Nursing 104 Chapter 34 & 35 Study Guide

A patient who is taking a monoamine oxidase inhibitor (MAOI) asks the nurse about the addition of St. John's wort to help with his depression. What would be the best response of the nurse?

"Did you know that St. John's wort can raise your blood pressure dramatically?"

The patient is concerned about confidentiality and asks the nurse not to tell anyone what is said. What is the best response by the nurse?

"I am required to report any intent to hurt yourself or others."

The nurse asks a patient with schizophrenia if he had any visitors on Sunday. Which response indicates loose association?

"We visited Yellowstone Park last summer."

What classifications of medications most often used to treat psychiatric problems? Give 1 medication in each category:

1. Antimanic: divalproex sodium (Depakote) 2. Antipsychotic: chlorpromazine 3. Atypical Antipsychotic: clozapine (Clozaril) 4. Antianxiety: alprazolam (Xanax) 5. Antidepressants: amittriptyline 6. Monoamine Oxidase Inhibitors (MAOIS): phenelzine sulfate (Nardil) 7. Selective Serotonin Reuptake Inhibitors (SSRIs): fluoxetine (Prozac) 8. Other Antidepressants: venlafaxine (Effexor)

What action consistently done by a patient should indicate to a nurse that the patient has a poor self-concept?

Apologizes to others repeatedly.

OCD- compulsion:

Are behaviors that are performed in response to an obsessive thought. The repetitive, ritualistic behaviors, such as checking the locks 10 times before going to bed, typically reduce the anxiety and tension produced by the obsession.

Anorexia nervosa:

Body weight at or below 85% of normal for age, sex, & height; Amenorrhea (in women); Self imposed starvation or semistarvation; Regular episodes of binge eating, self induced purging or misuse of laxatives, diuretics, or enemas; May use excessive exercise; Pt perceives self as fat; Intense fear of becoming fat; Denial of the problem & its seriousness

A home health nurse has a patient who is taking lithium. What should be included in the teaching plan?

Have her drug blood level checked every month.

What is the term used for the beginning stage of schizophrenia, characterized by a lack of energy and complaints of multiple physical problems?

Prodromal

The home health nurse assesses a patient who creates elaborate excuses for not leaving home. Further questioning reveals the patient had not left home for 6 months. How should this be documented?

Agoraphobia

What disorder is a severe form of self-starvation that can lead to death?

Anorexia nervosa

A perceived threat to self causes what emotion?

Anxiety

The nurse is sensitive to the fact that patients lose control over their lives when admitted to the hospital. In what does this loss of control frequently result?

Anxiety

What is the most likely result when an attempt at adaptation fails?

Anxiety

The nurse is assessing a female patient who has become rapidly and exceedingly anxious because her fingernail polish is chipped. What type of anxiety should the nurse conclude that the patient is exhibiting?

Anxiety traits

When all five axes of the Diagnostic and Statistical Manual of Psychiatric Disorders, V, are used, it provides what type of assessment approach to comprehensive care?

Holistic

During the 17th and 18th centuries, care of patients with mental illness often was cruel. What type of care was used by Dr. Philippe Pinel to bring about change?

Humane care

The patient talks with his dead brother and arranges furniture so that his brother will have a place to sit. How should the nurse document this behavior?

Hallucination

Delusions:

Is a false, fixed belief that cannot be corrected by feedback and that other people in the same cultural context do not accept as true. The affected individual believes that a false premise is true and fits this logically into his or her interpretation of reality. Because of the strong logic supporting the false premise, it is difficult for the individual to accept what is really true.

Cyclothymic Disorder (Cyclothymia):

Is a pattern that also involves repeated mood swings of hypomania and depression, although they are less intense. There are no periods of normal function with this condition. It is considered a muted version of bipolar disorder. Many individuals with this progress to bipolar disorder.

Hallucinations:

Is a sensory experience without a stimulus trigger. Auditory hallucinations are the type that people experience most often. Visual, olfactory, and tactile hallucinations are also possible in an individual with schizophrenia.

Stressor:

Is a situation, activity, or event that produces stress. They are physical, social, economic, chemical, spiritual, or developmental, or some combination of all of these.

How many people in the United States will develop a mental disorder during their lifetime?

One in two

When a patient demonstrates accelerated heart rate, trembling, choking, and chest pain along with acute, intense, and overwhelming anxiety, the nurse should recognize that the patient is most likely experiencing what condition?

Panic

What is a nursing intervention that helps to build trust, encourages the patient to have faith in the care being received, and meets psychosocial needs?

Patient education

The majority of people function in a relatively healthy manner. What can diminish their functional capacity?

Periods of crisis

A patient believes himself to be the president of the United States and that terrorists are trying to kidnap him. The nurse records these observations as which type of behavior?

Positive behavior

The situation in which a parent must choose between attending a daughter's ballet recital or a son's baseball game is an example of a __________.

conflict

In the movie Gone With the Wind, Scarlett O'Hara says, "I'll think about that tomorrow. Tomorrow is another day." The nurse recognizes the defense mechanism of __________.

repression

The nurse instructs a patient who has just been prescribed a protocol of fluoxetine HCl (Prozac) that the drug takes 2 to 4 ____ to take effect.

weeks

Bulimia nervosa:

Possibly underweight, normal weight, or overweight; The compulsive eating of an excessive amount of food while feeling a lack of control over eating; Binge eating or purging occurs at least twice per week for a period of 3 months or more; Regular episodes of self-induced vomiting or the misuse of laxatives, emetics, diuretics, or enemas; Use of fasting or excessive exercise; Feelings of self-worth disproportionately based on body weight, shape, and size; Usually aware that there is a problem

A 14-year-old survivor of a school shooting screams and dives under a table when firecrackers go off. What does this behavior represent?

Posttraumatic stress disorder

When the patient with a psychosis is thought to be a danger to self or others, by what method should the patient be admitted to the hospital?

Probating

The patient complains to the nurse that the health care provider does not like him and wants him to fail at following the diet prescribed. The nurse recognizes that the patient is using which defense mechanism?

Projection

What is the term for a long-term and intense form of psychotherapy developed by Sigmund Freud that allows a patient's unconscious thoughts to be brought to the surface?

Psychoanalysis

When the patient who overeats insists that weight gain is related to retained fluids, the nurse recognizes the patient is using which defense mechanism?

Rationalization

A 40-year-old patient cries and has a tantrum when the health care provider refuses to give her a prescription for diet pills. The nurse realizes that this is the use of which defense mechanism?

Regression

When assisting the older adult who is despondent about the need to leave his home, what technique should the nurse use?

Reminisce with the patient and review his life.

Using Freud's personality theory, what action by a patient identifies the influence of the superego?

Returning a $5 bill that another patient left on the table

The nurse is assessing a young woman who is a teacher, happily married, raising two children, taking care of her disabled mother, and going to school to get a master's degree. How should the behavior of the young woman be classified?

Role integrated

A profound, disabling mental illness is characterized by bizarre, nonreality thinking. What is the illness?

Schizophrenia

The nurse is assessing a nervous 18-year-old patient who has vital signs of P 120, R 30, and BP 160/90. The patient states that he feels something bad is about to happen. Based on this data alone, how should the nurse identify the patient's level of anxiety?

Severe

Which role is an example of an ascribed role?

Sex

The patient admitted to the hospital may adjust to illness by assuming a role in which everyday responsibilities are avoided. What is this role called?

Sick role

The nurse recognizes that stress can cause an ulcer, which is classified as a _______________ symptom illness.

Somatic

The patient complains of recurrent, multiple physical ailments for which there is no organic cause. How should the nurse assess this?

Somatic symptom disorder

The nurse is caring for a patient with a diagnosis of catatonic schizophrenia. What behavior is consistent with this diagnosis?

Stands on one foot for 15 minutes.

What does any event that requires change stimulate?

Stress

A patient admitted to the hospital after a motorcycle crash that has left him paralyzed from the waist down tells the nurse he has feelings of helplessness and hopelessness. What other feelings may the patient have that should be recognized?

Suicidal ideation

A patient admitted for delirium demonstrates increased disorientation and agitation only during the evening and nighttime. What is the term applied to this type of delirium?

Sundowning syndrome

The nurse cautions a patient to watch his step. What response indicates concrete thinking?

The patient fixedly begins to watch his feet.

The nurse is discussing the differences between a patient with a neurosis and one with a psychosis. What is true of the patient experiencing a neurosis?

The patient has insight that there is an emotional problem.

Adjunctive therapies are used for which reasons? (Select all that apply.)

To increase self-esteem; To promote positive interaction; To enhance reality orientation

The nurse is told that a patient believes he was born into the wrong body. What is the correct terminology for the desire to have the body of the opposite sex?

Transsexualism

Binge eating:

Usually obese; The compulsive eating of an excessive amount of food while feeling a lack of control over eating; Episodes occur at least twice per week for a period of 6 months or more; Eating until uncomfortably full; Eating when not physically hungry; Eating rapidly; Eating alone because of embarrassment; Feeling guilt, disgust, or depression after overeating; Poor self-esteem, possible depression; Aware that there is a problem

What action by a student before taking a test should indicate to a nursing instructor that the student is demonstrating signs of moderate anxiety?

Vomits

The nurse explains that an alternative therapy that uses essential oils and scented candles to help a patient relax and focuses on the atmosphere of the moment is ______________.

aromatherapy

The nurse alters the care plan for a patient with depression to include what type of activity?

Group outing to view wildflowers

What are the five subtypes of schizophrenia behavior?

1. Disorganized: Flat or inappropriate affect, incoherence; prognosis is poor. 2. Paranoid: Delusions, auditory hallucinations; prognosis is good with treatment 3. Catatonic: Stupor, negativism, rigidity, excitement, posturing; prognosis is fair. 4. Undifferentiated: Delusions, hallucinations, incoherence, gross disorganization (does not fit the criteria of other types; prognosis is fair. 5. Residual: Typical signs and symptoms associated with schizophrenia without evidence of gross disorganization, incoherence, delusions, and hallucinations; prognosis is poor.

What is the typical schedule for electroconvulsive therapy (ECT)?

10 treatments over several weeks

When was psychiatric training for nurses initially offered?

1882

The nurse recognizes that researchers have identified that hereditary factors account for what percentage of mood disorders?

60% to 80%

What coping mechanism demonstrated by a patient should indicate to the nurse that the patient is seeking ways to deal with and resolve stress?

Adaptation

Psychosis:

Are out of touch with reality and has severe personality deterioration, impaired perception and judgement, hallucinations, and delusions. A psychotic person does not recognize the fact that he or she has a psychiatric illness. Treatment often necessitates hospitalization with follow-up regularly through an outpatient setting. Some pt's seek voluntary treatment. Involuntary admission (probating) is also possible when a person is thought to be a danger to self or others. Although laws vary from state to state, a judge and either a clinical psychologist or a physician, or both, must be involved to complete an involuntary admission.

OCD- obsessive:

Are thoughts that are recurrent, intrusive, and senseless. These thoughts are anxiety producing and distressing in that they are uncontrollable.

What should the nurse preparing a patient for a scheduled appointment for electroconvulsive therapy (ECT) remind the patient to do?

Arrange for transportation to and from the appointment.

How do you define anxiety?

As a vague feeling of apprehension that results from a perceived threat to the self, although the source is often unknown. It is said to be a universal emotion and is a response to a stressful event.

What is the basis for classifying a person as having a mental illness?

Behavior exhibited and the context

Why is it important for the nurse to be observant of patient behavior?

Behavior is learned

For the past 3 weeks, the nurse has observed a patient interacting with staff and other patients, helping decorate the dining room for a party, and leading the singing in the activity room. Today, the patient tearfully refuses to dress or get out of bed. The nurse recognizes these behaviors as evidence of which psychiatric disorder?

Bipolar disorder

The nurse uses a diagram to show how the four parts of "self" fit together. What are the four parts? (Select all that apply.)

Body image; Self-esteem; Role; Identity

How can a nurse help the individual or family get through a crisis?

By providing accurate information that aids in realistic perception of the situation; Encourage expression of feelings and provide empathic gestures such as silent physical closeness, holding a hand, or giving a hug when appropriate (but not with an angry, hostile patient). These validate that individual's feelings of anger, denial, remorse, and grief as normal responses to crisis. Identifying family supports and adequate coping mechanisms helps the nurse recognize family communication patterns. Dysfunction in relationships sometimes indicates a need to include other psychosocial professionals in the care. Active listening, restating the facts, and using other therapeutic communication techniques during family conferences are ways to help address the problem constructively. Offer as much flexibility in visiting hours as possible o reduce the frustration of separation.

Dementia is an organic mental disease secondary to what problem?

Cerebral disease

When a patient is experiencing a panic attack, how should the nurse best assist the patient?

Coach in deep breathing.

A nurse tearfully confides to the head nurse that being assigned to care for eight patients is stressful and overwhelming. What demonstrates the use of a healthy coping mechanism?

Delegating appropriate care assignments to unlicensed assistive personnel

A young man with malaria spikes a temperature of 105°F (40.5°C) and begins to hallucinate. How should the nurse assess this?

Delirium

A family is informed that the brain damage to their daughter is irreversible. The father is later overheard making vacation plans and discussing what the family will do when his daughter leaves the hospital. The nurse recognizes the father is in which crisis stage?

Denial

After finding the patient with diabetes eating candy, the nurse reminds the patient that the candy will elevate blood sugar levels. The patient's response is: "It's only a little bit, and it won't do anything." Which defense mechanism is the patient using?

Denial

Under what circumstances is electroconvulsive therapy used?

Depression, mania, or schizoaffective disorders that do not respond to other treatment modalities.

How did Sigmund Freud describe personality development?

Described as having three parts: ID, Ego, & Superego. The ID functions on a primitive level; Its aims are primarily experiencing pleasure and avoiding pain. The Ego functions to integrate and mediate between the self and the res of the environment. It is the ego that experiences anxiety. The Superego is the moralistic censoring force. It develops from the ego in response to reward or punishment from other people. When all three substructures function in harmony, the individual experiences emotional stability; that person is considered to have a healthy self-concept. A mature, well adjusted personality is under the leadership of the ego.

How should the nurse document the behavior of a patient with mental illness?

Differing from socially acceptable behavior

When developing a care plan for a mentally ill patient, what should the nurse assess first?

Emotional status

Which theorist believed that personality development was based on task mastery?

Erik Erikson

Which event in the mental health care movement occurred first?

Establishment of Pennsylvania Hospital

Bipolar disorder:

Features shifts between emotional extremes from depression to mania; Mania is a mood disorder whose major characteristic is persistent, abnormal overactivity and a euphoric state. The early phase of the manic episode is often referred to as a hypomanic episode when symptoms are not severe. Often the manic person is engaging, outgoing, and charming, as well as achieving and successful; has excessive energy and optimism; and is possibly a very productive member of the community. Unfortunately, a manic episode has the potential to accelerate. As it intensifies, the episode of the mania changes from cheerfulness into excessive feelings of euphoria, rapid speech, flight of ideas, unrealistic beliefs, poor judgement, denial that anything could possibly go wrong, increased sex drive, and obnoxious or provocative behavior such as robbing a store without the fear of being caught. If untreated, delirium may ensue, and death from exhaustion or accident is possible.

When the patient is told that his insurance will no longer pay for his physical therapy, the nurse is aware that this obstruction to his goal may result in which concept?

Frustration

What is the prognosis for a schizophrenic patient who is exhibiting positive behaviors?

Good

Neurosis:

Is a term describing ineffective coping with stress that causes mild interpersonal disorganization. People with a neurosis have insight that they have a psychiatric problem. They remain oriented to reality but have some degree of distortion of reality manifested by a strong emotional response to the trigger event. The trigger event may be an everyday stressor, such as environmental stressors or family relationships. Various complaints of nervousness or emotional upset, compulsions, obsessiveness, and phobias are common. Many exhibit poor self-esteem and have social relationships that are impaled by the various complaints noted. Treatment is usually completed in an outpatient setting, if they seek treatment at all.

Stress:

Is the nonspecific response of the body to any demand made on it. An individual's response to a stressful situation or event is often a learned or conditioned behavior.

Using the mental health continuum as a guide, the nurse observes behavior that usually places an individual on the illness end of the continuum. What is true of this behavior?

It demonstrates that the person is out of touch with reality.

Explain the impact of the Omnibus Budget Reconciliation Act on mental health care:

It drastically reduced funding for the mental health system and put remaining funds into block grants for use and disbursement at the community level. Rapid, if not indiscriminate, deinstitutionalization was one consequence of the severe fiscal cuts. Continued declines in federal & state budgets have resulted in the loss of services to vulnerable populations. Between 2009 and 2012, $1.6 billion was cut from state-based mental health programs. In 2013, 35 states increased funding for mental health services but in 2014 only 29 states increased funding. This overall reduction in funding has translated into reduced availability of housing, reduced access to care providers, and limited access to psychotropic medications, therapy, and crisis services.

Using Freud's personality theory, what action by a patient indicates a strong ego?

Laughs at himself for being foolish.

The Diagnostic and Statistical Manual of Psychiatric Disorders, V (DSM-V), is used by most hospitals and is the current tool used to examine mental health and illness. What approach does the DSM-V use to classify mental disorders?

Multiaxial system

A patient is frequently late for appointments because he goes back to his room numerous times to assure himself that none of his belongings have been stolen. What does this behavior represent?

Obsessive-compulsive

What are considered warning signs of suicide? (Select all that apply.)

Talking about suicide; Drug or alcohol abuse; Difficulty concentrating on work or school; Personality changes

What definition should the nurse use to clarify the concept of "mental health"?

The ability to cope and adjust to everyday stresses

How are the phases of crisis similar to stages of grief and dying? What are these phases?

The initial phase consists of confusion, disbelief, and high anxiety. This progresses to a denial phase, with grasping of the conviction that everything will be all right. Once the reality of the situation becomes evident, anger and remorse generally are expressed. Sadness and crying constitute a phase of grief seen during a crisis. In this phase, the individual acknowledges and expresses the loss of what was and will never be again. The final phase of reconciliation is reached with the person's acceptance that life will continue but will be different from how it had been, and adaptation occurs.

What is the mental health nurse referring to when using the term behavior?

The manner in which a person performs

A variety of factors influence the level of anxiety experienced by the patient faced by a stressful situation. Which would the nurse outline? (Select all that apply.)

The number of stressors present at one time; Degree of change the stressors require; Present role assumption; Previous experience with a similar situation

What are commonly used defense mechanisms? Pick 5 and describe:

•Compensation: Making up for a "deficiency" in one area by excelling in or emphasizing another area; Ex- A boy who is small in stature places his emphasis on academics rather than attempting sports. •Conversion: Turning emotional conflicts into a physical symptom, which provides the individual with some sort of benefit (secondary gain). Ex- An individual who witnesses a murder then experiences sudden blindness with no organic cause. •Denial: Disregard for reality. Ex- A patient who had a severe myocardial infarction is told that he will have to severely restrict his physical activity. The evening nurse finds him on the floor of his room, doing sit-ups and push-ups. •Displacement: Expression of emotions toward someone or something other than the actual source of the emotion. Unconsciously, the individual does not feel safe expressing the feelings directly to the actual source. Ex- A man has an argument with his employer and comes home and yells at his family. •Dissociation: Separation and detachment of emotional significance and affect from an idea or situation. Ex- A person who has been traumatically victimized retells her situation, while smiling and joking about it.

How is the degree of anxiety influenced?

•How the individual views the stressor •The number of stressors the individual is handling at one time •Previous experience with similar situations •The magnitude of change that the event represents for the individual •The degree of physical and emotional health being experienced at the time of the stress;Events that have the potential to precipitate feelings of anxiety include the following:•Threats to physical integrity: Decreased ability to perform activities of daily living; impending physiologic disability (surgery, diagnosis of a life-threatening disorder, pain, infection, trauma)•Threats to self-esteem and insults to the identity: Loss of significant relationships, loss of spouse, difficulty at work, loss of job, change in jobs, relocation to a new home

List the factors that affect mental health:

•Inherited characteristics •Childhood nurturing & •Life circumstances; The influence of these factors on the individual's response to daily stressors in life is sometimes positive & sometimes negative. Possible possible influences include adherent adequate coping ability, mother-child bonding at birth, success in school, good physical health, and financial security. Possible negative influences include cognitive impairment, schizophrenia, extreme sibling rivalry, parental rejection, deprivation of maternal love, poor physical health, poverty, and dysfunctional relationships.

How are personality disorders characterized?

•Lack of insight; concrete thinking; poor attention; inability to understand the consequences of behavior or learn from them. •Distorted self-perception; either hatred or idealization of self•Impaired relationships; projecting own feelings onto others; poor impulse control; inability to maintain health interpersonal relationships •Inflexible behavioral response patterns that do not allow the individual to handle change easily

When determining placement on the continuum, what components of mental health must be assessed?

•Positive self-concept •Awareness of responsibility for one's own behavior and its consequences •Maintenance of satisfying interpersonal relationships •Adaptability to change •Effective communication •Awareness and acceptance of emotions & their expression •Effective problem solving & •Recognition & use of supportive systems.

What are some alternative therapies for treating mental disorders?

•St John's wort •Kava •Gotu kola •Ginkgo •Aromatherapy- Citrus essences, peppermint, cedarwood, rosemary, sandalwood, chamomile, and lavender (A few of the essential oils used)