response. a."Rape can happen anywhere." b."Blaming yourself increases your anxiety and discomfort." c."You are right. You should not have been alone on the street at night." d."You feel as though this would not have happened if you had not been alone."

D

A soldier returned 3 months ago from a combat zone and was diagnosed with PTSD. Which social event would be most disturbing for this soldier? a.Halloween festival with neighborhood children b.Singing carols around a Christmas tree c.A family outing to the seashore d.Fireworks display on July 4th

D

For which behavior would limit setting be most essential? The patient who a.clings to the nurse and asks for advice about inconsequential matters. b.is flirtatious and provocative with staff members of the opposite sex. c.is hypervigilant and refuses to attend unit activities. d.urges a suspicious patient to hit anyone who stares.

D

A store clerk was killed during a robbery 2 weeks ago. His widow, who has a long history of schizoaffective disorder, cries spontaneously when talking about his death. Select the nurse's most therapeutic response. a."Are you taking your medications the way they are prescribed?" b."This loss is harder to accept because of your mental illness. Do you think you should be hospitalized?" c."I'm worried about how much you are crying. Your grief over your husband's death has gone on too long." d."The unexpected death of your husband is very painful. I'm glad you are able to talk about your feelings."

D

A student asks the nurse at the student health clinic how AIDS is diagnosed. Which of the following statements would be the best response by the nurse? a."A diagnosis of AIDS is made when a screening test called an enzyme-linked immunosorbent assay (ELISA) is confirmed by the Western blot test." b."A diagnosis of AIDS is made when antibodies to HIV are detected about 6 weeks to 3 months following possible exposure." c."A diagnosis of AIDS is made when antibodies to HIV reach peak levels of 1000/ml of blood." d."A diagnosis of AIDS is made when CD4 T lymphocytes drop to less than 200/ml."

D

A student falsely accused a college professor of sexual intimidation. The professor tells the nurse, "I cannot teach nor do any research. My mind is totally preoccupied with these false accusations." What is the priority nursing diagnosis? a.Ineffective denial related to threats to professional identity b.Deficient knowledge related to sexual harassment protocols c.Impaired social interaction related to loss of teaching abilities d.Ineffective coping related to distress from false accusations

D

A student says, "Before taking a test, I feel very alert and a little restless." The nurse can correctly assess the student's experience as a.culturally influenced. b.displacement. c.trait anxiety. d.mild anxiety.

D

A troubled adolescent pulled out a gun in a school cafeteria, fatally shot three people and injured many others. Hundreds of parents come to the school after hearing news reports. After police arrest the shooter, which action should occur next? a.Ask police to encircle the school campuswith yellow tape to prevent parents from entering. b.Announce over the loudspeakers, "The campus is now secure. Please return to your classrooms." c.Require parents to pass through metal detectors and then allow them to look for their children in the school. d.Designate zones according to the alphabet and direct students to the zones based on their surnames to facilitate reuniting them with their parents.

D

A woman said, "I can't take anymore! Last year my husband had an affair and now we don't communicate. Three months ago, I found a lump in my breast. Yesterday my daughter said she's quitting college." What is the nurse'spriority assessment? a.Identify measures useful to help improve the couple's communication. b.The patient's feelings about the possibilityof having a mastectomy c.Whether the husband is still engaged in anextramarital affair d.Clarify what the patient means by "I can't take anymore."

D

A woman says, "I can't take anymore. Last year my husband had an affair and now we do not communicate. Three months ago, I found a lump in my breast. Yesterday my daughter said she's quitting college and moving in with her boyfriend." Which issue should the nurse focus on during crisis intervention? a.The possible mastectomy b.The disordered family communication c.The effects of the husband's extramaritalaffair d.Coping with the reaction to the daughter's events

D

A woman was found confused and disoriented after being abducted and raped at gunpoint by an unknown assailant. The emergency department nurse makes these observations about the woman: talking rapidly in disjointed phrases, unable to concentrate, indecisive when asked to make simple decisions. What is the woman's level of anxiety? a.Weak b.Mild c.Moderate d.Severe

D

A young adult has recently had multiple absences from work. After each absence, this adult returned to work wearing dark glasses and long-sleeved shirts. During an interview with the occupational health nurse, this adult says, "My partner beat me, but it was because I did not do the laundry." What is the nurse's next action? a.Call the police. b.Arrange for hospitalization. c.Call the adult protective agency. d.Document injuries with a body map.

D

An adult has recently been absent from work for 3-day periods on several occasions. Each time, the individual returned wearing dark glasses. Facial and body bruises were apparent. What is occupational health nurse's priorityassessment? a.Interpersonal relationships b.Work responsibilities c.Socialization skills d.Physical injuries

D

An adult seeks counseling after the spouse was murdered. The adult angrily says, "I hate the beast that did this. It has ruined my life. During the trial, I don't know what I'll do if the jury doesn't return a guilty verdict." What is the nurse's highest priority response? a."Would you like to talk to a psychiatristabout some medication to help you cope during the trial?" b."What resources do you need to help youcope with this situation?" c."Do you have enough support from your family and friends?" d."Are you having thoughts of hurting yourself or others?"

D

An emergency code was called after a patient pulled a knife from a pocket and threatened, "I will kill anyone who tries to get near me." The patient was safely disarmed and placed in seclusion. Justification for use of seclusion was that the patient a.was threatening to others. b.was experiencing psychosis. c.presented an undeniable escape risk. d.presented a clear and present danger to others.

D

Before a victim of sexual assault is discharged from the emergency department, the nurse should a.notify the victim's family to provide emotional support. b.offer to stay with the patient until stability is regained. c.advise the patient to try not to think about the assault. d.provide referral information verbally and In writing.

D

Disturbed body image is a nursing diagnosis established for a patient diagnosed with an eating disorder. Which outcome indicator is most appropriate to monitor? a.Weight, muscle, and fat congruence with height, frame, age, and sex b.Calorie intake is within required parameters of treatment plan c.Weight reaches established normal range for the patient d.Patient expresses satisfaction with body appearance

D

Family members of an individual undergoing a residential alcohol rehabilitation program ask, "How can we help?" Select the nurse's best response. a."Alcoholism is a lifelong disease. Relapses are expected." b."Use search and destroy tactics to keep the home alcohol free." c."It's important that you visit your family member on a regular basis." d."Make your loved one responsible for the consequences of behavior."

D

Four teenagers died in an automobile accident. One week later, which behavior by the parents of these teenagers most clearly demonstrates resilience? The parents who a.visit their teenager's grave daily. b.return immediately to employment. c.discuss the accident within the family only. d.create a scholarship fund at their child's high school.

D

Outpatient treatment is planned for a patient diagnosed with anorexia nervosa. Select the most important desired outcome related to the nursing diagnosis Imbalanced nutrition: less than body requirements. Within 1 week, the patient will a.weigh self accurately using balanced scales. b.limit exercise to less than 2 hours daily. c.select clothing that fits properly. d.gain 1 to 2 pounds.

D

Select the correct etiology to complete this nursing diagnosis for a patient diagnosed with dissociative identity disorder. Disturbed personal identity related to a.obsessive fears of harming self or others. b.poor impulse control and lack of self-confidence. c.depressed mood secondary to nightmares and intrusive thoughts. d.cognitive distortions associated with unresolved childhood abuse issues.

D

The correctional health nurse is doing a quick assessment on a newly admitted inmate who is HIV positive. Which of the following diseases should the inmate receive screening for immediately? a.Herpes zoster b.Hepatitis B c.Hepatitis C d.Tuberculosis

D

The nurse at a university health center leads a dialogue with female freshmen about rape and sexual assault. One student says, "If I avoid strangers or situations where I am alone outside at night, I'll be safe from sexual attacks." Choose the nurse's best response. a."Your plan is not adequate. You could still be raped or sexually assaulted." b."I am glad you have this excellent safety plan. Would others like to comment?" c."It's better to walk with someone or call security when you enter or leave a building." d."Sexual assaults are more often perpetrated by acquaintances. Let's discuss ways to prevent that."

D

The nurse caring for an individual demonstrating symptoms of schizotypal personality disorder would expect assessment findings to include a.arrogant, grandiose, and a sense of self-importance. b.attention seeking, melodramatic, and flirtatious. c.impulsive, restless, socially aggressive behavior. d.socially anxious, rambling stories, peculiar ideas.

D

The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention "monitor for complications of refeeding." Which system should a nurse closely monitor for dysfunction? a.Renal b.Endocrine c.Integumentary d.Cardiovascular

D

When preparing to interview a patient diagnosed with narcissistic personality disorder, a nurse can anticipate the assessment findings will include a.preoccupation with minute details; perfectionist. b.charm, drama, seductiveness; seeking admiration. c.difficulty being alone; indecisive, submissiveness. d.grandiosity, self-importance, and a sense of entitlement.

D

Which assessment finding for a patient diagnosed with an eating disorder meets criteria for hospitalization? a.Urine output 40 mL/hour b.Pulse rate 58 beats/min c.Serum potassium 3.4 mEq/L d.Systolic blood pressure 62 mm Hg

D

Which assessment findings are likely for an individual who recently injected heroin? a.Anxiety, restlessness, paranoid delusions b.Muscle aching, dilated pupils, tachycardia c.Heightened sexuality, insomnia, euphoria d.Drowsiness, constricted pupils, slurred speech

D

Which goal for treatment of alcohol use disorder should the nurse address first? a.Learn about addiction and recovery. b.Develop alternate coping strategies. c.Develop a peer support system. d.Achieve physiological stability.

D

Which medication to maintain abstinence would most likely be prescribed for patients with an addiction to either alcohol or opioids? a.Bromocriptine b.Methadone c.Disulfiram d.Naltrexone

D

Which nursing diagnosis is more appropriate for a patient diagnosed with anorexia nervosa who restricts intake and is 20% below normal weight than for a 130- pound patient diagnosed with bulimia nervosa who purges? a.Powerlessness b.Ineffective coping c.Disturbed body image d.Imbalanced nutrition: less than body requirements

D

Which of the following statements best explains why many health care providers are more afraid of getting hepatitis B than HIV? a.Everyone would assume the person infected with hepatitis B is a drug user. b.Having HBV would mean no further employment in health care. c.The fatality rate is higher and occurs sooner with HBV. d.There is no treatment for HBV, which can be a very serious illness.

D

Which scenario is an example of a situational crisis? a.The death of a child from sudden infant death syndrome b. Development of a heroin addiction c. Retirement of a 55-year-old person d. A riot at a rock concert

D

the nursing diagnosis Rape-trauma syndrome applies to a rape victim in the emergency department. Select the most appropriate outcome to achieve before discharging the patient. a.The memory of the rape will be less vivid and less frightening. b.The patient is able to describe feelings of safety and relaxation. c.Symptoms of pain, discomfort, and anxiety are no longer present. d.The patient agrees to a follow-up appointment with a rape victim advocate.

D

What medications for withdrawal of substance use disorders is described below: · Interferes with alcohol degradation, resulting in flushing, INTENSE NAUSEA AND VOMITING, palpitations if patients use alcohol ● Teaching: no alcohol of any kind; includes cold medication, cough syrup, mouthwash, recently read - vanilla extract ○ If they have past noncompliance or are likely not to comply, bad idea to give this medication ● REACTION CAN BE SEVERE ENOUGH TO END UP IN ER

Disulfiram/Antabuse

Interventions for bulimia nervosa includes cognitive behavioral approach PLUS antidepressant medications to improve symptoms. What drug has FDA approval for BOTH acute and maintenance treatment of this eating disorder? NEED TO KNOW.

Fluoxetine

The following is the DSM-5 Criteria for ______: A. excessive anxiety and worry occurring more days than not for at least 6 months about a number of events or activities B. finds it difficult to control the worry o HALLMARK symptom of _______ C. anxiety and worry associated with 3 or more of the following: o 1. Restlessness/feelings keyed up or on edge o 2. Easily fatigued o 3. Difficulty concentrating/mind going blank o 4. Irritability o 5. Muscle tension o 6. Sleep disturbance D. anxiety, worry, physical symptoms cause significant distress or impairment in functioning E. not attributable to a substance F. not better explained by another mental disorder

GAD (generalized anxiety disorder)

what anxiety disorder is described below: ● Family members and friends become overtaxed; person seeks continual reassurance and perseverates about meaningless details ● Parental overprotection and adverse experiences sociation with anxiety disorders ● Sleep disturbance common, fatigue ● Genetics account for ⅓ of diagnoses Often comorbid with major depressive disorder; other anxiety disorders frequently accompany

GAD (generalized anxiety disorder)

what anxiety disorder is described below: ● Huge amounts of time spent preparing for activities ● PUTTING THINGS OFF AND AVOIDANCE= KEY SYMPTOMS; result in lateness/absence from school or employment; overall social isolation, avoidance ● Interfere with daily life and relationships ○ Common worry = inadequacy in interpersonal relationships, job responsibilities, finances, health of family members

GAD (generalized anxiety disorder)

what anxiety disorder is described below: ● KEY PATHOLOGICAL FEATURE= EXCESSIVE WORRY ● Chronic and excessive worry / anxiety on more days than not for at least 6 months, encompassing many aspects of a person's life ● Out of proportion to true impact of events or situations

GAD (generalized anxiety disorder)

what anxiety disorder is described below: ● KEY PATHOLOGICAL FEATURE= EXCESSIVE WORRY ● Chronic and excessive worry / anxiety on more days than not for at least 6 months, encompassing many aspects of a person's life ● Out of proportion to true impact of events or situations ● Interfere with daily life and relationships ○ Common worry = inadequacy in interpersonal relationships, job responsibilities, finances, health of family members ● Huge amounts of time spent preparing for activities ● PUTTING THINGS OFF AND AVOIDANCE= KEY SYMPTOMS; result in lateness/absence from school or employment; overall social isolation, avoidance ● Family members and friends become overtaxed; person seeks continual reassurance and perseverates about meaningless details ● Parental overprotection and adverse experiences sociation with anxiety disorders ● Sleep disturbance common, fatigue ● Genetics account for ⅓ of diagnoses Often comorbid with major depressive disorder; other anxiety disorders frequently accompany

GAD (generalized anxiety disorder)

Treatment _______ for HIV includes: ● Common medications: ○ AZT (zidovudine) Retrovir ○ Protease inhibitors ○ ________ (highly active antiretroviral therapy) ○ Utilization of these medications the fatality rate dropped from 90% to 5% in the US with these medications as well as the treatment of your secondary infections and tumors decreased. ■ Fatality rate dropped ■ Secondary treatment of infections and tumors - this is the reason of death usually

HAART

What disease is caused by a retrovirus which is any of a group of viruses that carry their genetic blueprint in the form of ribonucleic acid (RNA) ■ This makes it Difficult to treat because it carries a double strand of RNA carrying its own blueprints*******

HIV

What disease is described below: ● Caused by a retrovirus ○ Any of a group of viruses that carry their genetic blueprint in the form of ribonucleic acid (RNA) ■ This makes it Difficult to treat because it carries a double strand of RNA carrying its own blueprints***** ○ Responsible for certain cancers and slow virus infections of animals and cause at least one type of human cancer ○ Identified as the cause of AIDS (acquired immune deficiency) ○ Infects and replicates in human lymphocytes and macrophages ● Diagnosis: Dx by an HIV antibody test and confirmed with a more specific test ● Confirmed by a more specific test ● Highly active antiretroviral therapy (HAART) depends on clinical stage ○ Therapies can have big side effects - ART

HIV

the following are modes of transmission for _____: 1. sexual contact, involving the exchange of body fluids, with an infected person 2. sharing or reusing needles, syringes, or other equipment used to prepare injectable durgs 3. perinatal transmission from an infected mother to her fetus during pregnancy or delivery to an infant when breastfeeding 4. transfusions or other exposure to HIV-contaminated blood or blood products, organs, or semen

HIV

● Disease of the immune system ● Incurable ● Chronic ● Retroviral infection ● Results in immunosuppression

HIV

The following is explaining the ____ ____ _____: ○ Rapid tests - used primarily ■ Provides test results within 1 hour and uses blood or saliva for testing ○ Detects antibodies to HIV ○ Enzyme link immunosorbant assay (ELISA) ■ Detects antibody to HIV ○ Western Blot ■ Confirmatory test ■ Window phase: (6 weeks) ● False negative; actually positive, but body hasn't produced antibody yet so it goes undetected ○ It is when a patient may have a false negative because the virus is present but antibodies are not detected yet by the test. ● Do test after 6 weeks of exposure then 6 months ○ If negative at 6 months then you're truly negative

HIV antibody test

· Vaccine HOPE · Began trials for this in 2017 and it is still in the work but hopefully within the next few years we will have a vaccine developed for HIV

HIV vaccine

What STI is described below: ● Incubation: 4-6 weeks, can be up to 9 months ● Viral; transmitted via skin to skin contact (condoms may not prevent spread) ○ Prevention methods such as a condom may not protect an individual from getting _______

HPV (human papilloma virus)

What STI is described below: ● Incubation: 4-6 weeks, can be up to 9 months ● Viral; transmitted via skin to skin contact (condoms may not prevent spread) ○ Prevention methods such as a condom may not protect an individual from getting _______ ● Usually presents as a painless lesion (cauliflower-like appearance--> elevated growth and texture of lesion) near vaginal opening, anus, shaft of the penis, or cervix; raised/textured, size can vary (1mm-5mm in diameter), colorations can vary depending on site, can have several or just one ● _____ on the cervix can cause cervical cancer in females ● Treatment: ○ No absolute cure! ○ Most will resolve without topical treatments ○ Imiquimod (3.75% or 5% cream) ○ Other treatments → cryotherapy (liquid nitrogen), laser treatment, and even surgical removal of the warts

HPV (human papilloma virus)

What STI is described below: ● Treatment: ○ No absolute cure! ○ Most will resolve without topical treatments ○ Imiquimod (3.75% or 5% cream) ○ Other treatments → cryotherapy (liquid nitrogen), laser treatment, and even surgical removal of the warts

HPV (human papilloma virus)

What STI is described below: ● Usually presents as a painless lesion (cauliflower-like appearance--> elevated growth and texture of lesion) near vaginal opening, anus, shaft of the penis, or cervix; raised/textured, size can vary (1mm-5mm in diameter), colorations can vary depending on site, can have several or just one ● _____ on the cervix can cause cervical cancer in females

HPV (human papilloma virus)

What 1st generation antipsychotic drug is used for violent patients and you need to keep in mind the EPS side effects? **MOST WIDELY USED 1st generation antipsychotic drug!!!

Haloperidol

any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his/her arms, legs, body, or head freely

restraint

With alcohol-induced persisting amnestic disorder, we have Wernicke's encephalopathy and Korsakoff's syndrome. Which one is described below: ● chronic memory disorder caused by thiamine deficiency****** ○ Recovery rate of only 20% treatment (thiamine 3-12 months). Most never recover ■ Cognitive improvement with nutritional support ○ Blackouts: excessive consumption of alcohol followed by episodes of amnesia ■ Person actively engages and can perform complicated tasks ■ Alcohol can block consolidation of new memories

Korsakoff's syndrome

What drug has been approved for binge eating disorder but is NOT the 1st line treatment? **Antidepressant better to try 1st due to more tolerable adverse effects and no risk of abuse

Lisdexamfetamine dimesylate (Vyvanse)

What is the drug of choice in the benzo class for violent patients?

Lorazepam (Ativan)

The following is talking about ______ HIV epidemic: ● Impact on _______ public health ● 2015: 1,139 persons diagnosed with HIV (24.4 per 100,000) ● 2014: ranked 2nd for HIV and 2nd for AIDS

Louisiana

what medication to treat PTSD is described below: ○ phenelzine (Nardil) ○ Has been used with some success with PTSD

MAOIs

What are the 3 types of crisis?

Maturational Situational Adventitious

T or F. Physical holding of patient against will is a restraint

T

**Rate of personality's change slows over time but does ________ cease!! Opportunity to develop more adaptive functioning! Able to make some changes, should entice us to work with these patients

NOT

For binge eating disorder, these individuals do _______ use compensatory behaviors such as vomiting and laxatives as seen with bulimia nervosa.

NOT

What general treatment for opioid use disorders is described below: ● indicated for relapse prevention following opioid detoxification ○ Side effects: weakness, tiredness, insomnia, increased thirst, anxiety, nervousness, restlessness, irritability, lightheadedness, fainting, muscle or joint aches, decreased sex drive, impotence

Naltrexone

What medications for withdrawal of substance use disorders is described below: decreases pleasurable feelings & cravings

Naltrexone

· Conducted by SAMHSA annually · More than 21 million - about 9% of US population has substance use disorder

National Survey on Drug Use and Health Survey

What bacteria causes gonorrhea?

Neisseria gonorrhoeae

What disorder is described below: ● DSM-5= levels of insight ○ Good or fair: aware that house will probably not burn down if stove is not checked 30 times before they leave the house ○ Poor: house will probably burn down if stove is not checked 30 times ○ Absent/delusional beliefs: convinced the house will burn down if stove is not checked 30 times

OCD (obsessive compulsive disorder)

What disorder is described below: ● Obsession: thoughts, images, or impulses that persist or recur so they cannot be dismissed from the mind, even though the person attempts to do so; INTRUSIVE AND UNWANTED; person attempts to ignore/suppress or to neutralize with other thoughts or actions—DSM-5 ● Compulsion: ritualistic behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly ○ Behaviors aimed at preventing or reducing anxiety; clearly excessive EX: patient wiggles while going through door, turning doorknob over and over to make sure it's locked

OCD (obsessive compulsive disorder)

What disorder is described below: ● Recurrent obsessions or compulsions that are time consuming (more than one hour per day) and cause significant impairment or distress. OCD may involve issues of sexuality, violence, contamination, illness, death. ● Sexual and physical abuse in childhood or trauma increases risk. Onset after 35 is rare. ● Comorbid Disorder: Postinfectious autoimmune syndrome

OCD (obsessive compulsive disorder)

What disorder is described below: ● Recurrent obsessions or compulsions that are time consuming (more than one hour per day) and cause significant impairment or distress. OCD may involve issues of sexuality, violence, contamination, illness, death. ● Sexual and physical abuse in childhood or trauma increases risk. Onset after 35 is rare. ● Comorbid Disorder: Postinfectious autoimmune syndrome ● Obsession: thoughts, images, or impulses that persist or recur so they cannot be dismissed from the mind, even though the person attempts to do so; INTRUSIVE AND UNWANTED; person attempts to ignore/suppress or to neutralize with other thoughts or actions—DSM-5 ● Compulsion: ritualistic behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly ○ Behaviors aimed at preventing or reducing anxiety; clearly excessive EX: patient wiggles while going through door, turning doorknob over and over to make sure it's locked ● DSM-5= levels of insight ○ Good or fair: aware that house will probably not burn down if stove is not checked 30 times before they leave the house ○ Poor: house will probably burn down if stove is not checked 30 times ○ Absent/delusional beliefs: convinced the house will burn down if stove is not checked 30 times

OCD (obsessive compulsive disorder)

What is the treatment for pediculosis pubis or crabs?

Permethrin ■ 1% lotion (OTC), 5% cream (Rx) ■ Not ovicidal (Won't kill the eggs), will have to repeat tx

what medication to treat PTSD is described below: used for nightmares and sleep disturbances

Prazosin (minipress)

what medication to treat PTSD is described below: ● beta blocker for hyperarousal & panic ○ **Most difficult side effect - hypotension

Propranolol (Inderal)

○ RNs with specialized training in caring for sexual assault patients ○ Demonstrated competency in conduction medical and legal evaluation ○ Ability to be an expert witness in court

SANEs (sexual assault nurse examiners)

What pharmacological intervention for anxiety disorders are described below: Venlafaxine Duloxetine

SNRIs

what medication to treat PTSD is described below: ○ Venlafaxine (Effexor) ○ Used to decrease anxiety and depressive symptoms

SNRIs

What pharmacological intervention for anxiety disorders are described below: are 1st line --Paroxetine - more calming than others --Escitalopram --Fluvoxamine --Fluoxetine and Sertraline - may increase anxiety initially

SSRIs

what medication to treat PTSD is described below: ○ Sertraline (Zoloft) and paroxetine (Paxil) approved - all other drugs are OFF LABEL according to FDA ○ Therapeutic effect - 4-6 weeks ○ Can be used to treat PTSD

SSRIs

● an infection acquired by having sexual contact with another who is infected and can be acquired either by intercourse, oral, or other sexual activity

STI

What Scheduled drug category (1-5) is described below: ○ Schedule II - high potential for abuse; considered dangerous; available only by prescription ■ Methadone ■ Meperidine- Demerol ■ ****Methylphenidate- Ritalin****

Schedule 2

T or F. Pre-exposure prophylaxis (PEP) shows beneficial in certain populations. It took 2 medications and used prophalactically to reduce the rates of HIV in your high risk populations and it did show reduction. However, when we look at PEP, we must ensure the effectiveness of their complicance because if they are not taking on a regular basis then it si not going to be effective and protect them.

T

T or F. Rapid HIV testing must be confirmed with a second screening test before HARRT can begin - draw blood, results will take 2 weeks

T

what substance use disorder is described below: BIG Category ● Includes many drugs such as: ○ Benzodiazepines ■ Dangerous detox → seizures ■ Detox should not be done alone or at home ○ Benzodiazepine-like drugs (zolpidem, zaleplon) ○ Carbamates ○ Barbiturates (secobarbital) ○ Barbiturate-like hypnotics (methaqualone) ○ Prescription sleeping meds ○ Almost all prescription anti anxiety drugs and prescription sleeping meds

Sedative, Hypnotic and Antianxiety Medication Use Disorder

what substance use disorder is described below: BIG Category ● Includes many drugs such as: ○ Benzodiazepines ■ Dangerous detox → seizures ■ Detox should not be done alone or at home ○ Benzodiazepine-like drugs (zolpidem, zaleplon) ○ Carbamates ○ Barbiturates (secobarbital) ○ Barbiturate-like hypnotics (methaqualone) ○ Prescription sleeping meds ○ Almost all prescription anti anxiety drugs and prescription sleeping meds ● CRAVING is a typical feature ● More seen in males: highest among 18 - 29 year olds, lowest among > 65 ● Intoxication - slurred speech, incoordination, unsteady gait, nystagmus, impaired thinking. ○ Side effect: inappropriate aggression and sexual behavior, mood fluctuation, impaired judgement ● Coma is a possibility ● *********Overdose treatment: gastric lavage, activated charcoal, careful Vital sign monitoring****NEED TO KNOW****** ○ Patients that are awake after OD should be kept awake to prevent loss of consciousness ○ If unconscious, start an IV ○ May need endotracheal tube and mechanical ventilation (intubation) ● Withdrawal - Symptoms: hyperactivity, tremor, insomnia, psychomotor agitation, anxiety and GRANDMAL SEIZURES ● Withdrawal treatment - GRADUAL REDUCTION of benzo prevents seizures ○ Barbiturate withdrawal - aided by the use of long acting barbiturate phenobarbital ○******* Should NOT be detoxing from benzodiazepines at home with no guidance*****NEED TO KNOW********

Sedative, Hypnotic and Antianxiety Medication Use Disorder

what substance use disorder is described below: ● CRAVING is a typical feature ● More seen in males: highest among 18 - 29 year olds, lowest among > 65 ● Intoxication - slurred speech, incoordination, unsteady gait, nystagmus, impaired thinking. ○ Side effect: inappropriate aggression and sexual behavior, mood fluctuation, impaired judgement

Sedative, Hypnotic and Antianxiety Medication Use Disorder

what substance use disorder is described below: ● Coma is a possibility ● *********Overdose treatment: gastric lavage, activated charcoal, careful Vital sign monitoring****NEED TO KNOW****** ○ Patients that are awake after OD should be kept awake to prevent loss of consciousness ○ If unconscious, start an IV ○ May need endotracheal tube and mechanical ventilation (intubation)

Sedative, Hypnotic and Antianxiety Medication Use Disorder

what substance use disorder is described below: ● Withdrawal - Symptoms: hyperactivity, tremor, insomnia, psychomotor agitation, anxiety and GRANDMAL SEIZURES ● Withdrawal treatment - GRADUAL REDUCTION of benzo prevents seizures ○ Barbiturate withdrawal - aided by the use of long acting barbiturate phenobarbital ○******* Should NOT be detoxing from benzodiazepines at home with no guidance*****NEED TO KNOW********

Sedative, Hypnotic and Antianxiety Medication Use Disorder

T or F. Reminder: the RN can initiate 1:1—do according to agency policy. If the patient is displaying anger and agression and other interventions have not worked, 1 to 1 can occur according to agency policy.

T

T or F. The Joint Commission requires staff education in family violence and abuse

T

T or F. The nurse is often the 1st point of contact for people experiencing abuse

T

T or F. The presence of chronic anxiety disorders may increase the rate of cardiovascular system related deaths. Anxiety disorders are persistent and often diableling

T

T or F. There is no specific medication used for treatment of cluster B histrionic personality disorder.

T

T or F. ***patients who differ from majority culture may be at risk for overdiagnosis (for example some cultures—females may seem dependent—but in their culture, they are functioning normally within their culture)

T

T or F. **History of violence is single best predictor of future violence!!!!!! STATED THIS TWICE IN LECTURE. ABSOLUTELY NEED TO KNOW.

T

T or F. **Rate of personality's change slows over time but does NOT cease!! Opportunity to develop more adaptive functioning! Able to make some changes, should entice us to work with these patients NEED TO KNOW THIS.

T

T or F. 1.2 million people in US are living with HIV. Also, 1 in 8 do not know that they have it ○ 44% of those that are unaware are between the ages of 13 and 24

T

T or F. An individual is a carrier of genital herpes and they may be asymptomatic because remember you will have episodic outbreaks. They will always be a chronic carrier of infection meaning that it will NEVER go away. ● Herpes zoster is NOT a chronic carrier.

T

T or F. Antiretroviral therapy (ART) is recommended for all HIV infected individuals regardless of CD4 T lymphocyte cell count to reduce the morbidity and mortality associated with HIV infection. ART is also recommended for HIV-infected individuals to take the medicine to prevent HIV transmission

T

T or F. Binge eating disorder is the most COMMON eating disorder.

T

T or F. Coping with a patient's anger is a challenge. Effective nursing intervention becomes more difficult when anger is directed at the nurse or nursing student. Nursing interventions should ideally begin BEFORE anger/aggression becomes a problem.

T

T or F. Crisis is Acute and time limited (4-6 weeks) BOLD AND UNDERLINED IN RED. NEED TO KNOW.

T

T or F. Crisis presents opportunity for personal growth, development of coping skills and positive change BOLD IN NOTES.

T

T or F. Crisis threatens personality organization, but it also presents an opportunity for personal growth

T

T or F. Crisis usually self-limiting and resolves in 4-6 weeks o By definition: a crisis should have this TIME limitation to it

T

T or F. During an assessment of a patient, a successful outcome for a crisis depends on the realistic perception of the event, adequate situational support, and adequate coping mechanisms. We are assessing these 3 components.

T

T or F. For chlamydia, CDC recommends annual sexual screening tests for all sexually active women 25 years old or younger as well in older women with the risk factors for infection. They also recommend us test all pregnant women for chlamydia.

T

T or F. Gay and bisexual, (young black, african american men that are gay and bi) account for most of new HIV dx ○ Are most effective with HIV

T

T or F. Greatest risk for violence is when the woman attempts to leave the relationship ○ this is when she is MOST VULNERABLE to violence

T

T or F. Hepatitis B is a chronic carrier state meaning the individual WILL HAVE IT FOREVER. this is a big difference between hep B and hep A.

T

T or F. If patient escalates -- may need to approach patient in a controlled, nonthreatening, caring manner. State expectations "I expect that you will stay in control." ○ ******If you (the RN) are experiencing fear, you may find this to be a challenge; maintaining a calm exterior requires self-discipline and comes with experience******** ○ Sometimes just have to find things to agree with them on- shows caring

T

T or F. In men, the urethra is the most common site of infection resulting in non-gonococcal urethritis or NGU. Symptoms of NGU include dysuria, urethral discharge, and epidiymitis may be a complication as well. **inflammation of the urethra **symptom in males for chlamydia

T

T or F. Largest number of new HIV infections are in men having sex with men and cases of HIV are more concentrated in urban areas versus rural areas

T

T or F. Mild or moderate anxiety levels can be constructive because anxiety may be a signal that something in a person's life needs attention or is dangerous.

T

T or F. Most reported chlamydia and gonorrhea infections occur among age 15-24

T

T or F. PLEASE NOTE: ****Family violence is common in the childhood histories of juvenile offenders, runaways, violent criminals, prostitutes, and those who are in turn violent toward others. BOLD IN RED IN NOTES. **under vulnerable children as vulnerable person

T

T or F. Personality disorders are among the most challenging and complex group of disorders to treat. A provider in looking at personality disorders should consider ethnic, cultural, and social factors.

T

T or F. Phobias are anticipated and not unexpected; different from a panic attack although some response may be similar in how they manifest themselves VERY IMPORTANT.

T

T or F. Treatment or testing in women may not be solved and may allow the infection to spread and not be detected until pelvic inflammatory disease has occurred. Gonorrhea is the major cause of PID as well as atopic pregnancy and infertility. It can cause an increased risk of acquiring and spreading HIV.

T

T or F. Tucking sheets tightly is considered a restraint ■ Do not resort to this!

T

T or F. Use of 4 side rails is considered a restraint except in seizure precautions; would have to follow policy according to facility you are at

T

T or F. When talking about prevention of HIV, as a nurse you want to promote HIV screening for newly pregnant women. ○ Zidovudine therapy for the mother and a cesarean section have greatly reduced perinatally acquired HIV : this is YUGE ○ It is dangerous when the women do not come in for prenatal visits - sometimes until they are 7 months pregnant

T

T or F. With alcohol use disorder, the patient's treatment should be done under supervision, not done alone, and should have a detox protocol.

T

T or F. With alcohol withdrawal, if a patient is detoxing to the point of psychosis, that is considered a MEDICAL EMERGENCY. ○ Risks of unconsciousness, seizures, delirium ○ Follow detox protocol → benzodiazepines ■ Elevated vital signs may result in a needed extra dose: keep patient comfortable - call provider ■ May go through more than one round of detox

T

T or F. With binge eating disorder, individuals develop new coping skills - have been using food to regulate mood***** NEED TO KNOW. BOLD IN RED IN NOTES.

T

T or F. With cluster B borderline personality disorder, individuals frequently seeks repeat hospitalizations!!!

T

T or F. With counseling, you want to facilitate access to resources; shelters or safe houses → Lafayette has Faith House; offers protection and other pertinent services for victims of violence

T

T or F. With genital herpes (herpes simplex 2), recurrence is common because it will NEVER go away.

T

T or F. With trichomoniasis, it is very important that the client understand that they should avoid sexual intercourse, but when taking the medication to treat this condition they should also AVOID ALCOHOL.

T

T or F. alcohol withdrawal begins as soon as 6-8 hours after alcohol cessation. *assessment: nurse should ask when was their last drink**** VERY IMPORTANT TO KNOW THIS.

T

T or F. anxiety is different from stress.

T

T or F. patients have the right to refuse any parts of the legal medical exam. **sexual assault cases

T

T or F. there are no FDA meds for anorexia nervosa.

T

T or F. you MUST have an order for seclusions and restraints.

T

T or F. ○ Obsessive-compulsive (worsens with age) ■ Not the same thing as obsessive-compulsive disorder which is more of a psychiatric disease and this one is more of a personality disorder which is how a person really is

T

One a patient is in ______, you MUST be very careful to follow protocol ○ Certain observations q 15 (VS, ROM, blood flow to hands and feet, nutrition, hydration, toileting) VERY IMPORTANT.

restraints

what bacteria causes trichomoniasis?

Trichomonas vaginalis

What disorder is described below: ● secretly swallowing the pulled hair ○ Can lead to hair masses or trichobezoar in the GI system ○ Rapunzel syndrome ● Females more affected - ratio of 10:1

Trichophagia

With alcohol-induced persisting amnestic disorder, we have Wernicke's encephalopathy and Korsakoff's syndrome. Which one is described below: ● acute and reversible - altered gait, confusion, ocular abnormalities, sluggish reaction to light and unequal pupil size ○ responds to large doses IV thiamine; may clear up or progress to Korsakoff's syndrome

Wernicke's encephalopathy

What is the goal of crisis? NEED TO KNOW.

return to AT LEAST PRECRISIS level of functioning

An adult patient assaulted another patient and was then restrained. One hour later, which statement by the restrained patient requires the nurse's immediate attention? a."I hate all of you!" b."My fingers are tingly." c."You wait until I tell my lawyer." d."The other patient started the fight."

`B

What trauma and stressor related disorder is described below: ● Nursing diagnosis - Post trauma syndrome (manifestations: alterations in concentration, anger, dissociative amnesia, HA, irritability, nightmares ● Outcomes - attaining mood equilibrium and well-being (anxiety maintained at mild to moderate)

acute stress disorder

The following are the different types of _______: ● Physical abuse ● Sexual abuse ● Emotional abuse ● Neglect ● Economic abuse

abuse

During an assessment of a patient with anorexia nervosa, these patients are HIGH ______ and ______ achievers********. ● Are not necessarily giving their parents trouble in rebellion, they do well in school as well as being athletes. ● What may happen is that the symptoms manifest when there has been a life change such as moving away or something that has been disruptive in their life They are not necessarily causing trouble in the family but can be doing well both athletically and academically

academic; athletic

_______ records include the following: ● Possibility of future legal action: accurate documentation very important 1) Verbatim statements of who caused the injury and when 2) Body map: size, color, shape, descriptions of injuries ○ Use of tool pg. 526 3) Physical evidence of sexual abuse when possible; follow procedures for collection very carefully as this impacts legal action; this requires consent form

accurate

_______ coping mechanisms and skills in a crisis includes: ○ Cultural responses- culture of neighbor helping neighbor ■ here in LA, during hurricanes the neighborhood looks out for each other and helps each other ○ Modeling others - "fall apart" or handle ■ Do children see family fall apart through crisis or see people handle it with skill and calmness?

acquired

_______ coping mechanisms and skills in a crisis includes: ○ Life experiences that have helped in developing **coping** mechanisms ■ EX: if you have gone through previous hurricane, flood, vehicle accident, etc and come out on the other side, the next time one comes there is some coping mechanisms that have been formed. ■ They LEARN through it and develop these coping mechanisms when it may come again OR to transfer to another type of crisis

acquired

_______ coping mechanisms and skills in a crisis includes: ● through variety of sources such as cultural responses, modeling behaviors o others, and life experiences that broaden the experience and promote adaptive development of new coping responses.

acquired

What stage of the cycle of violence is described below: ○ Tension peaks ○ Triggered by external event or abuser's state ○ Victim may cover up what is happening or may start looking for help

acute battering stage

What trauma and stressor related disorder is described below: ● Develops after exposure to highly traumatic event like those listed with PTSD ● Symptoms develop immediately, but a Diagnosis is not made until after symptoms PERSISTED FOR 3 DAYS ● Diagnosis must be made within a month of trauma ● AFTER 1 MONTH- STRESS RESPONSE RESOLVES OR GOES ON TO BECOME PTSD ○ Difference between acute stress and PTSD is time

acute stress disorder

What trauma and stressor related disorder is described below: ● Develops after exposure to highly traumatic event like those listed with PTSD ● Symptoms develop immediately, but a Diagnosis is not made until after symptoms PERSISTED FOR 3 DAYS ● Diagnosis must be made within a month of trauma ● AFTER 1 MONTH- STRESS RESPONSE RESOLVES OR GOES ON TO BECOME PTSD ○ Difference between acute stress and PTSD is time ● Nursing diagnosis - Post trauma syndrome (manifestations: alterations in concentration, anger, dissociative amnesia, HA, irritability, nightmares ● Outcomes - attaining mood equilibrium and well-being (anxiety maintained at mild to moderate) ● Implementation - ○ Promote problem solving ○ Connect person to supports ○ Education about ASD ○ Provide referrals ● Treatment - CBT is effective in reducing development of PTSD for people with ASD ○ Cognitive behavioral therapy **

acute stress disorder

What trauma and stressor related disorder is described below: ● Outcomes - attaining mood equilibrium and well-being (anxiety maintained at mild to moderate) ● Implementation - ○ Promote problem solving ○ Connect person to supports ○ Education about ASD ○ Provide referrals ● Treatment - CBT is effective in reducing development of PTSD for people with ASD ○ Cognitive behavioral therapy **

acute stress disorder

what concept for substance use disorder is described below: ○ Dysregulation of hedonic (pleasure seeking)/ reward pathway of the brain ○ Progressive - without treatment _______ is progressive and often results in disability or premature death ○ People who continue to use, according to AA, have three outcomes: ■ Death ■ Institution ■ Jail

addiction

what concept for substance use disorder is described below: ● - "Primary, chronic, disease of brain, reward, motivation, memory, and related circuitry" (American Society of _______ Medicine) ○ Behavioral _______ is called process addictions: gambling, internet gaming, social media, shopping, sexual activity. ■ Seldom have clearly identifiable intoxication or withdrawal symptoms

addiction

what concept for substance use disorder is described below: ● - "Primary, chronic, disease of brain, reward, motivation, memory, and related circuitry" (American Society of _______ Medicine) ○ Behavioral _______ is called process addictions: gambling, internet gaming, social media, shopping, sexual activity. ■ Seldom have clearly identifiable intoxication or withdrawal symptoms ○ Dysregulation of hedonic (pleasure seeking)/ reward pathway of the brain ○ Progressive - without treatment _______ is progressive and often results in disability or premature death ○ People who continue to use, according to AA, have three outcomes: ■ Death ■ Institution ■ Jail

addiction

What trauma and stressor related disorder is described below: ● Milder, less specific version of ASD and PTSD ● Precipitated by stressful event - retirement, chronic illness, breakup ● Not as severe - may not be considered traumatic event ● Diagnosed immediately or within 3 months of exposure ● Hallmarks → cognitive, emotional, behavioral symptoms that negatively impact functioning ● THIS WILL NOT BE ON EXAM OR THE FINAL.

adjustment disorder

What type of crisis is described below: ○ Psychological first aid through crisis intervention and debriefing can reduce incidence of acute stress disorder, posttraumatic disorder, major depressive disorder ○ Pg. 493: some people can fall into 2 categories at one time. The survivors of hurricane Katrina in 2005, many of them were members of vulnerable groups: racial, social, and financial. They may have already experienced maturational or situational crisis before the hurricane and THEN experienced ________ crisis through the hurricane.

adventitious

What type of crisis is described below: ● **********not part of everyday life; caused by nature or human made********** 1. Natural disaster- fire, flood, earthquake, hurricane 2. National disaster - terrorism, war, riots 3. Crime of violence - rape, assault, workplace or school murder, bombing in crowded area, spousal or child abuse

adventitious

What type of crisis is described below: ● **********not part of everyday life; caused by nature or human made********** 1. Natural disaster- fire, flood, earthquake, hurricane 2. National disaster - terrorism, war, riots 3. Crime of violence - rape, assault, workplace or school murder, bombing in crowded area, spousal or child abuse ○ Psychological first aid through crisis intervention and debriefing can reduce incidence of acute stress disorder, posttraumatic disorder, major depressive disorder ○ Pg. 493: some people can fall into 2 categories at one time. The survivors of hurricane Katrina in 2005, many of them were members of vulnerable groups: racial, social, and financial. They may have already experienced maturational or situational crisis before the hurricane and THEN experienced ________ crisis through the hurricane.

adventitious

What type of crisis is not part of everyday life and is caused by nature or human made?

adventitious

· action or behavior that results in verbal or physical attack; sometimes needed for personal protection

aggression

what anxiety disorder is described below: intense, excessive fear about being alone or in a public place from which escape would be difficult, embarrassing, or where help would be unavailable if the person became disabled in some manner (such as panic symptoms)

agoraphobia

what anxiety disorder is described below: intense, excessive fear about being alone or in a public place from which escape would be difficult, embarrassing, or where help would be unavailable if the person became disabled in some manner (such as panic symptoms) ● *****Often have fears of public transportation- bus, car, airplane, open spaces (parking lots), enclosed spaces (such as shops, elevator or theatres), standing in line or in a crowd, bridges, or being outside/home alone (from DSM-5)******* ● Will tend to avoid these situations, which can be debilitating and life constricting (avoidance behaviors) ● Adverse childhood events / stressful life situations are associated with development of _________ ○ Families described as "emotionally cool" or over protective ● Genetics implicated; heritability factor = 61%****** ● After onset, the person often experiences depressive disorders and alcohol use disorder ● Note: agora= marketplace of ancient Athens, Greece; more than shops where men met to discuss the issues of the day ● Would spend most of their time at home

agoraphobia

what anxiety disorder is described below: ● *****Often have fears of public transportation- bus, car, airplane, open spaces (parking lots), enclosed spaces (such as shops, elevator or theatres), standing in line or in a crowd, bridges, or being outside/home alone (from DSM-5)******* ● Will tend to avoid these situations, which can be debilitating and life constricting (avoidance behaviors)

agoraphobia

what anxiety disorder is described below: ● Genetics implicated; heritability factor = 61%****** ● After onset, the person often experiences depressive disorders and alcohol use disorder ● Note: agora= marketplace of ancient Athens, Greece; more than shops where men met to discuss the issues of the day ● Would spend most of their time at home

agoraphobia

What eating disorder is described below: Nursing Process: ● Outcome Identification ○ Most important outcome is attainment of a safe weight. The patient must stop losing weight ********** NEED TO KNOW.

anorexia nervosa

With alcohol use disorder, we have _____ _____ which includes: · 80 mg/dL (0.08g/dL) - 4 alcoholic drinks - poor muscle coordination, altered speech & hearing, difficulty danger, impaired judgment, poor self-control, decreased reasoning · 150 mg/dL (0.15g/dL) 6 alcoholic drinks: vomiting, (unless high tolerance) & major loss of balance · 300 mg/dL (0.30 g/dL) more than 10 drinks: reduction of body temperature, blood pressure, respirations, sleepiness, amnesia · 400 mg/dL (0.40g/dL) - impaired vital signs & possible death · In US - standard drink - contains 14 grams pure alcohol: o 12 ounces beer -5% alcohol content o 5 ounces wine - 12% alcohol content o 1.5 distilled spirits - 40% alcohol content

alcohol intoxication

With alcohol use disorder, we have _____ _____ which includes: ● Legal definition in most states - 80 or 100 mg ethanol per deciliter of blood ○ Expressed as 0.08-0.10 g/dL ○ Under 21 is 0.02 g/dL BUT should be 0 ○ 20mg/dL = 0.02g/dL - 2 drinks ○ 50mg/dL = 0.05 - 3 drinks ○ 80mg/dL =0.08 - 4 drinks ○ 100mg/dL= 0.10 - 5 drinks ○ 150m/dL =0.15 - 6 drinks ○ 200mg/dL=0.20 - 8-10 drinks ○ 300mg/dL=0.30 - more than 10 drinks ○ 400mg/dL=0.40 - impaired vital signs and possible death ● In the US, a standard drink contains 14 grams of pure alcohol ○ 12 ounces of beer - 5% alcohol content ○ 5 ounces of wine - 12% alcohol content ○ 1.5 distilled spirits - 40% alcohol content

alcohol intoxication

The following is the DMS-5 Criteria for what substance use disorder? A. Problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least 2 of the following in 12-month period · 1.Alcohol often taken in larger amounts over longer period of time than intended · 2.Persistent desire /effort to cut down · 3.Great deal of time -obtain alcohol, use alcohol, recover from effects · 4.Craving · 5.Failure to fulfill major role obligations at work, school, home · 6.Continued use despite problems caused by effects of alcohol · 7.Important social, occupational, recreational activities given up/ reduced because of alcohol use · 8.Use in situations when physically dangerous · 9.Continued use despite knowledge of persistent/recurrent physical or psychological problem likely caused by alcohol · 10.Tolerance: o Need for increased amounts of alcohol to achieve intoxication/desired effect o Markedly diminished effect with continued use of the same amount of alcohol · 11.Withdrawal: o Characteristic withdrawal syndrome o Alcohol (or closely related substance such as benzodiazepine)is taken to relieve/avoid withdrawal problems

alcohol use disorder

the following are other issues associated with ___ ____ ____: ● Cirrhosis—healthy liver tissue replaced by scar tissue ● Leukopenia - low WBC from vitamin deficiency and low protein intake → predisposition for infection ● Thrombocytopenia- complication of cirrhosis - low platelet count: see excessive bruising ● Cancer

alcohol use disorder

the following are other issues associated with ___ ____ ____: ● Peripheral neuropathy - "pins and needles" ● Alcoholic myopathy - muscle weakness and myonecrosis ● Alcoholic cardiomyopathy - enlargement of heart muscle → heart failure ● Esophagitis—esophageal varices—distended veins—risk for bleeding--> medical emergency ● Gastritis ● Pancreatitis ● Alcoholic hepatitis ● Cirrhosis—healthy liver tissue replaced by scar tissue ● Leukopenia - low WBC from vitamin deficiency and low protein intake → predisposition for infection ● Thrombocytopenia- complication of cirrhosis - low platelet count: see excessive bruising ● Cancer

alcohol use disorder

what substance use disorder is described below: actually a sedative, it creates an initial feeling of euphoria ● Should be done under supervision, not done alone, should have a detox protocol Types of problematic drinking: ○ BINGE DRINKING: too much too quickly ■ Women - 4 or more drinks within 2 hours ■ Men - 5 or more drinks within 2 hours 🍻🍻🍺 ○ ******HEAVY DRINKING: drinking too much, too often ■ Women - 8 or more in one week ■ Men - more than 14 in one week*******

alcohol use disorder

With alcohol use disorder, ___ ____ includes: ● ALCOHOL WITHDRAWAL DELIRIUM = delirium tremens (DT) = medical emergency ○ Shaking, confusion, delirium ○ Can result in death in 20% of untreated patients → usually as a result of medical problems ○ Can happen anytime within the FIRST 72 HOURS ○ *************Prevention of alchohol witdrawal delirium is the goal********* ○ May manifest: Tachycardia, Diaphoresis, Fever, Anxiety, Insomnia, HTN ○ May have delusions, visual/tatile hallucinations ● ****IMPORTANT ASSESSMENT QUESTION: When was your last drink??****

alcohol withdrawal

With alcohol use disorder, ___ ____ includes: ● Classic sign → tremulousness/shakes/jitters ● ***Begin as soon as 6-8 hours after alcohol cessation****NTK** ○ Assessment: Nurse should ask when was their last drink

alcohol withdrawal

With alcohol use disorder, ___ ____ includes: ● Classic sign → tremulousness/shakes/jitters ● ***Begin as soon as 6-8 hours after alcohol cessation****NTK** ○ Assessment: Nurse should ask when was their last drink ● Mild to moderate: ○ Agitation ○ Lack of appetite ○ Nausea; vomiting ○ Insomnia ○ Impaired cognition ■ Can have a condition known as "wet brain" which mimics common symptoms of Dementia ○ Mild perceptual changes ○ Elevated perceptual changes ○ Elevated vital signs ■ Elevated pulse, BP, temperature ○ CHLORDIAZEPOXIDE→ benzodiazepines used in alcohol detox protocols ■ Older medication; "old fashioned Librium" ● Psychotic & perceptual symptoms may begin in 8-10 hours ○ Psychotic state can last 3-4 days ● If patient is detoxing to the point of psychosis → considered a MEDICAL EMERGENCY ○ Risks of unconsciousness, seizures, delirium ○ Follow detox protocol → benzodiazepines ■ Elevated vital signs may result in a needed extra dose: keep patient comfortable - call provider ■ May go through more than one round of detox ● Withdrawal seizures may occur within 12-24 HOURS AFTER ALCOHOL CESSATION **** ○ Diazepam IV → common treatment for withdrawal seizures ○ If freestanding hospital doesn't have IV fluids, may have to transfer patient to a hospital that does ● ALCOHOL WITHDRAWAL DELIRIUM = delirium tremens (DT) = medical emergency ○ Shaking, confusion, delirium ○ Can result in death in 20% of untreated patients → usually as a result of medical problems ○ Can happen anytime within the FIRST 72 HOURS ○ *************Prevention of alchohol witdrawal delirium is the goal********* ○ May manifest: Tachycardia, Diaphoresis, Fever, Anxiety, Insomnia, HTN ○ May have delusions, visual/tatile hallucinations ● ****IMPORTANT ASSESSMENT QUESTION: When was your last drink??****

alcohol withdrawal

In application of the nursing process during a crisis, _______ includes: ○ General _________ ■ The nurse would determine the patient's potential for suicide as they are going through a crisis.

assessment

With alcohol use disorder, ___ ____ includes: ● Mild to moderate: ○ Agitation ○ Lack of appetite ○ Nausea; vomiting ○ Insomnia ○ Impaired cognition ■ Can have a condition known as "wet brain" which mimics common symptoms of Dementia ○ Mild perceptual changes ○ Elevated perceptual changes ○ Elevated vital signs ■ Elevated pulse, BP, temperature ○ CHLORDIAZEPOXIDE→ benzodiazepines used in alcohol detox protocols ■ Older medication; "old fashioned Librium"

alcohol withdrawal

With alcohol use disorder, ___ ____ includes: ● Psychotic & perceptual symptoms may begin in 8-10 hours ○ Psychotic state can last 3-4 days ● If patient is detoxing to the point of psychosis → considered a MEDICAL EMERGENCY ○ Risks of unconsciousness, seizures, delirium ○ Follow detox protocol → benzodiazepines ■ Elevated vital signs may result in a needed extra dose: keep patient comfortable - call provider ■ May go through more than one round of detox

alcohol withdrawal

With alcohol use disorder, ___ ____ includes: ● Withdrawal seizures may occur within 12-24 HOURS AFTER ALCOHOL CESSATION **** ○ Diazepam IV → common treatment for withdrawal seizures ○ If freestanding hospital doesn't have IV fluids, may have to transfer patient to a hospital that does

alcohol withdrawal

with alcohol withdrawal, we have ____ ____ ____, or delirium tremens (DT) which is a MEDICAL EMERGENCY. It includes shaking, confusion, and delirium. ○ Can result in death in 20% of untreated patients → usually as a result of medical problems ○ Can happen anytime within the FIRST 72 HOURS ********* ○ ***********Prevention of alchohol witdrawal delirium is the goal********* ○ May manifest: Tachycardia, Diaphoresis, Fever, Anxiety, Insomnia, HTN ○ May have delusions, visual/tatile hallucinations

alcohol withdrawal delirium

what substance use disorder is described below: ● Both as a result of thiamine deficiency ○ Most detox medications have thiamine ● WERNICKE'S ENCEPHALOPATHY- acute and reversible - altered gait, confusion, ocular abnormalities, sluggish reaction to light and unequal pupil size ○ responds to large doses IV thiamine; may clear up or progress to Korsakoff's syndrome

alcohol-induced persisting amnestic disorder

what substance use disorder is described below: ● Both as a result of thiamine deficiency ○ Most detox medications have thiamine ● WERNICKE'S ENCEPHALOPATHY- acute and reversible - altered gait, confusion, ocular abnormalities, sluggish reaction to light and unequal pupil size ○ responds to large doses IV thiamine; may clear up or progress to Korsakoff's syndrome ● KORSAKOFF'S SYNDROME - chronic memory disorder caused by thiamine deficiency ○ Recovery rate of only 20% treatment (thiamine 3-12 months). Most never recover ■ Cognitive improvement with nutritional support ○ Blackouts: excessive consumption of alcohol followed by episodes of amnesia ■ Person actively engages and can perform complicated tasks ■ Alcohol can block consolidation of new memories

alcohol-induced persisting amnestic disorder

what substance use disorder is described below: ● KORSAKOFF'S SYNDROME - chronic memory disorder caused by thiamine deficiency ○ Recovery rate of only 20% treatment (thiamine 3-12 months). Most never recover ■ Cognitive improvement with nutritional support ○ Blackouts: excessive consumption of alcohol followed by episodes of amnesia ■ Person actively engages and can perform complicated tasks ■ Alcohol can block consolidation of new memories

alcohol-induced persisting amnestic disorder

During an assessment of a patient with anorexia nervosa, _______ is cessation of menstruation (Not a requirement for the disorder)

amenorrhea

an emotional response to frustration of desires, threat to one's needs (emotional or physical), or a challenge; normal emotion that can be positive when expressed in a healthy manner

anger

The following is a general assessment of a patient with ____ _____: ■ Their perception of the problem ■ Eating habits ■ History of dieting Methods used to achieve weight control - restricting, purging, exercising ■ Value attached to a specific shape and weight ■ Interpersonal and social functioning ■ Mental status and physiological parameters

anorexia nervosa

The following is the criteria for hospitilization for a patient with ___ ____: ■ Less than 10% body fat ■ Daytime heart rate of less than 50 beats/min ■ Systolic blood pressure less than 90 ■ Temperature below 96 ■ Arrhythmias (hypokalemia)

anorexia nervosa

What eating disorder is described below: Etiology ● Psychological factors - currently cognitive - behavioral theorists suggest learned behavior based on positive feedback - lose weight- people positively comment → reinforce the behavior even if health at risk ● Research has not been able to determine any definitive family characteristics specific to eating disorders Environmental factors - there is no proof that thin ideals in media has direct effect on development of eating disorder

anorexia nervosa

What eating disorder is described below: Nursing Process: ASSESSMENT: ○ Lanugo - fine, downy hair over body; tell tale sign ○ Amenorrhea - cessation of menstruation (Not a requirement for the disorder) ○ Mottled, cool skin ■ Like a greyish blue coloration on the skin ○ Low blood pressure, pulse, temperature ○ Hypokalemia < 3.5 - may have severe electrolyte imbalance and enter the healthcare system via ICU ○ Hypoalbuminemia - peripheral edema noted ■ Protein level goes too low ○ Personality Traits ■ Perfectionism ■ Obsessive thoughts and actions related to food Box 18.2 pg. 336\ ● Terror of gaining weight ● Preoccupation of thoughts of food ● View themselves as fat even when enanciated ● Have peculiar way of handling food such as cutting food into small bites ● At mealtime, they may be pushing food around on plate ● Possible development of rigorous exercise regimen ● Possible self-induced vomiting ● Possible use of laxatives and diuretics ● Cognitive so disturbed that the individual judges his or herself worth by his or her weight ■ Intense feelings of shame ■ People pleasing ■ Need to have control over their therapy ■ From previous text book: these are high academic and athletic achievers******* ● Are not necessarily giving their parents trouble in rebellion, they do well in school as well as being athletes. ● What may happen is that the symptoms manifest when there has been a life change such as moving away or something that has been disruptive in their life ● They are not necessarily causing trouble in the family but can be doing well both athletically and academically ○ General Assessment: ■ Their perception of the problem ■ Eating habits ■ History of dieting Methods used to achieve weight control - restricting, purging, exercising ■ Value attached to a specific shape and weight ■ Interpersonal and social functioning ■ Mental status and physiological parameters

anorexia nervosa

What eating disorder is described below: Nursing Process: Nursing Process: ASSESSMENT: ○ Lanugo - fine, downy hair over body; tell tale sign ○ Amenorrhea - cessation of menstruation (Not a requirement for the disorder) ○ Mottled, cool skin ■ Like a greyish blue coloration on the skin ○ Low blood pressure, pulse, temperature ○ Hypokalemia < 3.5 - may have severe electrolyte imbalance and enter the healthcare system via ICU ○ Hypoalbuminemia - peripheral edema noted ■ Protein level goes too low ○ Personality Traits ■ Perfectionism ■ Obsessive thoughts and actions related to food Box 18.2 pg. 336\ ● Terror of gaining weight ● Preoccupation of thoughts of food ● View themselves as fat even when enanciated ● Have peculiar way of handling food such as cutting food into small bites ● At mealtime, they may be pushing food around on plate ● Possible development of rigorous exercise regimen ● Possible self-induced vomiting ● Possible use of laxatives and diuretics ● Cognitive so disturbed that the individual judges his or herself worth by his or her weight ■ Intense feelings of shame ■ People pleasing ■ Need to have control over their therapy ■ From previous text book: these are high academic and athletic achievers******* ● Are not necessarily giving their parents trouble in rebellion, they do well in school as well as being athletes. ● What may happen is that the symptoms manifest when there has been a life change such as moving away or something that has been disruptive in their life ● They are not necessarily causing trouble in the family but can be doing well both athletically and academically ○ General Assessment: ■ Their perception of the problem ■ Eating habits ■ History of dieting Methods used to achieve weight control - restricting, purging, exercising ■ Value attached to a specific shape and weight ■ Interpersonal and social functioning ■ Mental status and physiological parameters Nursing Process: ● Diagnosis ○ Imbalanced nutrition: less than body requirements ○ Decreased cardiac output ○ Risk for injury NOT related to falls (electrolyte imbalance) ○ Risk for imbalanced fluid volume ○ Disturbed body image ● Outcome Identification ○ Most important outcome is attainment of a safe weight. The patient must stop losing weight ********** ● Planning ○ Depends on acuity of the patient's situation ○ Electrolyte imbalance or weighs below 75% of ideal body weight - plan is to provide immediate medical stabilization >>probably inpatient ○ Other criteria for hospitalization ■ Less than 10% body fat ■ Daytime heart rate of less than 50 beats/min ■ Systolic blood pressure less than 90 ■ Temperature below 96 ■ Arrhythmias (hypokalemia) ○ *******Reintroduction of nutrients it must proceed slowly - avoid refeeding syndrome - potentially lethal treatment complication (Holocaust survivors)******** ■ Can lead to fluid imbalance abnormalities, abnormal glucose metabolism, etc. ■ The reintroduction of nutrients must proceed slowly to avoid this syndrome ● Intervention ○ Acute care- admitted to inpatient psych unit in crisis - address suicidal ideation if indicated (danger to self, danger to others, gravely ill = inpatient) ○ Psychosocial - begin **weight restoration program** that allows for: ■ Incremental weight gain ■ 90% ideal body weight- usually able to menstruate ■ Focus on eating behavior and underlying feelings of anxiety, low self-esteem, and lack of control ○ No FDA meds for ____ ______; SSRI fluoxetine - helps with obsessive behavior after reach maintenance weight******** ○ Milieu of eating disorder unit organized: ■ Precise meal times ■ Adherence to selected menu ■ Observation during and after meals ■ Regular weighing ○ Close monitoring of trips to bathroom after eating to prevent any self-induced vomiting. After visitors/ pass to ensure no access to any laxatives/ diuretics ○ *******Note- p. 341 - 1i A weight gain of 2-3 Ib./week is medically acceptable. Weight gain of more than 5 Ib. in 1 week may result in pulmonary edema********* ○ Note 1o- pt. Can exercise when reach a certain target weight; may make them lose more weight bc they don't have the fat to break down

anorexia nervosa

What eating disorder is described below: Nursing Process: ● Diagnosis ○ Imbalanced nutrition: less than body requirements ○ Decreased cardiac output ○ Risk for injury NOT related to falls (electrolyte imbalance) ○ Risk for imbalanced fluid volume ○ Disturbed body image

anorexia nervosa

What eating disorder is described below: Nursing Process: ● Intervention ○ Acute care- admitted to inpatient psych unit in crisis - address suicidal ideation if indicated (danger to self, danger to others, gravely ill = inpatient) ○ Psychosocial - begin **weight restoration program** that allows for: ■ Incremental weight gain ■ 90% ideal body weight- usually able to menstruate ■ Focus on eating behavior and underlying feelings of anxiety, low self-esteem, and lack of control ○ No FDA meds for ____ ______; SSRI fluoxetine - helps with obsessive behavior after reach maintenance weight******** ○ Milieu of eating disorder unit organized: ■ Precise meal times ■ Adherence to selected menu ■ Observation during and after meals ■ Regular weighing ○ Close monitoring of trips to bathroom after eating to prevent any self-induced vomiting. After visitors/ pass to ensure no access to any laxatives/ diuretics ○ *******Note- p. 341 - 1i A weight gain of 2-3 Ib./week is medically acceptable. Weight gain of more than 5 Ib. in 1 week may result in pulmonary edema********* ○ Note 1o- pt. Can exercise when reach a certain target weight; may make them lose more weight bc they don't have the fat to break down

anorexia nervosa

What eating disorder is described below: Nursing Process: ● Planning ○ Depends on acuity of the patient's situation ○ Electrolyte imbalance or weighs below 75% of ideal body weight - plan is to provide immediate medical stabilization >>probably inpatient ○ Other criteria for hospitalization ■ Less than 10% body fat ■ Daytime heart rate of less than 50 beats/min ■ Systolic blood pressure less than 90 ■ Temperature below 96 ■ Arrhythmias (hypokalemia) ○ *******Reintroduction of nutrients it must proceed slowly - avoid refeeding syndrome - potentially lethal treatment complication (Holocaust survivors)******** ■ Can lead to fluid imbalance abnormalities, abnormal glucose metabolism, etc. ■ The reintroduction of nutrients must proceed slowly to avoid this syndrome

anorexia nervosa

What eating disorder is described below: ● Mild: BMI > 17 kg /m2 ● Moderate: BMI 16- 16.99 ● Severe: BMI 15- 15.99 ● Extreme: BMI < 15

anorexia nervosa

What feeding/eating disorder has the following DSM-5 Criteria? ● A. Restrictions of energy intake ● B. Intense fear of gaining weight or becoming fat; persistent behavior that interferes with weight gain ● C. Disturbance in the way one's body weight or shape is experienced

anorexia nervosa

What feeding/eating disorder has the following DSM-5 Criteria? ● A. Restrictions of energy intake ● B. Intense fear of gaining weight or becoming fat; persistent behavior that interferes with weight gain ● C. Disturbance in the way one's body weight or shape is experienced ● **can be further characterized by restricting type which means during the last 3 months, the individual has not engaged in binge eating or purging behavior which is self-induced vomiting and/or the misuse of laxatives, diuretics, or enemas. There is the binge eating/purging type which is during the last 3 months the individual HAS engaged in recurrent episodes of binge eating or purging behavior which includes the misuse of laxatives, diuretics, or enemas. SO, Ms. Henderson wanted to call your attention to those with anorexia nervosa DO sometimes engage in the purging behaviors and not just in patients with bulimia.

anorexia nervosa

With Cluster B antisocial personality disorder, one of the characteristics includes antagonistic and disinhibited behaviors. which one is described below: ○ deceitful, manipulative for personal gain or hostile if needs are blocked

antagonistic

What pharmacological intervention for anxiety disorders are described below: -- Often used to treat somatic and psychological symptoms of anxiety disorders --Benzodiazepine used - quick onset -- Potential for dependence - USE FOR SHORT PERIODS -- Nursing Intervention >> monitor for sedation, ataxia, decreased cognitive function -- Not recommended for those with substance use disorder- too much chance for dependence OR for the elderly that are at risk for falls, delirium --Box 15.2 - Teaching- be careful with discontinuing BENZOS - seizures and other withdrawal symptoms; avoid alcoholic beverages and other anti anxiety drugs - need supervision. SHOULD NOT detox at home

antianxiety drugs

What pharmacological intervention for anxiety disorders are described below: --Box 15.2 - Teaching- be careful with discontinuing BENZOS - seizures and other withdrawal symptoms; avoid alcoholic beverages and other anti anxiety drugs - need supervision. SHOULD NOT detox at home

antianxiety drugs

What is the first line treatment for binge eating disorder?

antidepressants are better to try first due to more tolerable adverse effects and no risk of abuse

What medications can be used for treatment for cluster A schizoid personality disorder?

antidepressants: buproprion; 2nd generations antipsychotics such as Risperodone and ALonazpine which can improve emotional expressiveness

● A substance that can produce the immune response **HIV and immune system

antigen

Panel's Recommendations for Initiating ______ therapy in treatment includes: · Antiretroviral therapy (ART) is recommended for all HIV infected individuals regardless of CD4 T lymphocyte cell count to reduce the morbidity and mortality associated with HIV infection · ART is also recommended for HIV-infected individuals to take the medicine to prevent HIV transmission · When initiating ART, it is important to educate patients regarding the benefits and considerations regarding ART and to address strategies to optimize adherence. On a case-by-case basis, ART may be deferred because of clinical and/or psychosocial factors but therapy should be initiated as soon as possible · May be difficult when first receiving the diagnosis of being HIV positive so it may not be wise to start that day or the next day but you do want to start ASAP

antiretroviral

The following is the DMS-5 criteria for what cluster B personality disorder? A. a persuasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by 3 or more of the following: 1. Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest. 2. Deceitfulness as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure 3. Impulsivity or failure to plan ahead 4. Irritability and aggressiveness as indicated by repeated physical fights or assaults 5. Reckless disregard for safety of self or others 6. consistent irresponsibility as indicated by repeated failure to sustain consistent work behavior or honor financial obligations 7.lack of remorse as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another B. the individual is at least age 18 years old C. there is no evidence of conduct disorder with onset before age 15 years D. the occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder.

antisocial personality disorder

The following is the DMS-5 criteria for what cluster B personality disorder? B. the individual is at least age 18 years old C. there is no evidence of conduct disorder with onset before age 15 years D. the occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder.

antisocial personality disorder

What cluster B personality disorder has individuals that may be more commonly referred to a SOCIOPATHS?

antisocial personality disorder

What cluster B personality disorder is described below: ○ Impulsivity - act quickly in response to emotions without considering consequences; results in damaged relationships & suicide attempts or cutting ■ Gets involved with people in relationships very quickly ○ Can be challenging on a unit. They like a lot of chaos and commotion .

borderline personality disorder

What cluster B personality disorder is described below: ● Assessment - do not seek care for this disorder unless court-ordered. ○ Patients do not tend to answer honestly ○ Cooperation may not be the best and they may not answer questions honestly in an interview ○ Assessment guidelines - page 460 ■ Current life stressors ■ Criminal history ■ Suicidal/Violent/homicidal thoughts ■ Anxiety/aggression/anger levels ■ Motivation for maintaining control ■ Substance misuse past and present

antisocial personality disorder

What cluster B personality disorder is described below: ● Characteristics ○ *******Disturbing → Profound lack of empathy or regard for the rights of others********** ○ Absence of remorse or guilt ○ May be able to act witty/charming & good at manipulating the emotions of others ○ Look at number 7 under criteria A: lack of remorse as indicated as being indifferent to or rationalizing having hurt, mistreated, or stolen from another ■ Would say something like "he deserved it"

antisocial personality disorder

What cluster B personality disorder is described below: ● Characteristics ○ Antagonistic behaviors - deceitful, manipulative for personal gain or hostile if needs are blocked ○ Disinhibited behaviors - high risk taking, disregard for responsibility, impulsivity ■ Ex: deciding to rob a convenience store ○ Engage in criminal misconduct, substance misuse common ○ Relationships - they will focus on their own gratification to an extreme; no capacity for real intimacy & will exploit others; can be charming and manipulative to lure someone in, and when they don't get their way this "other side" will emerge

antisocial personality disorder

What cluster B personality disorder is described below: ● Implementation ○ Listen - can defuse - read Table 24.2 ■ Simply being heard can diffuse an emotionally charged situation. If the patient has a legitimate compliant, the nurse can listen to the emotional complaints about the staff and the hospital without correcting any errors and simply noting that the patient is actually hurt ■ Listening can be a therapeutic technique to diffuse a situation. The conversation written out in table 24.2, go through this. It depicts a therapeutic nurse interaction with another patient. ○ No FDA approved meds. May use medication for other issues - mood stabilizers for irritability, aggression

antisocial personality disorder

What cluster B personality disorder is described below: ● Implementation ○ Prevent/reduce effects of manipulation ○ Clear/realistic boundaries with consequences - all staff MUST follow whatever those boundaries and limitations are ○ Careful documentation of behaviors and signs of manipulation

antisocial personality disorder

What cluster B personality disorder is described below: ● Outcomes ○ Abusive behavior self-restraint ○ Aggression self-restraint ○ Coping, social interaction, social isolation knowledge ○ Health promotion knowledge ○ Health promoting behavior ○ These will be difficult to accomplish ○ Maintaining safety is the priority ● Planning - Profound inability to connect with others will impair usual process of developing therapeutic relationship

antisocial personality disorder

What cluster B personality disorder is described below: ● Possible Nursing diagnoses ○ Risk for other-directed violence ○ Defensive coping ○ Impaired social interaction ○ Ineffective health maintenance

antisocial personality disorder

What cluster B personality disorder is described below: ● Prevalence: 1.1%; most researched personality disorder; probably due to impact on society - they engage in criminal activity ● A persasive pattern of disregard for and violation of the rights of others, occurring since age 15 ○ The person is at least 18 years old ○ This type of disregard and violating the rights of others has been occurring since age 15

antisocial personality disorder

What cluster B personality disorder is described below: ● Prevalence: 1.1%; most researched personality disorder; probably due to impact on society - they engage in criminal activity ● A persasive pattern of disregard for and violation of the rights of others, occurring since age 15 ○ The person is at least 18 years old ○ This type of disregard and violating the rights of others has been occurring since age 15 ● Pattern of disregard for & violation of the rights of others ● *******May be more commonly referred to a SOCIOPATHS********** ● Diagnosis reserved for adults - but symptoms evident in mid-teens ● Characteristics ○ Antagonistic behaviors - deceitful, manipulative for personal gain or hostile if needs are blocked ○ Disinhibited behaviors - high risk taking, disregard for responsibility, impulsivity ■ Ex: deciding to rob a convenience store ○ Engage in criminal misconduct, substance misuse common ○ Relationships - they will focus on their own gratification to an extreme; no capacity for real intimacy & will exploit others; can be charming and manipulative to lure someone in, and when they don't get their way this "other side" will emerge ○ *******Disturbing → Profound lack of empathy or regard for the rights of others********** ○ Absence of remorse or guilt ○ May be able to act witty/charming & good at manipulating the emotions of others ○ Look at number 7 under criteria A: lack of remorse as indicated as being indifferent to or rationalizing having hurt, mistreated, or stolen from another ■ Would say something like "he deserved it" ● Assessment - do not seek care for this disorder unless court-ordered. ○ Patients do not tend to answer honestly ○ Cooperation may not be the best and they may not answer questions honestly in an interview ○ Assessment guidelines - page 460 ■ Current life stressors ■ Criminal history ■ Suicidal/Violent/homicidal thoughts ■ Anxiety/aggression/anger levels ■ Motivation for maintaining control ■ Substance misuse past and present ● Possible Nursing diagnoses ○ Risk for other-directed violence ○ Defensive coping ○ Impaired social interaction ○ Ineffective health maintenance ● Outcomes ○ Abusive behavior self-restraint ○ Aggression self-restraint ○ Coping, social interaction, social isolation knowledge ○ Health promotion knowledge ○ Health promoting behavior ○ These will be difficult to accomplish ○ Maintaining safety is the priority ● Planning - Profound inability to connect with others will impair usual process of developing therapeutic relationship ● Implementation ○ Prevent/reduce effects of manipulation ○ Clear/realistic boundaries with consequences - all staff MUST follow whatever those boundaries and limitations are ○ Careful documentation of behaviors and signs of manipulation ○ Listen - can defuse - read Table 24.2 ■ Simply being heard can diffuse an emotionally charged situation. If the patient has a legitimate compliant, the nurse can listen to the emotional complaints about the staff and the hospital without correcting any errors and simply noting that the patient is actually hurt ■ Listening can be a therapeutic technique to diffuse a situation. The conversation written out in table 24.2, go through this. It depicts a therapeutic nurse interaction with another patient. ○ No FDA approved meds. May use medication for other issues - mood stabilizers for irritability, aggression

antisocial personality disorder

______ disorders include the following: ● Use rigid, repetitive, ineffective behaviors to deal with anxiety ○ The person has developed some sort of patterns and repetitive behavior to deal with ______ which are normally ineffective ● The degree of _______ interferes with personal, occupational, and social functioning ● Tend to be persistent and actually disabling

anxiety

a feeling of apprehension, uneasiness, uncertainty, or dread from a real or a perceived threat even if the threat is NOT real · Affects at deeper level—invades core of personality

anxiety

The following are risk factors for ____ _____: · Behavioral o Anxiety— can be a learned response o Example: parent fearful of thunder and lightning or bad weather and acts accordingly, the child learns this. Would child be afraid of lizard, spider, etc. if the parent did not scream/run around when they see a lizard, spider, or something else? o When children are confronted with them themselves, they become anxious · Cognitive o Anxiety disorders caused by distortions of thoughts and perceptions o Perceive situations and events as potentially dangerous whether or not it is real § Some cases, it is distortion of thought and not really real

anxiety disorders

What is Cluster C for personality disorders?

anxious (includes: avoidant, dependent, and obsessive-compulsive disorder)

when ______ing a patient with potential HIV, ask the following questions: ● "I discuss routine HIV testing with all of my patients. I'd like to tell you the benefits of getting an HIV test." ● "I'd also like to make sure you know how the virus is transmitted. What do you know about HIV transmission?" ● "You might want to consider getting an HIV test today. It will only take a few minutes and we can discuss safer sex methods following the test." ● "Do you have any questions or concerns?" ● This process can be used for other testing and STD testing on other patients

assess

During an _______ of a violent patient includes: ● Get history of aggression or violence ● ________ guidelines (box on page 508) ○ **************History of violence is single best predictor of future violence ○ Higher risk = patients who are delusional, hyperactive, impulsive, irritable************

assessment

In application of the nursing process during a crisis, _______ includes: ○ *****_________ of perception of precipitating event***** - the more clearly the person define the problem - more likely to identify solutions. Some questions include: ■ What leads you to seek help now? ■ Has anything happened to you within the past few days/ weeks ■ How does this situation affect your life? Your future? ■ What do you hope to get out of this treatment? ■ How does the patient view the problem?

assessment

In application of the nursing process during a crisis, _______ includes: ○ General _________ ■ The nurse would determine the patient's potential for suicide as they are going through a crisis. ○ *****_________ of perception of precipitating event***** - the more clearly the person define the problem - more likely to identify solutions. Some questions include: ■ What leads you to seek help now? ■ Has anything happened to you within the past few days/ weeks ■ How does this situation affect your life? Your future? ■ What do you hope to get out of this treatment? ■ How does the patient view the problem? ○ A successful outcome for a crisis depends on the realistic perception of the event, adequate situational support, and adequate coping mechanisms. We are assessing these 3 components.

assessment

The most important outcome for a patient with anorexia nervosa is _____ ___ ____ ____ _____. The patient must stop losing weight. NEED TO KNOW.

attainment of a safe weight

What cluster C personality disorder is described below: ● Guidelines for nursing care ○ Friendly, accepting, reassuring approac ○ Acceptance of patient fears; being pushed into social situations can cause severe anxiety for these patients ○ Convey an attitude of acceptance towards their fears ○ Assertiveness training ■ Definitely for these patients; can assist the person to learn to express their needs

avoidant personality disorder

What cluster C personality disorder is described below: ● Prevalence: 2.4%; equally between men & women ● Characteristics - MAIN PATHOLOGICAL TRAITS ○ Low self-esteem ○ Shyness that increases with age (evident in infants & children) ○ Feelings of inferiority ○ Reluctance to engage with new people ○ Subject to depression, anxiety, and anger ○ Preoccupied with rejection, humiliation, and failure ○ Avoid new interpersonal relationships or activities due to their fears of critisicm of disapproval

avoidant personality disorder

What cluster C personality disorder is described below: ● Prevalence: 2.4%; equally between men & women ● Characteristics - MAIN PATHOLOGICAL TRAITS ○ Low self-esteem ○ Shyness that increases with age (evident in infants & children) ○ Feelings of inferiority ○ Reluctance to engage with new people ○ Subject to depression, anxiety, and anger ○ Preoccupied with rejection, humiliation, and failure ○ Avoid new interpersonal relationships or activities due to their fears of critisicm of disapproval ● Some can function in a protective environment - work where these traits match the job ● Guidelines for nursing care ○ Friendly, accepting, reassuring approac ○ Acceptance of patient fears; being pushed into social situations can cause severe anxiety for these patients ○ Convey an attitude of acceptance towards their fears ○ Assertiveness training ■ Definitely for these patients; can assist the person to learn to express their needs ● Treatment ○ Individual & group - processing anxiety - provoking symptoms & planning methods to approach anxiety-provoking situations ■ What is going to be the plan?

avoidant personality disorder

What cluster C personality disorder is described below: ● Some can function in a protective environment - work where these traits match the job

avoidant personality disorder

What cluster C personality disorder is described below: ● Treatment ○ Individual & group - processing anxiety - provoking symptoms & planning methods to approach anxiety-provoking situations ■ What is going to be the plan?

avoidant personality disorder

what feeding disorder is described below: ○ Starts in childhood ○ Note 40% of "picky" eaters resolve on their own

avoidant/restrictive food intake

With treatment of gonorrhea, if chlamydia is NOT ruled out, then we give _______ to treat for both.

azithromycin

What STI is described below: ○ Can spread to eye via direct contact; may have pus discharge, conjunctivitis ■ Trachoma→ Most common cause of blindness ○ Can also infect and attack joints causing dysarthria ■ Infective or reactive (WBC attack joint when trying to fight off _______) ● Diagnosis: diagnosed with a culture

chlamydia

What is the treatment for HPV or genital warts?

○ Imiquimod (3.75% or 5% cream) ○ Other treatments → cryotherapy (liquid nitrogen), laser treatment, and even surgical removal of the warts ■ Specifically for the warts

When talking about etiology, the following are _____ infections: chlamydia, gonorrhea, syphilis, trichomoniasis

bacterial

What STI is described below: ● Diagnosis: epithelial clue cells; amine (fishy) odor when KOH added "whiff test" ○ Clue cells are epithelial cells covered in bacteria ○ Wiff test: where the amine fishy odor is revealed when you ad KOH to a slide with a specimen on it

bacterial vaginosis

What STI is described below: ● Do not know how sex contributes and no research in treating a sexual partner of someone with BV ● Treating a sex partner ● Increased chances of getting other STDs ● Rarely affects women who have never had sex ● Cannot get from toilet seats, bedding, or swimming pools ● Prevention: abstain from sex, limiting number of sexual partners, and avoid douching as primary prevention measures

bacterial vaginosis

What STI is described below: ● Most commonly seen in women ages 15-44 ● Transmission: unknown ○ We do know that the infection typically occurs in sexually active women --DOUCHING

bacterial vaginosis

What STI is described below: ● Too much of a certain bacteria in the vagina; linked to an imbalance of "good" and "harmful" bacteria that are normally found in a woman's vagina ○ Having new sexual partners, multiple sexual partners, and douching can upset the balance of the bacteria in the vagina increasing the risk for BV

bacterial vaginosis

What disorder is described below: ● Preoccupied with imagined defective body parts ● False assumptions about the importance of their appearance, fear of rejection from others, perfectionism, and conviction of being disfigured, leading to emotions of disgust, shame, and depression ● Rate is higher among patients seeking cosmetic surgery, dermatology treatment, adult orthodontia, and/or oral/maxillofacial surgery ○ Preoccupation with feeling that they have defective body parts and have high importance on their body parts ● Many of these patients come from homes of abuse or neglect ● Suicide risk is high ● Most common comorbid is major depressive disorder ● Perfectionism is not our friend, it is very paralyzing because it is nearly impossible to reach; "I can't get it like I want it so I'm not even going to try"

body dysmorphic disorder

What STI is described below: ● Too much of a certain bacteria in the vagina; linked to an imbalance of "good" and "harmful" bacteria that are normally found in a woman's vagina ○ Having new sexual partners, multiple sexual partners, and douching can upset the balance of the bacteria in the vagina increasing the risk for BV ● Most commonly seen in women ages 15-44 ● Transmission: unknown ○ We do know that the infection typically occurs in sexually active women --DOUCHING ● Do not know how sex contributes and no research in treating a sexual partner of someone with BV ● Treating a sex partner ● Increased chances of getting other STDs ● Rarely affects women who have never had sex ● Cannot get from toilet seats, bedding, or swimming pools ● Prevention: abstain from sex, limiting number of sexual partners, and avoid douching as primary prevention measures ● Diagnosis: epithelial clue cells; amine (fishy) odor when KOH added "whiff test" ○ Clue cells are epithelial cells covered in bacteria ○ Wiff test: where the amine fishy odor is revealed when you ad KOH to a slide with a specimen on it ● Treatment: Metronidazole (Flagyl) (PO or vaginal inserts) (7 day course or 2 g 1 time dose) ○ Metrondiazole 500 mg BID for 7 days ○ Can also use the gel that is inserted vaginally twice a day for 5 days ○ OR Metronidazole 2 grams PO x 1 dose

bacterial vaginosis

What STI is described below: ● Treatment: Metronidazole (Flagyl) (PO or vaginal inserts) (7 day course or 2 g 1 time dose) ○ Metrondiazole 500 mg BID for 7 days ○ Can also use the gel that is inserted vaginally twice a day for 5 days ○ OR Metronidazole 2 grams PO x 1 dose

bacterial vaginosis

______ change for HIV in a patient includes: --help them help themselves: focus on today not the past ● Knowledge ● attitudes/beliefs ● Behaviors ○ What behaviors contribute to their risks? ● Circumstances ○ Why do they need to change and is it the right time for them to change? ● Skills ○ Do they have the skills and tools to change? ● Readiness ○ Are they ready to make this change in their life?

behavioral

What type of therapy for anxiety disorders and OCD disorders is described below: includes modeling, systematic desensitization, flooding, response prevention, and thought stopping

behavioral therapy

What pharmacological intervention for a violent patient is described below: ● Lorazepam (Ativan) is drug of choice in this class ○ Alprazolam (Xanax) ○ Diazepam (Valium)

benzodiazepines

What pharmacological intervention for anxiety disorders are described below: Alprazolam Chlordiazepoxide Clorazepate Diazepam Lorazepam Oxazepam Clonazepam

benzodiazepines

With alcohol use disorder, we have types of problematic drinking which includes binge drinking and heavy drinking. With _____ drinking, it is drinking too much too quickly and includes: ■ Women - 4 or more drinks within 2 hours ■ Men - 5 or more drinks within 2 hours 🍻🍻🍺

binge

What eating disorder is described below: ● Because they do not reguarly use the purging behaviors, when they start _____ _______ they may be of a normal weight, the _____ ________ inevitably causes obesity in this populations ● Repeated episodes of ____ ________ - after experience significant distress ○ Does not purge → gains all the weight ● Do NOT use compensatory behaviors - vomiting and laxatives as seen with bulimia nervosa

binge eating disorder

What eating disorder is described below: ● DSM- 5 has criteria for this disorder and qualifies as follows ○ Mild: 1-3 _____ ______ episodes per week ○ Moderate: 4- 7 _____ ________ episodes per week ○ Severe: 8-13 ______ ______ episodes per week ○ Extreme: 14 or more ______ _______ episodes per week

binge eating disorder

What eating disorder is described below: ● Lisdexamfetamine dimesylate (Vyvanse) - approved for binge eating disorder - NOT 1st line ○ Antidepressant better to try 1st due to more tolerable adverse effects and no risk of abuse ● *****New coping skills - have been using food to regulate mood*****

binge eating disorder

What eating disorder is described below: ● Nursing Diagnosis - usually the most appropriate ○ Imbalanced nutrition: more than body requirement

binge eating disorder

What eating disorder is described below: ● Repeated episodes of ______ _________- after experience significant distress ○ Does not purge → gains all the weight ● Do NOT use compensatory behaviors - vomiting and laxatives as seen with bulimia nervosa ● DSM- 5 has criteria for this disorder and qualifies as follows ○ Mild: 1-3 _____ ______ episodes per week ○ Moderate: 4- 7 _____ ________ episodes per week ○ Severe: 8-13 ______ ______ episodes per week ○ Extreme: 14 or more ______ _______ episodes per week ● Because they do not reguarly use the purging behaviors, when they start _____ _______ they may be of a normal weight, the _____ ________ inevitably causes obesity in this populations ● Nursing Diagnosis - usually the most appropriate ○ Imbalanced nutrition: more than body requirement ● Lisdexamfetamine dimesylate (Vyvanse) - approved for binge eating disorder - NOT 1st line ○ Antidepressant better to try 1st due to more tolerable adverse effects and no risk of abuse ● *****New coping skills - have been using food to regulate mood*****

binge eating disorder

with cluster A schizotypal personality disorder, the main characteristic is that they do NOT _____ ____ with the crowd. It does not bother them that this is how they are and they are not worried about changing. NEED TO KNOW.

blend in

What disorder is described below: ● Many of these patients come from homes of abuse or neglect ● Suicide risk is high ● Most common comorbid is major depressive disorder ● Perfectionism is not our friend, it is very paralyzing because it is nearly impossible to reach; "I can't get it like I want it so I'm not even going to try"

body dysmorphic disorder

What disorder is described below: ● Preoccupied with imagined defective body parts ● False assumptions about the importance of their appearance, fear of rejection from others, perfectionism, and conviction of being disfigured, leading to emotions of disgust, shame, and depression

body dysmorphic disorder

What disorder is described below: ● Rate is higher among patients seeking cosmetic surgery, dermatology treatment, adult orthodontia, and/or oral/maxillofacial surgery ○ Preoccupation with feeling that they have defective body parts and have high importance on their body parts

body dysmorphic disorder

Name the 3 cluster A personality disorders. **eccentric

○ Paranoid (worsen with age) ○ Schizoid ○ Schizotypal

What cluster B personality disorder is described below: ○ Splitting: Inability to view both positive and negative aspects of others as part of a whole; view person as wonderful or a horrible person. ■ Defense and coping style ■ Example - at first they may idealize new relationship/friend and kinda be all into it; if disappointed/frustrated by the other person - now quickly shifts and other person despised, devalued, etc. ■ "You're my best nurse, you're my best nurse!" then, if nurse does something they don't like "you're the worst nurse, you're the worst nurse!"

borderline personality disorder

What cluster B personality disorder is described below: ● *********Frequently seeks repeat hospitalizations!!!******** ● For depression, anxiety, suicidal/self-harm behaviors, substance use ● Hospitalizations may help with the self-destructive behaviors, it is NOT considered effective long-term solution. They may hop from one hospital to the next or one inpatient stay to another inpatient stay. ● Prevalence: 1.6% ● Epidemiology and comorbidity ○ 85%meet criteria for another psychiatric disorder

borderline personality disorder

What cluster B personality disorder is described below: ● Assessment ○ Semi-structured interview ○ Use of tool if needed - Minnesota Multiphasic Personality Inventory ■ Self-report inventory ○ Self-mutilation & self-harm ○ Suicidal behaviors ○ Feelings of emptiness ○ Risky behavior ○ Intense feelings of abandonment ○ Idealization of others; becoming too close too quickly ○ Anger, sarcasm bitterness ○ Sudden shifts in goals, values, career focus, ○ Extreme mood shifts ○ Intense, unstable romantic relationships

borderline personality disorder

What cluster B personality disorder is described below: ● Etiology ○ High genetic association ○ Separation-individuation factors - form Margaret Mahler - psychologist who proposed that there is a disruption in the process of feeling safe to explore away from caregiver. Carries fear of abandonment and anger into adulthood

borderline personality disorder

What cluster B personality disorder is described below: ● Implementation ○ *****Provide clear and consistent boundaries*** ■ Limit setting with the patient ■ All of the shifts need to adhere to whatever the limits and plan are for the patient******* ○ Use clear, straightforward communication ○ When behavioral problems arise, calmly review therapeutic goals ○ Respond matter-of-factly to superficial self-injuries- p. 469

borderline personality disorder

What cluster B personality disorder is described below: ● Implementation ○ ****Teamwork - united**** ■ Working with a patient like this, if there is going to be some sort of effectiveness, there has to be teamwork from one shift to another. It cant be that one shift is really enforcing limits and then in another shift the patient is able to manipulate the nurses to get his or her way.

borderline personality disorder

What cluster B personality disorder is described below: ● Implementation ○ In accordance with agency policies - nurse dresses wound in matter-of-fact manner; pt. writes down sequence of events leading up to injury with consequences before staff will discuss the event. ■ If the patient is even being closely watched is able to somehow able to perform self-injury, in accordance to agency policies the nurse would address the wounds if that is what happened in a very matter of fact manner and not adding to the comotion of it all. ○ Cognitive exercise encourages patient to think about behavior ○ No meds FDA approved; use meds for mood regulation ○ ****Teamwork - united**** ■ Working with a patient like this, if there is going to be some sort of effectiveness, there has to be teamwork from one shift to another. It cant be that one shift is really enforcing limits and then in another shift the patient is able to manipulate the nurses to get his or her way.

borderline personality disorder

What cluster B personality disorder is described below: ● Nursing diagnoses ○ Self-mutilation********* ○ Risk for suicide ○ Risk for self- and/or other-directed violence ○ Impaired social interaction ○ Disturbed personal identity ○ Ineffective coping ● Outcomes and planning ○ Realistic outcomes ○ Importance of the therapeutic relationship ○ Avoid manipulative behaviors

borderline personality disorder

What cluster B personality disorder is described below: ● Psychotherapy ○ ***Dialectical behavior therapy (DBT) -evidence-based therapy developed for patients with borderline personality disorder. Emphasizes being aware of thoughts & actively shaping them. Diagram page 470 ABSOLUTELY NEED TO KNOW.

borderline personality disorder

What cluster B personality disorder is described below: ● Well-known & dramatic of the personality disorders ● Clinical picture - severe impairments in functioning ○ Marked instability in emotional control ○ Identity/self-image distortions ○ Unstable mood & relationships ○ ******A primary feature → emotional lability = rapidly moving from 1 emotional extreme to the other****** ■ Not like bipolar cycling; very rapid, can have several different moods/emotions throughout the day

borderline personality disorder

What cluster B personality disorder is described below: ● Well-known & dramatic of the personality disorders ● Clinical picture - severe impairments in functioning ○ Marked instability in emotional control ○ Identity/self-image distortions ○ Unstable mood & relationships ○ ******A primary feature → emotional lability = rapidly moving from 1 emotional extreme to the other****** ■ Not like bipolar cycling; very rapid, can have several different moods/emotions throughout the day ○ Impulsivity - act quickly in response to emotions without considering consequences; results in damaged relationships & suicide attempts or cutting ■ Gets involved with people in relationships very quickly ○ Can be challenging on a unit. They like a lot of chaos and commotion . ○ Self-destructive behaviors/harmful self-soothing ■ Cutting****** ■ Promiscuous sexual behavior ■ Numbing with substances ○ Chronic suicidal ideation - back & forth to ER ■ These individuals seem to go back and forth in the ER and are involved in different suicide attempts ○ Hostility, anger, physical violence, destructive behaviors such as property damage ○ Splitting: Inability to view both positive and negative aspects of others as part of a whole; view person as wonderful or a horrible person. ■ Defense and coping style ■ Example - at first they may idealize new relationship/friend and kinda be all into it; if disappointed/frustrated by the other person - now quickly shifts and other person despised, devalued, etc. ■ "You're my best nurse, you're my best nurse!" then, if nurse does something they don't like "you're the worst nurse, you're the worst nurse!" ● *********Frequently seeks repeat hospitalizations!!!******** ● For depression, anxiety, suicidal/self-harm behaviors, substance use ● Hospitalizations may help with the self-destructive behaviors, it is NOT considered effective long-term solution. They may hop from one hospital to the next or one inpatient stay to another inpatient stay. ● Prevalence: 1.6% ● Epidemiology and comorbidity ○ 85%meet criteria for another psychiatric disorder ● Etiology ○ High genetic association ○ Separation-individuation factors - form Margaret Mahler - psychologist who proposed that there is a disruption in the process of feeling safe to explore away from caregiver. Carries fear of abandonment and anger into adulthood ● Assessment ○ Semi-structured interview ○ Use of tool if needed - Minnesota Multiphasic Personality Inventory ■ Self-report inventory ○ Self-mutilation & self-harm ○ Suicidal behaviors ○ Feelings of emptiness ○ Risky behavior ○ Intense feelings of abandonment ○ Idealization of others; becoming too close too quickly ○ Anger, sarcasm bitterness ○ Sudden shifts in goals, values, career focus, ○ Extreme mood shifts ○ Intense, unstable romantic relationships ● Nursing diagnoses ○ Self-mutilation********* ○ Risk for suicide ○ Risk for self- and/or other-directed violence ○ Impaired social interaction ○ Disturbed personal identity ○ Ineffective coping ● Outcomes and planning ○ Realistic outcomes ○ Importance of the therapeutic relationship ○ Avoid manipulative behaviors ● Implementation ○ *****Provide clear and consistent boundaries*** ■ Limit setting with the patient ■ All of the shifts need to adhere to whatever the limits and plan are for the patient******* ○ Use clear, straightforward communication ○ When behavioral problems arise, calmly review therapeutic goals ○ Respond matter-of-factly to superficial self-injuries- p. 469 ○ In accordance with agency policies - nurse dresses wound in matter-of-fact manner; pt. writes down sequence of events leading up to injury with consequences before staff will discuss the event. ■ If the patient is even being closely watched is able to somehow able to perform self-injury, in accordance to agency policies the nurse would address the wounds if that is what happened in a very matter of fact manner and not adding to the comotion of it all. ○ Cognitive exercise encourages patient to think about behavior ○ No meds FDA approved; use meds for mood regulation ○ ****Teamwork - united**** ■ Working with a patient like this, if there is going to be some sort of effectiveness, there has to be teamwork from one shift to another. It cant be that one shift is really enforcing limits and then in another shift the patient is able to manipulate the nurses to get his or her way. ● Psychotherapy ○ ***Dialectical behavior therapy (DBT) -evidence-based therapy developed for patients with borderline personality disorder. Emphasizes being aware of thoughts & actively shaping them. Diagram page 470

borderline personality disorder

With implementation of cluster B borderline personality disorder, you want to provide clear and consistent _________*** ■ Limit setting with the patient ■ All of the shifts need to adhere to whatever the limits and plan are for the patient ALL OF THIS IS VERY IMPORTANT.

boundaries

Physical signs for a patient with ____ ____ includes enlarged parotid glands, dental erosion, and caries (cavities) if the patient has been inducing vomiting.

bulimia nervosa

Thoughts and behaviors associated with _____ ____ include: ● Binge eating behaviors ● Often self-induced vomiting or use of laxatives, diuretics, or enemas ● After binging, that is what they do they will purge. Purging behaviors ● History of anorexia in ¼ to 1/3 of these individuals ● Depressive signs and symptoms

bulimia nervosa

Thoughts and behaviors associated with _____ ____ include: ● Problems in interpersonal relationship ● Self-concept and impulsive behaviors increase levels of anxiety and compulsivity ● Possible substance use disorders ● Possible impulsive stealing

bulimia nervosa

What type of therapy for anxiety disorders and OCD disorders is described below: ○ cognitive restructuring, psychoeducation, breathing techniques, muscle relaxation, self monitoring for panic and other symptoms, and real life exposure to feared objects/situations

cognitive behavioral therapy

What eating disorder is described below: Nursing Process ● Assessment ○ Appear well: at or near ideal body weight ○ Physical signs ■ Enlarged parotid glands, dental erosion, and caries (cavities) if the patient has been inducing vomiting ○ Emotional and relationship signs ■ Impulsivity and compulsivity ■ Chaotic, non-nurturing family relationships ■ Familial and/ or social instability ■ Difficult interpersonal relationships ○ Box 18.3: ■ Thoughts and behaviors associated with ______ ________: ● Binge eating behaviors ● Often self-induced vomiting or use of laxatives, diuretics, or enemas ● After binging, that is what they do they will purge. Purging behaviors ● History of anorexia in ¼ to 1/3 of these individuals ● Depressive signs and symptoms ● Problems in interpersonal relationship ● Self-concept and impulsive behaviors increase levels of anxiety and compulsivity ● Possible substance use disorders ● Possible impulsive stealing ● Diagnosis ○ Decreased cardiac output - loss of fluids ○ Disturbed body image ○ Ineffective coping ○ Powerlessness ○ Chronic low self esteem ○ Social isolation ● Outcomes ○ Electrolyte in balance - may be out of whack from vomiting ○ Adequate cardiac output ○ Satisfaction with body image ○ Effective coping ○ Verbalizes confidence of body image ○ Makes informed life decisions ○ Expresses independent decision making ○ Willingness to call others for assistance ○ Develops sense of belonging ● Interventions ○ Acute care ■ Cognitive behavioral approach plus antidepressant med improves symptoms ** Fluoxetine has FDA approval*** for both acute and maintenance treatment of bulimia nervosa ■ Structured to interpret cycle of binge eating and purging ■ Normalize eating habits ■ Therapy to examine underlying conflicts and body dissatisfaction that sustain the illness ○ Primary goal: observation during and after meals (up to 2 hours) to prevent purging, normalization of eating patterns, appropriate exercise ○ Care plan gives good review 345 ○ Self induced vomiting has effect on K+ level → cardiac arrhythmias ■ Short term goal: 1) patient will ID signs and symptoms of low potassium. 2) potassium will remain within normal limits throughout hospitalization ■ Intervention: educate patient regarding ill effects of self-induced vomiting on potassium

bulimia nervosa

What eating disorder is described below: ● Assessment ○ Appear well: at or near ideal body weight ○ Physical signs ■ Enlarged parotid glands, dental erosion, and caries (cavities) if the patient has been inducing vomiting ○ Emotional and relationship signs ■ Impulsivity and compulsivity ■ Chaotic, non-nurturing family relationships ■ Familial and/ or social instability ■ Difficult interpersonal relationships ■ Thoughts and behaviors associated with ______ ________: ● Binge eating behaviors ● Often self-induced vomiting or use of laxatives, diuretics, or enemas ● After binging, that is what they do they will purge. Purging behaviors ● History of anorexia in ¼ to 1/3 of these individuals ● Depressive signs and symptoms ● Problems in interpersonal relationship ● Self-concept and impulsive behaviors increase levels of anxiety and compulsivity ● Possible substance use disorders ● Possible impulsive stealing

bulimia nervosa

What eating disorder is described below: ● Diagnosis ○ Decreased cardiac output - loss of fluids ○ Disturbed body image ○ Ineffective coping ○ Powerlessness ○ Chronic low self esteem ○ Social isolation

bulimia nervosa

What eating disorder is described below: ● Interventions ○ Acute care ■ Cognitive behavioral approach plus antidepressant med improves symptoms ** Fluoxetine has FDA approval*** for both acute and maintenance treatment of bulimia nervosa ■ Structured to interpret cycle of binge eating and purging ■ Normalize eating habits ■ Therapy to examine underlying conflicts and body dissatisfaction that sustain the illness ○ Primary goal: observation during and after meals (up to 2 hours) to prevent purging, normalization of eating patterns, appropriate exercise ○ Self induced vomiting has effect on K+ level → cardiac arrhythmias ■ Short term goal: 1) patient will ID signs and symptoms of low potassium. 2) potassium will remain within normal limits throughout hospitalization ■ Intervention: educate patient regarding ill effects of self-induced vomiting on potassium

bulimia nervosa

What eating disorder is described below: ● Outcomes ○ Electrolyte in balance - may be out of whack from vomiting ○ Adequate cardiac output ○ Satisfaction with body image ○ Effective coping ○ Verbalizes confidence of body image ○ Makes informed life decisions ○ Expresses independent decision making ○ Willingness to call others for assistance ○ Develops sense of belonging

bulimia nervosa

What STI is described below: ● Symptoms: due to WBC that come to attack bacteria (apoptosis→ cell death) ○ Symptoms in males: ■ Non-gonococcal urethritis→ Inflammation of the urethra ● In men, the urethra is the most common site of infection resulting in non-gonococcal urethritis or NGU. Symptoms of NGU include dysuria, urethral discharge, and epidiymitis may be a complication as well. ■ Dysuria ■ Urethral discharge (pus) ■ Epididymitis

chlamydia

● MOST WIDELY USED PSYCHOACTIVE SUBSTANCE IN THE WORLD ● NOT an official use disorder, but can result in intoxication and withdrawal ○ Excess ______ use is not an official use disorder

caffeine

with cannabis use disorder, a person can experience ____ _____ which heightens new sensations; brighter colors; time moves slowly; motor skills impacted for 8-12 hours --Physical symptoms:red eyes, increased appetite, dry mouth, tachycardia

cannabis intoxication

what substance use disorder is described below: ● CANNABIS WITHDRAWAL within 1 week of cessation - irritability, anger, aggression, anxiety, restlessness, depressed mood, decreased appetite. ○ Physical Symptoms = One of the following: abdominal pain, shakiness, sweating, fever, chills, headache

cannabis use disorder

what substance use disorder is described below: ● Cannabis/ marijuana - most widely used often illegal drug in the world; 4th most common in US after caffeine, alcohol, nicotine ● From hemp plant: cannabis sativa ● THC = delta - 9-tetrahydrocannabinol - mind-altering effects ● **Concentrated form = hashish** ● Synthetic cannabinoids - dronabinol and nabilone - available by prescription for nausea and vomiting- chemotherapy for cancer

cannabis use disorder

what substance use disorder is described below: ● Males are more likely to have ____ _____ _______ ● Cannabis Intoxication: heightens new sensations; brighter colors; time moves slowly; motor skills impacted for 8-12 hours ○ Physical symptoms: red eyes, increased appetite, dry mouth, tachycardia .

cannabis use disorder

what substance use disorder is described below: ● TREATMENT- drug screens can detect in urine for up to 4 weeks after use. ○ ABSTINENCE AND SUPPORT→ Individual, group, family group therapy; ○ short- term anti anxiety med; ○ if appropriate antidepressant therapy

cannabis use disorder

What STI is described below: ○ Symptoms in females: ■ Mucopurulent cervicitis, or NONE ■ Vaginal or urethral discharge (pus) ■ Progress of symptoms ● Women are less likely to see symptoms; will go under-reported and will continue spread ● If untreated will see PID, abdominal pain, fever/chills, ectopic pregnancies, fertility issues, painful intercourse, bleeding during intercourse and neonatal complications ■ Include dysteria, urinary frequency, purulent discharge. It may progress if untreated and cause lower abdominal pain, lower back pain, nausea, fever, painful intercourse, and even bleeding during intercourse

chlamydia

What STI is the most common reportable infectious disease in the US?

chlamydia

What STI often co-infects with gonorrhea and dysteria or dysuria is common in both STIs?

chlamydia

what substance use disorder is described below: ● Cannabis/ marijuana - most widely used often illegal drug in the world; 4th most common in US after caffeine, alcohol, nicotine ● From hemp plant: cannabis sativa ● THC = delta - 9-tetrahydrocannabinol - mind-altering effects ● **Concentrated form = hashish** ● Synthetic cannabinoids - dronabinol and nabilone - available by prescription for nausea and vomiting- chemotherapy for cancer ● Males are more likely to have ____ _____ _______ ● Cannabis Intoxication: heightens new sensations; brighter colors; time moves slowly; motor skills impacted for 8-12 hours ○ Physical symptoms: red eyes, increased appetite, dry mouth, tachycardia . ● CANNABIS WITHDRAWAL within 1 week of cessation - irritability, anger, aggression, anxiety, restlessness, depressed mood, decreased appetite. ○ Physical Symptoms = One of the following: abdominal pain, shakiness, sweating, fever, chills, headache ● TREATMENT- drug screens can detect in urine for up to 4 weeks after use. ○ ABSTINENCE AND SUPPORT→ Individual, group, family group therapy; ○ short- term anti anxiety med; ○ if appropriate antidepressant therapy

cannabis use disorder

with cannabis use disorder, a person can experience ____ ____ within 1 week of cessation - irritability, anger, aggression, anxiety, restlessness, depressed mood, decreased appetite. ○ Physical Symptoms = One of the following: abdominal pain, shakiness, sweating, fever, chills, headache

cannabis withdrawal

most widely used often illegal drug in the world; 4th most common in US after caffeine, alcohol, nicotine

cannabis/marijuana

The following is part of the ___ ____ of substance use disorders: ● Alcoholics Anonymous ○ Founded 1930 ○ Oldest and best known of 12 step programs ■ Al-Alon: friends and family ■ Alateen: teenage relatives of alcoholic abusers ■ Nar-Anon: family and friends of drug users ********● Relapse prevention: plan in place; triggers; healthy coping skills; new apps*******

care continuum

The following is part of the ___ ____ of substance use disorders: ● Other housing ○ Three-quarter house ○ Drug free environment, peer support, attend outpatient substance use tx ● Partial hospitalization program (PHP)- intensive form of outpatient - structured setting ○ Example: 5 days/week for 6 hours ● Intensive outpatient program (IOP) - alternative to partial hospitalization program - scheduled tx group and at least 1 individual session regularly ○ Example: 3 days/week for 3 hours ● Outpatient treatment - least intensive tx form. No more than 5 contact hours/week. Web based interventions available

care continuum

the following are characteristics of vulnerable ______: ● Younger than 4 years ● Perceived as different ● Remind parents of someone they do not like ● Product of unwanted pregnancy ● Interference with emotional bonding between parent and child ● PLEASE NOTE: ****Family violence is common in the childhood histories of juvenile offenders, runaways, violent criminals, prostitutes, and those who are in turn violent toward others.

children

What STI can spread to the eye via direct contact and the individual may have pus discharge, conjuctivitis and it also infects and attacks joints causing dysarthria? **trachoma is the most common cause of blindness

chlamydia

What STI is described below: Treatment: several options: ○ Tertiary prevention (since they have been diagnosed) ■ Doxycycline 100 MG PO x 7 days (BID) ■ *****Azithromycin 1g PO x 1 dose** ● Expensive ● One time dose, can ensure compliance ● Most common form ● Very effective since you only have to take 1 dose ■ Erythromycin ■ Ofloxacin ■ CDC recommends annual sexual screening tests for all sexually active women 25 years old or younger as well in older women with the risk factors for infection. They also recommend us test all pregnant women for _________.

chlamydia

What STI is described below: · Asymptomatic in men about 90% of the time and 70% of the time in women · It is known as the silent disease · Also, because the cervix of young women is not fully developed, this may increase their susceptibility to ________ ● Incubation: 3-21 days; people are unaware of infection and can still spread it

chlamydia

What STI is described below: · Most common reportable disease in the US · Often co- infects with Gonorrhea · · · Dysteria is common in both _______ and gonorrhea · Can be transmitted via sexual activity, childbirth, or direct contact Intracellular bacterial infection · Infects the genital urinary tract and rectum in adults and can cause conjuctivittis and pneumonia in neonates · The mucal purulent discharge of infected sites contact the mucous membranes on non-infected persons to spread the infection

chlamydia

What STI is described below: · Most common reportable disease in the US · Often co- infects with Gonorrhea · · · Dysteria is common in both _______ and gonorrhea · Can be transmitted via sexual activity, childbirth, or direct contact Intracellular bacterial infection · Infects the genital urinary tract and rectum in adults and can cause conjuctivittis and pneumonia in neonates · The mucal purulent discharge of infected sites contact the mucous membranes on non-infected persons to spread the infection · Risk factors for ________ include: o Those under 25 o Those who may have multiple sexual partners and o history of another STI · Asymptomatic in men about 90% of the time and 70% of the time in women · It is known as the silent disease · Also, because the cervix of young women is not fully developed, this may increase their susceptibility to ________ ● Incubation: 3-21 days; people are unaware of infection and can still spread it ● Symptoms: due to WBC that come to attack bacteria (apoptosis→ cell death) ○ Symptoms in males: ■ Non-gonococcal urethritis→ Inflammation of the urethra ● In men, the urethra is the most common site of infection resulting in non-gonococcal urethritis or NGU. Symptoms of NGU include dysuria, urethral discharge, and epidiymitis may be a complication as well. ■ Dysuria ■ Urethral discharge (pus) ■ Epididymitis ○ Symptoms in females: ■ Mucopurulent cervicitis, or NONE ■ Vaginal or urethral discharge (pus) ■ Progress of symptoms ● Women are less likely to see symptoms; will go under-reported and will continue spread ● If untreated will see PID, abdominal pain, fever/chills, ectopic pregnancies, fertility issues, painful intercourse, bleeding during intercourse and neonatal complications ■ Include dysteria, urinary frequency, purulent discharge. It may progress if untreated and cause lower abdominal pain, lower back pain, nausea, fever, painful intercourse, and even bleeding during intercourse ○ Can spread to eye via direct contact; may have pus discharge, conjunctivitis ■ Trachoma→ Most common cause of blindness ○ Can also infect and attack joints causing dysarthria ■ Infective or reactive (WBC attack joint when trying to fight off _______) ● Diagnosis: diagnosed with a culture ● Treatment: several options: ○ Tertiary prevention (since they have been diagnosed) ■ Doxycycline 100 MG PO x 7 days (BID) ■ Azithromycin 1g PO x 1 dose ● Expensive ● One time dose, can ensure compliance ● Most common form ● Very effective since you only have to take 1 dose ■ Erythromycin ■ Ofloxacin ■ CDC recommends annual sexual screening tests for all sexually active women 25 years old or younger as well in older women with the risk factors for infection. They also recommend us test all pregnant women for _________.

chlamydia

What STI is described below: · Risk factors for ________ include: o Those under 25 o Those who may have multiple sexual partners and o history of another STI · Asymptomatic in men about 90% of the time and 70% of the time in women · It is known as the silent disease · Also, because the cervix of young women is not fully developed, this may increase their susceptibility to ________

chlamydia

What type of therapy for anxiety disorders and OCD disorders is described below: ○ COGNITIVE RESTRUCTURING- support efforts made by specialist. Psychotherapy is not within the scope of BSN RN ■ Based on belief that errors in thinking leads to mistaken negative beliefs

cognitive therapy

what are the 3 main symptoms of opioid overdose?

coma, pinpoint pupils (KEY SIGN), and respiratory depression

The following are ____ ____ while interviewing a client with a potential STI: ● Basic Pointers: ○ Privacy ○ Confidentiality ○ Acknowledge your feelings as well as your discomfort you may have when talking about these diseases ○ Never assume!!!!! ■ Just because someone is married doesn't mean they are faithful to their spouse. ■ When asking questions, do not ever skip that they may have other sexual partners even though they are married ○ Relaxed body posture to ensure that they are relaxed during the interview process as well ○ Use words lay terms where they can understand what you are talking about

communication skills

The following is the epidemiology and _____ of personality disorders: ● Prevalence: About 6% of global population ● Seen in up to 50% of psychiatric patients ● The presence of a personality disorder results in poorer outcomes in treatment of other psychiatric disorders and may underlie treatment-resistant cases ● Emotional dysregulation is amplified ● Risk factors ○ Genetic ○ Neurobiological ○ Psychological ○ Environmental ○ Diathesis-stress model

comorbidity

What defense mechanism is described below: used to counterbalance perceived deficiencies by emphasizing strengths

compensation

What type of gonorrhea includes such things as epidiymitis, asystemic gonococcal infection or even gonococcal meningitis?

complicated

What part of OCD is described below: ritualistic behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly ○ Behaviors aimed at preventing or reducing anxiety; clearly excessive EX: patient wiggles while going through door, turning doorknob over and over to make sure it's locked

compulsion

addiction, intoxication, tolerance, and withdrawal are the 4 ____ for substance use disorders.

concepts

______ testing of HIV includes: ● All positive HIV results, regardless done by rapid or conventional test, must be verified by second "confirmatory HIV" test ● Be mindful of "Window period" ○ Ask about last sexual encounter ○ When a false negative can be obtained by minimal antibodies which can last for 6 weeks to 3 months. So if they have unprotected sex in the past 3 months they will need to retest.

confirmatory

______ testing of HIV includes: ● If the initial EIA is positive, western blot or IFA is performed by the lab to confirm the EIA result ○ EIA is a lab test that measures antibodies in the blood ● Confirmation testing is built into the algorithm without the need for further specimen collection ● Test results are reported as positive, negative, or indeterminant ● All positive HIV results, regardless done by rapid or conventional test, must be verified by second "confirmatory HIV" test ● Be mindful of "Window period" ○ Ask about last sexual encounter ○ When a false negative can be obtained by minimal antibodies which can last for 6 weeks to 3 months. So if they have unprotected sex in the past 3 months they will need to retest.

confirmatory

Factors that compromise the patient's ability to ______ includes the following: ○ Other stressful life events going on at the same time ○ Other unresolved losses ○ Concurrent psychiatric disorders ○ Medical problems ○ Excessive fatigue or pain ○ Quality and quantity of person's usual coping skills ○ ***All of these can be factors on whether the person will be able to handle the crisis in a successful manner NEED TO KNOW.

cope

In a crisis, ____ _____ and skills include: ● **Acquired - through variety of sources such as cultural responses, modeling behaviors o others, and life experiences that broaden the experience and promote adaptive development of new coping responses. ○ Cultural responses- culture of neighbor helping neighbor ■ here in LA, during hurricanes the neighborhood looks out for each other and helps each other ○ Modeling others - "fall apart" or handle ■ Do children see family fall apart through crisis or see people handle it with skill and calmness? ○ Life experiences that have helped in developing coping mechanisms ■ EX: if you have gone through previous hurricane, flood, vehicle accident, etc and come out on the other side, the next time one comes there is some coping mechanisms that have been formed. ■ They LEARN through it and develop these coping mechanisms when it may come again OR to transfer to another type of crisis ● Factors that compromise ability to cope ○ Other stressful life events going on at the same time ○ Other unresolved losses ○ Concurrent psychiatric disorders ○ Medical problems ○ Excessive fatigue or pain ○ Quality and quantity of person's usual coping skills ○ ***All of these can be factors on whether the person will be able to handle the crisis in a successful manner ○ Figure 26.1 good depiction of different responses to stressful event ■ A human organism that is living live in a state of equilibrium. Along comes a stressful event thrown into a state of disequilibrium and there is now a need to restore equilibrium. ■ On the left side, the balancing factors (what they are trying to do to get back to homeostasis): what helps is a realistic perception of the event, adequate situational support, adequate coping mechanisms: this results in resolution of the problem, equilibrium is regained so there is no crisis state. ■ On the right side: one or more of those balancing factors is absent a distorted perception of the event, no adequate situational support, no adequate coping mechanisms and this results in the problem NOT being resolved so the disequilibrium continues and now we have a crisis state. ○ Crisis presents opportunity for personal growth, development of coping skills and positive change

coping mechanisms

When assessing ____ ______ or skills during an assessment: ● Nurse would assess if the ___ ______ or skills are positive or ineffective ● Are they positive or ineffective? ○ Ineffective → overeating (oops), drinking (oops), smoking, withdrawing, yelling, fighting ○ Questions to assess coping skills: (open ended) ■ What have you been doing to relieve anxiety you have been feeling? ■ What has helped in the past to relieve stress? ■ What helped you through difficult times in the past?

coping mechanisms

With cluster C dependent personality disorder, one of the main guidelines for nursing care is that the nurse should be aware of strong _______ that can develop because of the patient's demands for extra time.

countertransference

With Sedative, Hypnotic and Antianxiety Medication Use Disorder, what is a typical feature?

craving

A major Disturbance caused by a stressful event or a threat which disrupts homeostasis

crisis

At the resolution of a _____ the patient will emerge at 1 of 3 different levels: a) higher level of functioning (learned some new coping skills while going through crisis), b) same level of functioning, c) lower level of functioning (did not make adaptations or learn new knowledge or coping skills)

crisis

● A major Disturbance caused by a stressful event or a threat which disrupts homeostasis ● Normal coping mechanism fail ● Results in inability to function as usual ● Perception of threat is based on a person's unique perspective and coping abilities ● threatens personality organization, but it also presents an opportunity for personal growth

crisis

● Daily functioning in a stable state → **homeostasis or equilibrium** ○ Homeostasis = baseline ● _______ -- there is a major disturbance caused by a stressful event or threat; disrupts this homeostasis; knocks people off of the baseline ● Normal coping skills fail- inability to function as usual

crisis

Nurse in _____ _____ is more directive and creative role. Examples include making phone calls to arrange babysitters, scheduling to visit another nurse, finding shelter, and contacting social workers. You also identify needed social supports (with patients output) and mobilize priority. ABSOLUTELY NEED TO KNOW.

crisis intervention

The following are guidelines for _____ ______: 1. assess for suicidal or homicidal thoughts or plans 2. take initial steps to make patient feel safe and less anxious 3. Listen carefully (make eye contact, give frequent feedback to verify and convey understanding, summarize what patient says) 4. ____ ____ calls for directive and creative approaches. Initially the nurse may make phone calls to arrange babysitters, schedule a visiting nurse, find shelter, or contact a social worker. 5. ID needed social supports (with patient's input) and mobilize the priority. 6. ID needed coping skills (ex: problem solving, relaxation, assertiveness, job training, newborn care, self-esteem building) 7. Involve patient in identifying realistic acceptable interventions. 8.Plan regular follow up (phone calls, clinic visits, home visits) to assess patient's progress.

crisis intervention

The following are guidelines for _____ ______: 5. ID needed social supports (with patient's input) and mobilize the priority. 6. ID needed coping skills (ex: problem solving, relaxation, assertiveness, job training, newborn care, self-esteem building) 7. Involve patient in identifying realistic acceptable interventions. 8.Plan regular follow up (phone calls, clinic visits, home visits) to assess patient's progress.

crisis intervention

The following are modalities of _____ _____: ● Emergency rooms ● Telephone hotlines ● Peer crises services ● Crisis Intervention teams (CITs) ● Crisis stabilization beds ● ***Short term*** residential services - these places provide 24 hour observation and supervision for people who do not require inpatient at this point; provided this short term place to eliminate/ reduce acute symptoms

crisis intervention

The following is the foundation for _____ _____: --a crisis is self-limiting and usually resolves within 4-6 weeks --at the resolution of a crisis, the patient will emerge at 1 of the 3 different functional levels: 1. a higher level of functioning 2. the same level of functioning 3. a lower level of functioning --the goal of ____ _____ is to return the patient to at least the precrisis level of functioning *********** --the form of crisis resolution depends on the patient's actions and others' interventions --during a crisis, the people are often more receptive than usual to outside intervention. With intervention, the patient can learn different adaptive means of problem solving to correct inadequate solutions --the patient in a crisis situation is assumed to be mentally healthy, to have functioned well in the past, and to be presently in a state of disequilibrium --_____ _____ deals only with the patient's present problem and resolution of the immediate crisis (the "here and now") --the nurse must be willing to take an active, even directive, role in intervention, which isi in direct contrast to conventional therapeutic intervention that stresses a more passive and non-directive role --early intervention probably increases the chances for a good prognosis --encourage the patient to set realistic goals and plan a focused intervention with the nurse

crisis intervention

The following is the foundation for _____ _____: --during a crisis, the people are often more receptive than usual to outside intervention. With intervention, the patient can learn different adaptive means of problem solving to correct inadequate solutions --the patient in a crisis situation is assumed to be mentally healthy, to have functioned well in the past, and to be presently in a state of disequilibrium --_____ _____ deals only with the patient's present problem and resolution of the immediate crisis (the "here and now")

crisis intervention

The following is the foundation for _____ _____: --the nurse must be willing to take an active, even directive, role in intervention, which isi in direct contrast to conventional therapeutic intervention that stresses a more passive and non-directive role --early intervention probably increases the chances for a good prognosis --encourage the patient to set realistic goals and plan a focused intervention with the nurse

crisis intervention

●_____ ________ is an actual principle ● DIRECTIVE, TIME LIMITED, AND GOAL DIRECTED strategy designed to assist individuals who are experiencing a crisis ● Important for all nurses - no matter the specialty ○ Not limited to those who help in disasters or those that work in ER departments

crisis intervention

example of a tertiary intervention directed towards a group that has experienced a crisis § Examples: debriefing with staff on inpatient unit following patient suicide; debriefing with schoolchildren and school personnel after school shooting; debriefing with rescue and health workers who have responded to disaster, shooting, etc. **tertiary care

critical incident stress debriefing

What medication can help with obsessive behavior after reach maintenance weight? NEED TO KNOW. *intervention for anorexia nervosa

fluoxetine

The following is talking about ____ due to HIV/AIDS: --6,721 (in 2014) --Remains a significant cause of death for certain populations --8th leading cause of death for those 25-34 yo --9th leading cause of death for those 35-44 yo --not dx or tx early - reason for death

deaths

The following are _____ _____: practice principles for violent patients: --maintain the patient's self-esteem and dignity --maintain calmness (your own and the patient) --assess the patient and the situation --ID stressors and stress indicators --respond as early as possible --use a calm clear tone of voice --invest time --REMAIN HONEST --determine what the patient considers to be needed --ID goals --avoid invading personal space; in times of high anxiety, personal space increases --avoid arguing --give several clear options --use genuineness and empathy --be assertive (not aggressive) --do not take chances; maintain personal safety

deescalation techniques

Both can be used in both healthy and unhealthy ways ● Adaptive use → lower anxiety and achieve goals in acceptable ways ○ Healthy ways ● Maladaptive use → use in excess; overuse of immature ones ○ Unhealthy ways

defense mechanism

● AUTOMATIC coping mechanism to protect from anxiety and maintain self-image; blocking feelings, conflicts, and memories ● developed by Sigmund Freud & daughter Anna

defense mechanism

● developed by Sigmund Freud & daughter Anna ● AUTOMATIC coping mechanism to protect from anxiety and maintain self-image; blocking feelings, conflicts, and memories Both can be used in both healthy and unhealthy ways ● Adaptive use → lower anxiety and achieve goals in acceptable ways ○ Healthy ways ● Maladaptive use → use in excess; overuse of immature ones ○ Unhealthy ways ● Common examples include rationalization and displacement; ○ Projection - people take something out on someone else (always negative) ● Note: sublimation and altruism (not in list) are always positive ○ Ex: death of child from an illness, family starts foundation in their honor to help other families ● To determine if a ____ ______ is adaptive or maladaptive is determined by their frequency, intensity and duration of use

defense mechanism

With cluster A schizotypal personality disorder, according to the DSM-5, these individuals have severe social and interpersonal _______ as well as _______ - magical thinking, odd beliefs, strange speech patterns, inappropriate affect NEED TO KNOW

deficits; hallmarks

What defense mechanism is described below: · involves escaping unpleasant, anxiety-causing thoughts, feelings, wishes, need by ignoring their existence o Someone has an unpleasant situation going on and is something that they need to be dealing with but are simply ignoring it

denial

With substance use disorders, patients can experience ______: ● Some forms of _______ (note ineffective denial as nursing diagnosis table 22.5) ○ Minimizing ○ Rationalizing ○ Intellectualizing ○ Blaming ■ I drink because nursing school ○ Diversion - changing the subject ○ Also—dysfunctional family processes

denial

What cluster C personality disorder is described below: ● Guidelines for nursing care ○ Help address current stressors ○ Set limits that don't make the patient feel punished ○ Be aware of strong COUNTERTRANSFERENCE that can develop because of the patient's demands for extra time ○ Use therapeutic relationship as a testing ground for assertiveness training

dependent personality disorder

What cluster C personality disorder is described below: ● Prevalence: 0.5% ● Characteristics ○ High need to be taken care of ○ Submissiveness nature ○ Fears of separation and abandonment ○ Lack confidence in own ability or judgment, leading to *****manipulating others****** to take responsibilities ○ Intense anxiety when left alone even briefly ○ Will find relationships to take care of this desire

dependent personality disorder

What cluster C personality disorder is described below: ● Prevalence: 0.5% ● Characteristics ○ High need to be taken care of ○ Submissiveness nature ○ Fears of separation and abandonment ○ Lack confidence in own ability or judgment, leading to *****manipulating others****** to take responsibilities ○ Intense anxiety when left alone even briefly ○ Will find relationships to take care of this desire ● Guidelines for nursing care ○ Help address current stressors ○ Set limits that don't make the patient feel punished ○ Be aware of strong COUNTERTRANSFERENCE that can develop because of the patient's demands for extra time ○ Use therapeutic relationship as a testing ground for assertiveness training ● Treatment ○ Psychotherapy is treatment of choice. Cognitive-behavioral therapy can help patients healthier thinking by examining & challenging automatic thoughts that result in fearful behavior

dependent personality disorder

What cluster C personality disorder is described below: ● Treatment ○ Psychotherapy is treatment of choice. Cognitive-behavioral therapy can help patients healthier thinking by examining & challenging automatic thoughts that result in fearful behavior

dependent personality disorder

What dissociative disorder is described below: ○ focus on oneself; uncomfortable feeling of being an observer of one's own body ■ Out of body feeling --response to acute stress

depersonalization

What dissociative disorder is described below: ○ focus on outside world; one's surroundings are unreal and distant ■ Everything around them is strange and different --response to acute stress

derealization

With substance use disorders, we have ______ which includes: ● Follow protocol of facility - may be fixed time or every "so many" hours for "so many" doses ○ Example: ■ Clorazepate 15mg PO QID x 1 day, then ■ Clorazepate 15mg PO TID x 1 day, then ■ Clorazepate 15mg PO BID x 1 day, then ■ Clorazepate 15mg PO Q day x 1 day, then D/C ○ May have PRN dose ordered based on CIWA-AR scale ○ Thiamine probably included in the protocol along with maybe other nutritional supplements

detoxification

● person quits using substance known to cause withdrawal or already in withdrawal ○ Medically managed with 24 hour coverage ○ Uncomfortable, possibly fatal side effects caused by withdrawal **care continuum of substance use disorders

detoxification

Psychotherapy is used as treatment for cluster B borderline personality disorder. ____ ____ ____ falls under this and it is evidence-based therapy developed for patients with borderline personality disorder. Emphasizes being aware of thoughts & actively shaping them.

dialectical behavioral therapy

With alcohol withdrawal, withdrawal seizures may occur within 12-24 hours AFTER ALCOHOL CESSATION. ○ _____ ______→ common treatment for withdrawal seizures ○ If freestanding hospital doesn't have IV fluids, may have to transfer patient to a hospital that does

diazapam IV

What is an anti-anxiety agent for treatment for cluster A paranoid personality disorder?

diazepam

During implementation, the nurse must be willing to take an active, even ________ role (helping them specifically) in intervention, which is in direct contrast to conventional therapeutic intervention, which is nondirective ("we don't give advice")

directive

During a crisis, equilibrium is replaced by ________. Nursing planning and intervention comes from this acknowledgement. ○ Why are we assessing suicidality ○ Levels of anxiety? etc. ○ Equilibrium is (daily normal functioning where we find a rhythm in our lives even if there are ups and downs, deadlines, and stress that comes and go, we still get our foot planted in this area of homeostasis) ○ When a crisis comes, equilibrium is replaced by _______ and we do NOT have this footing. ○ When people come to us, especially in particular departments that have more ciriss component, that people are coming to us in disequilibrium and it is NOT limited to the patients. The families many times are displaying all kinds of emotional responses and if we keep this in the for front "ok their life has been rocked" and they are no longer in a state of homeostasis but now this equilibrium that they knew, their life has been replaced by ________ and many times that can account for their responses and can help us be empathetic ALL IN RED ON NOTES. NEED TO KNOW.

disequilibrium

With Cluster B antisocial personality disorder, one of the characteristics includes antagonistic and disinhibited behaviors. which one is described below: ○ high risk taking, disregard for responsibility, impulsivity ■ Ex: deciding to rob a convenience store

disinhibited

What defense mechanism is described below: · transference of emotions associated with a particular person, object, or situation o They transfer from one situation that seems to be more threatening to one that seems to be less threatening o Example: person has an unpleasant situation that happens at work with a supervisor or boss and they know better than to express their anger in the work setting but when they get home they start yelling at family members and children and they are displacing the anger. They are really anger over at work but they are letting it out and transfering it over to another situation.

displacement

With cluster B narcissistic personality disorder one of the MAIN characteristics is that these individuals have less ______ impairment than other personality disorders. NEED TO KNOW.

functional

What dissociative disorder is described below: ● UNCONSCIOUS DEFENSE MECHANISM that protects the person against overwhelming anxiety through an emotional separation ○ EX: sexual abuse. "Too much to feel" ○ Separation does result in disturbances in memory, self-identity, consciousness, and perception ○ People with a dissociative disorder are intact to reality. Even though they have flashbacks that are triggered by a current event and that related to past trauma, they are not illusions or hallucinations. So, a flashback is not the same thing as an illusion or a hallucination. ○ An example in the book includes a very mild fleeing dissociative experience we may have when we go into auto-pilot going somewhere and then we arrive and we do not have a memory of the last 15 minutes.

dissociation

_____ disorders occur after significant adverse experiences/traumas; person responds to stress with a severe interruption of consciousness

dissociative

What dissociative disorder is described below: ● Inability to recall important personal information ● Subtype- Dissociative fugue - sudden unexpected travel - inability to recall one's identity and the past. ○ Rare cases - assumes a whole new identity ○ They travel while in this state and they have an inability to recall some or all of the past.

dissociative anmesia

What dissociative disorder is described below: ● sudden unexpected travel - inability to recall one's identity and the past. ○ Rare cases - assumes a whole new identity ○ They travel while in this state and they have an inability to recall some or all of the past. *subtype of dissociative amnesia

dissociative fugue

What dissociative disorder is described below: ● Essential feature → presence of 2 or more distinct personality states that recurrently take control of behavior ● Each alternate personality: own pattern of perceiving, relating to, thinking about the self ● (movies) ○ Disorder that sometimes movies will protray. Example, the movie Civil and the 3 Faces of Eve. ● Previously known as multiple personality disorder Primary personality is the host which is normally not usually aware of the alters. It is actually confused about lost time and unexplained events such as finding unfamiliar clothes in the closet.

dissociative identity disorder

With Cluster B antisocial personality disorder, one of the MAIN characteristics is _______→ Profound lack of empathy or regard for the rights of others********** NEED TO KNOW.

disturbing

Occurrence of Family Violence is also called ______ violence and is among the most important public health issues in the US. Requires: perpetrator and vulnerable person

domestic

With cluster A paranoid personality disorder, one of the characteristics is the _______ defense mechanism - projection of feelings - people attribute their own unacknowledged feelings to others Example - Accuse partner of being hypercritical when they themselves are fault finding

dominant

With cluster B histrionic personality disorder, one of the MAIN characteristics is that they are excitable, _________; often high functioning; have a big presence ○ May refer to as "drama queen" or "drama major" NEED TO KNOW.

dramatic

Synthetic cannabinoids, ____ and _____ are available by prescription for nausea and vomiting as well as for chemotherapy for cancer. **cannabis use disorder

dronabinol and nabilone

With stage 3: latent syphilis, it is subdivided into 2 types based on time. which type is the initial infection within the previous 12 months?

early

What is Cluster A for personality disorders?

eccentric (includes: paranoid, schizoid, and schizotypal)

With cluster B borderline personality disorder, A primary feature → _____ ______ = rapidly moving from 1 emotional extreme to the other ■ Not like bipolar cycling; very rapid, can have several different moods/emotions throughout the day

emotional liability

With cluster B narcissistic personality disorder one of the MAIN characteristics is that these individuals come across as arrogant, need for constant admiration, LACK OF _________ FOR OTHERS → a factor that strains most relationships over time NEED TO KNOW

empathy

What symptom of gonorrhea includes swollen testicles and they are usually painful and if left untreated can cause infertility in men?

epidiymitis

When talking about crisis, ______ is the person's daily normal functioning where we find a rhythm in our lives even if there are ups and downs, deadlines, and stress that comes and go, we still get our foot planted in this area of homeostasis **this is replaced by disequilibrium in a crisis.

equilibrium

What is Cluster B for personality disorders?

erratic (includes: borderline, narcissistic, histrionic, and antisocial)

What is the key pathologic feature of GAD?

excessive worry

What disorder is described below: ● - skin picking - typically confined to face; other part of body may be targeted ● Means to deal with stress and relieve anxiety; others may engage without thinking about it ● 75% are females ● Onset → adolescence ● Ask patients where sores come from

excoriation disorder

reaction to a specific danger

fear

what is the most common manifestation of social anxiety disorder AKA social phobia?

fear of public speaking

what substance use disorder is described below: ● Leading cause of intellectual disability in US ● Alcohol during pregnancy inhibits uterine growth → microcephaly, craniofacial malformations, limb and heart defects ○ As adults, they tend to have short stature ● Figure - page 421 ● PREVENTABLE

fetal alcohol syndrome

What type of behavioral therapy for anxiety and OCD disorders is described below: ■ LARGE AMOUNT OF UNDESIRABLE STIMULUS- EFFORT TO EXTINGUISH ANXIETY RESPONSE; learn through the prolonged exposure that survival is possible Example - touches objects with paper towel - touch with bare hand x 1 hour

flooding

what substance use disorder is described below: compulsive activity; causes economic problems and significant disturbances in personal, social, or occupational functioning ● Otherwise honest people commit illegal acts to finance the addiction; may rely on others to help pay off debts ● Stress and depression may increase behavior ● Treatment: legal problems, pressure from family, and other psychiatric problems.GA (gamblers anonymous) hospitalization - to remove them from gambling environment.

gambling disorder

what risk factor for substance use disorders are described below: - alcohol use disorder runs in families about 40% - 60% risk → inherited

genetic

What STI is described below: ● Viral infection ● Incubation: 2-20 days ● S&S: painful vesicular ulceration of the penis, vaginal labia, perianal or anus within average of 11 days as an initial outbreaks; lesions last initially 5-6 weeks and spontaneously heal ○ Initial outbreak is the most severe ○ Most people will experience a prodromal phase. This may include a mild tingling sensation up to 48 hours before eruption or shooting pain into the area ● Recurrence is common; will NEVER get rid of this!!!!! ● If an infected person touches the lesions, then touches another body part the infection can be transmitted to that area. Also, if a pregnant woman as an outbreak it is necessary for them to have a C-section. However, if they are not active or do not have an outbreak they can deliver the baby naturally ● Carrier; can be symptomatic or asymptomatic ○ An individual is a carrier of ___ _______ and they may be asymptomatic because remember you will have episodic outbreaks. They will always be a chronic carrier of infection meaning that it will NEVER go away. ● Herpes zoster is NOT a chronic carrier. ● Treatment: ○ No cure ○ Treatment: ■ Episodic - when they first start with an outbreak ■ Suppressive - take meds on a daily basis ○ Acyclovir 400 mg PO TID x 7-10 days ○ Valacyclovir 1g PO BID for 7-10 days ○ Suppressive therapy: will start medication when they start getting symptoms; must refrain from sex while on medication (daily therapy when they have frequent occurrences) ■ Acyclovir (if you move your body like a cyclone you'll get herpes) ■ Valacyclovir ■ Why do we not do this on everyone?? ● The fact is that these viral medications do pose risk for liver damage, the cost of it, as well as the side effects of long term treatment

genital herpes (herpes simplex 2)

What STI is described below: ● Treatment: ○ No cure ○ Treatment: ■ Episodic - when they first start with an outbreak ■ Suppressive - take meds on a daily basis ○ Acyclovir 400 mg PO TID x 7-10 days ○ Valacyclovir 1g PO BID for 7-10 days

genital herpes (herpes simplex 2)

What STI is described below: Treatment: ○ Suppressive therapy: will start medication when they start getting symptoms; must refrain from sex while on medication (daily therapy when they have frequent occurrences) ■ Acyclovir (if you move your body like a cyclone you'll get herpes) ■ Valacyclovir ■ Why do we not do this on everyone?? ● The fact is that these viral medications do pose risk for liver damage, the cost of it, as well as the side effects of long term treatment

genital herpes (herpes simplex 2)

What STI is described below: ● Carrier; can be symptomatic or asymptomatic ○ An individual is a carrier of ___ _______ and they may be asymptomatic because remember you will have episodic outbreaks. They will always be a chronic carrier of infection meaning that it will NEVER go away. ● Herpes zoster is NOT a chronic carrier.

genital herpes (herpes simplex 2)

What STI is described below: ● Recurrence is common; will NEVER get rid of this!!!!! ● If an infected person touches the lesions, then touches another body part the infection can be transmitted to that area. Also, if a pregnant woman as an outbreak it is necessary for them to have a C-section. However, if they are not active or do not have an outbreak they can deliver the baby naturally

genital herpes (herpes simplex 2)

What STI is described below: ● Viral infection ● Incubation: 2-20 days ● S&S: painful vesicular ulceration of the penis, vaginal labia, perianal or anus within average of 11 days as an initial outbreaks; lesions last initially 5-6 weeks and spontaneously heal ○ Initial outbreak is the most severe ○ Most people will experience a prodromal phase. This may include a mild tingling sensation up to 48 hours before eruption or shooting pain into the area

genital herpes (herpes simplex 2)

This info comes from box 26.1: · Good synopsis · Crisis usually self-limiting and resolves in 4-6 weeks o By definition: a crisis should have this TIME limitation to it · At the resolution of a crisis, the patient will emerge at 1 of 3 different levels: o Resolved crisis--> a) higher level of functioning (learned some new coping skills while going through crisis), b) same level of functioning, c) lower level of functioning (did not make adaptations or learn new knowledge or coping skills) · ________--> return to AT LEAST PRECRISIS level of functioning****** · Assume patient to be mentally healthy (to have functioned well in the past) but in state of disequilibrium · *******Crisis intervention deals only with present problem and resolution of immediate crisis--> here and now; a bit different from nursing in other situations which looks a whole · Nurse in crisis intervention is more directive and creative role--> examples 26.2 pg. 497 o Make phone calls to arrange babysitters; schedule visiting nurse, find shelter, contact social worker o Identify needed social supports (with patient's output) and mobilize priority**********

goal

the following are ____ of treatment for HIV: ● Decrease viral load ● Maintain or raise the CD4 T cell counts ● Delay the onset of HIV related symptoms

goals

CDC recommends that if they are diagnosed with ________ that we get a detailed sexual history, we must treat all of those diagnosed with _______, and every effort to treat all patients sexual partners for the last 60 days. We are also to obtain cultures to test decreased susceptibility from any patients with any suspected or documented ________l treatment failures. We are also to report any suspected treatment failures to the public health officials to recognize any potential resistance.

gonorrhea

What STI is described below: Caused by bacteria (Neisseria gonorrhoeae) · Incubation: 3 to 21 days · 2nd most commonly reported infectious disease in the US · It is bacterial infection that affects mucous membranes of the GU tract, rectum, and pharynx · Transmitted by anal, oral, or vaginal sex and by fluids · Can spread by mother to infant as well during child birth

gonorrhea

What STI is described below: Symptoms: o Females § None or symptoms of pelvic inflammatory disease Majority of the time will have no symptoms § Purulent discharge § Urinal frequency § May become confused with a bladder or vaginal infection § Treatment or testing in women may not be solved and may allow the infection to spread and not be detected until pelvic inflammatory disease has occurred. ________ is the major ause of PID as well as atopic pregnancy and infertility. It can cause an increased risk of acquiring and spreading HIV.

gonorrhea

What STI is described below: · 2 types: o uncomplicated which is limited to cervical or urethral infection o Complicated which includes such thing as epididymitis, asystemic gonococcal infection or even gonococcal meningitis · Diagnosed: by a culture; swab patient, gram stain/culture o In LA we have a resistant form of gonorrhea in our state.

gonorrhea

What STI is described below: · Caused by bacteria (Neisseria gonorrhoeae) · Incubation: 3 to 21 days · 2nd most commonly reported infectious disease in the US · It is bacterial infection that affects mucous membranes of the GU tract, rectum, and pharynx · Transmitted by anal, oral, or vaginal sex and by fluids · Can spread by mother to infant as well during child birth · 2 types: o uncomplicated which is limited to cervical or urethral infection o Complicated which includes such thing as epididymitis, asystemic gonococcal infection or even gonococcal meningitis · Diagnosed: by a culture; swab patient, gram stain/culture o In LA we have a resistant form of gonorrhea in our state. · Symptoms: o Males § Urethritis: inflammation of the urethra as the primary symptom · Burning upon urination · inflammation of urethra: symptom = burning with urination; "bladder infection" (uncommon with men) § Purulent discharge: usually a white to yellow or even greenish discharge § Urinal frequency § Epidiymitis: swollen testicles and they are usually painful and if left untreated can cause infertility o Females § None or symptoms of pelvic inflammatory disease Majority of the time will have no symptoms § Purulent discharge § Urinal frequency § May become confused with a bladder or vaginal infection § Treatment or testing in women may not be solved and may allow the infection to spread and not be detected until pelvic inflammatory disease has occurred. ________ is the major ause of PID as well as atopic pregnancy and infertility. It can cause an increased risk of acquiring and spreading HIV. · Treatment: Ceftriaxone (Rocephin) 250mg IM x 1 dose ○ Resistant __________ ○ If chlamydia is not ruled out, give azithromycin to treat for both ○ CDC recommends that if they are diagnosed with _________ that we get a detailed sexual history, we must treat all of those diagnosed with gonorrhea, and every effort to treat all patients sexual partners for the last 60 days. We are also to obtain cultures to test decreased susceptibility from any patients with any suspected or documented _________l treatment failures. We are also to report any suspected treatment failures to the public health officials to recognize any potential resistance.

gonorrhea

What STI is described below: · Symptoms: o Males § Urethritis: inflammation of the urethra as the primary symptom · Burning upon urination · inflammation of urethra: symptom = burning with urination; "bladder infection" (uncommon with men) § Purulent discharge: usually a white to yellow or even greenish discharge § Urinal frequency § Epidiymitis: swollen testicles and they are usually painful and if left untreated can cause infertility

gonorrhea

What STI is described below: · Treatment: Ceftriaxone (Rocephin) 250mg IM x 1 dose ○ Resistant __________ ○ If chlamydia is not ruled out, give azithromycin to treat for both ○ CDC recommends that if they are diagnosed with _________ that we get a detailed sexual history, we must treat all of those diagnosed with gonorrhea, and every effort to treat all patients sexual partners for the last 60 days. We are also to obtain cultures to test decreased susceptibility from any patients with any suspected or documented _________l treatment failures. We are also to report any suspected treatment failures to the public health officials to recognize any potential resistance.

gonorrhea

With Sedative, Hypnotic and Antianxiety Medication Use Disorder, patients experience withdrawal which has the following symptoms: ● : hyperactivity, tremor, insomnia, psychomotor agitation, anxiety and ____ ______

grandmal seizures

the following are ______ for sexual assault cases: ● From US Dept. of Justice - a National Protocol for Sexual Assault Medical Forensic Examinations for Adults/ Adolescents >> this document assist facilities in establishing protocols ● Emergency Nurses Association - recommends employment of SANE nurses ○ Patient centered, private, unbiased competent care ○ SANE nurses - sexual assault nurse examiners

guidelines

With Cluster B antisocial personality disorder, one of the MAIN characteristics is that individuals have an Absence of remorse or ______. NEED TO KNOW.

guilt

With cluster C obsessive-compulsive personality disorder, one of the MAIN guidelines for nursing care is that the nurse needs to understand that these individuals need structure and yet have enough time for ________ behavior. ■ Let there be enough time for the person's habitual behavior. If they have to have enough time to wash their hands, you need to let them know what time lunch is so they can have enough time to get in line to eat

habitual

● continue work started in other treatment programs ○ Extend sobriety period ○ Case management ○ Educational, economic social needs ○ Integrate new life skills ○ Live here, but work outside **care continuum of substance use disorders

halfway houses

With hallucinogen use disorder, a person can experience ____ _____ which is characterized by clinically significant psychological behavioral changes: paranoia, impaired judgement, intensification of perceptions, depersonalization, derealization. ○ Especially illusions, hallucinations, and synesthesias (hearing color, seeing sound) ○ Physical symptoms: pupillary dilation, tachycardia, sweating, palpitations, blurred vision, tremor, incoordination ○ Tx: symptoms will subside, severe case: antipsychotic ■ Treatment: talking patient down; short term--> antipsychotic or benzo

hallucinogen intoxication

physical symptoms of hallucinogen intoxication or phencyclidine intoxication? ○ Physical symptoms: pupillary dilation, tachycardia, sweating, palpitations, blurred vision, tremor, incoordination

hallucinogen intoxication

what substance use disorder is described below: ● Hallucinogen intoxication - characterized by clinically significant psychological behavioral changes: paranoia, impaired judgement, intensification of perceptions, depersonalization, derealization ○ Especially illusions, hallucinations, and synesthesias (hearing color, seeing sound) ○ Physical symptoms: pupillary dilation, tachycardia, sweating, palpitations, blurred vision, tremor, incoordination ○ Tx: symptoms will subside, severe case: antipsychotic ■ Treatment: talking patient down; short term--> antipsychotic or benzo

hallucinogen use disorder

what substance use disorder is described below: ● Hallucinogen withdrawal - there is no official withdrawal Dx or pattern with prolonged hallucinogen use ○ May experience hallucinogen persisting perception disorder during sobriety (mainly with LSD) ■ This is when you re-experience perceptual symptoms that were experienced while intoxicated

hallucinogen use disorder

what substance use disorder is described below: ● Hallucinogens - Schedule I; no medical use; associated with flashbacks, panic attacks, psychosis, delirium, mood and anxiety disorders ○ Found in some plants, mushrooms (or their extract), or can be man made ● Two categories ○ 1. Classic - LSD ○ 2. Dissociative - PCP (Phencyclidine) & ketamine

hallucinogen use disorder

what substance use disorder is described below: ● Hallucinogens - Schedule I; no medical use; associated with flashbacks, panic attacks, psychosis, delirium, mood and anxiety disorders ○ Found in some plants, mushrooms (or their extract), or can be man made ● Two categories ○ 1. Classic - LSD ○ 2. Dissociative - PCP (Phencyclidine) & ketamine ● Hallucinogen intoxication - characterized by clinically significant psychological behavioral changes: paranoia, impaired judgement, intensification of perceptions, depersonalization, derealization ○ Especially illusions, hallucinations, and synesthesias (hearing color, seeing sound) ○ Physical symptoms: pupillary dilation, tachycardia, sweating, palpitations, blurred vision, tremor, incoordination ○ Tx: symptoms will subside, severe case: antipsychotic ■ Treatment: talking patient down; short term--> antipsychotic or benzo ● Phencyclidine intoxication "Angel dust- PCP" - medical emergency ○ Under the influence people can be beligerant, assaultive, impulsive, unpredictable ○ Physical symptoms: nystagmus, HTN, tachycardia, diminished response to pain, ataxia, muscle rigidity, seizures, coma, hyperacusis (sensitivity to sound), hyperthermia, seizure ○ Tx: management is primarily supportive, restraint, benzo, mechanical cooling ■ Treatment: can NOT be talked down; may need restraint and calming medication such as a benzodiazepine ● Hallucinogen withdrawal - there is no official withdrawal Dx or pattern with prolonged hallucinogen use ○ May experience hallucinogen persisting perception disorder during sobriety (mainly with LSD) ■ This is when you re-experience perceptual symptoms that were experienced while intoxicated

hallucinogen use disorder

what substance use disorder is described below: ● Phencyclidine intoxication "Angel dust- PCP" - medical emergency ○ Under the influence people can be beligerant, assaultive, impulsive, unpredictable ○ Physical symptoms: nystagmus, HTN, tachycardia, diminished response to pain, ataxia, muscle rigidity, seizures, coma, hyperacusis (sensitivity to sound), hyperthermia, seizure ○ Tx: management is primarily supportive, restraint, benzo, mechanical cooling ■ Treatment: can NOT be talked down; may need restraint and calming medication such as a benzodiazepine

hallucinogen use disorder

With hallucinogen use disorder, _______ are schedule 1 drugs that have no medical use. they are associated with flashbacks, panic attacks, psychosis, delirium, as well as mood and anxiety disorders. They are found in some plants, mushrooms (or their extract), or can be man made.

hallucinogens

With alcohol use disorder, we have types of problematic drinking which includes binge drinking and heavy drinking. With _____ drinking, the person is drinking too much too often. ■ Women - 8 or more in one week ■ Men - more than 14 in one week

heavy

What STI is described below: ○ Diagnosis: through blood testing ■ It is diagnosed through serological testing ○ Not a chronic infection; ONCE TREATED IT IS GONE ****** ■ Individuals are NOT a chronic carrier.

hepatitis A

What STI is described below: ○ Incubation: 30 days ○ Transmission: fecal-oral (most common), waterborne, sexual : ■ Most common is fecal-oral route and sources may be water, food, or sexual contact and is often silent in children ■ If an individual is positive, they need to avoid sexual contacts and those that they live need to get immunoglobulin to prevent the spread ■ Also want to look at food, who and where they ate, place of employment, and daycares for exposure

hepatitis A

What STI is described below: ○ Incubation: 30 days ○ Transmission: fecal-oral (most common), waterborne, sexual : ■ Most common is fecal-oral route and sources may be water, food, or sexual contact and is often silent in children ■ If an individual is positive, they need to avoid sexual contacts and those that they live need to get immunoglobulin to prevent the spread ■ Also want to look at food, who and where they ate, place of employment, and daycares for exposure ○ Diagnosis: through blood testing ■ It is diagnosed through serological testing ○ Not a chronic infection; ONCE TREATED IT IS GONE ****** ■ Individuals are NOT a chronic carrier. ○ Vaccine available ○ Viral - no specific tx ■ Can give IG to prevent spread ■ There is no specific treatment for ____ ______ ○ Hx: Ask about where they live and sexual contact; ask where they have eaten, hand wash

hepatitis A

What STI is described below: ○ Vaccine available ○ Viral - no specific tx ■ Can give IG to prevent spread ■ There is no specific treatment for ____ ______ ○ Hx: Ask about where they live and sexual contact; ask where they have eaten, hand wash

hepatitis A

What STI is described below: ○ Chronic carrier state: HAVE IT FOREVER. ONE DIFFERENCE BETWEEN THIS TYPE AND HEPATITIS A ○ Can cause chronic liver disease and liver cancer

hepatitis B

What STI is described below: ○ Incubation: 75 days ○ Diagnosis: Serological testing ○ Transmission: sexual, perinatal, blood and body fluids (bloodborne) ○ Can survive at room temperature for at least 1 week

hepatitis B

With cluster B borderline personality disorder, ______ is when the individual: ○ act quickly in response to emotions without considering consequences; results in damaged relationships & suicide attempts or cutting ■ Gets involved with people in relationships very quickly, "You're my best friend!!! Rawr XD"

impulsivity

The following is the ____ of HIV: 2016 - over 39,000 dx in US

incidence

what are 2 nursing diagnosis for patient during a crisis?

ineffective coping and anxiety

What STI is described below: ○ Incubation: 75 days ○ Diagnosis: Serological testing ○ Transmission: sexual, perinatal, blood and body fluids (bloodborne) ○ Can survive at room temperature for at least 1 week ○ Chronic carrier state: HAVE IT FOREVER. ONE DIFFERENCE BETWEEN THIS TYPE AND HEPATITIS A ○ Can cause chronic liver disease and liver cancer ○ Vaccination available (for infants) ■ Series of 3 vaccines recommended ■ In application: if you have a mom who is positive, their newborn needs the hepatitis B immunity. So the globulin is provided to provide passive immunity and prevent infection and then they will get the ____ ______ vaccine at birth and 2 more follow ups to create active immunity. Passive immunity is almost immediate but it is short lived and kind of like a stock gap until the active immunity has time to develop after the vaccination. ■ One at birth, 2 later on (stock gap??) to build up active immunity ■ Passive: immunoglobulin

hepatitis B

What STI is described below: ○ Vaccination available (for infants) ■ Series of 3 vaccines recommended ■ In application: if you have a mom who is positive, their newborn needs the hepatitis B immunity. So the globulin is provided to provide passive immunity and prevent infection and then they will get the ____ ______ vaccine at birth and 2 more follow ups to create active immunity. Passive immunity is almost immediate but it is short lived and kind of like a stock gap until the active immunity has time to develop after the vaccination. ■ One at birth, 2 later on (stock gap??) to build up active immunity ■ Passive: immunoglobulin

hepatitis B

What STI is described below: ○ Incubation: 45 days ○ Transmission: bloodborne and sexual ○ Chronic carrier state (once contracted) WILL HAVE FOREVER. ○ Diagnosis: Serological testing ○ Can cause chronic liver disease and liver cancer

hepatitis C

What STI is described below: ○ Incubation: 45 days ○ Transmission: bloodborne and sexual ○ Chronic carrier state (once contracted) WILL HAVE FOREVER. ○ Diagnosis: Serological testing ○ Can cause chronic liver disease and liver cancer ○ Most common chronic bloodborne infection in the US is ___ _____; leading cause of chronic liver disease, end-stage renal disease, liver cancer, and liver transplants ○ NO vaccine ○ New treatments ■ Developing new treatments that do not have interferon in them

hepatitis C

What STI is described below: ○ Most common chronic bloodborne infection in the US is ___ _____; leading cause of chronic liver disease, end-stage renal disease, liver cancer, and liver transplants ○ NO vaccine ○ New treatments ■ Developing new treatments that do not have interferon in them

hepatitis C

What cluster B personality disorder is described below: ● Characteristics ○ Attention-seeking, self-centered; low-frustration level ○ Excessive emotions; may be provocative; flirtatious ○ No insight into disorder or role in ruining relationships ○ Relationships do not last because partner feels smothered

histrionic personality disorder

What cluster B personality disorder is described below: ● Guidelines for nursing care ○ Know that seductive behavior is a response to distress. ○ Keep interactions professional; ignore flirtations. ○ Model concrete language. ○ Help patient clarify inner feelings ○ Teach and role-model assertiveness ○ Assess for suicidal ideation

histrionic personality disorder

What cluster B personality disorder is described below: ● Prevalence: Nearly 2% of population; more in females ● Characteristics ○ *****Excitable, dramatic; often high functioning; have a big presence***** ○ May refer to as "drama queen" or "drama major" ○ Bold external behaviors; flamboyant; like to be the center of attention ○ Limited ability to develop meaningful relationships ■ In relationships but not necessarily meaningful

histrionic personality disorder

What cluster B personality disorder is described below: ● Prevalence: Nearly 2% of population; more in females ● Characteristics ○ *****Excitable, dramatic; often high functioning; have a big presence***** ○ May refer to as "drama queen" or "drama major" ○ Bold external behaviors; flamboyant; like to be the center of attention ○ Limited ability to develop meaningful relationships ■ In relationships but not necessarily meaningful ○ Attention-seeking, self-centered; low-frustration level ○ Excessive emotions; may be provocative; flirtatious ○ No insight into disorder or role in ruining relationships ○ Relationships do not last because partner feels smothered ● Treatment—no specific medication used ○ Psychotherapy is treatment of choice ■ It may promote clarification of inner feelings and appropriate expression ○ Group therapy—although behavior can be distracting ■ Remember they are flamboyant and like to be the center of attention which can be distracting ● Guidelines for nursing care ○ Know that seductive behavior is a response to distress. ○ Keep interactions professional; ignore flirtations. ○ Model concrete language. ○ Help patient clarify inner feelings ○ Teach and role-model assertiveness ○ Assess for suicidal ideation

histrionic personality disorder

What cluster B personality disorder is described below: ● Treatment—no specific medication used ○ Psychotherapy is treatment of choice ■ It may promote clarification of inner feelings and appropriate expression ○ Group therapy—although behavior can be distracting ■ Remember they are flamboyant and like to be the center of attention which can be distracting

histrionic personality disorder

What disorder is described below: ● Accumulation of belongings that may have little or no value. Prevents from leading normal lives ○ Stuff that they hold onto forever (throw nothing away in case they need it later) or stuff that they keep buying and buying (a compulsive shopper) ○ Stuff on every surface in the house, may just have small walkways in the house without items - dangerous in the event of a fire or medical emergency

hoarding disorder

With inhalant use disorder, ___ ____ happens when small doses result in disinhibition and euphoria. ○ Can induce a psychotic response ○ High doses: fearfulness, illusions, auditory/visual hallucinations, distorted body image ○ Other symptoms include: apathy, diminished social/occupational judgment, impulsive/aggressive behavior ○ Physical symptoms: nausea, anorexia, nystagmus (involuntary eye movement), depressed reflexes, diplopia (double vision) ○ Serious possibilities: delirium, dementia, and psychosis

inhalant intoxication

what substance use disorder is described below: ● "Sudden Sniffing Death" result of cardiac arrhythmia ● Ages 12 -17 ● Tx: usually doesn't require tx. ○ Severe cases result in fatal responses: coma, cardiac arrhythmias, bronchospasm

inhalant use disorder

What disorder is described below: ● Accumulation of belongings that may have little or no value. Prevents from leading normal lives ○ Stuff that they hold onto forever (throw nothing away in case they need it later) or stuff that they keep buying and buying (a compulsive shopper) ○ Stuff on every surface in the house, may just have small walkways in the house without items - dangerous in the event of a fire or medical emergency ● Belongings fill every available surface - guests can no longer or will no longer visit ● May progress to the point where the house in uninhabitable - unsafe and unsanitary although they continue to live there ● MAY OR MAY NOT BE AWARE OF THE PROBLEM AND HOW THE QUEST TO COLLECT HAS CONSUMED THEIR LIVES AND ALIENATED OTHERS ○ Not easily open to changing ● Usually emerges in adolescence; disturbs functioning in 20s, significantly impair functioning in 30s ● CONDITION WORSENS WITH EACH DECADE OF LIFE IF ALLOWED TO PROGRESS; do not necessarily perceive that hoarding is a problem ● INDECISIVENESS - associated with hoarding; sorting thought/what to keep/give away which is extremely distressing to them ● Stressful life events - precede onset of symptoms ● Strongly heritable ● 75%- also experience major depressive and/or anxiety disorders ● 20% also have obsessive - compulsive disorder ● They seek treatment for the other problems because >> THEY RESIST SEEING HOARDING AS A PROBLEM ***** ○ Very difficult to get them to be convinced that what they are doing is an issue ● They may not spend a lot of money; thrift stores, dollar stores ● If spills over into yard, neighbors may call authorities and this becomes an issue. Their place in the neighborhood may start to annoy the neighbors. It can also be a safety issue.

hoarding disorder

What disorder is described below: ● Belongings fill every available surface - guests can no longer or will no longer visit ● May progress to the point where the house in uninhabitable - unsafe and unsanitary although they continue to live there ● MAY OR MAY NOT BE AWARE OF THE PROBLEM AND HOW THE QUEST TO COLLECT HAS CONSUMED THEIR LIVES AND ALIENATED OTHERS ○ Not easily open to changing

hoarding disorder

What disorder is described below: ● Stressful life events - precede onset of symptoms ● Strongly heritable ● 75%- also experience major depressive and/or anxiety disorders ● 20% also have obsessive - compulsive disorder ● They seek treatment for the other problems because >> THEY RESIST SEEING HOARDING AS A PROBLEM ***** ○ Very difficult to get them to be convinced that what they are doing is an issue

hoarding disorder

What disorder is described below: ● They seek treatment for the other problems because >> THEY RESIST SEEING HOARDING AS A PROBLEM ***** ○ Very difficult to get them to be convinced that what they are doing is an issue ● They may not spend a lot of money; thrift stores, dollar stores ● If spills over into yard, neighbors may call authorities and this becomes an issue. Their place in the neighborhood may start to annoy the neighbors. It can also be a safety issue.

hoarding disorder

What disorder is described below: ● Usually emerges in adolescence; disturbs functioning in 20s, significantly impair functioning in 30s ● CONDITION WORSENS WITH EACH DECADE OF LIFE IF ALLOWED TO PROGRESS; do not necessarily perceive that hoarding is a problem ● INDECISIVENESS - associated with hoarding; sorting thought/what to keep/give away which is extremely distressing to them

hoarding disorder

What stage of the cycle of violence is described below: ○ Period of calm - hope that things will change ○ Abuser displays kindness ○ Abuser may initially may be remorseful and apologetic for what happened ○ Makes promises, brings gifts ○ Victim feels needed, loved, and hopes for change ○ May abandon plans to leave ○ Without intervention, CYCLE CONTINUES

honeymoon stage

What is the MOST IMPORTANT PREDICTOR OF IMMINENT VIOLENCE? **pacing, restlessness NEED TO KNOW. REPEATED AT LEAST 2 TIMES IN LECTURE.

hyperactivity

During an assessment of a patient with anorexia nervosa, they will have _______ and PERIPHERAL EDEMA WILL BE NOTED.

hypoalbuminemia

During an assessment of a patient with anorexia nervosa, they will have _______ which is potassium levels less than ________. they may have severe electrolyte imbalances and enter the healthcare system via ICU.

hypokalemia; 3.5

what is the most appropriate nursing diagnosis for binge eating disorder?

imbalanced nutrition: more than body requirements

The ___ ____ response includes: ○ Antigen specific - "recognizes a specific antigen" ○ Systemic - uses entire body ○ Memory—of the exposure ○ Immune system will recognize and attack harder with repeated exposure ■ Failure in response is when we have disease **HIV and ___ _____

immune system

What part of our body, or what system of our body, is described below: ● Responsibility - recognize and activate response ● Antigen- A substance that can produce the immune response ● _____ ______ response: ○ Antigen specific - "recognizes a specific antigen" ○ Systemic - uses entire body ○ Memory—of the exposure ○ ___ ______ will recognize and attack harder with repeated exposure ■ Failure in response is when we have disease ● Blood system ○ Lymphocyte - circulate in blood and lymph ● Lymphatic system ○ Primary organs - bone marrow and thymus ○ Secondary organs - adenoids, tonsils, spleen, lymph nodes

immune system

_____ nurses include: ● Approximately 10-20% of nurses and nursing students have problems with substance abuse and addiction ● Louisiana State Board of Nursing has Recovering Nurse Program - must comply with board's requirements ● Provides Nurses with a second chance ○ Can't be alone with narcotic medications ○ May require a nurse to work as a tech while in the program

impaired

More specific interventions the nurse may be doing during _______ (crisis) includes phone calls for babysitters for patient, finding shelter

implementation

When using the nursing process for a patient during a crisis, _______ includes focusing on the PRESENT PROBLEM ONLY (not holistically) and has 2 intital goals: 1. Patient safety ■ During interview, the patient in crisis first needs to gain a feeling of safety 2. Anxiety reduction ■ Nurse can use anxiety reduction techniques so the patient can mobilize inner resources. Feelings of support and hope will temporarily diminish anxiety. The nurse needs to play an active role by indicating that help is available by using crisis intervention skills competently and showing genuine interest in support.

implementation

what substance use disorder is described below: ● Inhalant intoxication - small doses result in disinhibition and euphoria ○ Can induce a psychotic response ○ High doses: fearfulness, illusions, auditory/visual hallucinations, distorted body image ○ Other symptoms include: apathy, diminished social/occupational judgment, impulsive/aggressive behavior ○ Physical symptoms: nausea, anorexia, nystagmus (involuntary eye movement), depressed reflexes, diplopia (double vision) ○ Serious possibilities: delirium, dementia, and psychosis

inhalant use disorder

what substance use disorder is described below: ● Volatile hydrocarbons - toxic gases inhaled through nose or mouth to enter bloodstream ● Household products: ○ Solvents for glues and adhesives ○ Propellants in aerosol sprays and thinners--> Paint products and correction fluids, ○ Fuel --> gasoline and propane

inhalant use disorder

what substance use disorder is described below: ● Volatile hydrocarbons - toxic gases inhaled through nose or mouth to enter bloodstream ● Household products: ○ Solvents for glues and adhesives ○ Propellants in aerosol sprays and thinners--> Paint products and correction fluids, ○ Fuel --> gasoline and propane ● "Sudden Sniffing Death" result of cardiac arrhythmia ● Ages 12 -17 ● Inhalant intoxication - small doses result in disinhibition and euphoria ○ Can induce a psychotic response ○ High doses: fearfulness, illusions, auditory/visual hallucinations, distorted body image ○ Other symptoms include: apathy, diminished social/occupational judgment, impulsive/aggressive behavior ○ Physical symptoms: nausea, anorexia, nystagmus (involuntary eye movement), depressed reflexes, diplopia (double vision) ○ Serious possibilities: delirium, dementia, and psychosis ● Tx: usually doesn't require tx. ○ Severe cases result in fatal responses: coma, cardiac arrhythmias, bronchospasm

inhalant use disorder

During an assessment of a vulnerable person, you perform an _____ in private and DO NOT do the following: ○ Do not try to prove the abuse by accusations or demands ○ Do not display horror, anger, shock, or disapproval of the perpetrator or the situation ○ Do not place blame or make judgements ○ Do not allow the patient to feel at fault or in trouble ○ Do not conduct the interview with a group of interviewers ○ Do not overly probe for answers the patient is not willing to give you

interview

With Sedative, Hypnotic and Antianxiety Medication Use Disorder, _______ includes slurred speech, incoordination, unsteady gait, nystagmus, impaired thinking. ○ Side effect: inappropriate aggression and sexual behavior, mood fluctuation, impaired judgement

intoxication

what concept for substance use disorder is described below: ● using substance to excess ○ Under the influence, intoxicated, high ○ Terminology varies - alcohol → intoxicated; cocaine → high

intoxication

During an assessment of a patient with anorexia nervosa, ______ is fine, downy hair over body; tell tale sign.

lanugo

With stage 3: latent syphilis, it is subdivided into 2 types based on time. which type is the initial infection occurred > 1 year prior?

late

With stage 4: tertiary syphilis, we have ___ ____ tertiary syphilis which includes the following: ○ signs and symptoms includes the development of lesions of the bone, skin, and mucous membranes that are known as *gummatous syphilis.* ○ It also during this can infect the kidney, heart, brain, and respiratory

late benign

Name as many examples of maturational crisis.

leaving home for the 1st time, marriage, birth of a child, retirements, death of parent, graduation from high school and/or college

With seclusion and restraints, be sure to document everything that needs to be documented!!!! It is a ______ issue. ● Some hospitals have gone restraint free

legal

With reporting abuse: ● nurses are ______ _______ to report suspected or actual cases of child and vulnerable adult abuse ● But NOT the middle age groups ○ So in cases of abuse you would follow your agency's protocols and state laws ● Follow agency protocol

legally mandated

personality results in ongoing relationship problems or emotional distress

liability

Name as many examples of situational crisis.

loss/ change of job, death of a loved one, abortion, change in financial status, divorce, severe mental or physical illness, abortion

With cluster B histrionic personality disorder, one of the MAIN characteristics is that they are attention seeking, self-centered, and have a _____ ____ level.

low frustration

what is the most common comorbidity with body dysmorphic disorder?

major depressive disorder

With cluster C dependent personality disorder, one of the MAIN characteristics is that these individuals have a lack of confidence in their own ability or judgement, leading to ________ others to take responsibilities.

manipulating

What type of crisis is described below: ○ As people mature, new developmental stage is reached ○ Old coping skills no longer effective ○ Leads to increased tension and anxiety ○ To move successfully through developmental stages - need support systems, positive role models

maturational

What type of crisis is described below: ○ As people mature, new developmental stage is reached ○ Old coping skills no longer effective ○ Leads to increased tension and anxiety ○ To move successfully through developmental stages - need support systems, positive role models ○ Disrupts maturation → alcohol and/ or drug addiction ■ Where they begin ex: 15, once they get back on track, they return to 15 - so 26 year old maturing but mentally 15 again. ■ Where emotional development stops ■ Disrupts progression through maturational stages. When the addictive behavior is controlled, the person's development continues at the point of interruption. ○ Examples: leaving home for the 1st time, marriage, birth of a child, retirements, death of parent, graduation from high school and/or college ■ Death of parent--> more in the flow of normal where someone has lived a long life and is not premature

maturational

What type of crisis is described below: ○ Disrupts maturation → alcohol and/ or drug addiction ■ Where they begin ex: 15, once they get back on track, they return to 15 - so 26 year old maturing but mentally 15 again. ■ Where emotional development stops ■ Disrupts progression through maturational stages. When the addictive behavior is controlled, the person's development continues at the point of interruption.

maturational

What type of crisis is described below: ○ Examples: leaving home for the 1st time, marriage, birth of a child, retirements, death of parent, graduation from high school and/or college ■ Death of parent--> more in the flow of normal where someone has lived a long life and is not premature

maturational

The following are guidelines for the use of ______ ______: ○ Correct provider's signature according to state law ○ Healthcare team has moved from least restrictive to most restrictive --> document what used and patient's response ○ Monitor vital signs, blood flow to hands/feet (checking coloring and ROM), provide hydration, etc. according to protocol ○ Physical holding of patient against will is a restraint ○ 4 side rails: use according to policy ■ Use of 4 side rails is considered a restraint except in seizure precautions; would have to follow policy according to facility you are at ○ Tucking sheets tightly is considered a restraint ■ Do not resort to this!

mechanical restraints

What general treatment for opioid use disorders is described below: ● once/day dosing- opioid treatment program ○ Synthetic narcotic opioid used to decrease painful symptoms of opioid withdrawal, blocks euphoric effects ○ Education: seek medical care if difficulty breathing, shallow breathing, light headed/faint, chest pain, pounding heartbeat, hives, rash, facial swelling of lips, tongue, throat, confusion and hallucinations

methadone

What level of anxiety is described below: ○ PROBLEM SOLVING BECOMES MORE EFFECTIVE IN THIS LEVEL************ ○ PROPELS US TOWARD ACTIONS (such as studying for exams or meeting a deadline); not a bad thing

mild

What level of anxiety is described below: ● heightened sensory awareness; the person sees, hears, and grasps more information ○ PROBLEM SOLVING BECOMES MORE EFFECTIVE IN THIS LEVEL************ ○ Physical symptoms: slight discomfort, restlessness, irritability, mild tension relieving behaviors (nail biting, foot tapping, hand wringing, fidgeting etc.) ○ PROPELS US TOWARD ACTIONS (such as studying for exams or meeting a deadline); not a bad thing

mild

What level of anxiety is described below: ● heightened sensory awareness; the person sees, hears, and grasps more information ○ Physical symptoms: slight discomfort, restlessness, irritability, mild tension relieving behaviors (nail biting, foot tapping, hand wringing, fidgeting etc.)

mild

what are the 4 levels of anxiety? **developed by Hildegard Peplau

mild, moderate, severe, panic

the following are interventions for a patient experiencing _____-_____ anxiety: · Ask about past EFFECTIVE coping strategies o What has worked for them before and can they employ some of those to the present situations · Help ID thoughts or feelings before the onset of anxiety—"what were you thinking right before you started to feel anxious?"

mild-moderate

the following are interventions for a patient experiencing _____-_____ anxiety: · Calm presence; easily encourage problem solving because they can participate in that o Can do discharge planning, medication teaching, etc. · Recognizing person's distress · Willing to listen— lean forward, eye contact, nod head (body language)

mild-moderate

the following are interventions for a patient experiencing _____-_____ anxiety: · Reminder: still able to solve problems but ability to concentrate decreases as anxiety increases · Use specific communication techniques: open-ended questions, broad openings, clarification · Calm presence; easily encourage problem solving because they can participate in that o Can do discharge planning, medication teaching, etc. · Recognizing person's distress · Willing to listen— lean forward, eye contact, nod head (body language) · Ask about past EFFECTIVE coping strategies o What has worked for them before and can they employ some of those to the present situations · Help ID thoughts or feelings before the onset of anxiety—"what were you thinking right before you started to feel anxious?"

mild-moderate

_____ characteristics conducive to violence includes: (aspects of the hospital that contribute to violence) ○ Overcrowding ■ Putting too many people in a small day room ○ Staff inexperience ○ Provocative or over-controlling staff ■ Overly bossy with patient instead of being helpful ○ Poor limit setting ■ Can mean unfair limit setting and going beyond the rules in the setting ■ Things are different from one shift to the next ○ Arbitrary revoking privileges ■ Stating of certain patients may be limiting their phone time or taking away privledges of what the rules are ○ so...what should a wise RN do for the ______? Adhere to unit rules, be committed to the patient so legitimate needs can be met

milieu

What type of behavioral therapy for anxiety and OCD disorders is described below: ■ therapist models appropriate behavior for patient to see that it is safe ● example- therapist rides in elevator with person dealing with claustrophobia

modeling

What level of anxiety is described below: ○ CAN STILL CONCENTRATE, LEARN, AND PROBLEM SOLVE, although not at an optimal level ○ SYMPATHETIC NERVOUS SYSTEM KICKS IN ■ Symptoms: tension, pounding heart, increased pulse and respiratory rate, perspiration, mild somatic symptoms (gastric discomfort, headache, urinary urgency)

moderate

What level of anxiety is described below: ○ Voice tremors, shaking, more tension-relieving behavior such as pacing, banging hands on table

moderate

What level of anxiety is described below: ● perceptual field narrows; some details excluded from observation and are not noted. See, hear, and grasp less information; May demonstrate SELECTIVE INATTENTION in which only certain things in the environment are seen/heard unless pointed out; dulled, but can attend to greater sensory input if directed

moderate

The following is the ____ role in providing preventive care for communicable diseases: · At all levels of prevention the nurse functions as: o Counselor o Educator: Safer sex and drug use o Advocate o Case manager o Primary care provider o Community outreach · Standard precautions: when treating all patients

nurse's

What level of anxiety is described below: ● perceptual field narrows; some details excluded from observation and are not noted. See, hear, and grasp less information; May demonstrate SELECTIVE INATTENTION in which only certain things in the environment are seen/heard unless pointed out; dulled, but can attend to greater sensory input if directed ○ CAN STILL CONCENTRATE, LEARN, AND PROBLEM SOLVE, although not at an optimal level ○ SYMPATHETIC NERVOUS SYSTEM KICKS IN ■ Symptoms: tension, pounding heart, increased pulse and respiratory rate, perspiration, mild somatic symptoms (gastric discomfort, headache, urinary urgency) ○ Voice tremors, shaking, more tension-relieving behavior such as pacing, banging hands on table

moderate

During an assessment of a patient with anorexia nervosa, the patient will have _____, cool skin like a greyish blue coloration of the skin. They will also have low blood pressure, pulse, and temperature.

mottled

What cluster B personality disorder is described below: ● Prevalence: For 0% to 6%; more in males ● Characteristics ○ Feelings of entitlement, exaggerated self importance ○ Lack of empathy; tendency to exploit others ○ ****Less functional impairment than other personality disorders***** ○ Come across as arrogant, need for constant admiration, LACK OF EMPATHY FOR OTHERS → a factor that strains most relationships over time ○ Actually ..... under the arrogance, the individual has a weak self-esteem and hypersensitivity to criticism; Sensitive to rejection & criticism. Underneath surface is shame and fear of abandonment; call their bluff and stand up to people acting this way ● Guidelines for Nursing Care ○ Personality traits of narcissism intagonism, they have grandiosity, and attention seeking behavior. They tolerate rejection poorly. ○ Nurse should remain neutral. ○ Avoid power struggles or becoming defensive especially if they have remarks ○ Role model empathy. ■ Remember that they do not display empathy for others ● Treatment ○ Difficult to treat: patients not likely to seek help or confront shortcomings. More likely to be in couple's or family therapy than individual treatment. ○ If they seek treatment - Cognitive-behavioral therapy (CBT) can be effective to deconstruct faulty thinking ○ Group therapy may work; lithium for mood swings

narcissistic personality disorder

The following is what you will do if a __ _____ occurs in a nurse: What will you do? ○ 1. Wash the site with soap and water ○ 2. Ask the patient if they are on HAART ** ■ Why? ● This verifies positive HIV if they are on this medication regimen ● If they're on haart it decreases the viral load in the pt; reduces risk of transmission ○ 3. Tell infection control nurse ○ 4. Notify hospital supervisor ■ If you know patient, test them for positive or negative HIV --If they are HIV Positive- PEP - post exposure prophylaxis --Venous access devices are coordinated with a greater risk of transmitting HIV during an occupational exposure

needle stick

what risk factor for substance use disorders are described below: ● researchers have found neurotransmitters for all the substance use disorders with the EXCEPTION OF ALCOHOL ○ Example: Opioids act on opioid receptors ○ Receptors are used to having a flooding with the use so the body produces less - why the body gets cravings when suddenly stop getting the large amounts ○ Neurotransmitters involved in substance use disorders: opioid, catecholamine (especially dopamine), and GABA

neurochemical

does hepatitis C have a vaccine?

no

Can a person be talked down during phencyclidine intoxication during treatment?

no; the patient can NOT be talked down. May need restraint and calming medication such as a benzo

● A healthy reaction necessary for survival ● Provides needed energy to carry out tasks involved in living and striving toward goals ● Motivates to make and SURVIVE CHANGES which we are getting an opportunity to do in normal circumstances

normal anxiety

● A healthy reaction necessary for survival ● Provides needed energy to carry out tasks involved in living and striving toward goals ● Motivates to make and SURVIVE CHANGES which we are getting an opportunity to do in normal circumstances ● PROMPTS CONSTRUCTIVE BEHAVIORS, such as studying for examinations, being on time for a job interview, and working toward a promotion, or any type of deadline or goal or any accomplishment that someone has and the normal anxiety that presses us to meet these goals is normal and will motivate us ○ Will prompt us to these good behaviors

normal anxiety

● PROMPTS CONSTRUCTIVE BEHAVIORS, such as studying for examinations, being on time for a job interview, and working toward a promotion, or any type of deadline or goal or any accomplishment that someone has and the normal anxiety that presses us to meet these goals is normal and will motivate us ○ Will prompt us to these good behaviors

normal anxiety

The _____ role in HIV includes: ● Know the distribution of occurrence in our areas ○ can't be transmitted by kissing ○ Transmits through mucous membranes - eyes, vagina, sexual intercourse ● Be educated on HAART which is the Highly active antiretroviral therapy ● 85% increase in the survival rate for HIV infected persons who begin ART early in the disease process

nurse's

The _____ role in HIV includes: ● Be aware of transmission and become comfortable speaking about it to clients and others ● Know policy and procedures ● School nurses should know how to assist and advocate for HIV positive children ○ Kids with HIV have a decreased immune system so they are at risk of contracting something from other kids ● Identify resources ● Assist professionals in their work environment

nurse's

The _____ role in HIV includes: ● Take steps for your own protection - HIV dies at room air -Hep B can survive on surface ● Be familiar with groups at risk in our areas ● Know the distribution of occurrence in our areas ○ can't be transmitted by kissing ○ Transmits through mucous membranes - eyes, vagina, sexual intercourse ● Be educated on HAART which is the Highly active antiretroviral therapy ● 85% increase in the survival rate for HIV infected persons who begin ART early in the disease process ● Be aware of transmission and become comfortable speaking about it to clients and others ● Know policy and procedures ● School nurses should know how to assist and advocate for HIV positive children ○ Kids with HIV have a decreased immune system so they are at risk of contracting something from other kids ● Identify resources ● Assist professionals in their work environment

nurse's

The following are _____ diagnoses for anxiety disorders and OCD: ○ Anxiety, ineffective coping, chronic low self esteem, self mutilation

nursing

The following is part of the ______ process for anxiety disorders and OCD: ● People with anxiety and OCD rarely need hospitalization - unless suicidal or have compulsions that cause injury ● Encounter due to other reasons - for example panic attack in ER ● ASK WHAT HAS HELPED THEM IN THE PAST ● Tools- Yale-Brown Obsessive Compulsion Scale ○ Hamilton Anxiety Scale ○ Hoarding Scale Self - Report ● Severity Measure for Generalized Anxiety Disorder

nursing

_____ tasks-- patient centered approach-- includes: ● Summarize patient risk behaviors ● Ensure patient ready to discuss ● Ensure private area and a large portion of time ● Do not rush the patient ● Help patient develop a behavioral goal ○ What can you do to reduce your risk for transmitting HIV or getting HIV? ● Allow patient to identify the strategy or intervention ● Anticipate new problems or changes Ask "what if" questions

nursing

the _____ role in HIV includes: ● Brief, provider-delivered, tailored interventions in clinical settings have been shown more effective in behavior change than patient education. Research through the NIH on sexual practices showed that thius type of education to be the most beneficial way to increase safe sex practices. ○ Do not use cookie cutter interventions for all patients - everyone is different ● Most beneficial way to increase safe sex practices

nursing

The following are the 2 ___ ____ for a patient during a crisis: ○ Ineffective coping ○ Anxiety

nursing diagnoses

the following are _____ ______ for violent patients: ● Ineffective coping ● Stress overload ● Risk for self-directed violence ● Risk for other-directed violence ● Impaired impulse control

nursing diagnoses

What are the 3 risk factors for chlamydia?

o Those under 25 o Those who may have multiple sexual partners and o history of another STI

What part of OCD is described below: thoughts, images, or impulses that persist or recur so they cannot be dismissed from the mind, even though the person attempts to do so; INTRUSIVE AND UNWANTED; person attempts to ignore/suppress or to neutralize with other thoughts or actions—DSM-5

obsession

What cluster C personality disorder is described below: characteristics: ○ Strict standards ****interfere with project completion; so much emphasis on process****** NTK ■ Projects are normally incomplete because of overly strict standards ○ Unhealthy focus on perfection ■ The essence of the goal gets lost from the pre-occupation of perfection ○ No rituals!

obsessive-compulsive personality disorder

What cluster C personality disorder is described below: ● Characteristics ○ Rigidity; inflexible standards for others and self ○ Constant rehearsal of social responses ○ Excessive goal-seeking that is self-defeating or relationship-defeating ■ More concerned with the processes of getting to the end goal than just getting to the end goal

obsessive-compulsive personality disorder

What cluster C personality disorder is described below: ● Guidelines for nursing care ○ Guard against power struggles ○ Remember that the patient has difficulty dealing with unexpected changes such as change in time in group ○ ****Structure - yet enough time for habitual behavior***** ■ Let there be enough time for the person's habitual behavior. If they have to have enough time to wash their hands, you need to let them know what time lunch is so they can have enough time to get in line to eat ○ Identify ineffective coping → develop effective coping

obsessive-compulsive personality disorder

What cluster C personality disorder is described below: ● Obsessive-Compulsive Disorder → obsessive thoughts & rituals; aware that these thoughts & actions are unreasonable ● ______-____ _____ ______→ characterized more by the unhealthy focus on perfectionism - think their actions are right & feel comfortable with such self-imposed rules ○ **the preoccupation with all of these rules and perfectionism means that it can often result in losing the major point of the activity and projects are incomplete due to these overly strict standards

obsessive-compulsive personality disorder

What cluster C personality disorder is described below: ● Prevalence: 2% to 8%-1 of the most prevalent; more in men than women ● ******Hallmarks - Preoccupation with orderliness, perfectionism, control*******

obsessive-compulsive personality disorder

What cluster C personality disorder is described below: ● Prevalence: 2% to 8%-1 of the most prevalent; more in men than women ● ******Hallmarks - Preoccupation with orderliness, perfectionism, control******* ● Characteristics ○ Rigidity; inflexible standards for others and self ○ Constant rehearsal of social responses ○ Excessive goal-seeking that is self-defeating or relationship-defeating ■ More concerned with the processes of getting to the end goal than just getting to the end goal ○ Strict standards ****interfere with project completion; so much emphasis on process****** NTK ■ Projects are normally incomplete because of overly strict standards ○ Unhealthy focus on perfection ■ The essence of the goal gets lost from the pre-occupation of perfection ○ No rituals! ● Obsessive-Compulsive Disorder → obsessive thoughts & rituals; aware that these thoughts & actions are unreasonable ● ______-____ _____ ______→ characterized more by the unhealthy focus on perfectionism - think their actions are right & feel comfortable with such self-imposed rules ○ **the preoccupation with all of these rules and perfectionism means that it can often result in losing the major point of the activity and projects are incomplete due to these overly strict standards ● Guidelines for nursing care ○ Guard against power struggles ○ Remember that the patient has difficulty dealing with unexpected changes such as change in time in group ○ ****Structure - yet enough time for habitual behavior***** ■ Let there be enough time for the person's habitual behavior. If they have to have enough time to wash their hands, you need to let them know what time lunch is so they can have enough time to get in line to eat ○ Identify ineffective coping → develop effective coping ● Treatment ○ Patients tend to seek help ○ Also seek help for anxiety or depression ○ Group and behavioral therapy can be helpful ■ Can learn new coping skills for anxiety and see benefits from seeing feedback from the group ○ *****Clomipramine or fluoxetine for obsessions, anxiety, or depression*****

obsessive-compulsive personality disorder

What cluster C personality disorder is described below: ● Treatment ○ Patients tend to seek help ○ Also seek help for anxiety or depression ○ Group and behavioral therapy can be helpful ■ Can learn new coping skills for anxiety and see benefits from seeing feedback from the group ○ *****Clomipramine or fluoxetine for obsessions, anxiety, or depression*****

obsessive-compulsive personality disorder

what substance use disorder is described below: ● cravings result in larger amounts & longer periods of time being devoted to the drug & increasing tolerance to its effects. ● Significant impairment/alteration in life roles, interpersonal conflict, puts person in physically hazardous situations ● OPIOID INTOXICATION- exhibit psychomotor retardation, drowsiness→ coma, slurred speech, altered mood, impaired memory and attention, pupillary constriction

opioid use disorder

The following is the regimen of treatment for _____ exposure: ● Fewer than 60 cases of _______ transmission of HIV ● When workers are exposed, the CDC recommends immediate treatment with a short course of antiretroviral drugs to prevent infection ● Source later determined to be HIV negative, then the exposed client is to stop the treatment regimen immediately. ● Potential benefits and risks of PEP must be considered carefully when prescribing PEP ● Preferred HIV PEP regimen ○ Raltegavir (Isentress; RAL) 4oo mg PO twice daily ○ Olus ○ Truvada 1 PO daily (pre exposure) ■ Tenofovir DF 300 mg + emtricitabine 200 mg

occupational

The following is the regimen of treatment for _____ exposure: ● Preferred HIV PEP regimen ○ Raltegavir (Isentress; RAL) 4oo mg PO twice daily ○ Olus ○ Truvada 1 PO daily (pre exposure) ■ Tenofovir DF 300 mg + emtricitabine 200 mg

occupational

What STI is described below: ○ Can occur at any stage if _______ is left untreated ○ Increase in cases (may reflect better detection or actual increase in) ■ Between 2014 and 2015 ○ Suspected cases more likely to be men ○ Half (51%) were HIV-positive ○ Avoiding these outcomes → prompt dx and tx ■ Prompt diagnosis, urgent abdomic assessment, and effective treatment are essential here ○ Most frequent ocular manifestation: redness, tearing, blindness ○ S&S: ■ Can be uni- or bi-lateral ■ Redness and tearing in the eyes ■ Granulomatous features include keratic precipitates and iris nodules ■ "Iris roseola" (dilated iris vessels); occurs rarely but is relatively specific for _______ ■ Elevated intraocular pressure

ocular syphilis

What STI is described below: ○ S&S: ■ Can be uni- or bi-lateral ■ Redness and tearing in the eyes ■ Granulomatous features include keratic precipitates and iris nodules ■ "Iris roseola" (dilated iris vessels); occurs rarely but is relatively specific for _______ ■ Elevated intraocular pressure

ocular syphilis

The following is talking about HIV and the ____ ____: ● AIDS cases in _____ _____ ● 2/3 of AIDS cases in ____ _____ is men having sex with men and a higher proportion of older persons with HIV infection report an unknown source of HIV acquisition than younger age groups. This may reflect an unease among health care providers in discussing sexual practices and risk behaviors with their older patients. ● Report an "unknown" source of HIV acquisition. Why? ○ Because HCP do not speak with OA about sexual practices because they don't want to offend them or they feel uncomfortable

older adults

The following is talking about HIV and the ____ ____: ● Approximately 80% >50 yo are sexually active ○ 7% engage in risk behavior that may put them at risk for a sexually transmitted infection ● ED coupled with condom-associated erectile problems may promote "condom fatigue" - more at risk for STDs ● In women, Changes to the vaginal mucosa (drying and atrophy) and higher vaginal pH → may make older women more vulnerable to trauma and STI ● More likely to develop AIDS within 12 months after infection is detected ● Greatly benefit from treatment with combination ART and often achieve higher rates of viral suppression

older adults

With opioid use disorders, ___ _____ can occur to a patient and they exhibit psychomotor retardation, drowsiness→ coma, slurred speech, altered mood, impaired memory and attention, pupillary constriction.

opioid intoxication

With opioid use disorder, a patient can experience ____ ____ which includes: ● : 3 symptoms: coma, pinpoint pupils (Key sign), respiratory depression ○ Symptoms also include unresponsiveness, slow respiration, hypothermia, hypotension and bradycardia

opioid overdose

what substance use disorder is described below: GENERAL treatment: ● 1) Methadone - once/day dosing- opioid treatment program ○ Synthetic narcotic opioid used to decrease painful symptoms of opioid withdrawal, blocks euphoric effects ○ Education: seek medical care if difficulty breathing, shallow breathing, light headed/faint, chest pain, pounding heartbeat, hives, rash, facial swelling of lips, tongue, throat, confusion and hallucinations

opioid use disorder

what substance use disorder is described below: GENERAL treatment: ● 2) Buprenorphine - used to help people reduce/quit use of heroin or other opiates such as morphine ○ Sometimes people get addicted to this med; may bring problems - this drug is only used 12-24 hours after abstaining from opioids ○ Side effects: Nausea, vomiting, constipation, muscle aches, cramps, insomnia, irritability, fever

opioid use disorder

what substance use disorder is described below: GENERAL treatment: ● 3) Naltrexone - indicated for relapse prevention following opioid detoxification ○ Side effects: weakness, tiredness, insomnia, increased thirst, anxiety, nervousness, restlessness, irritability, lightheadedness, fainting, muscle or joint aches, decreased sex drive, impotence ● May see the use of Tramadol protocols

opioid use disorder

what substance use disorder is described below: OPIOID WITHDRAWAL: ● Clinical Opiate Withdrawal Scale (COWS) to assess opiate withdrawal : Symptoms to look for ● 11 categories ○ Resting pulse rate ○ Sweating ○ Restlessness ○ Pupil size ○ Bone or joint aches ○ Piloerection= Gooseflesh skin - Goosebumps ■ Origin of term cold turkey ○ Runny nose or tearing - rhinorrhea (not due to a cold) ○ GI upset ○ Tremors ○ Yawning ○ Anxiety/ irritability (especially in severe cases)

opioid use disorder

what substance use disorder is described below: ● GENERAL treatment ○ Individual therapy ○ Behavioral therapy ○ Cognitive behavioral therapy (CBT), family therapy (addictions affect the whole family) ○ Social skills therapy ○ Support Group: Narcotics Anonymous (good for some; need to find people that are serious about treatment and getting better; if not, they will just find more friends to use with) ○ Residential treatment (halfway houses, three quarter houses; important again how seriously the people are taking the program)'

opioid use disorder

what substance use disorder is described below: ● OPIOID OVERDOSE: 3 symptoms: coma, pinpoint pupils (Key sign), respiratory depression ○ Symptoms also include unresponsiveness, slow respiration, hypothermia, hypotension and bradycardia ● OVERDOSE TREATMENT → aspirate secretions, insert an airway, mechanical ventilation used until naloxone (Narcan) can be given

opioid use disorder

what substance use disorder is described below: ● cravings result in larger amounts & longer periods of time being devoted to the drug & increasing tolerance to its effects. ● Significant impairment/alteration in life roles, interpersonal conflict, puts person in physically hazardous situations ● OPIOID INTOXICATION- exhibit psychomotor retardation, drowsiness→ coma, slurred speech, altered mood, impaired memory and attention, pupillary constriction ● OPIOID OVERDOSE: 3 symptoms: coma, pinpoint pupils (Key sign), respiratory depression ○ Symptoms also include unresponsiveness, slow respiration, hypothermia, hypotension and bradycardia ● OVERDOSE TREATMENT → aspirate secretions, insert an airway, mechanical ventilation used until naloxone (Narcan) can be given ● GENERAL treatment ○ Individual therapy ○ Behavioral therapy ○ Cognitive behavioral therapy (CBT), family therapy (addictions affect the whole family) ○ Social skills therapy ○ Support Group: Narcotics Anonymous (good for some; need to find people that are serious about treatment and getting better; if not, they will just find more friends to use with) ○ Residential treatment (halfway houses, three quarter houses; important again how seriously the people are taking the program)' ● 1) Methadone - once/day dosing- opioid treatment program ○ Synthetic narcotic opioid used to decrease painful symptoms of opioid withdrawal, blocks euphoric effects ○ Education: seek medical care if difficulty breathing, shallow breathing, light headed/faint, chest pain, pounding heartbeat, hives, rash, facial swelling of lips, tongue, throat, confusion and hallucinations ● 2) Buprenorphine - used to help people reduce/quit use of heroin or other opiates such as morphine ○ Sometimes people get addicted to this med; may bring problems - this drug is only used 12-24 hours after abstaining from opioids ○ Side effects: Nausea, vomiting, constipation, muscle aches, cramps, insomnia, irritability, fever ● 3) Naltrexone - indicated for relapse prevention following opioid detoxification ○ Side effects: weakness, tiredness, insomnia, increased thirst, anxiety, nervousness, restlessness, irritability, lightheadedness, fainting, muscle or joint aches, decreased sex drive, impotence ● May see the use of Tramadol protocols OPIOID WITHDRAWAL: ● Clinical Opiate Withdrawal Scale (COWS) to assess opiate withdrawal : Symptoms to look for ● 11 categories ○ Resting pulse rate ○ Sweating ○ Restlessness ○ Pupil size ○ Bone or joint aches ○ Piloerection= Gooseflesh skin - Goosebumps ■ Origin of term cold turkey ○ Runny nose or tearing - rhinorrhea (not due to a cold) ○ GI upset ○ Tremors ○ Yawning ○ Anxiety/ irritability (especially in severe cases)

opioid use disorder

____ _____ take advantage of the lower immune system which is a RED FLAG. the following are examples: ● Thrush: also called "candida" ● Shingles ○ Varicella zoster virus ● Vaginal infections ● Oral and genital herpes ● Kaposi sarcoma -- human herpes virus ● Leukoplakia - white raised lesions on the lateral aspect of tongue ○ Indicates a disease progression ● PCP - pneumonia not angel dust ● TB ● School aged children are more likely to get measles, mumps, as a secondary dx from HIV and we should encourage vaccines ○ They are more susceptible to other disease

opportunistic infections

the following are HIV-related _____ ___: --toxplasmosis --cryptococcal meningitis --cytomegalovirus (CMV) --candidiasis (yeast)****** --pneumocystic carinni pneumonia (PCP)****** --TB and histoplasmosis --cryptospoidiosis --mycobacterium avium complex (MAC) --herpes simplex and shingles --genital herpes --HPV --vaginal candidiasis (yeast)

opportunistic infections

When talking about etiology, the following are _____ infections: candidiasis

other

What pharmacological intervention for anxiety disorders are described below: -- Beta blockers - propranolol -- Gabapentin, pregabalin -- Antihistamines- safe, non-addictive -- Antipsychotic meds if anxiety symptoms are more severe -- These are added if first course of medications are ineffective

others

Successful ________ of crisis depends on: 1. Realistic perception of the event ■ May not be as bad as they're making it out to be 2. Adequate situational supports; involves people ■ Crisis intervention 3. Adequate coping mechanisms VERY IMPORTANT TO REMEMBER THIS.

outcomes

When using the nursing process for a patient during a crisis, ______ identification includes: ● - determine these with the patient ○ ________ are patient centered so would determine WITH the patient

outcomes

With opioid use disorders, _____ treatment includes: ● → aspirate secretions, insert an airway, mechanical ventilation used until NALOXONE (Narcan) can be given

overdose

With Sedative, Hypnotic and Antianxiety Medication Use Disorder, _____ ______ includes: GASTRIC LAVAGE, ACTIVATED CHARCOAL, AND CAREFUL VITAL SIGN MONITORING. ○ Patients that are awake after OD SHOULD BE KEPT AWAKE to prevent loss of consciousness ○ If unconscious, start an IV ○ May need endotracheal tube and mechanical ventilation (intubation)

overdose treatment

What level of anxiety is described below: ○ Physical behavior may become erratic, uncoordinated, impulsive ○ Disorganized/irrational reasoning ○ Brief leading statements or actions (take someone by the hand) Not a time to do any teaching or discharge planning or have the person make any decisions

panic

What level of anxiety is described below: ● MARKEDLY DYSREGULATED BEHAVIOR; unable to process what is going on in the environment and may actually lose touch with reality ○ Behavior: pacing, running, shouting, screaming, withdrawal, hallucinations, false sensory perceptions (seeing people/objects not really there)

panic

What level of anxiety is described below: ● MARKEDLY DYSREGULATED BEHAVIOR; unable to process what is going on in the environment and may actually lose touch with reality ○ Behavior: pacing, running, shouting, screaming, withdrawal, hallucinations, false sensory perceptions (seeing people/objects not really there) ○ Physical behavior may become erratic, uncoordinated, impulsive ○ Disorganized/irrational reasoning ○ Brief leading statements or actions (take someone by the hand) Not a time to do any teaching or discharge planning or have the person make any decisions

panic

· May see coming to ER department · These are VERY REAL to the individual experiencing these symptoms o Empathy, care, and concern should be interventions and definitely not making fun of them · If someone described these symptoms—what would you think? o Mimics heart attack

panic attacks

The following is the DSM-5 Criteria for ____ _____: Panic Attack +4 or more from the list* A. 1. Palpitations, pounding heart, accelerated heart rate o 2. Sweating o 3. Trembling, shaking o 4. Sensations of shortness of breath or smothering o 5. Feelings of choking o 6. Chest pain/discomfort o 7. Nausea/abdominal distress o 8. Dizzy unsteady light headed, faint o 9. Chills/heat sensation o 10. Paresthesias (numbness/tingling) o 11. Derealization or depersonalization o 12. Fear of losing control or "going crazy" o 13. Fear of dying B. at least 1 of the attacks has been followed by 1 month (or more) of 1 or both of the following o 1. Persistent concern or worry about additional panic attacks of consequences o 2. Significant maladaptive change in behavior (avoiding exercise) C. not related to substance/ medical condition D. not better explained by another mental disorder

panic disorder

the following is a generic care plan for ____ ____: Short term goal: 1. patient's anxiety will decrease to moderate by (date) and 2. patient will gain mastery over panic episodes by (date) Intervention: 1a. if hyperventilation occurs, instruct patient to take slow deep breaths. breathing with the patient may be helpful. 1b. keep expectations minimal and simple 2a. help patient correct feelings before attack with onset of attack: "what were you thinking about just before the attack?" 2b. help patient recognize symptoms as resulting from anxiety, not from a catastropic physical problem. examples include: explain physical symptoms of anxiety, discuss the fact that anxiety causes sensations similar to those of physical events such as a heart attack. Rationale: 1a. focus is shifted away from distressing symptoms 1b. anxiety limits ability to attend to complex tasks 2a. phsyiological symptoms of anxiety usually appear first as the result of a stressor. They are immediately followed by automatic thoughts such as "i am dying" or "i am going crazy" which are distorted statements 2b. factual info and alternative interpretations can help patient recognize distortions in thought

panic disorder

what anxiety disorder is described below: ● After onset, a panic attack typically lasts about 10 minutes before subsiding - People begin to "fear the fear" ○ Comorbid Disorders: hyperthyroidism, dizziness, cardiac arrhythmias, asthma, COPD, IBS ● If HYPERVENTILATING, instruct to take slow, deep breaths; breathing exercises break the cycle of escalating symptoms of anxiety ○ May see patients presenting to the emergency department ○ Keep in mind that panic attacks are very real to the person

panic disorder

what anxiety disorder is described below: ● Help patient recognize symptoms as resulting from ANXIETY, NOT from catastrophic physical problem; factual information and alternative interpretations can help patient recognize distortions in their thoughts ● People that know they have these attacks sometimes can learn how to get themselves out of it. these attacks last maybe 10 minutes or so but they feel like they are going to die.

panic disorder

what anxiety disorder is described below: ● PANIC ATTACKS= KEY FEATURE OF _____ _______ ● Sudden onset of extreme apprehension/fear associated with feelings of impending doom

panic disorder

what anxiety disorder is described below: ● PANIC ATTACKS= KEY FEATURE OF _____ _______ ● Sudden onset of extreme apprehension/fear associated with feelings of impending doom ● Severe: normal functioning is suspended, perceptual fields severely limited, misinterpretation of reality may occur ○ Individual may feel like they are losing their minds or having a heart attack ○ May end up in ER ● Panic attacks are UNPREDICTABLE and "come out of the blue"; there is not necessarily a trigger for them ● After onset, a panic attack typically lasts about 10 minutes before subsiding - People begin to "fear the fear" ○ Comorbid Disorders: hyperthyroidism, dizziness, cardiac arrhythmias, asthma, COPD, IBS ● If HYPERVENTILATING, instruct to take slow, deep breaths; breathing exercises break the cycle of escalating symptoms of anxiety ○ May see patients presenting to the emergency department ○ Keep in mind that panic attacks are very real to the person ● Help patient recognize symptoms as resulting from ANXIETY, NOT from catastrophic physical problem; factual information and alternative interpretations can help patient recognize distortions in their thoughts ● People that know they have these attacks sometimes can learn how to get themselves out of it. these attacks last maybe 10 minutes or so but they feel like they are going to die.

panic disorder

what anxiety disorder is described below: ● Severe: normal functioning is suspended, perceptual fields severely limited, misinterpretation of reality may occur ○ Individual may feel like they are losing their minds or HAVING A HEART ATTACK ○ May end up in ER ● Panic attacks are UNPREDICTABLE and "come out of the blue"; there is not necessarily a trigger for them

panic disorder

what cluster A personality disorder is described below: Treatment: ■ Psychotherapy versus group therapy → group therapy is threatening to those with this disorder. However it can improve social skills ■ ***Anti-anxiety agent - diazepam** may be used to reduce anxiety and agitation

paranoid personality disorder

what cluster A personality disorder is described below: ● Characteristics ○ May be apparent in childhood ○ Social anxiety in childhood - parent notices child does not have friends ○ Relationships difficult - Jealous, controlling as adults ○ Unwillingness to forgive ○ **Dominant defense mechanism - projection of feelings*** - people attribute their own unacknowledged feelings to others Example - Accuse partner of being hypercritical when they themselves are fault finding

paranoid personality disorder

what cluster A personality disorder is described below: ● Characterized by: ○ Longstanding distrust and suspiciousness of others ○ NO EVIDENCE—believe that others want to exploit, harm, or deceive the person ■ Hypervigilant ■ Anticipate hostility ● That is how they function with others ■ Provoke hostile responses by initiating counterattack ● Prevalence: 2% to 4% (don't need to know %) ○ NOT ON EXAM.

paranoid personality disorder

what cluster A personality disorder is described below: ● Characterized by: ○ Longstanding distrust and suspiciousness of others ○ NO EVIDENCE—believe that others want to exploit, harm, or deceive the person ■ Hypervigilant ■ Anticipate hostility ● That is how they function with others ■ Provoke hostile responses by initiating counterattack ● Prevalence: 2% to 4% (don't need to know %) ○ NOT ON EXAM. ● Characteristics ○ May be apparent in childhood ○ Social anxiety in childhood - parent notices child does not have friends ○ Relationships difficult - Jealous, controlling as adults ○ Unwillingness to forgive ○ **Dominant defense mechanism - projection of feelings*** - people attribute their own unacknowledged feelings to others Example - Accuse partner of being hypercritical when they themselves are fault finding ● Treatment ○ ***Psychotherapy is 1st line of treatment***** ■ Tend to reject treatment ■ Difficult to interview with all of their suspicousness ■ ***Counteract mistrust by (a) adhering to schedules and (b) avoiding being overly friendly, and (c) projecting a neutral but kind affect**** ● Being too nice or friendly may be met with suspisciousness ■ Psychotherapy versus group therapy → group therapy is threatening to those with this disorder. However it can improve social skills ■ ***Anti-anxiety agent - diazepam** may be used to reduce anxiety and agitation

paranoid personality disorder

what cluster A personality disorder is described below: ● Treatment ○ ***Psychotherapy is 1st line of treatment***** ■ Tend to reject treatment ■ Difficult to interview with all of their suspicousness ■ ***Counteract mistrust by (a) adhering to schedules and (b) avoiding being overly friendly, and (c) projecting a neutral but kind affect**** ● Being too nice or friendly may be met with suspisciousness

paranoid personality disorder

what are the 2 goals for the patient during implementation of a crisis?

patient safety and anxiety reduction

What STI is described below: ● Symptoms: pruritus (severe itching), pediculoid rash (around the hair) ○ Visible lice or nits in the pubic hair or adjacent areas ○ Lives in coarse hair such as pubic hair, eyebrows, eyelashes, and beards ○ In the skin, you will see a pediculoid rash which the area of skin is usually red and irritated from the pediculosis pubis nit ● Do not have to have sexual contact; people can share beds and catch it

pediculosis pubis (crabs)

What STI is described below: ● Transmission: Direct or Indirect (via fomites) ; condoms will not protect from this ● Louse lay 10 eggs (nits) at hair follicle base usually lays 10 eggs per day that hatch within 8-10 days and live 5-6 weeks

pediculosis pubis (crabs)

What phase of rape-trauma syndrome is described below: ○ Acute phase or disorganization ■ Fear, anxiety disbelief ■ anger , shock ■ Crying, humiliation, shame, guilt ■ Physical - sleep disturbances, nightmares , body aches and pains ■ Ritual behaviors - checking window and door locks frequently ■ Feel vulnerable

phase 1

What phase of crisis is described below: ○ ******Beginning of trial and error attempt to solve problem and restore normal balance again******

phase 2

What STI is described below: ● Transmission: Direct or Indirect (via fomites) ; condoms will not protect from this ● Louse lay 10 eggs (nits) at hair follicle base usually lays 10 eggs per day that hatch within 8-10 days and live 5-6 weeks ● Symptoms: pruritus (severe itching), pediculoid rash (around the hair) ○ Visible lice or nits in the pubic hair or adjacent areas ○ Lives in coarse hair such as pubic hair, eyebrows, eyelashes, and beards ○ In the skin, you will see a pediculoid rash which the area of skin is usually red and irritated from the pediculosis pubis nit ● Do not have to have sexual contact; people can share beds and catch it ● Treatment: ○ Permethrin ■ 1% lotion (OTC), 5% cream (Rx) ■ Not ovicidal (Won't kill the eggs), will have to repeat tx ○ Spinosad ■ Is ovicidal, only need to use once because the eggs will be killed as well ○ Launder all clothing, linens, etc. ○ Vacuum house ○ Store objects in sealed bag for 2 weeks which will kill the nits

pediculosis pubis (crabs)

What STI is described below: ● Treatment: ○ Permethrin ■ 1% lotion (OTC), 5% cream (Rx) ■ Not ovicidal (Won't kill the eggs), will have to repeat tx ○ Spinosad ■ Is ovicidal, only need to use once because the eggs will be killed as well ○ Launder all clothing, linens, etc. ○ Vacuum house ○ Store objects in sealed bag for 2 weeks which will kill the nits

pediculosis pubis (crabs)

In a crisis, the ______ of the event includes the following: ● May range from realistic to distorted ● People vary in how they absorb, process, and use information from the environment ○ People react differently to news. Stress increases when it is out of their comfort level or out of their control ● Some respond to minor change as though life threatening ● Some respond to serious situation as new opportunity ● Example: twins of divorcing parents. One has drop in grades, the other looking forward to moving (different perceptions)

perception

In a crisis, the ______ of the event includes the following: ● Some respond to minor change as though life threatening ● Some respond to serious situation as new opportunity ● Example: twins of divorcing parents. One has drop in grades, the other looking forward to moving (different perceptions)

perception

Perpetrator or Vulnerable person? characteristics: ● It is common for abusers to accompany their partners to and from activities and this can include doctor appointments ● Restrict mobility by monitoring odometers and keeping stopwatches ○ It should of taken you this much time at the grocery store, for example ● Even with these restrictions, often accuse partners of infidelity

perpetrator

Perpetrator or Vulnerable person? ■ Characteristics: ● Consider their own needs more important than the needs of others ● Extreme pathological jealousy ○ Intimate partner abuser ● Forbid victim to have personal friends or participate in activities outside home ● May control family finances/expenditures

perpetrator

Perpetrator or Vulnerable person? ○ who can be any member of a household who is violent towards another ■ Characteristics: ● Consider their own needs more important than the needs of others ● Extreme pathological jealousy ○ Intimate partner abuser ● Forbid victim to have personal friends or participate in activities outside home ● May control family finances/expenditures ● It is common for abusers to accompany their partners to and from activities and this can include doctor appointments ● Restrict mobility by monitoring odometers and keeping stopwatches ○ It should of taken you this much time at the grocery store, for example ● Even with these restrictions, often accuse partners of infidelity

perpetrator

- individual's characteristic pattern of relatively permanent thoughts, feelings, behaviors that define his/her quality of experiences & relationships; people that are more friendly/optimistic than others may have a different outlook than someone who is more suspicious/paranoid/pessimistic ○ From Latin-persona>> "mask">> may refer to what other people see

personality

During an assessment of a patient with anorexia nervosa, _______ traits include perfectionism and obsessive thoughts and actions related to food: ● Terror of gaining weight ● Preoccupation of thoughts of food ● View themselves as fat even when enanciated ● Have peculiar way of handling food such as cutting food into small bites ● At mealtime, they may be pushing food around on plate ● Possible development of rigorous exercise regimen ● Possible self-induced vomiting ● Possible use of laxatives and diuretics ● Cognitive so disturbed that the individual judges his or herself worth by his or her weight

personality

The following are the different clusters of _____ disorders: ● Cluster A: Eccentric ○ Paranoid (worsen with age) ○ Schizoid ○ Schizotypal ● Cluster B: Erratic (lessen with age) (more of a bigger/flamboyant type of personality) ○ Borderline ○ Narcissistic ○ Histrionic ○ Antisocial ● Cluster C: Anxious ○ Avoidant ○ Dependent ○ Obsessive-compulsive (worsens with age) ■ Not the same thing as obsessive-compulsive disorder which is more of a psychiatric disease and this one is more of a personality disorder which is how a person really is

personality

● "enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment." ● Not a diagnosis as Major Depressive Disorder; more HOW THE PERSON IS and how their personality has developed; if they are put on medication, it is usually because of a side issue; _____ ______ will not/cannot be cured; there is only so much that can be done

personality disorder

________ interventions for a violent patient includes benzodiazepines, 1st generation and 2nd generation antipsychotics. ● Combinations = Haloperidol, lorazepam, diphenhydramine or benztropine

pharmacological

________ interventions may be appropriate to offer patient PRN medication for anxiety or agitation. When used in conjunction with psychosocial interventions and deescalation techniques can prevent an aggressive or violent incident.

pharmacological

What phase of crisis is described below: ● Person is confronted with conflict or problem that threatens his or her self-concept ○ Self concept threatened ● Increased anxiety stimulates use of problem solving techniques and defense mechanisms (sometimes resolves the problem) in an effort to address the problem and lower the anxiety ● If not resolved, then we go to the next phase

phase 1

What phase of crisis is described below: ● The person tried in phase 1 with what they know what to do to solve the issue. If the usual defensive response fails (have tried) and the threat persists, the anxiety continues to rise and produces levels of extreme discomfort. Now the person's functioning is disorganized, they have already done what they knew would work and it did not work so now their own functioning is disorganized. So, they try this and try that and trial and errors attempts to solve problems and restore normal balance begins. In THIS PHASE, they BEGIN this trial and error attempts. ○ Threat persists ○ Anxiety increases ○ Feeling of extreme discomfort ○ Functioning disorganized ○ ******Beginning of trial and error attempt to solve problem and restore normal balance again******

phase 2

What phase of rape-trauma syndrome is described below: ○ long- term process of reorganization ■ Work toward resolution of the experience ■ Many do benefit from professional help ■ Return to previous level of functioning

phase 2

What phase of crisis is described below: ● The Trial and error attempts have failed- so there have been efforts attempted in this phase but they failed. Now, the anxiety can escalate to severe level or panic. The person mobilized automatic relief behaviors such as withdrawal or flight. They do try to continue to reach an acceptable solution even if they have to redefine the situation or compromise their own needs. ○ Anxiety can escalate to severe level or panic ○ Automatic relief behaviors mobilized (withdrawal and flight) ○ Some form of resolution may be devised (compromising needs or redefining situation) ○ May see them try to reach out for help, usually not before this phase

phase 3

What phase of crisis is described below: where we may see them in psych setting ● Problem is still unsolved and coping skills are ineffective. Now the anxiety can overwhelm the person and lead to serious personality disorganization: depression, confusion, violence against others, or even ****suicidal behaviors*****. When presented with a crisis and a person goes through the 3 phases where the problem is still unsolved, this can lead to serious consequences including suicide. ○ Overwhelming anxiety ○ Possible serious personality disorganization, depression, confusion, violence against others or suicidal behavior because things have not been resolved

phase 4

What phase of crisis is described below: ○ Possible serious personality disorganization, depression, confusion, violence against others or *****suicidal behavior***** because things have not been resolved

phase 4

With hallucinogen use disorder, a person can experience _____ _____ or "Angel Dust PCP" which is a MEDICAL EMERGENCY. ○ Under the influence people can be beligerant, assaultive, impulsive, unpredictable ○ Physical symptoms: nystagmus, HTN, tachycardia, diminished response to pain, ataxia, muscle rigidity, seizures, coma, hyperacusis (sensitivity to sound), hyperthermia, seizure ○ Tx: management is primarily supportive, restraint, benzo, mechanical cooling ■ Treatment: can NOT be talked down; may need restraint and calming medication such as a benzodiazepine

phencyclidine intoxication

physical symptoms of hallucinogen intoxication or phencyclidine intoxication? ○ Physical symptoms: nystagmus, HTN, tachycardia, diminished response to pain, ataxia, muscle rigidity, seizures, coma, hyperacusis (sensitivity to sound), hyperthermia, seizure

phencyclidine intoxication

what anxiety disorder is described below: Specific _________: persistent, irrational fear of a specific object or situation that leads to a desire for avoidance or actual avoidance of the object, activity, or situation ● Examples: spiders, heights, animals, seeing blood, germs/dirt, closed spaces

phobias

what anxiety disorder is described below: persistent or irrational fear attached to an object or situation that objectively does not really pose a significant danger ● Overwhelming, crippling anxiety when faced with that object or situation that provokes the phobic response ● Daily functioning compromised; go to great lengths to avoid the feared object/situation

phobias

what anxiety disorder is described below: persistent or irrational fear attached to an object or situation that objectively does not really pose a significant danger ● Overwhelming, crippling anxiety when faced with that object or situation that provokes the phobic response ● Daily functioning compromised; go to great lengths to avoid the feared object/situation ● Example in text: fear of elevators after being trapped in one- now will use stairs/escalators to the point of avoiding social events where using elevator may be a possibility ● ******** ______ are anticipated and not unexpected; different from a panic attack although some response may be similar in how they manifest themselves**********

phobias

what anxiety disorder is described below: ● Example in text: fear of elevators after being trapped in one- now will use stairs/escalators to the point of avoiding social events where using elevator may be a possibility ● ******** ______ are anticipated and not unexpected; different from a panic attack although some response may be similar in how they manifest themselves**********

phobias

When assessing ______ abuse: ● If the explanation does not match the injury, suspect abuse. ○ Ask the patient ****directly*** in a non-threatening manner if someone close to them has caused the injury ○ Observe the nonverbal response (hesitation, lack of eye contact) ● When was the last time it happened? ● How often does it happen? ● Notice if the explanations are inconsistent or vague. Vague explanations should lead the nurse to possible abuse

physical

When assessing ______ abuse: ● Series of minor complaints including accidents - especially falls may be indicator of violence ● Bruises, scars, burns, in various stages of healing ● If the explanation does not match the injury, suspect abuse. ○ Ask the patient ****directly*** in a non-threatening manner if someone close to them has caused the injury ○ Observe the nonverbal response (hesitation, lack of eye contact) ● When was the last time it happened? ● How often does it happen? ● Notice if the explanations are inconsistent or vague. Vague explanations should lead the nurse to possible abuse

physical

With accurate records of vulnerable persons, use _____ ____ of sexual abuse when possible; follow procedures for collection very carefully as this impacts legal action; this requires consent form

physical evidence

what feeding disorder is described below: ○ Eating nonfood items well past toddlerhood ○ Not part of other illness ○ Dirt or paint that have no nutritional value

pica

The following are pharmaceutical interventions for a patient with _____ _____ _______: ● If the SSRIs or SNRIs do not work - try TCA or Mirtazapine (Remeron) ● Clonidine (Catapres) - addresses hyperarousal & intrusive symptoms ● Prazosin (minipress) - used for nightmares and sleep disturbances ● Propranolol (Inderal) - beta blocker for hyperarousal & panic ○ **Most difficult side effect - hypotension

posttraumatic stress disorder

The following are pharmaceutical interventions for a patient with _____ _____ _______: ● Prazosin (minipress) - used for nightmares and sleep disturbances ● Propranolol (Inderal) - beta blocker for hyperarousal & panic ○ **Most difficult side effect - hypotension ● FDA approved trial for the use of ecstasy as a prescription drug ● Sometimes people with ____ _____ ______ will use substances to attempt to self-medicate

posttraumatic stress disorder

The following are pharmaceutical interventions for a patient with _____ _____ _______: ● SSRIs ○ Sertraline (Zoloft) and paroxetine (Paxil) approved - all other drugs are OFF LABEL according to FDA ○ Therapeutic effect - 4-6 weeks ○ Can be used to treat ____ _____ _____ ● MAOI ○ phenelzine (Nardil) ○ Has been used with some success with _____ _____ _____ ● SNRI ○ Venlafaxine (Effexor) ○ Used to decrease anxiety and depressive symptoms ● If the SSRIs or SNRIs do not work - try TCA or Mirtazapine (Remeron) ● Clonidine (Catapres) - addresses hyperarousal & intrusive symptoms ● Prazosin (minipress) - used for nightmares and sleep disturbances ● Propranolol (Inderal) - beta blocker for hyperarousal & panic ○ **Most difficult side effect - hypotension ● FDA approved trial for the use of ecstasy as a prescription drug ● Sometimes people with ____ _____ ______ will use substances to attempt to self-medicate

posttraumatic stress disorder

The following is part of the nursing process: assessment for a patient with _____ ______ ____: ● Screening tools - Primary Care PTSD Screen & PTSD Checklist. ● If screen positive - Severity of Posttraumatic Stress Scale ● Additional comprehensive history, medications, mental status exam, past psychiatric medical history

posttraumatic stress disorder

The following is part of the nursing process: diagnoses and outcomes for a patient with _____ _____ ______: ● Nursing diagnosis - Post Trauma syndrome - sustained maladaptive response to traumatic overwhelming event ● Outcomes ○ Manage anxiety -demonstrate use of relaxation techniques, adequate sleep, ability to maintain role or work requirements ○ Increase self-esteem—grooming/hygiene, eye contact, positive statements about self, acceptance of self-limitations ○ Improved ability to cope AEB decrease in physical symptoms and ability to ask for help

posttraumatic stress disorder

The following is part of the nursing process: evaluation for a patient with ____ ____ ____: ● Recognizes symptoms as related to trauma ● Use new strategies to manage anxiety ● Experiences no flashbacks or intrusive thoughts about the event ● Able to sleep adequately without nightmares ● Can assume usual roles and maintain satisfying interpersonal relationships

posttraumatic stress disorder

The following is part of the nursing process: implementation for a patient with ______ _______ _______: ● Psychoeducation ○ Initial education should include reassurance ○ Nurse should inform significant others of the ways trauma is manifested: interpersonal problems ( friend/ family issues), occupational problems, substance use disorders ○ Strategies: improve coping, enhance self care, and facilitate recognition of problems

posttraumatic stress disorder

The following is part of the nursing process: implementation for a patient with ______ _______ _______: ● Staged treatment protocol - standard for trauma treatment- see page 300 ○ Stage 1, stage 2, and stage 3 ○ Will not be learning these** ● Therapeutic relationship- non-judgemental, acceptance, empathy ● Assist person in managing his/her arousal level -provide safe, predictable environment as much as we can ● Anxiety-reducing strategies - such as deep breathing, imagery, ● Allow patient to share experience - can begin to heal - support groups, family, friends ● Psychoeducation ○ Initial education should include reassurance ○ Nurse should inform significant others of the ways trauma is manifested: interpersonal problems ( friend/ family issues), occupational problems, substance use disorders ○ Strategies: improve coping, enhance self care, and facilitate recognition of problems

posttraumatic stress disorder

The following is the DSM-5 Criteria for _____ ____ ______: B. presence of 1 or more of intrusion symptoms ○ 1. Recurrent, involuntary, intrusive distressing memories of an event ○ 2. Recurrent distressing dreams ○ 3. Children frightening dreams; unrecognizable content ■ Children older than 6 ○ 4. Dissociative reactions (flashbacks) and feels as though event it recurring ○ 5. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the event ○ 6. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the event C. persistent avoidance of stimuli associated with the traumatic event

posttraumatic stress disorder

The following is the DSM-5 Criteria for _____ ____ ______: D. negative alterations in cognitions and mood associated with the traumatic event as evidenced by 2 or more from DSM list ○ 1. Inability to remember an important aspect of the traumatic event due to dissociative amnesia (not head injury) ○ 2. Persistent and exaggerated negative beliefs or expectations about oneself, others, world (I am bad, no one can be trusted, etc.) ○ 3. Persistent distorted cognitions about the cause of consequences of the traumatic events that lead the individual to blame himself/herself ○ 4. Persistent negative emotional state (fear, horror, anger) ■ Lingering fear or anger ○ 5. Markedly diminished interest or participation in significant activities ○ 6. Feelings of detachment or estrangement from others ○ 7. Persistent inability to experience positive emotions

posttraumatic stress disorder

The following is the DSM-5 Criteria for _____ ____ ______: E. marked alterations in arousal and reactivity associated with the traumatic event: 2 or more of the following: ○ 1. Irritable behavior and angry outburst ○ 2. Reckless or self-destructive behavior ○ 3. Hypervigilence ○ 4. Exaggerated or startled response ○ 5. Problems with concentration ○ 6. Sleep disturbance

posttraumatic stress disorder

What 2 stages of syphilis is where if it is not treated in these stages that the individual will be able to spread syphilis to others?

primary and secondary

what are the 3 stages of HIV?

primary infection, clinical latency, and final stage of symptomatic disease

The following is the DSM-5 Criteria for _____ ____ ______: F. duration is more than 1 month******* ○ After 1 month - stress response resolves or goes on to become PTSD G. *****The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning***** H. the disturbance is not attributable to the physiological effects of a substance (ex: education, alcohol) or another medical condition

posttraumatic stress disorder

The following is the DSM-5 Criteria for _____ ____ ______: ● duration is LONGER THAN A MONTH A. exposure to actual or threatened death, serious injury, or sexual violence in 1 or more of the following ways: ○ 1. Directly experiencing ○ 2. Witnessing, in person, the event as it occurred to others ■ Ex: child watching domestic abuse going on ○ 3. Learning that the traumatic events occurred to a close family member or close friend. If cases of actual or threatened death of family member or friend, event must have been violent or accidental. ○ 4. Experiencing repeated or extreme exposure to aversive details of the traumatic events (first responders, polic officers). Note that this does not refer to electronic media unless it is part of their job

posttraumatic stress disorder

The following is the DSM-5 Criteria for _____ ____ ______: ● duration is LONGER THAN A MONTH A. exposure to actual or threatened death, serious injury, or sexual violence in 1 or more of the following ways: ○ 1. Directly experiencing ○ 2. Witnessing, in person, the event as it occurred to others ■ Ex: child watching domestic abuse going on ○ 3. Learning that the traumatic events occurred to a close family member or close friend. If cases of actual or threatened death of family member or friend, event must have been violent or accidental. ○ 4. Experiencing repeated or extreme exposure to aversive details of the traumatic events (first responders, polic officers). Note that this does not refer to electronic media unless it is part of their job B. presence of 1 or more of intrusion symptoms ○ 1. Recurrent, involuntary, intrusive distressing memories of an event ○ 2. Recurrent distressing dreams ○ 3. Children frightening dreams; unrecognizable content ■ Children older than 6 ○ 4. Dissociative reactions (flashbacks) and feels as though event it recurring ○ 5. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the event ○ 6. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the event C. persistent avoidance of stimuli associated with the traumatic event D. negative alterations in cognitions and mood associated with the traumatic event as evidenced by 2 or more from DSM list ○ 1. Inability to remember an important aspect of the traumatic event due to dissociative amnesia (not head injury) ○ 2. Persistent and exaggerated negative beliefs or expectations about oneself, others, world (I am bad, no one can be trusted, etc.) ○ 3. Persistent distorted cognitions about the cause of consequences of the traumatic events that lead the individual to blame himself/herself ○ 4. Persistent negative emotional state (fear, horror, anger) ■ Lingering fear or anger ○ 5. Markedly diminished interest or participation in significant activities ○ 6. Feelings of detachment or estrangement from others ○ 7. Persistent inability to experience positive emotions E. marked alterations in arousal and reactivity associated with the traumatic event: 2 or more of the following: ○ 1. Irritable behavior and angry outburst ○ 2. Reckless or self-destructive behavior ○ 3. Hypervigilence ○ 4. Exaggerated or startled response ○ 5. Problems with concentration ○ 6. Sleep disturbance F. duration is more than 1 month******* ○ After 1 month - stress response resolves or goes on to become PTSD G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning H. the disturbance is not attributable to the physiological effects of a substance (ex: education, alcohol) or another medical condition

posttraumatic stress disorder

With bulimia nervosa, self-induced vomiting has an effect on the patient's ______ levels leading to CARDIAC ARRYTHMIAS. ■ Short term goal: 1) patient will ID signs and symptoms of low ___________ 2) ______________ will remain within normal limits throughout hospitalization ■ Intervention: educate patient regarding ill effects of self-induced vomiting on ___________

potassium

With cluster C obsessive-compulsive personality disorder one of the hallmarks is the _________ with orderliness, perfectionism, control NEED TO KNOW..

preoccupation

The following is the _____ of HIV: 2016 - estimated at over 1.1 million adults and adolescents in US living w/ it

prevalence

______ of HIV includes: ● Heterosexual transmission—has surpassed injection drug use ○ Primary mode of HIV infection in women ● Homosexual transmission ● AA Women are most at risk for HIV ● Promote the use of latex condoms and educate how to use ● Promote HIV screening for newly pregnant women ○ Zidovudine therapy for the mother and a cesarean section have greatly reduced perinatally acquired HIV : this is YUGE ○ It is dangerous when the women do not come in for prenatal visits - sometimes until they are 7 months pregnant

prevention

Primary, secondary, or tertiary prevention for STIs? *history tracking ● Contact information ● PMH - includes past STD hx ● Medications ● Allergies ● Contraception use ● Last menstrual period ● Vaccination Records ● Recreational drug use ● Social history- sexual preference of partners

primary

What level of care (primary, secondary, or tertiary) is described below for a patient going through a crisis? o Teach specific skills such as problem solving or assertive skills, relaxation skills o Assist the patient in evaluating the timing or reduction of life changes--> to help decrease negative effects of stress as much as possible § May involve working with a patient to make some changes that may reduce stress such as making important interpersonal changes or changes in occupational role

primary

What level of care (primary, secondary, or tertiary) is described below for a patient going through a crisis? · promotes mental health and reduces mental illness to decrease incidence of crisis o The nurse evaluates the patient's experience of stressful life events which helps to recognize potential problems § If the patient has never been through this crisis before, the potential problems of not getting things solved versus someone that has and has somewhat of a skill set and has coping mechanisms in place

primary

What level of care (primary, secondary, or tertiary) is described below for a patient going through a crisis? · promotes mental health and reduces mental illness to decrease incidence of crisis o The nurse evaluates the patient's experience of stressful life events which helps to recognize potential problems § If the patient has never been through this crisis before, the potential problems of not getting things solved versus someone that has and has somewhat of a skill set and has coping mechanisms in place o Teach specific skills such as problem solving or assertive skills, relaxation skills o Assist the patient in evaluating the timing or reduction of life changes--> to help decrease negative effects of stress as much as possible § May involve working with a patient to make some changes that may reduce stress such as making important interpersonal changes or changes in occupational role

primary

primary, secondary, or tertiary prevention of HIV? ● Aims to keep healthy people healthy ● Provide community education ● Community outreach such as the needle exchange programs ● Condom use is associated with 80-90% reduction in transmission

primary

With cluster C obsessive-compulsive personality disorder one of the main characteristics is that these individuals have strict standards that interfere with ________ completion; so much emphasis on process ■ _________s are normally incomplete because of overly strict standards

project

_______ intervention for violent patients includes the following: ● Box 27.2 - should also be a review ○ Note: be honest; do **NOT** promise things that cannot be provided ○ Determine what the patient considers to be needed, and meet the need (if possible) ○ Stay honest - cannot make promises

psychosocial

_______ intervention for violent patients includes the following: ● Determine what patient is feeling; tell patient that you are concerned and willing to listen ● Acknowledge patient's needs whether rational or not ○ The patient needs to know that someone hears them and is acknowledging their needs

psychosocial

_______ intervention for violent patients includes the following: ● Determine what patient is feeling; tell patient that you are concerned and willing to listen ● Acknowledge patient's needs whether rational or not ○ The patient needs to know that someone hears them and is acknowledging their needs ● If patient escalates -- may need to approach patient in a controlled, nonthreatening, caring manner. State expectations "I expect that you will stay in control." ○ If you (the RN) are experiencing fear, you may find this to be a challenge; ******maintaining a calm exterior requires self-discipline and comes with experience******** ○ Sometimes just have to find things to agree with them on- shows caring ● Staff safety section should be a review ○ #6 could possibly spark discussion ● Box 27.2 - should also be a review ○ Note: be honest; do **NOT** promise things that cannot be provided ○ Determine what the patient considers to be needed, and meet the need (if possible) ○ Stay honest - cannot make promises

psychosocial

_______ intervention for violent patients includes the following: ● If patient escalates -- may need to approach patient in a controlled, nonthreatening, caring manner. State expectations "I expect that you will stay in control." ○ If you (the RN) are experiencing fear, you may find this to be a challenge; ******maintaining a calm exterior requires self-discipline and comes with experience******** ○ Sometimes just have to find things to agree with them on- shows caring ● Staff safety section should be a review ○ #6 could possibly spark discussion

psychosocial

What is the 1st line of treatment for cluster A paranoid personality disorder? NEED TO KNOW

psychotherapy

What is the treatment of choice for cluster B histrionic personality disorder.? (it may promote clarification of inner feelings and appropriate expression)

psychotherapy

what is the treatment of choice for cluster C dependent personality disorder? **Cognitive-behavioral therapy can help patients healthier thinking by examining & challenging automatic thoughts that result in fearful behavior

psychotherapy

what cluster A schizoid personality disorder ______ can work because they are introspective people and ____ therapy can work as well because they can practice interactions and get feedback.

psychotherapy; group

What is the key symptoms of GAD?

putting things off and avoidance

What form of sexual assault is described below: ● Non Consensual activity********* ● Any penetration of the vagina or anus with any object or body part, or the oral penetration by a sex organ of another person, without the consent of the victim ● The FBI considers ______ to be the second most violent crime in a group of crimes that includes murder, robbery, and aggravated assault

rape

What nursing diagnosis is described below: ○ Evaluation ■ Sleeping well- few instances of nightmares or broken sleep ■ Eating as before ■ Calm, relaxed; mildly suspicious, fearful, or restless ■ Support for friends/ family ■ Positive self regard ■ Absence or mild instances of somatic reactions

rape-trauma syndrome

What nursing diagnosis is described below: ○ Phase 1 - Acute phase or disorganization ■ Fear, anxiety disbelief ■ anger , shock ■ Crying, humiliation, shame, guilt ■ Physical - sleep disturbances, nightmares , body aches and pains ■ Ritual behaviors - checking window and door locks frequently ■ Feel vulnerable

rape-trauma syndrome

What nursing diagnosis is described below: ○ Phase 1 - Acute phase or disorganization ■ Fear, anxiety disbelief ■ anger , shock ■ Crying, humiliation, shame, guilt ■ Physical - sleep disturbances, nightmares , body aches and pains ■ Ritual behaviors - checking window and door locks frequently ■ Feel vulnerable ○ Phase 2 - long- term process of reorganization ■ Work toward resolution of the experience ■ Many do benefit from professional help ■ Return to previous level of functioning ○ Evaluation ■ Sleeping well- few instances of nightmares or broken sleep ■ Eating as before ■ Calm, relaxed; mildly suspicious, fearful, or restless ■ Support for friends/ family ■ Positive self regard ■ Absence or mild instances of somatic reactions

rape-trauma syndrome

What nursing diagnosis is described below: ○ Phase 2 - long- term process of reorganization ■ Work toward resolution of the experience ■ Many do benefit from professional help ■ Return to previous level of functioning

rape-trauma syndrome

the following are defining characteristics of ____-_____ ______: --shame, guilt, helplessness, powerlessness, dependence, low self-esteem, depression, mood swings, aggression, anger, agitation, revenge, substance abuse, suicide attempts, anxiety, fear, disturbed sleep, nightmares, sexual dysfunction, muscle tension, hyperalertness, dissociation, disorgnization, shock, confusion, phobias, paranoia

rape-trauma syndrome

the following is a summary of ____ ____ testing: ● Accuracy - all tests provide greater than 99% accuracy at detecting HIV antibodies ● Easy to use, CLIA waived ○ More than 98$ of individual can correctly read the results after only reading the product insert ○ This testing is CLIA waived which is testing approved outside of labs just like you perform flu testing, strep testing, and CBGs. ● Easy to read ○ Interpretation of results is the same as all of the CLIA waived HIV tests ● Immunosuppressed and/or immunocompromised individuals infected with HIV may NOT have a detectable level of HIV antibodies

rapid HIV

_____ ______ testing provides results within 10 minutes of taking it. it also: ● Increase receipt - more people will do it because there is no wait time ● Increase identification of HIV infected pregnant women so that they can receive effective prophalaxis - pt still in room so they are able to be told then and there (before they had to wait 6 weeks and then try to contact them with results) ● Increase feasibility of testing in acute care settings with same day results - easier and cost effective ● Increase number of venuses where testing can be offered to high risk person ● Must be confirmed with a second screening test before HARRT can begin - draw blood, results will take 2 weeks

rapid HIV testing

What defense mechanism is described below: · justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller and listener o Example: One that is stated sometime is the typical example of a child telling the teacher that they do not have their homework because the dog ate my homework OR I cannot get to work on time because my alarm clock did not go off.

rationalization

In order to have successful outcomes of crisis it depends on what 3 concepts??

realistic perception of the event, adequate situational supports, and adequate coping mechanisms

Harm _____ of HIV includes: ● risk -natural and universal ● Coping the best they know how ○ Be compassionate ● Change "process" or journey marked by numerous stages ○ Methadone clinic ● Change at own pace ● Accurate, practical information and support no matter where they are in the process of change

reduction

During planning for a patient with anorexia nervosa, reintroduction of nutrients MUST be proceeded slowly in order to avoid ____ _____ which could potentially lethal treatment complication (Holocaust survivors)********. ■ Can lead to fluid imbalance abnormalities, abnormal glucose metabolism, etc. The reintroduction of nutrients must proceed slowly to avoid this syndrome

refeeding syndrome

______ for HIV include: ● HIV case management/prevention case management programs ● Other behavioral interventions such as individual group or community support ● Individual, group, community ● Other services such as substance use, mental health, and family planning assistance

referrals

What defense mechanism is described below: · reverting to an earlier, more primitive and childlike pattern of behavior that may or may not have been previously exhibited Example: a young child reverting back to baby-like behavior if there is a new baby born into the family. They may start sucking their thumb or start doing things that they have outgrown.

regression

○ 1. Medically managed (24 hour staff) ○ 2. Medically monitored (less complex conditions) **care continuum of substance use disorders

rehabilitation

What defense mechanism is described below: · unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas, from conscious awareness o Example: May happen if someone has a very traumatizing event in their past and instead of feeling it or dealing with it it has been pushed back into the unconscious and is not really at the conscious level

repression

the following is talking about ____ concerning HIV: ● After aware they are HIV positive prevalence of high risk sexual behavior is reduced substantially. ● The second study was the White Hart Study which was where HIV positive participants reduced unprotected intercourse and increased the use of condoms ● Meta-analysis of high risk sexual behavior in persons aware and unaware they are infected with HIV in the US

research

the latest ____ of HIV includes: ● Pre-exposure prophylaxis (PEP) shows beneficial in certain populations. It took 2 medications and used prophalactically to reduce the rates of HIV in your high risk populations and it did show reduction. However, when we look at PEP, we must ensure the effectiveness of their complicance because if they are not taking on a regular basis then it si not going to be effective and protect them. ● The IPERGAY study ○ Men who had anal sex without a condom and had creatinine levels above 60 mL/min (affects kidneys) ○ Men in the prophylaxis group used a median of 16 pills per month ○ Findings: the combination of tenofovir and emtricitabine ● Massive side effects; bone cancers, liver, kidney issues WEAR a condom wrap it before you tap it ● Still at risk for other STDs

research

the latest ____ of HIV includes: ● The IPERGAY study ○ Men who had anal sex without a condom and had creatinine levels above 60 mL/min (affects kidneys) ○ Men in the prophylaxis group used a median of 16 pills per month ○ Findings: the combination of tenofovir and emtricitabine ● Massive side effects; bone cancers, liver, kidney issues WEAR a condom wrap it before you tap it ● Still at risk for other STDs

research

______ with HIV is a problem with most of the antiretroviral drugs and includes: ● Combination of 3 or more of the medications that are listed, it appears that these drugs when used together they are full strength and are effective for treating the AIDS symptoms and HIV. But one of the big issues when someone is taking these meds is that they can have lethal interactions with medications and that is even with your OTC medications. ● Drugs are used in full strength ● Lethal interactions

resistance

What type of behavioral therapy for anxiety and OCD disorders is described below: ■ therapist does not allow certain ritual - patient learns that anxiety subsides even when ritual not completed ● EX: pt wants to go wash their hands, therapist does not allow them to, the pt deals with the anxiety until the feeling passes

response prevention

The following is discussing figure 26.1: good depiction of different ______ to stressful event: ■ A human organism that is living live in a state of equilibrium. Along comes a stressful event thrown into a state of disequilibrium and there is now a need to restore equilibrium. ■ On the left side, the balancing factors (what they are trying to do to get back to homeostasis): what helps is a realistic perception of the event, adequate situational support, adequate coping mechanisms: this results in resolution of the problem, equilibrium is regained so there is no crisis state. ■ On the right side: one or more of those balancing factors is absent a distorted perception of the event, no adequate situational support, no adequate coping mechanisms and this results in the problem NOT being resolved so the disequilibrium continues and now we have a crisis state.

responses

the following are sexual behavior ____ markers for STIs: ● Regular partner or multiple partners ● Preferences (men, women, or both?) ○ Never assume someone's infidelity ● Type of intercourse (oral, rectal, vaginal) ● IV drug use

risk

what feeding disorder is described below: ○ Regurgitation with re chewing, re-swallowing, or spitting (Baby Bird) ○ No medical or mental reason

rumination

During counseling, counsel to develop a ______ _______ → plan for rapid escape when abuse recurs; pick a particular abusive sign; "now is the time to leave"; if children are involved, plan a code word; have items packed, because it is time to leave. ○ May have a suitcase of bag that are already packed and put in place where perpetrator will not find it

safety plan

What Scheduled drug category (1-5) is described below: ○ - HIGH POTENTIAL for abuse; no acceptable medical use ■ Heroin ■ Lysergic acid diethylamide (LSD) ■ Can't find a legitimate use

schedule 1

What Scheduled drug category (1-5) is described below: ○ Schedule III -LOW TO MODERATE POTENTIAL for misuse; available only by prescription ■ Acetaminophen / codeine ■ Buprenorphine

schedule 3

What Scheduled drug category (1-5) is described below: ○ Schedule IV - LOW RISK; available by prescription ■ Alprazolam ■ Lorazepam ■ propoxyphene/ acetaminophen

schedule 4

What Scheduled drug category (1-5) is described below: contain limited quantities of narcotics. Treatment of diarrhea, coughing, pain

schedule 5

when talking about scheduled drugs, we have 5 categories or _____ which are based on the drug's acceptable medical use/ misuse potential- the lower the number, the higher the potential for abuse. **1-5

schedules

what cluster A personality disorder is described below: ● Characteristics ○ Avoid close relationships ■ Not seeking out close relationships and neither approval or rejection from others seem to have no effect so it is no big deal ■ If trust is established the person may devulge numerous imaginary friends ○ Can work - solitary occupation - such as night security guard; work where they can be alone ○ Depersonalization, detachment

schizoid personality disorder

what cluster A personality disorder is described below: ● Characteristics ○ LIFELONG PATTERN OF SOCIAL WITHDRAWAL ○ Somewhat expressionless; restricted range of emotional expression; blunted affect ○ Discomfort in social interaction ○ Appear in childhood & adolescence - loners; do poorly in school; ridiculed due to odd behavior ○ Increased prevalence of disordered family life—schizophrenia or schizotypal personality disorder is in the family

schizoid personality disorder

what cluster A personality disorder is described below: ● Guides for nurses ○ Avoid being too "nice" or "friendly" ○ ****Do not try to increase socialization********* ○ Assess for symptoms the patient is reluctant to discuss ○ Protect the patient against group's ridicule

schizoid personality disorder

what cluster A personality disorder is described below: ● Prevalence: Nearly 5% of population ● Characteristics ○ LIFELONG PATTERN OF SOCIAL WITHDRAWAL ○ Somewhat expressionless; restricted range of emotional expression; blunted affect ○ Discomfort in social interaction ○ Appear in childhood & adolescence - loners; do poorly in school; ridiculed due to odd behavior ○ Increased prevalence of disordered family life—schizophrenia or schizotypal personality disorder is in the family ○ Avoid close relationships ■ Not seeking out close relationships and neither approval or rejection from others seem to have no effect so it is no big deal ■ If trust is established the person may devulge numerous imaginary friends ○ Can work - solitary occupation - such as night security guard; work where they can be alone ○ Depersonalization, detachment ● Guides for nurses ○ Avoid being too "nice" or "friendly" ○ ****Do not try to increase socialization********* ○ Assess for symptoms the patient is reluctant to discuss ○ Protect the patient against group's ridicule ● Treatment ○ Psychotherapy ■ Can work because they are introspective ○ Group therapy ■ They can practice interactions and get feedback ○ ***Antidepressants- bupropion; 2nd generation antipsychotics such as Risperodone and Alonzapine - improve emotional expressiveness****

schizoid personality disorder

what cluster A personality disorder is described below: ● Treatment ○ Psychotherapy ■ Can work because they are introspective ○ Group therapy ■ They can practice interactions and get feedback ○ ***Antidepressants- bupropion; 2nd generation antipsychotics such as Risperodone and Alonzapine - improve emotional expressiveness****

schizoid personality disorder

The following is talking about the differences between _____ vs. schizophrenia: · May see psychotic symptoms - but lesser degree & briefly · Can be made aware of their suspiciousness, magical thinking, odd beliefs · Schizophrenia - ****far stronger delusions******

schizotypal

what cluster A personality disorder is described below: ● DSM-5 - BOTH a personality disorder & also schizophrenia spectrum disorder; considered a "precursor" to schizophrenia ○ ****Severe social and interpersonal deficits***** ○ ****Hallmarks - magical thinking, odd beliefs, strange speech patterns, inappropriate affect****** ○ Extreme anxiety in social situations ○ Ramble in conversations ○ Paranoia - overly suspicious

schizotypal personality disorder

what cluster A personality disorder is described below: ● Nursing care guidelines ○ **Respect patient's need for social isolation*** ○ Be aware of and intervene appropriately with patient's suspiciousness. ○ Perform careful diagnostic assessment for symptoms that may need intervention (e.g., suicidal thoughts). ○ Be aware that some of their strange beliefs and activities may be part of patient's life such as strange religious practices or peculiar thoughts may be part of their life

schizotypal personality disorder

what cluster A personality disorder is described below: ● Prevalence: Varies from 0.64 to 4.6% population ● ******Characteristics - do NOT blend in with crowd; doesn't bother them that this is how they are; are not worried about changing******

schizotypal personality disorder

what cluster A personality disorder is described below: ● Prevalence: Varies from 0.64 to 4.6% population ● ******Characteristics - do NOT blend in with crowd; doesn't bother them that this is how they are; are not worried about changing****** ● DSM-5 - BOTH a personality disorder & also schizophrenia spectrum disorder; considered a "precursor" to schizophrenia ○ ****Severe social and interpersonal deficits***** ○ ****Hallmarks - magical thinking, odd beliefs, strange speech patterns, inappropriate affect****** ○ Extreme anxiety in social situations ○ Ramble in conversations ○ Paranoia - overly suspicious ● Nursing care guidelines ○ **Respect patient's need for social isolation*** ○ Be aware of and intervene appropriately with patient's suspiciousness. ○ Perform careful diagnostic assessment for symptoms that may need intervention (e.g., suicidal thoughts). ○ Be aware that some of their strange beliefs and activities may be part of patient's life such as strange religious practices or peculiar thoughts may be part of their life ● Treatment ○ Psychotherapy (provider should investigate possible involvement with cults) ○ Low-dose antipsychotics

schizotypal personality disorder

what cluster A personality disorder is described below: ● Treatment ○ Psychotherapy (provider should investigate possible involvement with cults) ○ Low-dose antipsychotics

schizotypal personality disorder

Why do we ____ for HIV? ● Can be detected before symptoms develop ● Treatment more beneficial when done from the beginning (before symptoms of HIV develop) ● Reliable, inexpensive and is an acceptable screening test. Costs of ______ning- reasonable in relation to anticipated benefits of it

screen

The following are _____ recommendations for adults and adolescents when it comes to HIV: ● Retroviral infection-possibility. RNA test in conjunction with an antibody test ○ When an acute retroviral infection is possible, use an RNA test in conjuction with an antibody test you must repeat HIV screenings of persons at least annually.

screening

The following are _____ recommendations for adults and adolescents when it comes to HIV: ● Routine, voluntary HIV _______ for all persons 15-65 NOT based on risk should be conducted ● TB or seeking treatment for STDs should be screened for HIV ● Repeat _______ with known risk at least annually ● Retroviral infection-possibility. RNA test in conjunction with an antibody test ○ When an acute retroviral infection is possible, use an RNA test in conjuction with an antibody test you must repeat HIV screenings of persons at least annually.

screening

involuntary confinement of a patient in a room, or from which patient is physically prevented from leaving, but can still move around

seclusion

With _____ or ______: ● Must have an order! ○ Document every little detail for legal purposes ○ RN can initiate if the patient escalates quickly and there is not enough time to call the provider but GET THAT ORDER. ■ If escalates quickly and is emergent enough, RN can initiate; but get the order immediately after the fact ■ Get the order immediately after the fact!!

seclusion; restraints

______ or ________ are used LAST RESORT. ● Despite efforts, may progress to this; (cut my life into pieces, this is my) last resort; only after other interventions have been tried

seclusion; restraints

Primary, secondary, or tertiary prevention for STIs? *history of signs and symptoms ● Discharge → Rectal or genital ● Dysuria→ Discomfort when urinating ● Itching ● Rashes ● Pelvic pain ● Dyspareunia → Difficult or painful sexual intercourse ● Ulcerations → Can be in genital areas or anal areas and upper thigh region ○ Signs and symptoms they may exhibit with an STI

secondary

What level of care (primary, secondary, or tertiary) is described below for a patient going through a crisis? o Assess patient's problems, support systems, and coping styles o Explore goals and plan interventions o lessens time person mentally disabled during a crisis o occurs in hospital units, er departments, clinics, and mental health centers

secondary

What level of care (primary, secondary, or tertiary) is described below for a patient going through a crisis? · intervene during acute crisis to prevent prolonged anxiety from diminishing personal effectiveness and personality organization o Primary focus: safety of the patient

secondary

What level of care (primary, secondary, or tertiary) is described below for a patient going through a crisis? · intervene during acute crisis to prevent prolonged anxiety from diminishing personal effectiveness and personality organization o Primary focus: safety of the patient o Assess patient's problems, support systems, and coping styles o Explore goals and plan interventions o lessens time person mentally disabled during a crisis o occurs in hospital units, er departments, clinics, and mental health centers

secondary

primary, secondary, or tertiary prevention of HIV? ● Prevention for positives ○ Directed towards people who are already HIV positives ● Differs from primary prevention which focuses on people who are NOT HIV infected ● Screening to ensure early identification and follow-ups with contacts

secondary

what is the main nursing diagnosis for cluster B borderline personality disorder?

self-mutilation

what anxiety disorder is described below: ● Normal part of infant development (8 months; peaks at about 18 months) ○ Small child when parent is dropping them off and they start crying intensely ○ Part of normal growth and development of child ● Developmentally inappropriate levels over being away from a significant other; fear that something terrible will happen to the other person ○ The child should be able to handle separation better than they are but now they have this disorder. There is a real fear that something bad will happen to the other person.

separation anxiety disorder

what anxiety disorder is described below: ● Adult form: ○ The subject of the attachment (parent, spouse, child, friend) may become alienated due to NEEDINESS AND CLINGINESS of the one who is manifesting the separation anxiety disorder ○ Often have difficulties in romantic relationships; more likely to be unmarried ○ characteristics: harm avoidance, worry, shyness, uncertainty, fatigability, and lack of self direction ○ Significant level of discomfort/disability; impairs social and occupational functioning; does NOT respond to psychotherapy = cognitive-behavioral therapy

separation anxiety disorder

what anxiety disorder is described below: ● Developmentally INAPPROPRIATE LEVELS over being away from a significant other; fear that something terrible will happen to the other person ○ The child should be able to handle separation better than they are but now they have this disorder. There is a real fear that something bad will happen to the other person. ● Intense enough to distract from normal activities; may cause sleep disturbances and nightmares. ○ Can also manifest as GI disturbance and headaches

separation anxiety disorder

what anxiety disorder is described below: ● Normal part of infant development (8 months; peaks at about 18 months) ○ Small child when parent is dropping them off and they start crying intensely ○ Part of normal growth and development of child ● Developmentally inappropriate levels over being away from a significant other; fear that something terrible will happen to the other person ○ The child should be able to handle separation better than they are but now they have this disorder. There is a real fear that something bad will happen to the other person. ● Intense enough to distract from normal activities; may cause sleep disturbances and nightmares. ○ Can also manifest as GI disturbance and headaches ● Adult form: ○ The subject of the attachment (parent, spouse, child, friend) may become alienated due to neediness and clinginess of the one who is manifesting the separation anxiety disorder ○ Often have difficulties in romantic relationships; more likely to be unmarried ○ characteristics: harm avoidance, worry, shyness, uncertainty, fatigability, and lack of self direction ○ Significant level of discomfort/disability; impairs social and occupational functioning; does NOT respond to psychotherapy = cognitive-behavioral therapy

separation anxiety disorder

What level of anxiety is described below: ○ As the RN will you teach/instruct a patient at this level? The answer is no because learning and problem solving is NOT possible at this level. So, discharge planning, discharge teaching, medication teaching, cannot happen while the person is displaying severe anxiety symptoms. Now, we can give short concise calm instructions if someone is hyperventilating. You can help them to lower their breathing and something that could be calming and short enough to where the person can understand

severe

What level of anxiety is described below: ○ Dazed and confused; behavior is automatic and aimed at reducing anxiety ○ Somatic symptoms (headache, nausea, dizziness, insomnia) often increase ○ Will also see trembling, pounding heart, hyperventilation, sense of impending doom, dread; loud, rapid speech, threats/demands ○ Offer observations to patients that they may be able to understand ("you are hyperventilating"); don't try to teach at this point

severe

What level of anxiety is described below: ● perceptual field greatly reduced; may focus on one detail or many scattered details. May have difficulty noticing what is going on in the environment, even when another points it out

severe

What level of anxiety is described below: ● perceptual field greatly reduced; may focus on one detail or many scattered details. May have difficulty noticing what is going on in the environment, even when another points it out ○ LEARNING AND PROBLEM SOLVING IS NOT POSSIBLE AT THIS LEVEL; education is ineffective ○ Dazed and confused; behavior is automatic and aimed at reducing anxiety ○ Somatic symptoms (headache, nausea, dizziness, insomnia) often increase ○ Will also see trembling, pounding heart, hyperventilation, sense of impending doom, dread; loud, rapid speech, threats/demands ○ Offer observations to patients that they may be able to understand ("you are hyperventilating"); don't try to teach at this point ○ As the RN will you teach/instruct a patient at this level? The answer is no because learning and problem solving is NOT possible at this level. So, discharge planning, discharge teaching, medication teaching, cannot happen while the person is displaying severe anxiety symptoms. Now, we can give short concise calm instructions if someone is hyperventilating. You can help them to lower their breathing and something that could be calming and short enough to where the person can understand

severe

the following are interventions for a patient experiencing _____-_____ anxiety: · Remember that they can NOT problem solve and thoughts are more confused and illogical · Calm manner; remain with patient · Move to quieter setting and stay with the patient · Clear, simple statements and repetition; speak slowly

severe-panic

the following are interventions for a patient experiencing _____-_____ anxiety: · Remember that they can NOT problem solve and thoughts are more confused and illogical · Calm manner; remain with patient · Move to quieter setting and stay with the patient · Clear, simple statements and repetition; speak slowly · Safety—firm voice if needed—"you may not hit anyone here." May be out of control. o Safety is FIRST!! · Meet physical needs as needed · Reinforce reality if distortions are occurring

severe-panic

the following are interventions for a patient experiencing _____-_____ anxiety: · Safety—firm voice if needed—"you may not hit anyone here." May be out of control. o Safety is FIRST!! · Meet physical needs as needed · Reinforce reality if distortions are occurring

severe-panic

Best practice guidelines for ____ assault cases include: ● Must have a consent! Before photos, exam, any procedure that might be needed to collect evidence and provide treatment ● ******Have the right to refuse any parts of the legal medical exam***** ● Examination involves five steps: _________ collection of evidence ○ 1. Head to toe physical assessment for signs of injury ○ 2. Detailed genital examination observing for signs of injury ○ 3. Evidence collection and preservation ○ 4. Documentation of physical findings both written and photo documentation ○ 5. Treatment, discharge planning, and follow- up care

sexual

The following are unwanted _____ advances and are considered _____ harassment: ○ Stranger rape ○ Marital ○ Date rape ○ Drug facilitated sexual assault ○ Incest ○ Human sex trafficking ○ Female genital mutilation

sexual

______ offenders and relationships with victims includes the following: ● Not necessarily strangers ● Acquaintance rape - significant numbers point to rape perpetrated by acquaintances (people that they knew) ● Courts do recognize marital rape

sexual

The following is talking about _____ of HIV: ● Rare occurrences of ________ between family members in households ○ Remember that HIV is not transmitted through casual contact such as hygiene or touching someone that does have HIV ● Can transmit after becoming infected (2-3 days) ○ Not contracted through casual contact - hugging, touching

transmission

The following is the regimen of treatment for ___ ____ victims for HIV: ● Recommendations ○ UNDERSTAND THE RECOMMENDATIONS. When deciding whether to recommend the intitiation of PEP after _____ _______, the clinician should assess and carefully weigh the following factors: ■ Whether or not a significant exposure occurred during the assault ■ The knowledge of the HIV status of the alleged assaulant ● HIV status of alleged ■ Whether the victim is ready and willing to complete the PEP regimen ■ It will be the clinician's decision to recommend PEP but it should **** NOT be influenced by the geographic location of the assault*****

sexual assault

The following is the regimen of treatment for ___ ____ victims for HIV: ● The preferred PEP regimen for ____ ______: ○ Tenofovir 300 mg PO qd + Emtricitabine 200 mg PO qd (Truvada) ■ Plus Raltegravir (Isentress) 400 mg PO BID ○ If the patient wants to do this regimen, they will be seen by an infection specialist. Once they start the regimen they CANNOT stop, do not want a superbug. ○ If the victim knows the person who assaulted them, they will be arrested and tested ○ ***NOT EXPECTED TO REMEMBER THE MEDICATION; JUST KNOW THE RECOMMENDATIONS. ● Recommendations ○ UNDERSTAND THE RECOMMENDATIONS. When deciding whether to recommend the intitiation of PEP after _____ _______, the clinician should assess and carefully weigh the following factors: ■ Whether or not a significant exposure occurred during the assault ■ The knowledge of the HIV status of the alleged assaulant ● HIV status of alleged ■ Whether the victim is ready and willing to complete the PEP regimen ■ It will be the clinician's decision to recommend PEP but it should NOT be influenced by the geographic location of the assault

sexual assault

what does SANE nurses stand for

sexual assault nurse examiners

● multidisciplinary team approach to caring for victims of sexual assault

sexual assault response team (SART)

______ _______ residential services are places that provide 24 hour observation and supervision for people who do not require inpatient at this point; provided this short term place to eliminate/ reduce acute symptoms. **Modalities of crisis intervention

short term

What type of crisis is described below: ○ Arise from events that are ■ extraordinary ■ External ■ Often unanticipated ○ Affects how tolerate stressful event ■ Degree of support from family, friends, others ■ Own emotional and physical status - affects how tolerate the stressful events

situational

What type of crisis is described below: ○ Arise from events that are ■ extraordinary ■ External ■ Often unanticipated ○ Affects how tolerate stressful event ■ Degree of support from family, friends, others ■ Own emotional and physical status - affects how tolerate the stressful events ○ Examples: loss/ change of job, death of a loved one, abortion, change in financial status, divorce, severe mental or physical illness, abortion ■ •Sometimes events are catastrophic. These events are unplanned and may be accidental, caused by nature, or human-made. This type of crisis results from (1) a natural disaster(e.g., flood, fire, earthquake), (2) a national disaster (e.g., acts of terrorism, war, riots, airplane crashes), or (3) a crime of violence.

situational

What type of crisis is described below: ○ Examples: loss/ change of job, death of a loved one, abortion, change in financial status, divorce, severe mental or physical illness, abortion ■ •Sometimes events are catastrophic. These events are unplanned and may be accidental, caused by nature, or human-made. This type of crisis results from (1) a natural disaster(e.g., flood, fire, earthquake), (2) a national disaster (e.g., acts of terrorism, war, riots, airplane crashes), or (3) a crime of violence.

situational

In a crisis, ______ ______ includes: ● Includes all the **people** who are available that can be depended upon to help during the time of a crisis ○ Associate situational support with PEOPLE. ● Nurse and health professionals who use crisis intervention are providing ______ _______ ● What can this mean practically ○ Good for people to ask for help ○ If help is offered, receive it ○ Assess patient's support system ■ Who do they have in term of people that can help in a time of crisis

situational support

In a crisis, ______ ______ includes: ● Nurse and health professionals who use crisis intervention are providing ______ _______ ● What can this mean practically ○ Good for people to ask for help ○ If help is offered, receive it ○ Assess patient's support system ■ Who do they have in term of people that can help in a time of crisis

situational support

When assessing _______ _______ in the nursing process: ● Nurse determines resources by assessing patient's support systems ○ Is there anyone - family or friends- you would like to have involved in your care? ○ Have you ever used community agency for support? ■ Perhaps, they have a history with someone that may be a resource for them now ○ Do you have a church affiliation? ○ Contact with a faith based group? ● Has to do with the ***people*** that are available as resources for the patient

situational supports

what anxiety disorder is described below: ● FEAR OF PUBLIC SPEAKING IS THE MOST COMMON MANIFESTATION OF THIS DISORDER. ○ Comorbid disorders: high functioning autism, selective mutism, bipolar, body dysmorphic disorder

social anxiety disorder AKA social phobia

what anxiety disorder is described below: ● Want to avoid situations in which they may be exposed to strangers or scrutiny from others ○ Examples: having a conversation, public speaking, meeting unfamiliar people, eating or performing in front of others ■ In situation that can be evaluated by others and there is a level of judgement ○ If this interaction cannot be avoided, it will be endured with intense anxiety and emotional distress

social anxiety disorder AKA social phobia

what anxiety disorder is described below: ● severe anxiety or fear that is provoked by exposure to a social/performance situation that could be EVALUATED NEGATIVELY BY OTHERS

social anxiety disorder AKA social phobia

The following is talking about _____ of HIV: ● requirements : ○ Large amount of virus & susceptible host ● Viral load ○ Blood is large ○ Semen (less than blood) ○ Blood or tissues is not used from individuals who have a history of high risk behaviors or are infected by HIV. In addition to screening, blood and tissue coagulation factors used to treat hemophilia or other blood disorders are made safe through heat treatments to ensure that the HIV virus is inactivated.

transmission

what is the classic sign of alcohol withdrawal?

tremulousness/ shakes/ jitters

what anxiety disorder is described below: ● severe anxiety or fear that is provoked by exposure to a social/performance situation that could be EVALUATED NEGATIVELY BY OTHERS ● Want to avoid situations in which they may be exposed to strangers or scrutiny from others ○ Examples: having a conversation, public speaking, meeting unfamiliar people, eating or performing in front of others ■ In situation that can be evaluated by others and there is a level of judgement ○ If this interaction cannot be avoided, it will be endured with intense anxiety and emotional distress ● FEAR OF PUBLIC SPEAKING IS THE MOST COMMON MANIFESTATION OF THIS DISORDER. ○ Comorbid disorders: high functioning autism, selective mutism, bipolar, body dysmorphic disorder

social anxiety disorder AKA social phobia

With cluster A schizotypal personality disorder, nursing care guidelines includes the nurse having to respect the patient's need for _____ _____.

social isolation

One of the characterisitics for cluster A schizoid personality disorder is a lifelong pattern of?

social withdrawal

what risk factor for substance use disorders are described below: sense of belonging for otherwise isolated individuals; cultures have varying habit regarding use of alcohol

sociocultural

One of the characteristics of cluster A schizoid personality disorder is that these individuals can work at ____ _____ where they can work where they can be alone such as a night security guard.

solitary occupation

________ sexual assault services includes: ● Sexual Assault Nurse Examiners (SANEs) ○ RNs with specialized training in caring for sexual assault patients ○ Demonstrated competency in conduction medical and legal evaluation ○ Ability to be an expert witness in court ● Sexual assault response team (SART)—multidisciplinary team approach to caring for victims of sexual assault

specialized

With cluster B borderline personality disorder, _____ is the inability to view both positive and negative aspects of others as part of a whole; view person as wonderful or a horrible person. ■ Defense and coping style ■ Example - at first they may idealize new relationship/friend and kinda be all into it; if disappointed/frustrated by the other person - now quickly shifts and other person despised, devalued, etc. ■ "You're my best nurse, you're my best nurse!" then, if nurse does something they don't like "you're the worst nurse, you're the worst nurse!"

splitting

What stage of syphilis is described below: ■ Incubation: 10-90 days ■ Chancre (painless ulcer) at entry; most common is on penis but can occur on other areas (such as tongue); may not know it is there; spontaneously heals within a few weeks, may not seek treatment bc it resolves on its own ● Firm, round, small, and painless ● If left untreated, the chancre persists for 3-6 weeks and heals spontaneously. However if it is not adequately treated, it progresses to stage 2. The problem here is once the chancre disappears, people may think that they are cured since it is no there but in actuality they have moved on to stage 2 syphilis.

stage 1: primary

What stage of HIV is described below: ■ What to expect? ● Occurs within about a month of contracting the disease ● Flu like symptoms: Don't recognize as HIV ○ Lymphenopathy, sore throat, fever, rash, maliase, lethargy, etc. so most of the times individuals do not recognize as HIV ● The actual antibiody testing at this stage is negative - may go undetected

stage 1: primary infection

What stage of HIV is described below: ■ What to expect? ● No obvious signs of HIV ● 6 weeks to 3 months of when HIV antibodies will appear in the blood ● Clients will experience gradual deterioration of immune system at the end of this long incubation period ● *******ART (antiretroviral therapy) should be used at this time****** ● Intermediate Chronic Infection—CDC4 T-cell drops ○ This is where your CD4 T-cell count drops below 500 cells and possibly 200 ● Viral load increasing ○ Symptoms become more exaggerated, you may have nervous system involvement, and localized infections as well as lymphenopathy

stage 2: clinical latency

What stage of HIV is described below: ● Intermediate Chronic Infection—CDC4 T-cell drops ○ This is where your CD4 T-cell count drops below 500 cells and possibly 200 ● Viral load increasing ○ Symptoms become more exaggerated, you may have nervous system involvement, and localized infections as well as lymphenopathy

stage 2: clinical latency

What stage of syphilis is described below: ■ Incubation: 6 weeks to 6 months ■ Spreads to lymphatic system and spreads throughout the body ■ Presents as a rash (on hands or feet; can spread to torso) ● Rash doesn't itch! ● Palmar/plantar rash with NO ITCHING ● MAJOR SYMPTOM ■ Lymphadenopathy→ Abnormal size, number, or consistency of lymph nodes ■ Sore throat, patchy hair loss, muscle aches, headaches, and fatigue ■ Fever ■ Malaise ■ May see oral ulcerations ■ Symptoms of stage 2 will go away with or without treatment but without treatment, it will move to stage 3: latent stage

stage 2: secondary

What stage of HIV is described below: ■ What to expect? ● This is AIDS: ● Dx: by t cell count = < 200 with or without documented HIV infection ○ Don't necessarily need an HIV positive test ● Many of the opportunistic infections are caused by microorganisms that are commonly present in healthy individuals but do not cause disease in healthy people ● AIDS according to the CDC Criteria: ○ 1. Wasting Syndrome ○ 2. T cell count below 200 ○ 3. AIDS Dementia complex ○ 4. An opportunistic infection ○ 5. An opportunistic cancer ■ Invasive cervical cancer ■ Kaposi sarcoma Lymphoma

stage 3: final stage of symptomatic disease

What stage of HIV is described below: ● AIDS according to the CDC Criteria: ○ 1. Wasting Syndrome ○ 2. T cell count below 200 ○ 3. AIDS Dementia complex ○ 4. An opportunistic infection ○ 5. An opportunistic cancer ■ Invasive cervical cancer ■ Kaposi sarcoma Lymphoma

stage 3: final stage of symptomatic disease

What stage of syphilis is described below: ■ Organisms persist in the infected person's body without causing S&S ■ Can be >6 months to years ● Any range of greater than 6 months to years ■ Subdivided into 2 types: based on TIME ● Early: initial infection within the previous 12 months ● Late: initial infection occurred >1 year prior

stage 3: latent syphilis

What STI is described below: ● Caused by protozoan bacterium → Trichomonas vaginalis ● Spread through sexual contact ● Can survive on infected objects (such as washcloths) and can be transmitted by sharing these objects

trichomoniasis

What stage of syphilis is described below: ■ Several years before manifesting in an individual ■ 3 types: ● Neuro-syphilis, ● cardiovascular syphilis and ● late benign tertiary syphilis ○ signs and symptoms includes the development of lesions of the bone, skin, and mucous membranes that are known as gummatous syphilis. ○ It also during this can infect the kidney, heart, brain, and respiratory ■ Some degree of acute or subacute aseptic meningitis is present, even in primary syphilis; therefore, neurosyphilis, in a broad sense, begins early ■ You can also spread congenital syphilis which is the transmission through the placenta if it is untreated.

stage 4: tertiary

With stimulant use disorder, ____ ____ includes: the patient feels superhuman while using stimulants, elated, euphoric, sociable. ○ Hypervigilant, sensitive, anxious, tense, angry ○ Physical symptoms include 2 or more of the following: chest pain, arrhythmia, high/low BP, tachy/bradycardia, respiratory depression, dilated pupils, perspiration, chills, nausea, vomiting, weight loss, psychomotor retardation/agitation, weakness, confusion, seizures, coma

stimulant intoxication

what substance use disorder is described below: ● Amphetamine-type, cocaine, other stimulant drugs are second only to cannabis as the most widely used ILLICIT substances in the US. ○ Produce euphoric feeling and high energy ○ Used by long distance truck drivers, students, soldiers, athletes

stimulant use disorder

what substance use disorder is described below: ● Amphetamine-type, cocaine, other stimulant drugs are second only to cannabis as the most widely used ILLICIT substances in the US. ○ Produce euphoric feeling and high energy ○ Used by long distance truck drivers, students, soldiers, athletes ● Stimulant intoxication - feel superhuman while using stimulants, elated, euphoric, sociable. ○ Hypervigilant, sensitive, anxious, tense, angry ○ Physical symptoms include 2 or more of the following: chest pain, arrhythmia, high/low BP, tachy/bradycardia, respiratory depression, dilated pupils, perspiration, chills, nausea, vomiting, weight loss, psychomotor retardation/agitation, weakness, confusion, seizures, coma ● Stimulant withdrawal -BEGINS WITHIN A FEW HOURS TO SEVERAL DAYS**** ○ Symptoms: tiredness, vivid nightmares, increased appetite, insomnia, hypersomnia, psychomotor agitation/retardation ○ MOST SERIOUS SIDE EFFECT: Depression and suicidal thoughts ● Withdrawal treatment - inpatient setting usually necessary, family/group/individual therapy useful ○ May experience fatigue, mood changes, disturbed sleep, craving, depression ○ Intense craving associated with cocaine may require hospitalization to remove person from drug source environment ○ For amphetamines—inpatient ○ For cocaine—1 to 2 week withdrawal no physiological symptoms that require inpatient; may have intense craving ○ Unscheduled urine drug testing

stimulant use disorder

what substance use disorder is described below: ● Stimulant intoxication - feel superhuman while using stimulants, elated, euphoric, sociable. ○ Hypervigilant, sensitive, anxious, tense, angry ○ Physical symptoms include 2 or more of the following: chest pain, arrhythmia, high/low BP, tachy/bradycardia, respiratory depression, dilated pupils, perspiration, chills, nausea, vomiting, weight loss, psychomotor retardation/agitation, weakness, confusion, seizures, coma

stimulant use disorder

what substance use disorder is described below: ● Stimulant withdrawal -BEGINS WITHIN A FEW HOURS TO SEVERAL DAYS**** ○ Symptoms: tiredness, vivid nightmares, increased appetite, insomnia, hypersomnia, psychomotor agitation/retardation ○ MOST SERIOUS SIDE EFFECT: Depression and suicidal thoughts

stimulant use disorder

what substance use disorder is described below: ● Withdrawal treatment - inpatient setting usually necessary, family/group/individual therapy useful ○ May experience fatigue, mood changes, disturbed sleep, craving, depression ○ Intense craving associated with cocaine may require hospitalization to remove person from drug source environment ○ For amphetamines—inpatient ○ For cocaine—1 to 2 week withdrawal no physiological symptoms that require inpatient; may have intense craving ○ Unscheduled urine drug testing

stimulant use disorder

With stimulant use disorder, ___ ____ BEGINS WITHIN A FEW HOURS TO SEVERAL DAYS. ○ Symptoms: tiredness, vivid nightmares, increased appetite, insomnia, hypersomnia, psychomotor agitation/retardation ○ MOST SERIOUS SIDE EFFECT: Depression and suicidal thoughts

stimulant withdrawal

Anxiety is different from ______. ____ is not a disorder and it is a part of everyday life and is not intrinsically good or bad. ● Perception of _______ is individually based ○ If _______ is seen as a negative, it is based on a person's evaluation of the stressor and their ability to respond to it. ○ If the mind interprets events as threatening, it responds with symptoms of anxiety

stress

What defense mechanism is described below: · unconscious process of substituting mature and socially acceptable activity for immature and unacceptable impulses; by definition is considered constructive o Example: someone who is anger or using anger again and instead of acting it out they go for a long job or exercise or something that is considered constructive

sublimation

The following are examples of nursing diagnoses for ____ ____ _____: risk for suicide, risk for injury, disturbed sleep pattern, nutrition: less than body requirements, nutrition: more than body requirements, self-neglect, ineffective coping, ineffective denial, hopelessness, risk for impaired liver function, decreased cardiac output, and dysfunctional family processes

substance use disorders

The following is the DSM-5 Criteria for ____ ____ _____: ● No longer differentiates between abuse and dependence ● Will now see it written as Alcohol Use Disorder → mild, moderate, severe ● Others - Opioid Use Disorder, Stimulant Use Disorder, Tobacco Use Disorder ● DSM - 5 provides diagnostic criteria for the following psychoactive substances: ETOH, caffeine, cannabis, hallucinogen, inhalant, opioid, sedative, hypnotic, antianxiety medication, stimulant, tobacco ● Symptoms - 4 Categories ○ 1. Impaired Control ○ 2. Social Impairment ○ 3. Risky Use ■ Spill over into risky behavior that has consequences ■ On the job ○ 4. Physical effects (Intoxication, tolerance, withdrawal)

substance use disorders

What type of disorders are described below: a pathological use of a substance that leads to a disorder of use ● Complex diseases of the brain - craving, seeking, using regardless of the consequences ● Chronic and relapsing ● Compromised executive functioning

substance use disorders

When using the nursing process for ___ ____ disorders, evaluation includes evaluating the effectiveness of the treatment plan.

substance use disorders

When using the nursing process for ___ ____ disorders, implementation includes: ○ Psychosocial - supportive environment for managing disorders. coping skills (alcohol use is a maladaptive coping skill); assist in setting goals, relapse prevention (read p. 427) ■ Safety and sleep are the 1st line interventions; healthy food and hydration; support for selfcare; identifying coping skills; assist in goal setting ○ Pharmacological - follow protocol; use of tools such as CIWA, COWS; staying ahead of withdrawal; monitoring of vital signs ○ Health teaching & health promotion - By 2020, substance use disorders & mental health disorders are predicted to surpass all physical diseases as major causes of disability worldwide. ○ Prevention -may be best answer; classes in understanding addiction; better coping

substance use disorders

When using the nursing process for ___ ____ disorders, outcomes include: ○ Immediate detox and stabilization if experiencing withdrawal ○ Abstinence; motivated for treatment ○ Pursuit of recovery lifestyle

substance use disorders

When using the nursing process for ___ ____ disorders, planning includes: ○ Based on assessment and diagnoses; take into account the recognition of problem and motivation for change

substance use disorders

When using the nursing process for ___ _____ disorders we use ASSESSMENT. This includes: ● Assessment: ○ Comprehensive; may include looking at family, own thoughts, feelings, and opinions ■ Codependence--> overly responsible ○ CIWA-AR - Clinical Institute Withdrawal assessment of Alcohol scale ■ Revised = 10 categories ■ Note specific questions in each box ○ COWS - Clinical Opiate Withdrawal Scale ■ 10 categories ○ Family assessment - presence of co-dependence; enabler ■ Ex: spouse calls into work, but other spouse calls for them, but they're both hungover EX of not enabling: Don't bail family out of jail: let them face their consequence

substance use disorders

When using the nursing process for ___ _____ disorders we use SCREENING. This includes: ● Screening: ○ SBIRT - early intervention and tx service ■ Screening- assess severity and determine level of tx ■ brief intervention- increase insight and awareness, motivation toward behavior change ■ referral to treatment - need more extensive tx with access to specialty care ○ AUDIT: alcohol use disorder ID test ○ *****CAGE - common: Learn the questions → assessment/ screening tool****** ■ Have you felt the need to cut down ■ Are you annoyed by your drinking ■ Have you felt guilty about your drinking ■ Have you have a drink in the morning (eye opener) ■ ***Score 2 or more is significant, score of 1 requires further assessment ○ CAGE-AID- questions are the same but refer to Adapted to Include Drugs ○ T-ACE: Tolerance, Annoyance, Cut down, Eye Opener

substance use disorders

genetic, neurochemical, and sociocultural are risk factors for what disorders?

substance use disorders

With implementation of cluster B borderline personality disorder, you want to respond matter-of-factly to _______ self-injuries. ○ Self-destructive behaviors/harmful self-soothing ■ Cutting***** ■ Promiscuous sexual behavior ■ Numbing with substances

superficial

During counseling, ____ ______ _____ and emphasize people have a right to live without fear of violence; "no one deserves to be hit"

support the victim

What STI is described below: ○ Stage 3: Latent ■ Organisms persist in the infected person's body without causing S&S ■ Can be >6 months to years ● Any range of greater than 6 months to years ■ Subdivided into 2 types: based on TIME ● Early: initial infection within the previous 12 months ● Late: initial infection occurred >1 year prior

syphilis

What STI is described below: 4 stages: (if not treated during primary or secondary stages → able to spread to others) ○ Stage 1 Primary ■ Incubation: 10-90 days ■ Chancre (painless ulcer) at entry; most common is on penis but can occur on other areas (such as tongue); may not know it is there; spontaneously heals within a few weeks, may not seek treatment bc it resolves on its own ● Firm, round, small, and painless ● If left untreated, the chancre persists for 3-6 weeks and heals spontaneously. However if it is not adequately treated, it progresses to stage 2. The problem here is once the chancre disappears, people may think that they are cured since it is no there but in actuality they have moved on to stage 2 ______

syphilis

What STI is described below: bacteria: Treponema pallidum 4 stages: (if not treated during primary or secondary stages → able to spread to others) ○ Primary ■ Incubation: 10-90 days ■ Chancre (painless ulcer) at entry; most common is on penis but can occur on other areas (such as tongue); may not know it is there; spontaneously heals within a few weeks, may not seek treatment bc it resolves on its own ● Firm, round, small, and painless ● If left untreated, the chancre persists for 3-6 weeks and heals spontaneously. However if it is not adequately treated, it progresses to stage 2. The problem here is once the chancre disappears, people may think that they are cured since it is no there but in actuality they have moved on to stage 2 ______ ○ Secondary ■ Incubation: 6 weeks to 6 months ■ Spreads to lymphatic system and spreads throughout the body ■ Presents as a rash (on hands or feet; can spread to torso) ● Rash doesn't itch! ● Palmar/plantar rash with NO ITCHING ● MAJOR SYMPTOM ■ Lymphadenopathy→ Abnormal size, number, or consistency of lymph nodes ■ Sore throat, patchy hair loss, muscle aches, headaches, and fatigue ■ Fever ■ Malaise ■ May see oral ulcerations ■ Symptoms of stage 2 will go away with or without treatment but without treatment, it will move to stage 3: latent stage ○ Latent ■ Organisms persist in the infected person's body without causing S&S ■ Can be >6 months to years ● Any range of greater than 6 months to years ■ Subdivided into 2 types: based on TIME ● Early: initial infection within the previous 12 months ● Late: initial infection occurred >1 year prior ○ Tertiary ■ Several years before manifesting in an individual ■ 3 types: ● Neuro-______, ● cardiovascular ______ and ● late benign tertiary _______ ○ signs and symptoms includes the development of lesions of the bone, skin, and mucous membranes that are known as gummatous ________. ○ It also during this can infect the kidney, heart, brain, and respiratory ■ Some degree of acute or subacute aseptic meningitis is present, even in primary _______; therefore, neurosyphilis, in a broad sense, begins early ■ You can also spread congenital ______ which is the transmission through the placenta if it is untreated. ● Treatment: ○ Primary, secondary, or early latent (<1 year): ■ Benzathine penicillin G (Bicillin) 2.4 million units IM x1 dose (2 injections, one in each hip) ○ Late latent (>1 year): ■ Benzathine penicillin G (Bicillin at a larger dose) 7.2 million units total over 3 weeks, 1 dose per week

syphilis

What STI is described below: ○ Stage 2: Secondary ■ Incubation: 6 weeks to 6 months ■ Spreads to lymphatic system and spreads throughout the body ■ Presents as a rash (on hands or feet; can spread to torso) ● Rash doesn't itch! ● Palmar/plantar rash with NO ITCHING ● MAJOR SYMPTOM ■ Lymphadenopathy→ Abnormal size, number, or consistency of lymph nodes ■ Sore throat, patchy hair loss, muscle aches, headaches, and fatigue ■ Fever ■ Malaise ■ May see oral ulcerations ■ Symptoms of stage 2 will go away with or without treatment but without treatment, it will move to stage 3: latent stage

syphilis

What STI is described below: ○ Stage 4: Tertiary ■ Several years before manifesting in an individual ■ 3 types: ● Neuro-______, ● cardiovascular ______ and ● late benign tertiary _______ ○ signs and symptoms includes the development of lesions of the bone, skin, and mucous membranes that are known as gummatous ________. ○ It also during this can infect the kidney, heart, brain, and respiratory ■ Some degree of acute or subacute aseptic meningitis is present, even in primary _______; therefore, neurosyphilis, in a broad sense, begins early ■ You can also spread congenital ______ which is the transmission through the placenta if it is untreated.

syphilis

What STI is described below: ● Treatment: ○ Primary, secondary, or early latent (<1 year): ■ ********Benzathine penicillin G (Bicillin) 2.4 million units IM x1 dose (2 injections, one in each hip)********* ○ Late latent (>1 year): ■ Benzathine penicillin G (Bicillin at a larger dose) 7.2 million units total over 3 weeks, 1 dose per week

syphilis

What type of behavioral therapy for anxiety and OCD disorders is described below: ■ patient gradually introduced to a feared object or experience through a series of steps - graduated exposure; patient taught to use relaxation techniques at each step ● EX: agoraphobia → walk to steps of house gradually working up to attending movie

systematic desensitization

What stage of the cycle of violence is described below: ○ Begins with minor incidents- pushing, shoving, verbal abuse ■ victim may begin to take the blame for being abused ■ victim may ignore or accept behavior due to fear of escalation

tension building stage

Name the 3 stages of the cycle of violence.

tension building stage Acute battering stage honeymoon stage

What level of care (primary, secondary, or tertiary) is described below for a patient going through a crisis? o *******critical incident stress debriefing (CISD)*****: example of a _______ intervention directed towards a group that has experienced a crisis § Examples: debriefing with staff on inpatient unit following patient suicide; debriefing with schoolchildren and school personnel after school shooting; debriefing with rescue and health workers who have responded to disaster, shooting, etc. § (skip phases of CISD)

tertiary

What level of care (primary, secondary, or tertiary) is described below for a patient going through a crisis? · support for those who have experienced a severe crisis and are now recovering from a disabling mental state o Goals are to facilitate optimal levels of functioning and prevent further emotional disruptions

tertiary

What level of care (primary, secondary, or tertiary) is described below for a patient going through a crisis? · support for those who have experienced a severe crisis and are now recovering from a disabling mental state o Goals are to facilitate optimal levels of functioning and prevent further emotional disruptions o *******critical incident stress debriefing (CISD)*****: example of a _______ intervention directed towards a group that has experienced a crisis § Examples: debriefing with staff on inpatient unit following patient suicide; debriefing with schoolchildren and school personnel after school shooting; debriefing with rescue and health workers who have responded to disaster, shooting, etc. § (skip phases of CISD)

tertiary

primary, secondary, or tertiary prevention of HIV? ● Management of symptoms ● Psychosocial support ● Family/caregiver education

tertiary

_____ of HIV should be anonymous and be given a number to check results (most are involved in criminal activity). ● Should not be contingent on a behavioral risk assessment ● Acceptance of HIV _______ when offered routinely ● Early Dx shown to reduce morbidity and mortality rates ● Awareness of infection reduce behaviors that risk transmission ● Cost effective even in healthcare settings with low prevalence rates of HIV

testing

With cluster B antisocial personality disorder, with planning the main thing is the profound inability to connect with others. This will impair usual process of developing _______ relationship

therapeutic

What type of behavioral therapy for anxiety and OCD disorders is described below: ■ say "Stop" or snap rubber band when negative thought or obsession occurs ● EX: rubber band popping ● Basically a distraction

thought stopping

what substance use disorder is described below: craving, persistent, and recurrent use, tolerance. ● Cigarettes → most commonly used tobacco product ● Tobacco withdrawal ○ 4 of the following symptoms occur: irritability, anxiety, depression, difficulty concentrating, restlessness, insomnia ● Withdrawal treatment - behavioral therapy, hypnosis, nicotine replacement: gum, lozenges ● Antidepressant Bupropion reduces nicotine cravings ● Clonidine, Varenicline

tobacco use disorder

with tobacco use disorder, ____ ____ includes 4 of the following symptoms occur: irritability, anxiety, depression, difficulty concentrating, restlessness, insomnia

tobacco withdrawal

what concept for substance use disorder is described below: ● a person no longer responds to the drug in the way that the person initially responded. Higher dose of the drug to achieve the same level of response achieved initially. Need more to get same effect. Start spending their time seeking substances. Money. Controls their life

tolerance

The following is talking about _____ of HIV: ○ Breast milk, blood, semen, vaginal secretions ● Rare ________ methods → needle sticks, organ transplants, artificial insemination ● Presence of STDs - increase risk for HIV infection (due to presence of sores and decreased immune system) ● HIV does not survive well in the environment ● Rare occurrences of ________ between family members in households ○ Remember that HIV is not transmitted through casual contact such as hygiene or touching someone that does have HIV ● Can transmit after becoming infected (2-3 days) ○ Not contracted through casual contact - hugging, touching ● requirements : ○ Large amount of virus & susceptible host ● Viral load ○ Blood is large ○ Semen (less than blood) ○ Blood or tissues is not used from individuals who have a history of high risk behaviors or are infected by HIV. In addition to screening, blood and tissue coagulation factors used to treat hemophilia or other blood disorders are made safe through heat treatments to ensure that the HIV virus is inactivated.

transmission

What STI is described below: ● Caused by protozoan bacterium → Trichomonas vaginalis ● Spread through sexual contact ● Can survive on infected objects (such as washcloths) and can be transmitted by sharing these objects ● S&S: ○ Male: ■ asymptomatic ○ Female: ■ Frothy, bubbly, greenish discharge ■ Painful intercourse/abdominal pain ■ "Strawberry cervix" ● Treatment: ○ *****Metronidazole (Flagyl) 2g in single dose ■ To ensure the compliance of the medication through single dose is why it is the most common treatment ○ Metronidazole (Flagyl) 500 mg BID x 7 days******* ● It is very important that the client understand that they should avoid sexual intercourse, but when taking the medication to treat this condition they should also AVOID ALCOHOL.

trichomoniasis

What STI is described below: ● S&S: ○ Male: ■ asymptomatic ○ Female: ■ Frothy, bubbly, greenish discharge ■ Painful intercourse/abdominal pain ■ "Strawberry cervix"

trichomoniasis

What STI is described below: ● Treatment: ○ *****Metronidazole (Flagyl) 2g in single dose ■ To ensure the compliance of the medication through single dose is why it is the most common treatment ○ Metronidazole (Flagyl) 500 mg BID x 7 days******* ● It is very important that the client understand that they should avoid sexual intercourse, but when taking the medication to treat this condition they should also AVOID ALCOHOL.

trichomoniasis

What disorder is described below: ● Both occur more in children; linked to OCD ● - hair pulling disorder - 1 of the oldest recorded psychiatric problems (tendency of a person to pull out own hair) ○ "I was so annoyed that I wanted to pull my hair out." ● Typically hair on head, but can be any body hair ○ Small patches - baldness ● Pain - eases anxiety - similar to cutting

trichotillomania

What type of gonorrhea is limited to cervical and urethral infection?

uncomplicated

- interpersonal & social relationships & functioning → maladaptive, complicated, dysphoric (unease, misery, or anxiety) (a state of being dissatisfied)

unhealthy

With cluster C obsessive-compulsive personality disorder one of the main characteristics is that these individuals have an ________ focus on perfection ■ The essence of the goal gets lost from the pre-occupation of perfection

unhealthy

If attempts to meet needs/teach alternatives __________: ○ 1. Leave room as soon as verbal abuse begins. Inform patient that nurse will return in ___ minutes when calmer. If in middle of procedure, stay matter-of-fact; complete procedure and leave the room ○ 2. Withdrawal of attention to verbal abuse AND positively reinforcing non-abusive communication ■ Switch the subject: Discussing non-illness topics, responding to requests, provide emotional support ○ 3. Keep schedule as predictable as possible; scheduled contact with nurse -- every ___ minutes ● Remain neutral, matter-of-fact with patients who habitually use anger and intimidation

unsuccessful

What symptom of gonorrhea in males is the inflammation of the urethra which is the primary symptom? **they have burning upon urination ** inflammation of urethra: symptom = burning with urination; "bladder infection" (uncommon with men)

urethritis

With accurate records of vulnerable persons, use _____ ____ of who caused the injury and when.

verbatim statements

In the hospitals, _______ is most frequent in ○ Psychiatric units ○ Emergency departments ○ Geriatric units

violence

The following are predictors of ______: --increasing anxiety and tension: clenched jaw or fist, rigid posture, fixed or tense facial expression, mumbling to self (patient may have SOB, sweating, and rapid pulse) --verbal abuse: profanity, argumentativeness --loud voice, change of pitch or very soft voice, forcing others to strain to hear --stone silence

violence

The following are predictors of ______: --intense eye contact or avoidance of eye contact --recent acts of ______ including property ______ --alcohol or drug intoxication --possession of a weapon or object that may be used as a weapon (fork, knife, rock) --isolation that is uncharacteristic

violence

The following are predictors of ______: Milieu characteristics conducive to _____: --overcrowding --staff inexperience --provacative or controlling staff --poor limit setting --arbitrary revocation of privledges

violence

The following are predictors of ______: Signs and symptoms that usually (but not always) precede ______: --hyperactivity: MOST IMPORTANT PREDICTOR OF IMMINENT _______ (pacing, restlessness) --increasing anxiety and tension: clenched jaw or fist, rigid posture, fixed or tense facial expression, mumbling to self (patient may have SOB, sweating, and rapid pulse) --verbal abuse: profanity, argumentativeness --loud voice, change of pitch or very soft voice, forcing others to strain to hear --stone silence --intense eye contact or avoidance of eye contact --recent acts of ______ including property ______ --alcohol or drug intoxication --possession of a weapon or object that may be used as a weapon (fork, knife, rock) --isolation that is uncharacteristic Milieu characteristics conducive to _____: --overcrowding --staff inexperience --provacative or controlling staff --poor limit setting --arbitrary revocation of privledges

violence

The following are predictors of _______: ● Hyperactivity: pacing, etc. (MOST IMPORTANT PREDICTOR OF IMMINENT _________) ○ Pacing in a way they were not before ● Increased anxiety and tension (clenched jaw/fist, tense expression, etc.) ○ Mumbling to self, sweating, rapid pulse, etc. ● Verbal abuse ● Loud voice, change in pitch, or very soft voice ● Stone silence ● Intense eye contact or avoidance of eye contact ● Recent acts of _______ including property violence on the unit ○ A history of _________ is the single best predictor of future ________! ● alcohol/drug intoxication ● Possession of a weapon or object that can be used as a weapon (fork, knife, rock, etc) ● Isolation that is uncharacteristic for that patient

violence

· always an objectionable act—intentional use of force

violence

When talking about etiology, the following are _____ infections: HIV, Hepatitis A/B/C, HPV, Herpes Simplex II

viral

During an assessment of a _____ _____: ● Establish trust, be non-threatening and supportive ● Allow the person to tell story with little to no interruption ● Reassure they did nothing wrong ● Use therapeutic communication - reflection, paraphrasing, open-ended questions, etc. ○ Read examples pg. 525

vulnerable person

Perpetrator or Vulnerable person? ■ Characteristics of Vulnerable Children: ● Younger than 4 years ● Perceived as different ● Remind parents of someone they do not like ● Product of unwanted pregnancy ● Interference with emotional bonding between parent and child PLEASE NOTE: ****Family violence is common in the childhood histories of juvenile offenders, runaways, violent criminals, prostitutes, and those who are in turn violent toward others

vulnerable person

Perpetrator or Vulnerable person? ○ (Victim, survivor, or victim/survivor) is the family member upon whom the abuse is perpetrated ■ Characteristics of Vulnerable Women: ● Pregnancy may trigger or increase violence ● Violence may escalate when wife makes move toward independence such as visiting friends without permission ● Greatest risk for violence is when the woman attempts to leave the relationship ○ this is when she is MOST VULNERABLE to violence

vulnerable person

Perpetrator or Vulnerable person? ○ (Victim, survivor, or victim/survivor) is the family member upon whom the abuse is perpetrated ■ Characteristics of Vulnerable Women: ● Pregnancy may trigger or increase violence ● Violence may escalate when wife makes move toward independence such as visiting friends without permission ● Greatest risk for violence is when the woman attempts to leave the relationship ○ this is when she is MOST VULNERABLE to violence ■ Characteristics of Vulnerable Children: ● Younger than 4 years ● Perceived as different ● Remind parents of someone they do not like ● Product of unwanted pregnancy ● Interference with emotional bonding between parent and child PLEASE NOTE: ****Family violence is common in the childhood histories of juvenile offenders, runaways, violent criminals, prostitutes, and those who are in turn violent toward others

vulnerable person

The following are interview guidelines for ________ ______: DO: --conduct the interview in private --be direct, honest, and professional --use language the patient understands --be understanding and attentive --inform the patient if you must make a referral to Children's or Adult Protective Services and explain the process --assess safety and help reduce danger at discharge DO NOT --try to "prove" abuse by accusations or demands --display horror, anger, shock, or disapproval of the perpetrator or situation --place blame or make judgements --allow the patient to feel "at fault" or "in trouble" --probe or press for answers the patient is NOT willing to give --conduct the interview with a group of interviewers

vulnerable persons

Intervention for a patient with anorexia nervosa includes beginning ____ ___ program that allows for: ■ Incremental weight gain ■ 90% ideal body weight- usually able to menstruate ■ Focus on eating behavior and underlying feelings of anxiety, low self-esteem, and lack of control

weight restoration

When talking about the HIV antibody test, there is a ____ ____ which includes: ■ (6 weeks) ● False negative; actually positive, but body hasn't produced antibody yet so it goes undetected ○ It is when a patient may have a false negative because the virus is present but antibodies are not detected yet by the test. ● Do test after 6 weeks of exposure then 6 months ○ If negative at 6 months then you're truly negative

window phase

what concept for substance use disorder is described below: ● set of physiological symptoms that occur when person stops using a substance ○ Specific to substance being used ○ Mild → life threatening (need to be monitored in hospital) ○ Vomiting or seizures when withdrawing from substances (esp. alcohol)

withdrawal

with substance use disorders we have _____ which includes: · Benzodiazepines - lorazepam, chlordiazepoxide, diazepam, oxazepam, clorazepate · Sedation, decrease anxiety & blood pressure · Use CIWA-AR scale - agency policies · Assess for seizures & signs of delirium tremens · ***Get the patient through the detox process safely****

withdrawal

With Sedative, Hypnotic and Antianxiety Medication Use Disorder, patients can undergo _____ _____ which includes GRADUAL REDUCTION of benzo prevents seizures and: ○ Barbiturate withdrawal - aided by the use of long acting barbiturate phenobarbital ○ *******Should NOT be detoxing from benzodiazepines at home with no guidance*******

withdrawal treatment

with tobacco use disorder, ____ ____ includes: ● behavioral therapy, hypnosis, nicotine replacement: gum, lozenges ● Antidepressant Bupropion reduces nicotine cravings ● Clonidine, Varenicline

withdrawal treatment

the following are characteristics of vulnerable ______: ● Pregnancy may trigger or increase violence ● Violence may escalate when wife makes move toward independence such as visiting friends without permission ● Greatest risk for violence is when the woman attempts to leave the relationship ○ this is when she is MOST VULNERABLE to violence

women

With hallucinogen intoxication, can the patient be talked down with treatment?

yes; talking patient down is SHORT TERM using either an antipsychotic or benzo

Name the 5 criteria for hospitalization for a patient with anorexia nervosa.

■ Less than 10% body fat ■ Daytime heart rate of less than 50 beats/min ■ Systolic blood pressure less than 90 ■ Temperature below 96 ■ Arrhythmias (hypokalemia)

With alcohol use disorder we have binge drinking with is too much too quickly. what is the amount of drinks for a woman and a man to qualify for this type of problematic drinking?

■ Women - 4 or more drinks within 2 hours ■ Men - 5 or more drinks within 2 hours 🍻🍻🍺

With alcohol use disorder we have heavy drinking which is drinking too much, too often. what is the amount of drinks for a woman and a man to qualify for this type of problematic drinking? VERY IMPORTANT TO KNOW THIS.

■ Women - 8 or more in one week ■ Men - more than 14 in one week

What are the 2 different treatments for genital herpes (herpes simplex 2)?

○ Acyclovir 400 mg PO TID x 7-10 days ○ Valacyclovir 1g PO BID for 7-10 days

Name the 4 cluster B personality disorders. **erratic (lessen with age) (more of a bigger/flamboyant type of personality)

○ Borderline ○ Narcissistic ○ Histrionic ○ Antisocial