Mental Health MNL 1.1-1.3, 7.1-7.3, 9.5
Who focuses on client-centered care?
Carl Rogers
In her theory, Watson identified 10 ________ __________ processes
Clinical Caritas
The client states to the nurse, "I take citalopram (Celexa) 40 mg every day, and I have also been taking St. John's wort 750 mg daily for the past 2 weeks." Which manifestations would lead the nurse to suspect that the client is developing serotonin syndrome? (7.2 post)
Diaphoresis Confusion Ataxia Headache
_____ __________ (person) focuses on human relationships and the nurse's ability to understand his or her own behavior as it relates to helping others. What is her theory called?
Hildegard Peplau; interpersonal theory
Which of the following criteria would a court consider when there is a case involving a mentally ill client's right to refuse treatment? (1.3 remember)
How permanent is the treatment? Is the client competent? What is the risk-benefit ratio of the treatment?
Freud: anxiety results from conflict between the ____ and the _____
Id, ego
What is the relationship between mood disorders and violence? (7.1 R)
Increases the risk of suicide
What is the interdependence mode of adaptation?
Involves the need to achieve, give and recieve love, and communicate effectively
_________ is known for his theory of cognitive development, focusing on thought processes and the link between how we think and how we act
Jean Piaget
Acronym MANIC EPISODE
M: mood swings A: Active; aggressive N: "Nothing is wrong" (Denial) I: irritable, impulsive, intrusive behavior C: can't sit still E: Euphoric mood P: poor judgement, provocative behavior I: increased sexual interest S: Substance (Stimulants, sleeping pills. alcohol) abuse O: omnipotent feelings D: decreased need for sleep E: endless energy
What are the 4 types of health within psychosocial health?
Mental health (thinking) spiritual health (being) social health (relating) emotional health (feeling)
Who recommended that psychiatric nursing be integrated into nrusing curriculum?
National League for Nursing (NLN)
Blunted?
Response to immediate situation is dulled
Most commonly prescribed antidepressant category
SSRI-- fewer side effects than tricyclic antidepressants
T or F: LGBT clients are more likely to commit suicide than heterosexuals
T; 2x
Which activity should the nurse recommend to the client on an inpatient unit when the client has thoughts of suicide? (9.5 pre)
Talking with the nurse: can assess if the client will act on his thoughts and assist with methods to cope with suicidal thoughts; important part of safety
The nurse is planning care for a client diagnosed with situational depression. Which intervention is essential to include when planning care? (7.2 post)
Teach assertiveness techniques.
The first "Diagnostic and Statistical Manual of Mental Disorders" (DSM) was published in 1952 by.... What is it?
The APA. Taxonomy of mental health disorders used by health care professionals. DSM-5 most current version
What is the rationale for this answer?
The best response asks the client to explore his/her feelings about the situation. Parroting, changing the topic from the client to the mother without exploring what the client has said, and belittling what the client has expressed as a concern are not appropriate responses.
Client goals/outcomes that may be appropriate for the suicidal client
The client will... -remain free from injury -verbalize help when necessary -talk about feelings of depression and hopelessness -partake in scheduled sessions with the therapist -identify healthy coping mechanisms -will begin to reveal a request to live
According to King, the patient is a social being who has 2 fundamental needs. What are they?
The need for health information, the need for care that seeks to prevent illness, and the need for care when the patient is unable to care for himself/herself
What population is especially sensitive to lithium?
Those of Asian descent; toxicity as low as 0.6
A client with a history of mental illness has threatened a police officer and is brought to the mental health facility by the police for admission. What criteria would have to be present for admission without the client's consent? (1.3 pretest)
Threat to self or others
A client is prescribed electroconvulsive therapy as treatment for depression. What should the nurse review with the client about these treatments? (7.1 post)
Treatments will be 3 times a week for 12 treatments.
A person with bipolar disorder may have periods of remission T or F
True
Mood stabilizers are often used together with antidepressants t or f
True
T or F: There is a direct link between substance abuse/addiction and mood disorders
True
What information is important for the nurse to assess in the assessment phase of a client with bipolar disorder? (7.3 rem)
Work/school history Assessment of the client's appearance Observation of the client's affect, thought processes, judgment, demeanor, and speech
Does the environment influence mood?
Yes; impacts the ability to regulate one's mood intensity and shifts
The concept of the least restrictive setting refers to....
a therapeutic setting that will provide the needed care while allowing maximum freedom
It is important for the nurse to remember that working with clients with depression can.....
affect the nurse's own mood-- must be vigilant to avoid emotional contagion
What is the mechanism of action of lithium?
alkali metal that can become toxic at high levels that alters neurotransmission in the CNS *Blood work must be done on a regular basis*
What is the PSDA
allows competent clients to be informed of their right to accept or refuse aspects of their care upon admission into the hospital
What are the major concepts of Carl Roger's theory?
an unconditional positive regard, genuineness, and empathetic understanding; each individual is a unique being in search for meaning and values and beliefs are basis for all behavior
What 4 interpersonal factors signify mental health?
balance of separateness and connection helping others intimacy effectvie communication
the being with attribute involves what nursing action?
being emotionally present for the client
Emotions are....
feeling responses to various stimuli
Which of the following principles of bioethics involves keeping your promises to your clients? (1.3 remember)
fidelity
Mental health nursing advocacy interventions are directed at....
identifying causes of client abuse
Mood is....
individual's internal and subjective emotional state
What are the two types of torts?
intentional, unintentional
What is the self-concept mode of adaptation?
involves a sense of meaning and purposefulness in the universe
function of temporal
involves all aspects of auditory processing
What is fidelity?
involves maintaining loyalty and commitment to your clients and being faithful to your promises, duties, and obligations. -establishes trust -do not make promises you can't keep -
What is the role function mode of adaptation?
involves taking on roles and developing the instrumental and expressive behaviors needed for each role
function of cholinergics?
mediates brain, CNS function, and pain
Marla Delson is a 34-year-old woman who has come into the clinic because of hearing loss. In the previous month, she was hit by a car and suffered a head injury. What structure of the brain might be affected? (1.2 apply)
temporal lobe
What is importan to know about treatment with MAOIs?
tyramine-free diet-- if patient eats tyramine, hypertensive crisis will occur
function of frontal
vital to cognition and thinking processes
The adult daughter of Zora Koskovich, an 80-year-old client being treated for a foot wound, is concerned that her mother is depressed. What is the best response by the nurse to the daughter's concern? (7.1 apply)
"That is possible since over 10% of people over the age of 80 have symptoms of depression."
A client lives in a group home and visits the community mental health center regularly. During one visit with the nurse, the client states, "The voices are telling me to hurt myself again." Which question by the nurse is most important to ask? (9.5 post)
"Are you going to hurt yourself?"
A nurse is caring for Tyrone Willis, a 28-year-old male who has been diagnosed with bipolar disorder. Tyrone tells the nurse that he has been having feelings of hopelessness and sadness and has not been able to sit down and eat a full meal in the past 2 weeks. During the nursing assessment, what is the most important question the nurse will ask Tyrone? (7.3 apply)
"Are you having any thoughts of suicide?"
The new graduate BSN has been employed at a mental health facility and asks what his/her role will be. How would the nursing supervisor respond? (1.1 posttest)
"Assisting staff and clients to evaluate outcomes of treatment." "Assessing clients for reactions to treatments and therapies." "Implementing therapeutic communication for all interactions with clients." "Developing a therapeutic relationship with the clients."
A client is admitted to a mental health unit for depression. After a week, the client continues to withdraw from others. Which statement by the nurse would most likely promote interaction with other clients? (7.2 post)
"Come and play cards with me": The other comments tell the client what he/she should do instead of offering the client a means to interact.
The nurse identifies a client with risk factors for suicide. Which question would be appropriate for the nurse to ask when assessing the client's thoughts about suicide? (9.5 pre)
"Do you ever think of harming yourself when you're feeling down?"
Which question should the nurse ask to best determine the seriousness of a client's suicidal ideation? (9.5 post)
"How are you planning to harm yourself?"
During a health history assessment, the nurse first believed that a client was experiencing manifestations of grief until a specific comment was made. What did the client state that helped the nurse determine that the client is experiencing depression? (7.1 post)
"I am a complete failure"
At the conclusion of an appointment with a behavioral therapist, a client with anger management issues asks the nurse why the therapist believes the client needs to start taking serotonin. Which response should the nurse make to the client? (7.1 pre)
"It is associated with aggressive behavior"
The nurse is taking a mental health assessment of Byron Jonas, a 23-year-old male who tells the nurse that he has experienced alternating periods of elevated mood and moderate depression since he was in his late teens. The alternating periods last for several days each. Byron also tells the nurse that he recently received a bad report at work in which his supervisor described him as moody and unpredictable. The healthcare provider prescribes lithium carbonate to treat Byron's symptoms. What information regarding this pharmacologic therapy will the nurse include in Byron's teaching? (7.3 apply)
"Signs of lithium toxicity include nausea and vomiting"
The teenage client tells the nurse, "My mother is always upset and mad at me. I can't do anything right." Which is the best response by the nurse? (1.2 pretest)
"Tell me about what was going on with your mother that makes you feel this way."
The mother of an adolescent diagnosed with depression was hoping that the child would not have the problem even though both she and her spouse struggle with depression every day. Which is the best response by the nurse to the mother? (7.1 pre)
"The genetic risk for children to be diagnosed with depression is greatest if both parents have the disorder."
A client with acute mania, who has previously threatened suicide, has been admitted to the inpatient unit voluntarily. The nurse approaches the client with medication to be taken orally as prescribed by the primary healthcare provider. The client states, "I don't need that stuff" Which is the best response by the nurse? (9.5 pre)
"The medication will help stabilize your mood": concisely explain the benefit of the medication to the client to increase the possibility of compliance. The client has the right to refuse treatment
nurse is caring for a client with bipolar disorder. The healthcare provider has prescribed olanzapine (Zyprexa) for the collaborative treatment of the client's condition. What information will the nurse include in the client teaching regarding this medication? (7.3 pre)
"This medication is called antipsychotic mood stabilizer." "This medication is often taken with an anticonvulsant mood stabilizer."
A nurse is caring for a female client with bipolar disorder. The healthcare provider has prescribed lithium carbonate for the collaborative treatment of the client's condition. What information will the nurse include in the client teaching regarding this medication? (7.3 post)
"This medication may be used with an antipsychotic mood stabilizer." "This medication should not be used if you suspect you may be pregnant." "Monitor for nausea and vomiting, as this could indicate a lithium toxicity." "Lab work will be needed to monitor the therapeutic level of this medication."
Which comment by the client indicates an understanding of the nurse's teaching regarding sertraline (Zoloft)? (9.5 pre)
"This medicine can exacerbate suicidal thinking": it is an SSRI, SSRIs can do this
You are caring for Mrs. Jenks, a pregnant woman with an anxiety disorder. On the day Mrs. Jenks goes into labor, she shows you a small amulet in her hand. She tells you that the amulet will ensure a good delivery and that it has been used by generations of women in her family. Mrs. Jenks asks you if it is all right if she holds the amulet during labor. What is your best response to Mrs. Jenks's question? (1.1 apply)
"You may hold the amulet during labor."
Mr. Borden has been involuntarily placed in a psychiatric hospital where you are a nurse. He has recently been diagnosed with a serious mental illness. At the end of his first week in the hospital, Mr. Borden asks you when he will be allowed to leave. What is your best response to Mr. Borden's question? (1.3 apply)
"You will have periodic reviews to determine when you can leave."
The client with bipolar disorder asks the nurse if he will ever be cured. Which statement BEST demonstrates the ethical principle of veracity? (1.3 posttest)
"Your mental illness can be controlled."
Which statement by the nurse is a direct and respectful question when interviewing a suicidal client? (9.5 rem)
"do you have a plan for killing yourself": Nurses working with suicidal clients should be direct but respectful when asking questions. Asking direct questions does not cause the client to act in a suicidal manner. A question like "do you have a plan for killing yourself" is more effective than using phrases such as "hurting yourself" in place of suicide. Asking about the client having a will or if the spouse is aware of where the client is, is not relevant. It is not important to know how long the client may have thought about harming himself; it is important to know whether the client has a current plan.
How does a client act against a nurse's advice?
-A nurse might inform a client of the risks of certain actions, but they decide to act against a nruse's advice -unless there are grounds for limitation, such as harm to self or others, clients maintain the right to freedom of movement and actions
The nurse is admitting a client with severe depression and a suicide attempt to the mental health unit. What would the nurse take into consideration when obtaining the client's consent for treatment? (1.3 pretest)
-Ability to process the information about the proposed treatment plan -Ability to understand the treatment process -results of a mental health exam -Gives consent willingly
Which are accurate statements about the treatment of the mentally ill? (1.2 remember)
-Dorothea Dix was Superintendent of Army Nurses for the Union Army during the Civil War. -Dorothea Dix lobbied state legislatures and the U.S. Congress to build public mental hospitals. -Pinel is known as the "father of modern psychiatry." -French physician Philippe Pinel advocated humane treatment of the mentally ill.
The student nurse asks the instructor what nursing has contributed to the care of mentally ill clients. What are appropriate responses by the instructor? (1.2 pretest)
-Dorothea Dix, a nurse, advocated the establishment of the first state mental hospital in Illinois. -Dix lobbied state legislatures to build public -Dorothea Dix Hospital opened in North Carolina.
What are 2 self-reporting tools that can be used on postpartum women to screen for/assess depression?
-Ediburgh postnatal depression scale -Beck's postpartum depression predictors inventory-revised
What is transcranial magnetic stimulation?
-FDA approved treatment for depression -use of magnetic field that passes through the skull,causing cells in the cerebral cortex to fire -target area is the L prefrontal cortex, the area of the brain disrupted in depression -rapid onset (1-2 weeks) of action
Factors that increase suicidal risk include...
-Gender: men are more likely to die from suicide, women are twice as likely to attempt -Age: older adult men are at high risk; ages 25-64 are now at higher risk w/in the last 10 years -Depression -Substance abuse -family history of abuse -previous suicide attempts -gun in home -separated, divorced, or widowed
What are 2 self-reporting tools that can be used on older adults to screen for/assess depression?
-Geriatric Depression Scale -Cornell Depression Scale
What are the differences between depression and grief?
-Grief has a trigger: loss; depression does not always -when grieving they actively feel their emotional pain and sadness; when depressed passive behavior tends to keep client "stuck" in sadness -Grief: experience range of intense emotions; depression: generalized feeling of helplessness, hopelessness -Grief: sometimes will be able to laughand enjoy humor and are likely to accept support; depression: humorless and incapable of being happy or temorarily cheered up, likely to resist support -Grieving people more willing to participate in activities -grieving self-esteem remains intact and do not feel like a failure, depressed has low self-esteem and feels like a failure -any self-blame or guilt during grief relates directly to the loss and feelings resolve; when depressed they may dwell on past behaviors and catastrophize feelings
Signs of lithium toxicity
-N/V -irregular heartbeat -slurred speech -dizziness -trembling of hands and legs -swelling of feet and legs -difficulty walking -diarrhea
Which are true of peptides? (1.2 remember)
-Play important role in the memory process -Modulate the response of the postsynaptic cell to the neurotransmitter -Secreted by the hypothalamus and the pituitary gland -Can be inhibitory or excitatory
The nurse is using Watson's focus on caring to work with a client. What carative factors would the nurse use for a client in spiritual distress? (1.2 posttest)
-Referring the client to an appropriate clergyperson -Developing a helping, trusting relationship -Providing a spiritual environment -Allowing for existential-phenomenologic forces
behavioral changes that suggest someone is considering suicide
-Spoken signals suggesting a will to die or to "make it all stop" -preparing to commit suicide, such as purchasing a gun, knife, or pills -inability to participate in activities -decreased interest in school or work -partaking in dangerous behavior like drug use or driving fast
list some client goals and outcomes that may be appropriate for inclusion in the plan of care for the client with depression
-The client will remain safe and free from injury -The client will demonstrate ability to maintain self-care and activities of daily living -The client will reduce the verbalization of hopelessness -the client will demonstrate positive coping behaviors -the client will demonstrate improved slef esteem
Ethics involves balance among what 3 things
-The rightness or wrongness of actions -the goodness or badness of one's motives -the goodness or badness of the results of one's actions
Gender bias/feminist theory of depression
-Women experience depression more than men -AA women at higher risk than caucasian women in US -gender socialization differences: internalization of cultural norms of behavior; rigid gender role and age expectations
What is assertive behavior?
-allows the individual to express himself but not at the expense of others -assists in development of healthy self-confidence and self-esteem -
antipsychotic mood stabilizers are often given in conjuction with....
-anticonvulsant mood stabilizers -Lithium, because lithium takes 1-3 weeks to be effective
What are 3 common drug categories given to suicidal clients?
-antidepressants -mood stabilizers -antipsychotics
Pharmacologic treatment for manic episodes includes what categories of drugs?
-antipsychotic mood stabilizers -lithium -anticonvulsants
6 factors that contribute to bipolar disorder
-appears at age 15-30 -immunological abnormalities -genetic -mitochondria dysfunction and oxidative distress -sleep cycle disruptions -family or caregivers who express high emotion
HCPs describe affect in terms of what characteristics?
-appropriateness -stability -range -intensity -congruence
What is passive behavior?
-avoids conflict at all times, even at the expense of one's own feelings -holds in feelings and allows build up of behavior that may unexpectedly explode -individual gives up control then experiences residual resentment
What are the benefits of managed care?
-better management of expenses for employees and employers who pay for health care plans and improved quality of service
Social factors that increase risk of suicide
-bullies in school or workplace -economic recessions such as job loss and financial restraints
characteristics of major depressive episode
-change in individual's emotional state and daily functioning lasting > or = 14 days -feelings of sadness, hopelessness, discouragement, or no feelings at all -aches and pains -anger, frustration, irritability, unusual outbursts over small things
characteristics of persistent depressive disorder?
-chronic depression for the majority of most days that lasts at least 2 years in adults (no more than 2 months symptom free during that time) -symptoms less severe than MDD but similar, with less psychomotor probs -poorer long-term prognosis usually with comorbid anxiety or conduct disorder and impaired functioning
What are some sources of liability regarding malpractice in a MH setting?
-client suicide -improper treatment -misuse of psychotropic medications -breach of confidentiality -false imprisonment -injuries or problems related to ECT -secual contact with a client -failure to obtain informed consent -failure to report abuse -failure to warn potential victims
Describe the performing group developmental stage
-collaborative work toward goal achievement occurs
Describe the norming group developmental stage
-committment to team goals develops -work begins on group tasks
diagnosis of depression will be made through...
-complete and thorough physical exam provided by medical HCP -psychological testing performed by a licensed HCP
3 methods used to help diagnose BD
-complete thorough history and physical, noting when client or family have reported symptoms to rule out other physiological conditons -completion of drug testing to rule out a behavior change due to ingested substances -demonstration of client behaviors meeting the criteria DSM-5 Diagnostic Criteria for Bipolar I Disorders
Roles of mental health nurses with a doctorate
-conduct research -serve as professors -administer hospitals, agencies, or graduate programs.
Changes in/descriptors of affect that indicate someone is considering suicide
-depression -hopelessness -loneliness -anger -anxiety
Interventions appropriate for a suicidal client include...
-discussing feelings of helplessness, worthlessness, and lack of energy -explaining how medications work, their purpose, and side effects -removing any sharp items or other objects that could be used in a suicide attempt -educating visitors on what objects they cannot have while visiting client -reviewing the suicide contract with client -monitoring for suicidal warning signs
What is electroconvulsive therapy?
-electrical current passes through brain to induce seizure -used with clients who have proven difficult to treat -given 2-3 times a week for 12 treatments -over 80% effective at treating depression -requires anesthesia -improved mood, functional status, anxiety, and quality of life
Important considerations about ECT
-electrical current passing through brain 1.) effective at treating depression, esp w psychosis 2.) C/I in hose with increased ICP or recent MI 3.) safe in all trimesters of pregnancy (poss more safe than meds) 4.) safe for all ages 5.) for those who do not tolerate side effects of meds or meds are ineffective 6.) transient, short-term memory loss 7.) not curative; ongoing meds or psychotherapy needed to prevent relapse
What occurs during the intervention stage?
-establish rapport and trust with the client to resolve conflict -foster and maintain connections between clients and health care providers
How is respect for persons accomplished when doing research?
-ethical considerations include client autonomy -that the research subject must be valued -that the researcher acknowledges boundaries -that respect is present for the subject's body, family, culture, and community.
What occurs during the outcome stage?
-evaluate whether conflicts have been resolved -If not, return to perception to reassess or intervention to attempt different intervention strategies
When collecting health history on suicidal patient, what is it especially important to consider?
-family history of mood disorder -history of suicidal attempts or ideation -history of family member committing suicide -history of depression
What are some typical symptoms of depression?
-feelings of sadness, hopelessness, powerlessness, apathy, guilt, worthlessness, discouragement -changes in sleep or appetite -Anhedonia -somatic complaints -inability to concentrate -psychomotor retardation or aggravation -irritability -feelings of anxious distress: restlessness, fear, worry
The most common methods of suicide are...
-firearms -suffocation -poison
What are Assertive Community Treatment (ACT) Programs?
-focuses on community-based care -clients are assigned to specific teams that deliver all services needed by a client living in the community
5 methods of preventing depression
-genetic factors can't be altered; instead do strategies that help client maintain healthy lifestyle and manage stress 1.) exercise regularly 2.) avoiding illicit drugs and alcohol 3.) getting enough rest 4.) eating appropriate diet 5.) recognizing depression symptoms, seeking prof help when needed
Describe the adjourning group developmental stage
-group members acknowledge goal achievement -members achieve closure
What are some interpersonal factors that increase risk of suicide?
-history of abuse or rape -recent break up with significant other -loss and grief with loved one's death -job loss or financial difficulties
What did Harry S. Sullivan theorize?
-how transmission of anxiety caused by societal issues affects interpersonal processes (mom transmits anxiety to baby) -Sullivan suggested that each individual develops views of personifications of self: good me, bad me, not me-- serve to reduce feelings of anxiety
Describe key points of Martha Rogers "sciene of unitary human beings" systems theory
-humans integral with universe -nursing interventions center on people and the manifestations that emerge from the shared human-environment process -humans develop patterns of behaving that make their behaviors become predictable -humans = wholes more than sum of parts -constantly interacting with environment
interpersonal relationship factors that may indicate some is considering suicide
-inadequate support systems -social pressure -feeling isolated from society -ending an important relationship -death of a close friend, spouse, or family member
8 clinical manifestations of manic episode
-increased self-esteem -decreased need for sleep -pressure of speech -flight of ideas -distractibility -increased involvement in goal-directed activities -psychomotor agitation -excessive involvement in pleasureable activities that carry a high risk of painful consequences **less severe with hypomania, patients describe themselves as feeling "wonderful" and may not recognize changes in their behavior, but friends and family will**
Describe how the different types of psychotherapy are used in those with bipolar disorder
-individual therapy is needed to establish nurse-client relationship -group may be difficult for BD patient; unable to share feelings during depressed episode, but encouraged to go to prevent feelings of isolation. Unable to focus/exhibit disruptive behavior during manic epsiodes -family is necessary because manic/hypomanic epsiodes can create conflict and strife in the home -activity focuses on ensuring the client is less isolated during depressive periods. Good way to divert energy during manic periods
At the basic level, psychiatric mental health nurses work with _________, assess _________, and develop, implement, and evaluate ___________. They also work in collaborative relationships with....
-individuals, families, groups, and communities -mental health needs -plans of care -consumer groups to help guide advancements in recovery-focused treatments for people with mental conditions and substance use disorders.
characteristics of adjustment disorder with depressed mood
-low self-esteem, anhedonia, irritability, difficulty concentrating, sleep disturbances, feelings of hopelessness and sadness -ignores financial responsibilities, argues a lot, poor school/work performance, reckless behavior
If a client knows he/she is at risk, what are 3 preventative measures he/she can take?
-maintaining a proactive resonse to stressful life events and getting counseling as indicated -maintaining positive self care routine, getting adequate nutrition, sleep, and exercise -utilizing effective communication techniques
Cultural considerations for latin americans regarding mood disorders
-may look to faith and family rather than HCPs for help -associate suffering with deep sense of tragedy
Cultural considerations for african americans regarding mood disorders
-may look to faith and family rather than HCPs for help -fear of hospitalization and involuntary commitment -distrust of medical community, communication challenges, financial considerations
function of peptides?
-modulate the response of the postsynaptic cell to the neurotransmitters (neuromodulators) -secreted by the hypothalamus and pituitary gland -play an important role in the memory process
What is aggressive behavior?
-no consideration of others' feelings; just want to get what they want -uses intimidation -discredits others, who tend to avoid aggressive person -
What is Betty Newman's model?
-nursing interventions are based on three levels of prevention -
7 other treatment team members who may be added depending on client needs
-nutritionist -occupational therapist: focuses on developing life skills to meet personal needs (performing ADLs, making home safer -recreational therapist: assists client to develop social skills and creativity through art and recreation -radiologist -mental health technician -pharmacist -auxiliary staff (housekeeping department, engineering department)
Behavioral cues that indicate a client is considering suicide
-obsession with death -talking about wanting their plan to end -talking about suicide -giving away valued posessions -taking unnecessary risks like drug use
characteristics of MDD
-one episode or recurring episodes -> or = 14 days -depressed mood for much of day most days; anhedonia; insomnia or hypersomnia (feeling tired even after sleeping a normal amount), weight loss or weight gain unrelated to diet, psychomotor agitation/retardation, fatigue, impaired concentration and indecisiveness, feelings of worthlessness, guilt, suicide ideations/attempts -women more likely; average age of onset mid 20s -if untreated lasts > or = 6 months to years
What are causes of cleint abuse?
-overstressed staff may become impatient and show signs of burnout -staff members may not be suited for work with clients who lack control or are difficult to work with -others may lack necessary knowledge or proper training to work with clients in high-stress situations
Nursing diagnoses that may be appropriate to include in the plan of care for a suicidal patient
-potential for suicide -potential for self-harm -impaired self-concept -alterations in self-esteem -diminished feelings of hope -diminished feelings of power -increased risk of vascular harm related to wounds and lacerations -potential for enhanced knowledge
Ex. of nursing interventions
-providing distraction from self-absorption and negative thoughts, such as recreational activities and conversation -encouraging client to engage in activities even before client feels better -providing positive reinforcement of behaviors without being overly cheerful -accepting negative feelings while setting limits on negative conversation -teaching assertiveness techniques -helping the client to identify personal strengths -assisting the client to set goals -helping the client evaluate alternatives and make choices -practicing problem solving with the client -helping client identify supportive resources such as family and friends
4 main mental health team members
-psychologist: doctorate in psychology, specialist in mental processes and human behavior and how mental health disorders affect the client's life. Meet with client in individual and group settings -physician: psychiatrist, diagnoses and treats mental disorders -nurse: -social worker: essential for idenitifying and securing outside resources for a client, including identifying resources to cover the cost of hospitalization and personal needs when the client lacks adequate financial resoucres
Describe the storming group developmental stage
-questions arise regarding group's purpose and goals -roles may be challenged -members may leave
objectives of CBT
-reduce symptoms by correcting client's negative, distorted thinking -to determine which behaviors the client needs to change
5 principles of delegation
-right task -right circumstance -right person -right direction/communcation -right supervision/evaluation
List some nursing diagnoses that may be appropriate for inclusion in the plan of care for a client with depression
-risk for violence directed at self -impaired self-care -potential for hopelessness -alterations in coping mechanisms -risk for social isolation -diminished self-esteem
How do genetics and neurobiology influence risk of suicide?
-risk is 5 x higher if relative has attempted suicide in the past -relationship between genes and situational stressors increases suicidal behavior -decreased levels of serotonin can increase suicidal behavior
In general, interventions for clients with bipolar disorderfocus on....
-safety of client and others -engagement in therapeutic activities -adherence to prescribed medication regimen -promoting reality-based thinking -promoting self-care
Describe biological rhythms theory of depression
-seasonal-affective disorder: depressive symptoms related to time of year, usually occuring in fall and winter with normal mood in spring and summer -sun increases melatonin production and melatonin affects mood, sensations of fatigue and sleepiness -fatigue, decreased activity, crying, sadness, irritability, decreased concentration -internal desynchronization of circadian rhythms
What precautions to take if the nurse thinks the client poses a danger to self
-should not be left alone -objects deemed dangerous should be removed from client's room -contact primary physician and suicide prevention counselor, or the psychiatric department
sociocultural theory of depression
-stressful life events such as expansion of family -reduction of family through children leaving, divorce, death -childhood sexual abuse -job difficulties, illness, encounters with law enforcement -exhausting events: holidays, family arguments, relocating residence
Evaluations of successful outcomes for suicidal client
-the client remained free from injury -the client expressed emotions and concerns -the client participated in scheduled sessions with therapist -the client identified healthy coping mechanisms -the client looked for help when needed
How is the duty of care established?
-there must be "good faith"-- the nurse's intentions are to help the client -nurse uses nursing process to assess and evaluate client
The primary goals of the treatment team are...
-to find the client a permanent, stable living situation -a job
cognitive clinical manifestations that indicate someone may be considering suicide
-unyielding thinking -illusions about death -thought disorders -obsessive thoughts about death -insomnia
What is cognitive behavioral therapy?
-uses skill training and problem solving to help clients reorient patterns of negative thinking and behaviors -helps clients identify patterns of irrational thinking and and learn how to replace these problems with more logical thought processes
What is included in the phsyical exam that may help diagnose depression
-vital signs -neuro exam -physical assessment related to any current complaints of disorders
What to focus on when gathering psychosocial history of BD pt
-work history and work role functioning -ability and ease of social interactions -quality of interpersonal relationships -history of suicidal ideation -changes in client's thought processes -assessment of client's reported self-esteem -observation of client's affect, thought processes, judgement, demeanor, speech, and appearance -assessment of sense of self, attention span, and notation of hallucinations -info provided by family, if present
age and characteristics of sensorimotor
0-2; reflex activities and sensorimotor solutions to problems
The therapeutic range of Lithium is....
0.8-1.2 mEq/L
A client who has bipolar disorder and is in a manic phase has been taking lithium carbonate 600 mg orally 3 times per day for 14 days. What serum lithium level does the nurse note is therapeutic? (7.3 pre)
0.8-1.2 mEq/L: It takes 10-21 days to achieve a lithium level within the therapeutic range. During an acute manic episode, the normal therapeutic range is 0.8-1.2 mEq/L.
age range and characteristics of anal stage
1-3 focus on controlling bladder and bwoel movements
What are 3 self-reporting tools that can be used on adults to screen for/assess depression?
1.) Beck Depression Inventory 2.) Center of Epidemiological Studies Depression Scale 3.) Mood Disorder Questionnaire
The nurse is discussing the stages of psychosexual development of a child to an adult to a group of parents. Arrange the stages of psychosexual development in the correct sequence.(1.2 pretest)
1.) Begins the developing sense of self 2.) Works at toilet training 3.) Boys develop the Oedipal complex 4.) Develops relationships with peers 5.) Develops relationships with opposite sex
What are 2 self-reporting tools that can be used on children and adolescents to screen for/assess depression?
1.) Center of Epidemiological Studies Depression Scale for Children 2.) Children's Depression Inventory 2
1.1 Pretest Q3: Effective treatment teams typically progress through group developmental stages. Arrange the developmental stages in the correct order
1.) Forming 2.) Storming 3.) Norming 4.) Performing 5.) Adjourning
What are the 4 structures that make up personality (Freud)
1.) Id 2.) ego 3.) superego 4.) libido
What are 7 criteria that courts often consider when there is a right to refuse treatment?
1.) Is the client competent? If so, informed consent is possible 2.) How invasive is the treatment? More invasive treatments come in closer scrutiny by the courts 3.) How permanent is the treatment? If the treatment results in adverse or permanent side effects, the court is less likely to override the court's refusal 4.) How experimental is the treatment? The treatment must have scientific merit 5.) What is the risk-benefit ratio of the treatment? benefits should outweigh the risks 6.) What is the motivation for the treatment? For example, clients can not be treated to "quiet" them at the staff's benefit 7.) what is the motivation for refusal of the treatment? For ex, treatment refusal based on religious beliefs is generally upheld
What are Swanson's five attributes to the caring process?
1.) Knowing 2.) Being with 3.) Doing for others 4.) facilitating passage through life transitions 5.) sustaining faith in others
What are the 3 stages of cultural brokering?
1.) Perception 2.) Intervention 3.) outcome
According to the Belmont Report, what are the 3 main principles upon which all research must be based?
1.) Respect for persons 2.) Beneficence 3.) Justice
What are the 6 principles of bioethics
1.) autonomy 2.) beneficence 3.) fidelity 4.) justice 5.) nonmaleficence 6.) veracity
What are 3 main categories of neurotransmitters?
1.) biogenic amines 2.) amino acids 3.) peptides
What are 7 different theories for the cause of depression?
1.) biological rhythms 2.) neurobiological 3.) interpersonal factors 4.) learning theory 5.) cognitive theory 6.) sociocultural theory 7.) gender bias theory/feminist theory
What are the 5 roles of the mental health nurse
1.) care provider 2.) educator 3.) advocate 4.) utilizer of research 5.) coordinator/manager
What are 3 types of biogenic amines?
1.) catecholamines 2.) indolamine 3.) cholinergic
3 main nonpharmacologic therapies for treating depression
1.) cognitive behavioral therapy 2.) electroconvulsive therapy 3.) transcranial megnetic stimulation
What are the 3 elements of informed consent?
1.) competency 2.) information 3.) voluntariness
3 stages of classical conditioning (Pavlov)
1.) conditional response 2.) acquisition 3.) extinction
According to Freud, what are the 3 levels of consciousness and how is info stored at each level?
1.) conscious: client's current thinking and issues he/she is paying attention to 2.) preconscious: info that the client is aware of but not paying attention to 3.) subconscious: issues out of the client's direct reach and out of the conscious mind
What 6 conditions are used to establish what is considered negligence?
1.) contract for care 2.) duty of care 3.) presence of harm 4.) common practice 5.) boundary guidelines 6.) acting against nurse's advice
What 6 things must be present for a malpractice suit to be valid?
1.) duty 2.) breach of duty 3.) forseeability 4.) causation 5.) harm/injury 6.) damage
5 concepts of Roger's Science of Unitary Human Beings theory
1.) energy field 2.) openness 3.) pattern 4.) pandimensionality 5.) homodynamic principles
Five cultural phenomena in addition to the language barrier affect health and health care among cultural groups bc they influence health care beliefs and practices. What are they?
1.) environmental control: the ability to attempt to control nature or environmental factors-- the use of folk healers and specific healing traditions attempt to intervene with environment 2.) biologic variations: any genetic and physical differences among cultural groups 3.) social organization: type of family unit, such as nuclear or extended; type of religion 4.) space: different cultures have different definitions of personal space 5.) time orientation: different cultures value different aspects of time (focus on past and present vs our focus on future)
What are 4 ways nurses can advocate for their patients?
1.) evaluating policies and procedures regarding client rights 2.) being sure that clients have the info they need to make informed decisions or give informed consent 3.) speaking out for safe practice conditions when threatened by budget cuts 4.) educating clients and families about their legal rights
What are 10 alternative therapies to treat depression?
1.) exercise: aerobic and anerobic releases endorphins, yoga 2.) St. John's Wort: should not be combined with antidepressants 3.) SAMe: compound made by cells that help produce dopamin, serotonin, and norepinephrine 4.) Vitamin B: help produce dopamin, serotonin, and norepinephrine, deficiency assoc with depression 5.) Tyrosine: do not take with MAOIs 6.) Melatonin: regulates sleep-wake cycle, promotes sleep 7.) Omega-3 Fatty acids: blocks calcium channels, helps regulate serotonin 8.) Acupuncture 9.) Animal-assisted therapy 10.) Music therapy
4 general clinical manifestations of depression
1.) feelings of sadness and hopelessness 2.) anger 3.) physical symptoms 4.) sleep disturbances *different manifestations appear in different depressive disorders
6 steps of the EBP research process
1.) formulate research problem 2.) determine study methods 3.) collect research data 4.) analyze reseach data 5.) communicate research findings 6.) use research findings in practice
What are the 3 most common forms of managed care providers?
1.) health maintenance organizations (HMOs) 2.) preferred provider organizations (PPOs) 3.) point-of-service providers (POSs)
What are 3 cases in which the right to privacy can be breached without a signed release form?
1.) in an emergency in order to provide treatment for the client 2.) child abuse and criminal proceedings 3.) reporting contagious diseases and gunshot wounds 4.) when acting to protect third parties
5 symptoms of postpartum/peripartum depression
1.) insomnia 2.) fatigue 3.) anxiety 4.) crying 5.) mood swings
4 barriers to team success
1.) insufficient or ineffective leadership 2.) conflict in team members' goals 3.) poor communication among team members 4.) lack of community services and/or impaired client access to community-based mental health services
What 5 concepts are within the interpersonal system?
1.) interaction 2.) communication 3.) transaction 4.) role 5.) stress
behavioral approaches often used in the therapeutic mileu include....
1.) limit setting 2.) token economies 3.) awarding or removal of privileges
5 types of depressive disorders
1.) major depressive episode 2.) major depressive disorder 3.) persistent depressive disorder 4.) seasonal affective disorder 5.) adjustment disorder with depressed mood
Symptoms of depression that may manifest in older adults include....
1.) memory issues 2.) social isolation 3.) disturbed sleep 4.) loss of appetite 5.) irritability 6.) delusions or hallucinations **likely have other conditions that can complicate treatment
Freud's 5 stages of psychosexual development
1.) oral 2.) anal 3.) phallic/oedipal 4.) latency 5.) puberty
What 5 concepts are within the social system?
1.) organization 2.) authority 3.) power 4.) status 5.) decision making
What 6 concepts are within the personal system?
1.) perception 2.) self 3.) time 4.) body image 5.) growth and development 6.) space
The 3 interacting systems within the Theory of Goal Attainment Theory are....
1.) personal system 2.) interpersonal system 3.) social system *each system contains different concepts
5 categories of Maslow's hierarchy of needs (from basic needs to higher-order)
1.) physiological: need air, water, food, sleep, and sex to maintain homeostasis 2.) safety: need for health, employment, property, resources, and security of the environment one lives in 3.) love and belonging: need for lvoe, family, friendships, intimacy 4.) esteem and recognition: need for self-esteem, feelings of acheivement, confidence, respect 5.) self-actualization: need for moral foundation, ability to problem solve, and creativity
Skinner identified 4 types of reinforcers. What are they?
1.) positive reinforcement 2.) negative reinforcement 3.) positive punishment 4.) negative punishment
What are the 4 phases of the nurse-client relationship according to Peplau?
1.) pre-orientation 2.) orientation 3.) working 4.) termination
What 3 neurobiological factors play a role in mood disorders?
1.) prefrontal cortex 2.) neurotransmitters 3.) MAO
Two characteristics of mentally healthy individuals are....
1.) resilience 2) hardiness
What are Piaget's 4 stages of cognitive development?
1.) sensorimotor 2.) preoperational 3.) concrete operational 4.) formal operational/development of logical solutions to solve problems
There are 5 client rights that are particularly important to the mental health client. What are they?
1.) the right of informed consent 2.) right to refuse treatment 3.) right to privacy 4.) right to treatment in the least restrictive setting 5.) right to periodic review
Diagnostic tests done to rule out other conditions before diagnosing mood disorders/beginning therapy (4)
1.) thyroid function panel: thyroid disorders can mimic depression 2.) electrolytes, urinalysis, and/or toxicology to test for substance abuse 3.) liver function panel; antidepressants are metabolized in liver 4.) pregnancy test; antidepressants can affect fetal development
What 4 drug categories are commonly used for mood disorders?
1.) tricyclic antidepressants 2.) selective serotonin reuptake inhibitors 3.) monoamine oxidase inhibitors 4.) Lithium
Before signed the release form, a client must be informed of what 4 things?
1.) what info will be released 2.) who needs it and why 3.) When it will be needed 4.) How it will be used
S/S of toxicity occur once lithium reaches what level in the blood?
1.5
age range and characteristics of puberty stage
11-18: onset of puberty and development of relationships with opposite sex
age and characteristics of formal operational
11-adulthood ability to form logical solutions to ALL types of problems
If one parent has depression, the child has a _____% chance of having depression at some point in lifetime. If two parents, ____%
16; 75
When was the first major tranquilizer introduced? What was it?
1950; Thorazine
The US Surgeon General's Report addressed mental health and mental disorders in ___________, the first such report to address this
1999
Two homeless individuals with mental health disorders need to receive care but have been turned away because they cannot pay for treatment. How would the nurse assist the process of cultural brokering for the clients? Place the options in order from stage 1 to stage 3. (1.3 pretest)
1st: Barriers to accessing health care are identified. 2nd: Rapport and trust are established with the client. 3rd: Connections between the client and health care provider are fostered. 4th: Determine if conflicts have been resolved. 5th: .Attempt different strategies if conflicts continue.
age and characteristics of preoperational
2-7 prelogical thought to solve problems
The age group with the most suicides per 100,000 is....
25-64
What is the homodynamic principles concept?
3 domains that include resonancy, helicy, and integrality
age range and characteristics of latency stage
6-11; develops values, social skills, relationships with peers
age and characteristics of concrete operational
7-11 development of logical solutions to solve problems
What is the rationale for this answer?
A client who threatens the safety of self or others can be involuntarily admitted on an emergency basis for a short period of time. A court can order a mental health commitment until the client is stabilized, but a police officer cannot commit the client. The client's inability to care for self is not a reason for commitment to a mental health facility. In many instances, the only way uninsured clients can receive treatment is through commitment to a public facility, but this is not the case for this client.
What is tort law?
A division of civil law, defined as a wrongful act resulting in injury for which the injured party files a civil suit -nurses are held responsible for their own actions, so they should carry malpractice insurance
What is the rationale for this answer?
A mental health exam would enable the nurse to determine if the client has the ability to understand the explanation of the treatment process. The client must be competent to understand the treatment plan, and must be able to process the information provided, before informed consent can be given. The client must not be coerced or forced to give consent for treatment. There is no evidence in this situation that the client is being involuntarily committed for treatment. If a client were found by a court to be incapable of giving informed consent, an advocate or guardian would be appointed to protect the client's rights.
What is malpractice?
A professional fails to act in a responsible and/or prudent manner when carrying out professional duties and responsibilites
What is the rationale for this answer?
A serotonin deficiency is associated with anxiety, aggression, and self-destructive behavior. Serotonin does not affect excitability. An acetylcholine deficiency is associated with sleep disorders. The protein P11 manages how brain cells respond to serotonin.
Which manifestations are associated with grief? (7.1 R)
Able to accept support Self-esteem intact
What is the rationale for this answer?
According to Sigmund Freud, there are 5 stages of psychosexual development. The first phase, the oral phase, begins with the client developing a sense of self. In the anal stage, the client works on toilet training of both bowel and bladder. In the third stage, boys enter the phallic stage where they develop the Oedipal complex. In the latency phase, the client begins to develop relationships with peers. In the last stage, the puberty stage, the client cultivates relationships with people of the opposite sex.
Who initiated the psychobiologic theory of mental illness?
Adolph Meyer
Overreactive?
Affect is appropriate to the situation but out of proportion to the immediate situation
What is appropriate affect?
Affect is congruent with the immediate situation
Inappropriate affect?
Affect is not related to immediate situation
Depressed?
Affect is one of despondency not necessarily related to the current situation
Elevated?
Affect is one of extreme elation not necessarily related to the current situation
Labile?
Affect shifts suddenly in a way that can not be understood in the context of the situation
Risk factors for bipolar disorder
Age: 15-30 Family History: children with bipolar parents have 4%-16% increased risk drug use periods of high stress major life-alterng event gender: men and women have equal risk but women have more rapid cycling and depressive episodes and greater risk for alcohol abuse
What is the rationale for this answer?
Although hospitals were built, the majority of staff was poorly trained, and they frequently abused the clients. The first medication for mental illnesslong dash—Thorazinelong dash—was not introduced until 1950, in the 20th century, so 19th-century clients were not overmedicated. The U.S. Surgeon General's report of 1999 was the first ever to address mental health and mental illness. Mentally ill clients, especially those with severe illness, were institutionalized in state-run hospitals, where the poor treatment they received rarely resulted in release.
Which organization established the standards of care in psychiatric-mental health nursing in 1973? (1.1 remember)
American Nurses Association (ANA)
The nurse is planning care for an Asian American adolescent male client who has attempted suicide twice. Which information will the nurse use to understand the client's risk for future suicide attempts? (9.5 pre)
Amount and frequency of alcohol ingestion (can affect judgement) Client's race and culture Client's age (adolescents have increased risk)
What is the rationale for this answer?
An effective treatment team goes through 5 stages to meet goals. The first stage is forming. This is a short stage where the members are excited about participating in the group. In the storming phase, the group?s purpose and goals are established and roles may be challenged. The third stage is the norming stage. This stage is where the members are committed to working together to solve a problem. Performing is the fourth stage is where collaborative work takes place towards meeting the goal of the group. The adjourning stage is the last stage. In this stage, the group members adjourn the group as the goal has been met.
Which characteristic does a resilient individual possess? (1.1 remember)
An individual who is resilient is able to bounce back from difficulty when faced with tragedy, trauma, and threats. Being able to accept loss as a fact of life is a characteristic of hardiness, not resilience. The inability to gain coping skills and the inability to make realistic plans are characteristics of individuals who lack resilience.
The nurse is completing a health history on a client with seasonal affective disorder (SAD). What data should the nurse obtain during this interview?
Anhedonia Medical history Feelings of guilt Sleep disturbances
The nurse is working with mentally ill clients using Roy's adaptation model. What is the role of the nurse in this model? (1.2 posttest)
Assist the client to facilitate effective adaptation.
The nurse is writing a plan of care for a client with acute mania. Which nursing interventions are appropriate when caring for this client? (7.3 pre)
Assist with personal hygiene as needed. Maintain proper client nutritional status. Administer medications as ordered. Discuss sleep patterns and methods to promote at least 6 hours of sleep at night.
1.1 Pretest Q7: The nurse is working with the treatment team and the client who was admitted for treatment of his bipolar disorder. How can the treatment team help the client?
Assists the client to improve relationship skills Assists the client in prioritizing goals Directs the client's treatment Helps the client find a job
The nurse is conducting a follow-up interview with a client using alternative therapy to aid in the treatment of depression. Which observations indicate that yoga therapy has been helpful for this client? (7.1 pre)
Attentive during the interview Motivated to return to work Expressed satisfaction with treatment
A female client is pacing the corridor of the mental health facility and tells the nurse, "I've been here 4 days. Now I feel fine, and I am going to discharge myself and go home." The nurse tells the client what might happen if she goes home at this time, but the client remains intent on discharging herself. By accepting the client's decision, what ethical principle is the nurse demonstrating? (1.3 pretest)
Autonomy
The nurse is providing medication teaching with Harold Jackson, a 22-year-old male client who is prescribed a monoamine oxidase inhibitor. What should the nurse emphasize when teaching Harold about this medication? (7.1 apply)
Avoid foods containing tyramine
While reviewing previous documentation, the nurse notes that a client is described as demonstrating passive behavior. What should the nurse expect when communicating with this client? (7.1 pre)
Avoiding conflict or confrontation Unexpected explosions of anger
The nurse is determining which clients would benefit from interventions to prevent suicide. Based on age alone, which client is at the highest risk for suicide? (9.5 pre)
A 23-year-old college student who was fired from part-time employment: Suicide is the leading cause of death in persons aged 15-24 years; this client has an added stressor of job loss, which puts the student at risk. Suicide is the fourth leading cause of death for adults aged 45-54 and the seventh leading cause of death for adults aged 55-64 years.
What is the rationale for this answer?
A helping, trusting relationship is a foundation for working with a client, which in mental health nursing means developing a contract, discussing confidentiality, and developing a nursing care plan. All aspects of the client, including the mental, physical, and sociocultural, must be included, not just spiritual distress. The nurse does not impose his/her own faith on the client, but respects the diversity of the client's spiritual needs as the nurse builds a connection with the client. Watson believed that spirituality takes many forms and the nurse should be open to power components not fully understood. The nurse should complete a spiritual assessment before discussing the option of clergy referral with the client. Being present for the client is a part of Kristen Swanson's theory of caring. It is not part of Jean Watson's theory of caring.
The nurse is preparing an educational seminar on depression for a community health fair. Which strategies should the nurse include to reduce depressive episodes? (7.1 post)
Be aware of family risk factors Obtain adequate rest Have regular visits with the healthcare provider Build a strong support system
Identify the cultural phenomena that affects health and health care (1.3 remember)
Biologic Variations: Susceptibility to certain diseases Environmental Control: Alteration of the surroundings Social Organization: Religious affiliation Environmental Control: Use of specific healing traditions Social Organization: Ethnic identity Environmental Control: Use of folk healers Biologic Variations: Skin color Social Organization: Nuclear family Biologic Variations: Body build
The nurse is assessing a new client on the mental health unit. The client states that she has been overly busy every day most of the time for the past 2 years and is unable to cope with family responsibilities. The nurse suspects that this client is suffering from which type of disorder? (7.3 pre)
Bipolar disorder with mania
What is the rationale for this answer?
Bipolar disorders are a group of mood disorders that include manic episodes, hypomanic episodes, and mixed episodes. Symptoms may include euphoria, inability to take time to eat, sleep disturbances, and possibly sexual disinhibition. Cyclothymic disorder symptoms include fluctuating mood disturbances, involving numerous periods of hypomanic symptoms and numerous periods of depressive symptoms. Hypomania is a less extreme form of mania that is not severe enough to markedly impair functioning or require hospitalization. A depressed episode occurs when manic or hypomanic episodes have occurred in the past, but the features of the current episode are purely depressive.
What is the rationale for this answer?
Both the NLN and Brown's report recommended the incorporation of mental health nursing in the curricula of all nursing programs. Peplau's book analyzed the therapeutic interpersonal process between nurses and clients, and the ANA published the standards of care in psychiatric-mental health nursing. Linda Richards, the first trained psychiatric nurse in America, promoted care for the mentally ill and directed the first school for mental health nursing. Harriet Bailey wrote the book "Nursing Mental Disease." The National Institute of Mental Health (NIMH) funded research on mental health disorders, training of mental care professionals, and the establishment of mental health centers.
1.1 Pretest Q2:What is required for an Advanced Nurse Practitioner (ANP) to practice psychotherapy with individuals or groups of clients?
Certification exam
Danial Kvitkova is an 85-year-old Caucasian male client who has been receiving hemodialysis for several years for chronic renal failure. The nurse notes a change in Danial's affect over the last several hemodialysis treatments. Which would be the most appropriate assessment of Danial by the nurse? (7.1 apply)
Change in spouse's health status or loss of spouse
What is the rationale for this answer?
Characteristics of passive behavior include unexpected explosions of anger and avoiding conflict or confrontation. Intimidating others and lacking consideration for others' feelings are characteristics of aggressive behavior. Expressing feelings but not at the expense of others is a characteristic of assertive behavior.
What are the risk factors for the development of depression? (7.2 R)
Childhood sexual abuse Dysfunctional family relationship Family member with depression
What is the rationale for this answer?
Children of depressed parents have twice the risk of experiencing depression over a lifetime. If both parents have depression, the risk rises to 75%. Depression in adolescence is not a minor disorder since 11.2% of adolescents between the ages of 13 and 18 have been diagnosed. There is no evidence to suggest that an adolescent will outgrow the symptoms of depression. There is no evidence to support that there aren't treatments designed for adolescents with depression.
A new nurse is performing a cultural assessment and observes that the client does not make eye contact, although he will raise his eyes to look at items the nurse shows him. Which conclusion would the nurse make based on this observation? (1.3 posttest)
Client is showing respect.
The client was informed not to take certain recreational drugs when client teaching was provided concerning the prescribed antipsychotic medication. After a visitor leaves, the client is found semi-comatose, with fresh needle marks on the arm. What is the nurse's legal responsibility for this client's actions? )1.3 postest)
Client maintained the freedom of actions.
The nurse is visiting the home of a new mother and full-term infant. During the course of the visit, the nurse suspects that the mother is experiencing early signs of postpartum depression. How did the nurse come to this conclusion? (7.1 post)
Client scored 13 on the Edinburgh Postnatal Depression Scale
What is the rationale for this answer?
Clients have the right to autonomy and to make decisions about their care. If the client was voluntarily admitted to the mental health facility, then the client has the freedom to leave the facility. Nonmaleficence is the nurse not acting in a way that harms the client or self. Veracity is telling the client the truth, and it is frequently shown when providing information to the client and family. Justice is treating all clients equally and fairly at all times.
Who wrote "The Mind that Found Itself" and founded the Connecticut Society for Mental Hygiene?
Clifford Beers
At the conclusion of a health history, the nurse is concerned that a middle-aged client is experiencing physical manifestations of depression. What did the nurse assess to come to this conclusion? (7.1 pre)
Clothing rumpled; hair not washed or combed States a considerable loss of energy Inability to recall the last time ingested food
What is the rationale for this answer?
Cognitive characteristics of a manic state include grandiose self-beliefs, hallucinations, and the belief that self is unusually beautiful. The inability to experience guilt and constantly seeking fun and excitement are affective characteristics of the manic state.
What did Eisenhower do for mental health/mental disorders?
Commission on Mental Illness and Health was initiated
What did Kennedy do for mental disorders/mental health?
Community Mental Health Centers Act: focused on deinstitutionalizing those with mental disorders and providing community based care with them; provided funding for community mental health disorders
During morning report, the nurse learns that a client's affect is flat. What should the nurse expect when interacting with this client? (7.1 pre)
Complete lack of emotional response
A client diagnosed with major depressive disorder is admitted to the mental health unit because of attempted suicide. The nurse identified the problem of impaired self-care. Upon evaluation, What data indicate that the client achieved the outcome identified for this problem? (7.2 pre)
Completes shower and brushes teeth independently: client is meeting the outcome established by the nurse for the problem of impaired self-care
A client is admitted because of a threat to harm herself. The nurse leaves the client to get some admission materials. When the nurse returns, the client has slit both her wrists and has no pulse. What is the nurse's liability in this client's suicide? (1.3 posttest)
Creating a legally binding contract by accepting the client Assessing the client for means to harm self Protecting the client from harm
At the conclusion of a health interview, the nurse suspects a middle-aged adult female client is experiencing seasonal-affective disorder. What did the nurse assess to make this determination? (7.1 post)
Crying Irritability Sadness Constant fatigue
You observe another nurse telling a client that the client will be put into restraints if she doesn't stay out of other clients' rooms. How can you best advocate for this client? (1.3 pretest)
Discuss alternatives with the nurse.
What is the rationale for this answer?
Dorothea Dix was a nurse; Pinel and Beers were not. Dix vigorously lobbied state legislatures and the U.S. Congress to build public mental hospitals with spacious campuses for humane treatment of the mentally ill, and her advocacy was directly responsible for the establishment of Illinois's first state mental hospital. The Dorothea Dix Hospital, opened in Raleigh, North Carolina, in 1856, was named to honor Ms. Dix for her work in providing better care of the indigent mentally ill. The French physician Philippe Pinel advocated the humane treatment of the mentally ill, and he worked to establish mental health disorder classifications. Clifford Beers, who experienced inhumane treatment when he was an inpatient, wrote the book "The Mind That Found Itself," which may have helped change care for the mentally ill.
During an assessment, the nurse learns that a 53-year-old female client engages in multiple chronic self-destructive behaviors. Which data did the nurse assess in this client to come to that conclusion? (9.4 post)
Drinks a six-pack of beer each day Smokes marijuana with husband and friends every evening after dinner Smokes three packs of cigarettes a day Takes diazepam (Valium) 10 mg four times a day for leg cramps
The nurse is assessing a new client on the mental health unit. The client states that she has been depressed most of the time for the past 2 years, is unable to cope with family responsibilities, and has frequent thoughts of suicide and death. Based on these data, which type of diagnosis does the nurse anticipate? (7.2 pre)
Dysthymic disorder: demonstrate a depressed mood most of the time for 2 years (for adults), are unable to cope with responsibilities, and have thoughts of suicide and death. Other symptoms include self-pity, chronic fatigue, poor self-esteem, difficulty concentrating, and pessimism about the future.
Who was the first professor of psychiatric nursing (Yale)?
Effie Taylor
The Commission on Mental Illness and Health was initiated by what United States president? (1.2 remember)
Eisenhower
What is the rationale for this answer?
Environmental influences strongly impact the ability to regulate one's mood intensity and shift. After learning that a community clinic is closing and the next closest one is 20 miles away, the client becomes irritated and angry. There is no information to support that the client's irritation and anger is because of an underlying health problem, length of time the community clinic was the location to receive care, or the relationship with the person sharing the news about the clinic closing.
Who wrote the report "Nursing for the Future," that recommended the incorporation of psychiatric nursing into the curricula of all basic nursing programs?
Esther Lucille Brown
A group of nurses on a locked mental health unit are discussing revising their policy for using restraints with some clients who are out of control and may harm themselves or others. Where would the nurses find the best information to review for updating their policy on the use of restraints? (1.1 posttest)
Evidence-based nursing research articles
A client's spouse complains that his wife's depression isn't any better after taking an antidepressant medication for 1 week. What action should the nurse initially take? (7.2 pre)
Explain that it may take 1-3 weeks to see any improvement.
SAMe has been shown to be effective against both bipolar disorder and depression T or F
F, worsens bipolar disorder
T or F: The more severe the depression symptoms, the higher the risk of suicide
F: As symptoms improve, they gain the cognitive ability and energy to develop a suicide plan
The nurse is assisting a nurse researcher to collect information regarding the effects of a medication clinical trial. What principles regarding research with human subjects must the nurse assure for the clients in the study? (1.1 posttest)
Fair treatment of clients. Client values are respected. Clients are to be protected from harm.
T or F: Research participants under 18 must receive and sign an informed consent before being enrolled in a study or trial
False, ALL research participants must recieve and sign an informed consent
What information is important for the nurse to obtain during the assessment of a client at risk for suicide? (9.5 rem)
Family history of mood disorders History of suicidal ideation History of family member committing suicide History of depression
What are the risk factors for the development of mood disorders? (7.3 R)
Family member with depression Childhood sexual abuse -No ethnicities are risk factors -MAles and Females have equal risk
Which are symptoms of depression? (7.1 R)
Feeling apathetic Changes in sleep Experiences anhedonia Psychomotor retardation
What is the rationale for this answer?
Fidelity is demonstrated when the nurse keeps the promise or commitment to the client to return for an hour to talk. Beneficence is the act of performing good for the client or protecting the client, even when that means preventing clients from harming themselves. Nonmaleficence is not doing harm or causing pain to the client. Veracity is always telling the truth to clients and their families.
You are caring for Mr. Gutierrez, a 45-year-old man who has obsessive-compulsive disorder. Mr. Gutierrez displays ritual behaviors such as repeatedly washing his hands, to the point where it interferes with his ability to hold a conversation with you. You have never treated a client with obsessive-compulsive disorder before and you are unsure what to do next. What action could you take to improve your communication with Mr. Gutierrez? (1.1 apply)
Find research about obsessive-compulsive disorder to use in practice (EBP)
What are the 4 lobes of the brain?
Frontal, parietal, occipital, temporal
The mother of twin toddler girls asks the nurse to separate them at the time of annual inoculations because they will both "fly off the handle" at the same time, making it difficult to control the situation. Which information about affect is this mother describing to the nurse? (7.1 post)
Genetic influence
Which action is a way for a nurse to foster client autonomy? (1.3 remember)
Give clients the information they need to make a choice. Help clients understand the information that they need to make a choice. Support the clients' choices regardless of whether you think they are right.
The nurse is planning care for a client with bipolar disorder. Which intervention would the nurse implement to maintain adequate nutrition during a manic episode? (7.3 pre)
Give the client foods to be eaten while the client is active.
Which are cognitive characteristics of a manic state?
Grandiose self-beliefs Believes self is unusually beautiful Experiences hallucinations
3 other types of psychotherapy
Group therapy Recreational activities: laughter, releases endorphins Family therapy
Which clinical manifestation of depression are often associated with bipolar disorder? (7.3 R)
Guilt, feelings of hopelessness, difficulty concentrating
What are some of the clinical manifestations of depression? (7.2 R)
Guilt, feelings of hopelessness, sleep disturbances
What are characteristics of mental illness? (1.1 remember)
Hallucinations Delayed development Poor self-concept
The home care nurse is concerned that a 75-year-old widowed male client is at risk for suicide. Which data caused the nurse to come to this conclusion when conducting the home assessment? (9.5 pre)
Handguns located in the bedroom and living room: The risk for suicide is high in those over the age of 65, and the most common method for suicide by those in this age group is firearms; thus, this client's having handguns quickly and easily available indicates an increased risk
Mental health vs mental illness attitude towards health
Health = positive self-concept Illness = negative self-concept
What is the rationale for this answer?
Health care beliefs, language, and values are part of a culture's worldview and can influence a client's acceptance of and cooperation with the treatment plan. If the client does not speak the same language as the nurse and the health care provider, an interpreter will be required. Health care practices may differ from what the nurse plans and can include alternative practices that may interfere with the treatment plan. Although not part of the worldview or culture, the client's education will be considered when planning teaching for the client.
Which assessment information is important for the nurse to obtain in a potentially suicidal client? (9.5 post)
History of suicide attempts Family history of mood disorders History of depression History of suicidal ideation
A nurse is caring for a client with bipolar disorder who is admitted to the hospital after an accidental overdose of sleeping medication. What are appropriate nursing diagnoses for this client? (7.3 post)
Impaired knowledge about the disease process Risk for altered nutritional status Impaired coping mechanisms Potential for appropriate medication management
The nurse is caring for a client who is recovering from the repair of a ruptured aneurysm in the hippocampus of the brain. The nurse will assess the client for what possible impairment? (1.2 pretest)
Inability to retrieve memories from the past
What is worldview?
Includes art, language, religion, values, and health care beliefs and practices, among other things. -it is how members of that group view themselves within the group's social world and physical environment -promotes a sense of identity as an ethnicity, a culture, or a nationality
The nurse is attempting to understand the pathophysiology of a client with high anxiety. What biogenic amine and its level might be responsible for the client's increased anxiety? (1.2 posttest)
Increase in serotonin levels
What role does MAO play?
Increased MAO deactivates more neurotransmitters: decreased transmission of impulses Decreased MAO causes accumulation of NTs at synapse: increased transmission of impulses
What treatment modalities of psychotherapy are used to treat bipolar disorder?
Individual therapy Family therapy Cognitive-behavioral therapy (CBT) Lithium therapy
learning theory of depression
Individuals learn to be depressed as they percieve they have no control in life, this reinforces helplessness -problems adapting
Describe the competency element of informed consent
Is the client able to understand the treatment process? If not sure, a mental status exam may be necessary
A client in an outpatient mental health clinic is diagnosed with cyclothymic disorder. Which statement about cyclothymic disorder is true? (7.3 pre)
It involves a mood range from moderate depression to hypomania.
________ ________ focused on caring as a major component of nursing care
Jean Watson
_______ _______ identifiedfive attributes of the caring process
Kristen Swanson
What part of the brain does transcranial magnetic stimulation target?
L prefrontal cortex, where depression might originate
Deficiency in NE causes...
Lack of motor arousal, energy, movement, concentration & motivation
Which components are encompassed by a group's worldview? (1.3 remember)
Language Religion Health care practices Values
Who was the first trained psychiatric nurse in America?
Linda Richards-- became director of first school for mental health nursing
A client, who usually demonstrates an appropriate affect, becomes irritated and angry after learning that a community health clinic is closing and care will need to be obtained 20 miles away. What should the nurse suspect as being the reason for this client's change in affect? (7.1 pretest)
Location of the clinic 20 miles away
The first mental health hospital was established in _______ in the ______ century. It was named ___ ____ ________ hospital, but was later referred to as ________ hospital
London, 14th, St Mary Bethlehem, Bedlam
Which are factors that often motivate a person to commit suicide? (9.5 rem)
Losing a job Bullying in school or workplace Suffering depression Losing a loved one
Which are goals of managed care for the client with mental illness? (1.1 remember)
Lower cost Better coordination of care More accountability Higher-quality care
You are taking a mental health assessment of Mrs. Castillo, a woman in her 30's. Mrs. Castillo tells you that she has been having feelings of deep sadness all summer and that she has never experienced this type of long-lasting sadness before. She tells you that she is usually optimistic and energetic, but in the past 4 months her mood has completely changed. Upon further questioning, you learn that Mrs. Castillo has two children, ages 2 and 5, and that a year ago she and her family moved to a new city where she has no friends or extended family members. Based on this information, which mood disorder is Mrs. Castillo most likely experiencing? (7.2 apply)
MDD
What is the difference between major depressive disorder and persistent depressive disorder?
MDD: Experiences symptoms of depression for most of the day every day for 2 weeks or more. PDD: chronic disorder, periods of depression fluctuate with periods of normal mood.
What are Advanced Practice Nurses (APNs)
MSNs who have been certified by accrediting exams as either Clinical Nurse Specialists or Nurse Practitioners -perform all tasks of nurse generalists, but they are also able to perform psychotherapy (e.g., individual, group, and family therapy) -In many states, they have prescriptive authority -able to function as supervisors and managers and can provide complementary and alternative therapy, if properly trained.
______ ________ (person) focused on transcultural nursing and the ability to provide culturally specific care
Madeline Leininger
A 42-year-old was admitted to the mental health unit after a failed suicide attempt by drug overdose. The client sought help when her husband informed her of his decision to leave her and the children after 21 years of marriage. Upon initial contact with the nurse, the client looked exhausted, affect was sad, movements and responses were slowed, and self-care impairments were evident. What type of disorder would the nurse suspect the client is experiencing? (7.2 pre)
Major depressive disorder: evidenced by psychomotor retardation, impairment of self-care, inability to sleep, and a suicide attempt.
What is the rationale for this answer?
Making arrangements with a shelter would be a tertiary prevention intervention because it involves restoring the family to a nonabusive environment. A family therapist could be part of the intervention, but the primary focus is to provide for the family's safety. Unless a spiritual advisor is assessed as a need or is requested by the family, this referral would not be a tertiary prevention. Safety is the immediate need.
The nurse is helping to lead a group therapy session for clients with bipolar disorder. During the session, Janet Lee, a 46-year-old female with bipolar I disorder, becomes increasingly restless, constantly interrupting and criticizing other members of the group. She ignores the nurse's repeated requests to stop her disruptive behavior. What type of bipolar episode is Janet likely experiencing? (7.3 apply)
Manic
Identify the restrictive setting (more or less) for clients with mental illness based on the description provided. (1.3 remember)
More Restrictive: Rules enforced by coercion Less Restrictive: Clear goals of treatment More Restrictive: Locked ward Less Restrictive: Halfway house More Restrictive: Psychosurgery Less Restrictive: Living with family More Restrictive: Mechanical restraints Less Restrictive: Short-acting medication
Who provided funds for research on mental health disorders, training of mental health care professionals, and the establishment of mental health centers?
National Institute of Mental Health (NIMH)
Which are theories used to explain mood disorders? (7.1 R)
Neurobiological Cognitive Intrapersonal Biological rhythms
A nurse is caring for a client with bipolar disorder who is being treated for this condition with lithium carbonate. Upon assessment, the nurse notes that the client's lower extremities appear swollen. What is the nurse's best response to this clinical finding? (7.3 post)
Notify the physician immediately
What is considered a boundary violation?
Once you are in a professional relationship with a client, you can't engage in a social relationship with them such as dating or sex
Is the a relationship between genetics and mood?
One study indicate that genetics have a strong influence on mood
Under which conditions is it acceptable to breach the right to privacy for a client with mental illness? (1.3 remember)
Overdose Gunshot wound Contagious diseases Child abuse
bipolar disorders are characterized by....
Periods of depression alternating with periods of mania or hypomania; mood swings
What is the rationale for this answer?
Persons with resilience have the capability to experience stressful situations in their lives and to adjust and adapt to the stress. Previous successes give these people the skills to work through future tragedies. Clients may seem to be coping and then break down later, but that would not describe a client who had learned resilience. Questioning whether a person is actually coping or asking whether a client wishes to be able to cope does not answer the client's question or explain a person's ability to develop resilience.
During the 18th century, French physician ________ _______ advocated for the humane treatment of the mentally ill and in an atmosphere of kindess and understanding.
Phillipe Pinel: AKA father of modern psychiatry, made contributions to classification of mental disorders
What is the rationale for this answer?
Physical manifestations of depression include a loss of energy, lack of appetite, and appearing unkempt with poor hygiene. Sleeping 1 to 2 hours each night is a physical manifestation of mania. Tearfulness is an affective characteristic of depression.
The nurse is planning tertiary preventive care for a family whose members have been victims of family abuse. Which is an example of a tertiary preventive intervention? (1.2 pretest)
Placing family in a shelter
The nurse is planning care for a client diagnosed with major depressive disorder. Which activity should the nurse encourage the client to participate in based on the diagnosis? (7.2 pre)
Playing a card game: the nurse should involve the client in recreational activities and conversation that provide distraction from self-absorption and negative thoughts
What is assertive community treatment (ACT) ? Who recieves this treatment
Programs for clients with severe mental healht disorders in which they are assigned to specific teams that deliver all services needed by a client living in a community
Miss Laura Luke, an 18-year-old client, is isolating herself from peers and refuses to go to school. She refuses to maintain her ADLs. Upon admission to a mental health unit, Miss Luke is diagnosed with major depressive disorder. Which intervention should you initiate upon admission to the unit? (7.2 apply)
Provide a safe, protective environment
1.1 Pretest Q6: The nurse is working with a client with bipolar disorder who is to be discharged home. What intervention is a priority for the nurse to complete before this client is discharged?
Provide instruction regarding sodium intake
The nurse manager has been assigned to an inpatient mental health unit. What management skills would the nurse manager use when dealing with the staff? (1.1 posttest)
Provide sufficient directions for any assignment. Maintain accountability for tasks assigned to an LPN/LVN. Assess the capabilities of staff members.
What would the instructor tell the student nurse is the purpose of the statistical reference guide used by psychiatrists and nurses? (1.2 posttest)
Provides a taxonomy of mental health disorders
Before the 21st century, the focus of mental health care was on keeping the mentally ill in institutions. What is the current focus of mental health care? (1.2 posttest)
Providing community-based mental health care
What kinds of weather will cause symptoms related to seasonal affective disorder (SAD) to be more prominent? (7.2 R)
Rainy, cloudy (only weather that has decreased sunlight)
A nurse is providing discharge instructions for a client with bipolar disorder who presented to the hospital in a manic state. What instructions will the nurse include in the home care instruction of the client with bipolar disorder? (7.3 post)
Recognize medication side effects. Learn effective self-administration of medications. Recognize the importance of adhering to therapy schedules. Seek help when needed.
The teenage client tells the nurse, "My mother is always upset and mad all the time. I can't do anything right. I'm just bad." What sociocultural theory characteristic is the client exhibiting? (1.2 posttest)
Reducing feelings of anxiety by accepting the blame
The nurse is concerned that a client is threatening to commit suicide. Which behavior did the nurse observe in this client? (9.5 pre)
Refusing to talk with friends and family: The suicide threat might include behavior changes, mood swings, personality changes, changes in work or school performance, withdrawal from friends and family, and significant attitude changes. Suicidal ideation is the step before a suicide threat; it occurs when the client thinks about suicide as a possible solution to life's problems
the nurse is working with an adult client admitted for bipolar disorder. What team members would most likely be part of this client's treatment team? (1.1 posttest)
Registered nurse Social worker Psychologist Psychiatrist
The nurse is providing care to a client who attempted suicide prior to being admitted to the mental health care unit. Which intervention is a priority for this client? (9.5 post)
Removing the disposable razor from the bedside
You are making an assessment of Mrs. Willapana, a recent immigrant from Thailand who does not speak English. Because you do not speak Mrs. Willapana's native language, you are having trouble understanding what she is trying to communicate. Mrs. Willapana is becoming increasingly distressed. What would be the best action to take to overcome the communication barrier between Mrs. Willapana and you? (1.3 apply)
Request an interpreter who knows Mrs. Willapana's native language.
1.1 Pretest Q8: The student nurse asks the instructor what makes a person who is from a Western culture have a view of mental illness that differs from the view of someone from another culture. What characteristics define Western culture's beliefs regarding mental illness?
Results from genetics or chemical imbalances
Which priority problem should the nurse include when planning care for a client diagnosed with major depressive disorder? (7.2 post)
Risk for violence directed at self: safety issues are priority!
Who came up with the Human BEcoming Theory? What is it?
Rosemary Rizzo Parse; quality of life from each person's own perspective is goal of nursing practice and emphasizes individual's free interaction with the universe, which tranforms a person
Which classifications of medications are prescribed for mood disorders? (7.1 R)
Selective serotonin reuptake inhibitors Tricyclic antidepressants Monoamine oxidase inhibitors
The nurse explains to the student nurse that dopamine is implicated in which mental health disorders? (1.2 posttest)
Severe depression Mania Parkinson dementia. Schizophrenia
Spiritual healers are known by various names depending on specific cultures. What are some spiritual healers called in the United States? (1.1 posttest)
Shaman Curandero Medicine man A psychologist is a Western culture health care provider with a master's degree or doctorate who treats persons with mental illness. In a Hispanic or Latino culture, a curandero may use herbs and prayer to relieve the symptoms of mental illness. A psychologist is a Western culture health care provider with a master's degree who treats persons with mental illness. A psychiatric social worker with a master's degree can perform social histories; arrange for the placement of clients; and, with training in psychotherapy, provide therapy sessions. Neither a psychologist nor a psychiatric social worker is considered to be a spiritual healer.
Full range of affect?
Shows range of emotional response appropriate to situation or conversation
Which are alternative therapies used to treat mood disorders? (7.1 R)
St. John's wort Vitamin B Exercise Acupuncture
What types of alternative therapies are often used to treat bipolar disorder? (7.3 rem)
St. John's wort Transcranial magnetic stimulation (TMS) Aerobic exercise
Identify the stages of culture brokering based on the description (1.3 remember)
Stage 1: Perception: Recognize barriers to access health care Stage 2: Intervention: Help connect client and health care providers Stage 3: Outcome: Return to a previous stage if necessary Stage 1: Perception: Identify need for brokering Stage 2: Intervention: Establish trust with client to resolve conflict Stage 3: Outcome: Evaluate whether conflicts have been resolved
What all did Dorethea Dix do for mental health
Superintendent of Army Nurses in the Union Army in 19th century during Civil War -labbied state legislatures and US Congress to build public mental hospitals with humane treatment -established Illinois's first state mental hospital -first public mental hospital in the US in pennsylvania in 1851 -Dorthea Dix Hospital in NC in 1856
1.1 Pretest Q5: A client is to be discharged after a panic episode. What nursing action would demonstrate that the nurse is the client's advocate?
Support the client's returning to work immediately after discharge.
T or F: no single neurotransmitter is responsible for a single mental disorder
T: more likely disproportionate ratio of NTs, not just a surplus or deficit of one
Writing therapy or journal writing can be usual for the suicidal client T or F
T; helps them work through difficult emotions and thoughts and suicidal ideations. May sign a "no suicide" contract that states they will seek help before attempting again
A client with depression is prescribed an omega-3 fatty acid supplement. What should the nurse suggest when the client takes this supplement? (7.1 post)
Take with orange juice
The nurse is planning care for a client who recently made an unsuccessful suicide attempt. Which interventions would the nurse include in this client's plan of care? (9.5 post)
Talking openly about suicidal thoughts Taking threats of suicide seriously Searching the client's room Implementing suicide precautions
What is the rationale for this answer?
The ANP is an MSN who successfully completes an accreditation exam to become certified and maintains the professional clinical hours required to maintain the certification. The ANP would be licensed as a registered nurse but must have accreditation as an ANP to practice psychotherapy. A registered nurse can hold a master's or doctoral degree, but unless the nurse has successfully completed the accreditation exam to become certified, he/she cannot practice psychotherapy.
1.1 Pretest Q1: What milestones helped ensure that psychiatric-mental health nursing became a part of the curriculum for basic nursing programs in the United States?
The National League for Nursing (NLN)'s recommendation and Esther Brown's report on the future of nursing
Imogene King constructed what theory?
The Theory of Goal Attainment
What is the rationale for this answer?
The action of leaving the EMR unsecured would be seen as an intentional tort for not maintaining the client's confidentiality. The nurse's action constitutes an invasion of privacy and failure to maintain the client's confidentiality and expectation of privacy rather than defamation of character, misrepresentation, or slander.
Describe the information element of informed consent
The client must be able to process new information. The illness itself, drugs, and educational level may all affect this
The exception to the client's right to refuse treatment arises when....
The client poses an immediate danger to his/herself or others, which might be decided by courts
What are expected outcomes for a client with a depressive disorder? (7.2 R)
The client sleeps 8 hours a night. The client does not express suicidal ideation. The client returns to work or school The client describes hopefulness for the future.
The nurse is evaluating the effectiveness of the nursing interventions for a client with bipolar disorder. Which evaluation of outcomes are appropriate for this client? (7.3 post)
The client was able to set appropriate limits in a variety of situations. The client did not commit violent or harmful acts against self or others. The client remained in a safe environment and free from injury. The client was able to demonstrate reality-based thinking by making an effective decision.
The nurse is planning care for a client with bipolar disorder who is experiencing depression. What outcomes are appropriate for the nurse to include in the client's plan of care? (7.3 pre)
The client will have no suicidal ideations. The client will maintain a safe environment and remain free from injury. The client will maintain appropriate personal self-care. The client and family will become knowledgeable about the disorder, effective communication, and problem solving
The nurse is planning care for a client with bipolar disorder who is experiencing mania. What outcomes are appropriate for the nurse to include in the client's plan of care? (7.3 post)
The client will maintain a safe environment and remain free from injury. The client will demonstrate socially appropriate behaviors during interactions with others in a variety of settings. The client will not commit violent or harmful acts against self or others. The client will get at least 6 hours of sleep per night.
A client with depression is admitted to the mental health unit because of attempted suicide. Which short-term goal should be given high priority for this client? (7.2 pre)
The client will seek out the nurse when feeling self-destructive: safety is the priority goal for this client to achieve at this time.
What is the rationale for this answer?
The hippocampus is responsible for emotional reactions and learning; it also stores and retrieves memories. The temporal lobe of the brain is involved in all aspects of auditory processing. The sole role of the occipital lobe is to control the individual's vision and ability to understand written words.
What is veracity?
The intention to tell all truth. -critical for establishing trust -do not lie to clients, even to "humor" them
What happens during extinction stage?
The loss of learned behavior responses
What is the rationale for this answer?
The nurse is demonstrating the essence of caring through positive regard for the client in spite of the client's outward appearance. The nurse has not interviewed the client and therefore does not know the client's values or if the client's self-esteem needs to be reinforced. Safety is a basic human need, but there is no evidence that this client lacks security.
What is the rationale for this answer?
The nurse may see the benefit resulting from the client's return to work after stabilizing at home, but the choice is the client's. As an advocate, the nurse supports the client's right to choose. The dosage of Prozac is at the maximum recommended, but it is within a therapeutic level for an adult. The nurse can explore the living arrangements, but the nurse is not acting as an advocate when he/she tells the client what to do.
What is cultural sensitivity?
The process of understanding, respecting, and appreciating the importance of cultural factors in the delivery of health care services -attempting to learn about the values, health care beliefs and practices, and healing traditions of a different culture helps to plan care -also demonstrates respect for other cultures
What is the rationale for this answer?
The role of the treatment team is to provide direction for clients in meeting their goals and then to prioritize those goals. The primary goals that team members work toward are helping the client find a permanent, stable place to live and a job. Another treatment goal is to help the client to develop interpersonal relationship skills. Clients are included in developing their treatment goals; goals are not imposed upon clients by the treatment team.
What is the rationale for this behavior?
The spouse's reaction of staring into space is flat since there are no visible emotional cues. Laughing at the question demonstrates an inappropriate affect since the response is not congruent with the situation. Dramatic is not a term used to describe affect. An appropriate affect demonstrates congruency with the immediate situation. An over-reactive affect is one that is out of proportion to the immediate situation.
Flat?
There are no visible cues to the person's emotions
What is a possible negative consequence of the client's rights related to involuntary commitment to a public mental health facility? (1.3 posttest)
There is no standard time for case review.
What does common practice have to do with negligence?
There might be no written law or policy to guide the nurse's actions, but there is a strong indication for action based on common practice
What is the rationale for this answer?
The client's blood sodium is low at 133 mEq/L (normal: 135-145 mEq/L). Lithium (Eskalith) and a restriction of dietary sodium can reduce the excretion of lithium and increase the risk for toxicity. The client's one dose of Prozac a day should be given in the morning to prevent insomnia. A well-balanced diet would be encouraged because the client's hematocrit and hemoglobin are within the normal range for both men and women. There is no evidence that the client should not be discharged home. Therapy will continue on an outpatient basis.
What actions of considered "not me" in the self system?
Things that produce anxiety and are pushed into the unconscious in order to avoid them
A client with schizotypal disorder asks the nurse if she can refuse to take the medication. What are appropriate reasons for the client's refusal of prescribed treatment? (1.3 posttest)
This drug is still in pharmaceutical trials. Religious beliefs are violated. Side effects of the medication cause long-lasting effects. The client believes that the drug is for sedation:If the client is not a threat to self or others and the intent of the treatment is only to quiet the client, then the client can refuse the medication.
The nurse is reviewing orders written for a client demonstrating signs of depression. Which diagnostic test should the nurse expect to be prescribed for this client? (7.1 pre)
Thyroid function
What is the rationale for this answer?
Thyroid function tests may be prescribed for a client demonstrating manifestations of depression because thyroid disorders can mimic depression. Serum electrolytes would be prescribed for the client demonstrating signs of substance abuse. White blood cell count and hemoglobin and hematocrit levels are not prescribed to determine a physical cause for depression.
T or F: there must be homogeneity in a group for it to be considered a culture or a subculture
True
T or F: As a mental health nurse, you should support your client's decisions even if you do not agree with the decision
True, this is part of being a patient advocate: provides information to the client and supports client decisions by acting on behalf of the client
A client is admitted to the emergency room in a depressed state. The client is limping and unkempt, with body odor and ragged clothing. The nurse gently takes the client's arm, assists the client to an exam room, helps the client sit down, and offers a drink. The nurse is exhibiting which humanistic characteristic? (!.2 pretest)
Unconditional positive regard
In the 19th century, hospitals were built to care for clients with mental illness. What was a major concern for the clients in these hospitals? (1.2 pretest)
Untrained hospital staff
What allows an adult client to lose a significant person in his/her life and to exhibit hardiness in the grieving process? (1.1 posttest)
Use of effective coping skills
Hope King is a 65-year-old client who is hospitalized for treatment of schizophrenia. Which treatment for schizophrenia was once popular but is no longer employed today? (1.2 apply)
Use of straitjacket for restraint
The nurse is admitting a client to the mental health unit for possible persistent depressive disorder. What data should the nurse collect when completing the client's physical assessment? (7.2 pre)
Vital signs: Suicidal ideations, medication use, and sleep disturbances are data that the nurse needs to obtain when completing the health history.
What is the rationale for this answer?
Western culture views mental illness as a result of genetics or chemical imbalances. Cultures define what is normal, and some cultures believe that mental illness is a punishment from God, or the result of having a hex or sign put on them, for doing something that is forbidden or offensive. Western culture believes that mental illness is self-determined and not determined by the environment.
What is the rationale for this answer?
When the nurse accepts an assignment, the nurse accepts the responsibility as a legally binding contract to provide for the client's safety. The nurse did not assess this client for the means to commit suicide, and thus breached the duty of care. The nurse has the obligation and duty to care for the client and to protect the client from harm or from harming self; assessing the client for means to harm self is a first-priority action by the nurse for a potentially suicidal client. There is no indication that the nurse provided advice before leaving the suicidal client alone. Common practice would be to not leave a suicidal client alone; the nurse is liable for that lack of action.
What is rapid cycling?
When those with bipolar disorder (I or II) may experience 4 mood episodes within 1 year, along with periods of full or partial remission that last 2 months or more -may have episodes more than once a week or once a day
What is the rationale for this answer?
With a flat affect, there are no visible cues to the person's emotions. Affect that suddenly changes in a way that cannot be understood in the context of the situation is labile. Engaging in meaningful conversation would be consistent with an appropriate affect. Affect that is appropriate but out of proportion to the immediate situation, such as loudly stating the joy of being hospitalized, is over-reactive.
What is the rationale for this answer?
Yoga has been found to improve life satisfaction, attentiveness, motivation and energy in clients with depression. Experiencing chronic headaches and fatigue indicates that yoga has not been effective in the treatment of depression in the client.
What is the rationale for this answer?
You act as a client advocate when you provide additional education regarding alternatives to restraints or seclusion of a client. The nurse needs to understand that restraints are a last resort, that a health care provider's order is necessary when use of restraints is the only alternative, and what facility policy is regarding the use of restraints. As part of the education of the nurse, you would provide the policy for restraints, and may discuss what you heard with the nurse, but neither of these actions constitutes advocating for the client.
what is the pandimensionality concept?
a domain without special or temporal characteristics
Suicidal behavior arises from a client's need for....
a permanent and final solution to emotional distress -it is a "cry for help" -some want to die, others just want attention and validation because they are lonely
Define managed care
a process of structuring the delivery of care to emphasize communication and coordination of care among all health care provdiers -promote provision of high-quality care with less costs and more accountability -when planning care for a client, mental health providers may have to obtain prior approval from managed care organizations for the services of certain clinicians, inpatient care, length of stay, outpatient services, new psychiatric drugs, referrals to other professionals, and ancillary services-- additional level of oversight
What is the milieu?
a structured group setting where interactions among the staff and members of the group help shape expected outcomes
How is the contract for care established?
accepting an assignment, offering info, providing treatment, or accepting a client into an ectivity creates a legally binding contract between the nurse and the client
What is professional autonomy?
accounting for and accepting the consequences of decisions and actions in the health care setting
Patients with Alzheimer disease, Parkinson disease, and Huntington chorea are known to have decreased levels of which neurotransmitter? (1.2 remember)
acetylcholine
Role of a nurse generalist/BSN in mental health nursing
administering medication assessing for positive and negative responses providing basic care and comfort strategies developing a therapeutic relationship with the client implementing therapeutic communication and managing the milieu
Cognitive behavior therapy for suicide prevention is used for...
adolescents who have attempted suicide or who have severe suicidal thoughts, helps them identify coping mechanism and avoid all self-harm
A client is brought to the hospital by police and admitted involuntarily. The client is diagnosed with schizophrenia. Which medication would the nurse expect the healthcare provider to prescribe for this client? (9.5 post)
antipsychotics
Deficiency in serotonin causes....
anxiety, aggression, self-destructive behavior
Once periodic review determines the client no longer fits the criteria for involuntary placement....
appropriate outpatient treatment is planned
What are intentional torts?
assault, battery, defamation of character, false imprisonment, invasion of privacy, fraud, and misrepresentation
The goal is to teach clients _________ behavior in order for them to express without fear of disapproval from others
assertive
In nursing, delegation means...
assigning responsibilities for tasks to a subordinate while maintaining accountability for the performance of those tasks
function of catecholamines?
assists in regulating physiologic processes by signaling the CNS
What is cyclothymic disorder?
at least 2 years of chronic fluctuating periods of hypomanic and depressive behaviors -must be free from the severe symptoms assoc with manic disorder and MDD -moody, unpredictable, temperamental -may progress to develop an overlay of the symptoms of MDD or mania
What is criminal law?
behavior that is considered to be a threat to society as a whole, such as robbery, murder, and assault -either felony or misdimeanor
The client tells the nurse that spanking her child is the right way to correct bad behavior. "My mother spanked me, and I learned to do what she wanted." The nurse understands that the client's actions are based on what psychosocial theory? (1.2 posttest)
behavioral theory
What is the difference between bipolar I and bipolar II disorders?
bipolar I: presents with one or more manic or mixed episodes, course of illness may be accompanied by major depressive episodes bipolar II: presents with one or more major depressive episodes and a min of one hypomanic episode
Age range and characteristics of oral stage
birth-1: primary pleasure from oral stimulation increased; begins to develop sense of self
How does the nurse give care independently?
by assisting clients directly or by supervising patient care technicians to ensure that needs such as bathing, dressing, and eating are met
How to accomplish beneficence during a research project?
by doing good, which includes not harming participants, preventing or removing harm, and promoting benefits for research subjects.
function of amino acids
can be inhibitory or excitatory
What is resiliency?
capacity to respond successfully to stressors-- better able to bounce back after stress and grow emotionally and psychologically
What is the function of the amygdala?
center of emotional awareness and response; sustains long-term emotional memories
Serotonin syndrome can occur if....
client is taking 2 or more drugs (prescription or OTC) that can increase serotonin levels
What is the most effective psychotherapy for depression?
cognitive behavioral therapy
what is the function of the corpus callosum?
connects both hemispheres of the brain medially; allows communication to both sides of the brain through a complex bundle of neurologic fibers
function of occipital
controls the individual's visual areas and functions
What is vagus nerve stimulation?
cookie-sized generator is placed under skin in chest to convey electrical impulses via a lead to the vagus nerve
What are the two main classes of law?
criminal (public) and civic (private)
What are the characteristics of a mixed episode?
depressive episodes are accompanied by mania or hypomania symptoms and vice versa
During this century, the focus has been on....
discovering neurobiologic causes of mental illness and evidence-based practice in providing client care. Complementary and alternative medical (CAM) therapies are being used more often
function of the ego
distinguishes reality from nonreality and attempts to maintain balance between the id and the superego
According to Kristen Swanson, which attribute of the caring process is indicated by the action of skillful nursing interventions that comfort and promote health? (1.2 remember)
doing for others
exisential theory focuses on..... + List 3 exisentialists
each individual's struggleto search for the meaning of his/her life 1.) Rollo May 2.) Viktor Frankel 3.) Irvin Yalom
secondary prevention focuses on....
early identification and prompt interventions -illness, pathology
What is mania? Hypomania?
elevated mood usually accompanied with increased activity that greatly impairs functioning; lasts a week or more = mania Mania requires hospitalization, hypomania may not-- less severe
A client is demonstrating extreme excitement, inability to sit still, agitation, and states she is the First Lady of the United States. It appears the client is having a manic episode. What additional characteristic might the nurse find in this client? (7.3 post)
endless energy
According to Maslow's hierarchy of needs, what stage is indicated by the need for respect and feelings of achievement? (1.2 remember)
esteem and recognition
The facilitating passage through life transitions attribute involves what nursing action?
explaining, supporting, validating, and focusing
T or F: ignorancce of a policy is an acceptable reason to not follow that policy
fale, not acceptable
bipolar episodes typically decrease in frequency with age: T or F
false; increase
Maryann Dodge is a 45-year-old female who is being assessed because her husband is concerned that she is suicidal and depressed. Which assessment information is important for the nurse to obtain from Mrs. Dodge? (9.5 apply)
family history of mood disorders
The nurse tells the client that he will spend an hour later today with the client talking about concerns regarding going home. The nurse does return and spends the hour with the client. Which ethical principle is BEST demonstrated by the nurse's doing what he promised to do? (1.3 pretest)
fidelity
The spouse of a client who passed away a few moments ago is sitting in the room staring into space. When asked if there is anything that can be done at this time, the spouse begins to laugh. Which terms should the nurse use to describe the spouse's affect at this time? (7.1 post)
flat, inappropriate
cognitive theory of depression
focus on negative messages rather than positive -consistent negative thoughts leads to feelings of incompetentness and worthlessness
primary prevention focuses on...
focuses on health promotion and protection against disease -wellness, prepathology
What is civil law?
focuses on the legal rights and duties of private parties-- most legal actions against nurses are civil
Arrange the steps of the research process used in evidence-based practice in the correct sequence (1.1 remember)
formulate research problem determine study methods collect research data analyze research data communicate research findings use research findings in practice
What is the energy field concept?
fundamental unit of living that is open, dynamic, and in continuous motion and change
What happens during acquisition?
gained by learned responses
Describe the forming group developmental stage
group members are excited about participating
If the client is incompetent, consent or refusal must be given by...
guardian or next of kin
3 common ways to commit suicide
gun, hanging, jumping from building
Mental health vs Mental illness mastery of environment
health = control over environment illness = controlled by environment
Mental health vs mental illness autonomy
health = functons independently illness = dependent functioning
Mental health vs mental illness growth and development
health = normal illness = delayed
Mental health vs Mental illness reality perception
health = oriented to persn, place, and time illness = hallucinations or delusions
Mental health vs mental illness integration
health = social support system available illness = lack of social support system
The nurse is to provide an assessment for a client of Asian descent and the family. What would the nurse need to understand related to the client and family's worldview? (1.3 pretest)
health care practices, values, language and health care beliefs
According the Peplau, the purpose of nursing is to...... and the foundation of nursing practice is what?
help the client identify those difficulties that are causing problems; the nurse-client relationship
function of indolamine?
helps with temp regulation and mood
What actions of considered "bad me" in the self system?
hidden aspects of self that are considered negative, such as feelings of guilt
What factors place patient at risk for depression?
history of abuse, significant loss, dysfunctional family relationships, family/personal history of mental illness, substance abuse Life altering event (divorce, break up, significant loss, loss of job): situational depression
What occurs during the perception stage?
identify the need for brokering by recognizing barriers to health care access
Affect is...
immediate emotional expression of mood that is expressed verbally or nonverbally. More fluctuating emotional state than mood and can be observed externally
Describe neurobological theory of depression
impaired neurotransmission, limbic dysfunction -excess or deficiency in NE, serotonin, acetylcholine, dopamine -MAO imbalance -thyroid dysfunction
For the suicidal client, nursing interventions are aimed at....
improving feelings of hope, enhancing self-confidence, decreasing suicidal thoughts, and other considerations
This century (21st) has seen a greater number of mentally ill being ___________. Also, many mentally ill are _________
incarcerated, homeless
What are all the s/s of serotonin syndrome?
include restlessness or agitation, headache, diaphoresis, ataxia, myoclonus, shivering, tremor, diarrhea, nausea, abdominal cramps, and hyperreflexia.
Describe the Roy model of adaptation
includes 4 adaptive modes that occur when client is faced with a stressful situation: physiologic, self-concept, role function, and interdependence. Those with mental illness have trouble adapting properly
What is the physiologic mode of adaptation?
includes need for oxygenation, nutrition, elimination, protection, rest and sleep
What is an adverse effect of antidepressants in children and adolescents?
increase in suicidal ideation/behavior
Short-term commitment is now the standard in California and New York, rather than...
indefinite stays in psychiatric hospitals -review of mental status is required by courts to extend commitment for another short period of time
What is the difference between independent and collaborative interventions?
independent can be performed by the nurse as needed collaborative/dependent need order from primary care provider
the doing for others attribute involves what nursing action?
initiating competent, skillful nursing interventions that comfort and promote health
A client is being admitted for treatment of major depressive disorder. Which symptom should the nurse anticipate the client would experience during hospitalization? (7.2 post)
insomnia
What is the definition of nonmaleficence as it relates to bioethics? (1.3 remember)
intention to do no wrong
What is the function of the hippocampus?
involved in emotional reactions and learning; processes, stores, and retrieves memories
what is justice?
involves treating everyone fairly and equally -raises the question of whether MH care should be available to everyone or only those who can pay for the services -true justice dictates that benefits and burdens should be distrubuted equally among all people
What is bioethics?
it applies ethical reasoning to issues in healthcare
Why is spirituality important for mental health?
it helps to increase the individual's emotional strength and resilience
Which action could a nurse take to demonstrate cultural competence? (1.1 remember)
keep knwoledge of different cultures current
What is anhedonia?
lack of pleasure in normally pleasing activities
What cultural factors signify mental illness? (6)
lack of resources substance abuse or dependence violence poverty ageism sexism
behavioral theorists suggest that all behavior is _________, founded on the work of what two theorists?
learned; Pavlov, Skinner
Are clearly stated goals more or less restrictive than ambiguous or nonexistent goals?
less
What is hypomania?
less severe than mania, no psychotic features
Which complementary and alternative medical therapies are often used in the treatment of mental illness? (1.2 remember)
light therapy, guided imagery, massage therapy, aromatherapy
What is one nonpharmacologic therapy specifically for seasonal affective disorder?
light therapy/phototherapy-- application of different forms of light to skin and eyes at different times to reduce fatigue and depression
interpersonal factors theory of depression
loss (real of symbolic) of another person, relationship, item, self-esteem, or sense of security -inability to achieve goals or feelings of no control in life
What 5 interpersonal factors signify mental illness?
loss of emotional control ineffective communication manipulation excessive dependency withdrawal from relationships
The sustaining faith in others attribute involves what nursing action?
maintaining hopefulness and being persistent
Cultural considerations for muslims regarding mood disorders
may view suffering within a religious context of martyrdom
Documentation of informed consent should be recorded in the patient's ________ ________, along with the client's signed _______ ________
medical record; consent form
A severely depressed client received electroconvulsive therapy (ECT) this morning. Which finding would the nurse recognize as normal posttreatment? (7.2 pre)
memory loss: transient, short-term
Suicide is the seventh leading cause of death for which group? (9.5 rem)
men; women are twice as likely to attempt suicide
How does the nurse give care interdependently?
might include working collaboratively with a nutritionist to ensure that the client is maintaining a balanced diet.
Children and adolescents with bipolar disorder often present with....
mood and behavioral changes such as: being unusually silly or happy, little sleep but not acting or feeling tired, talking a lot, expressing racing thoughts
Is long-acting medication more or less retrictive than short-acting
more
What are unintentional torts?
negligence/malpractice
What is the Theory of Goal Attainment?
nurse and patient communicate info, set goals together, and then take actions to achieve those goals. Interpersonal relationship that allows a person to grow and acheive life goals.
What aspect will the nurse address in the psychosocial history of the nursing assessment of a client with bipolar disorder? (7.3 rem)
observation of client affect
Which lobe of the brain is involved in all aspects of visual processing? (1.2 remember)
occipital
what is negligence?
occurs whenever a nurse fails to act in a manner in which most reasonable and prudent people would act -guidelines for what is reasonable and prudent can be found in the NPA, civil and criminal law codes, and guidelines for standards of nursing care at the facility you work at
What is ethnicity?
one's sense of identity and belonging to a certain social group. Might be based on common religion or ancestry, language, cultural, or tribal origins
While Pavlov = classical conditioning, Skinner = ____________ conditioning
operant
function of parietal
performs sensory functions
Clients who are involuntarily placed in a psychiatric hospital have the right to....
periodic review of their mental status to avoid indefinite committment
The nurse is planning care for a client with seasonal affective disorder (SAD). After which intervention would the nurse expect to see improvement in emotional stability? (7.2 post)
phototherapy
Although mental health care includes__________ ___________, its main focus is on....
physical care; your effective communication with your client
What 6 individual factors signify mental health?
positive self-worth vitality meaningful life sense of harmony positive identity biologic factors
According to Piaget's stages of cognitive development, what stage is indicated by the characteristic of prelogical thought to solve problems? (1.2 remember)
preoperational
What are the 3 levels of prevention?
primary: addresses issues of education and health promotion secondary: early diagnosis and health restoration tertiary: need for conservation to reduce further complications
Which nursing intervention is initiated for a client diagnosed with major depressive disorder? (7.2 R)
promoting client safety (other interventions focus on reducing negative thinking and hopelessness)
What is crucial in minimizaing the risk of legal liability should a client seek legal recourse?
proper documentation that follows facility guidelines
What is the ADA
protection to those with physical or mental disabilities that allows them to have access to public services, employment, and benefits
Which task may an advanced practice nurse perform that a nurse generalist may not perform? (1.1 remember)
psychotherapy
positive punishment?
reduce behaviors by adding a negative punishment
negative punishment?
reduce behaviors by adding positive reinforcers or rewards
what is the pattern concept?
refers to the enrgy field of the client and the patient, which is constantly changing
What is negative reinforcement?
remove negative consequences to increase positive behavior
How to accomplish justice during a research project?
research subjects must be treated fairly and given what is due to them
tertiary prevention focuses on....
restoration and rehabilitation -return to wellness, rehabilitation
what is positive reinforcement?
rewards given to increase a behavior
Edward Jones is a 64-year-old man who lives in a shelter and was brought to the clinic for a psychiatric evaluation. Based on Maslow's hierarchy of needs, what level has top priority for Mr. Jones at this time? (1.2 apply)
safety
________ is the highest priority for patients at risk for committing suicide
safety
According to Sister Callista Roy, what adaptive mode has a related need that involves a sense of purposefulness in the universe? (1.2 remember)
self-concept
The nurse is caring for an adolescent client diagnosed with depression. Which assessment findings support this diagnosis? (7.2 post)
self-neglect: Whininess is a manifestation of depression in a preschool child. Boredom and threats to run away are manifestations of depression in a school-age client.
What cultural factors signify mental health? (4)
sense of community adequate resources intolerance of violence support of diversity among people
Info cannot be disclosed about a client without a....
signed release form
Deficiency in Acetylcholine causes....
sleep disturbances in bipolar disorder
The nurse observes the client in prayer with family. Which cultural phenomenon would the nurse recognize is occurring? (1.3 posttest)
social organization
Which member of a mental health treatment team is responsible for identifying and securing appropriate outside resources for the client? (1.1 remember)
social worker
function of the superego
strives for perfection; the foundation of values, beliefs, morals;promotes feelings of guilt
humanists believe that mental illness results from..... because.....
stunted human growth, stress, poor environmental and social conditions; they believe all humans are fundamentally good and strive to meet basic and higher-order needs
A nurse is caring for an adolescent client with bipolar disorder. The nurse understands that this client may also have additional psychosocial alterations. Which condition is most likely complicating the client's diagnosis? (7.3 post)
substance abuse: While the client may also have anorexia nervosa, schizophrenia, or a personality disorder, the client is not at a greater risk for developing these conditions than any other client.
A nurse is caring for a client with bipolar disorder with a depressive episode. The client tells the nurse, open double quote"I don't know why I even try anymore. I always fail at everything in my life. I should just give up.close double quote" What aspect of the psychosocial history during the nursing exam is most important at this time for this client? (7.3 pre)
suicide assessment
You are assessing Doreen Hampshire, a 25-year-old woman who has mood swings, has regularly been calling in sick to work, and has withdrawn from her friends. Which best describes this phase of a suicidal client? (9.5 apply)
suicide threat: more serious than suicidal ideation and might include behavior changes, mood swings, personality changes, changes in work or school performance, withdrawal from friends and family, and significant attitude changes. Suicidal ideation occurs when the client thinks about suicide as a possible solution to life's problems.
What personality structure promotes feelings of guilt? (1.2 remember)
superego
Define resilience
the ability to function with healthy responses, even when facing significant stress and adversity -involves the process of adapting and adjusting to a crisis -able to bounce back -through their successes they gain coping skills and utilize resources that aid in facing future challenges -capacity to make realistic plans and proceed to take steps to reach their goals
What is cultural brokering?
the act of bridging between or linking groups of people from different cultural systems to reduce conflict or produce change -need for this is seen with the disadvantaged client who is powerless to access health care due to culutral, economic, personal, or political reasons
function of libido
the center of sexual pleasure
Describe the voluntariness element of informed consent.
the client must not be forced or coerced to give consent
Define hardiness
the client's ability to resist stress, anxiety, and depression -allows person to accept the loss as a fact of life
What occurs during the working phase?
the focus is on addressing issues of concern to the client and exploring different approaches to problem solving
What is autonomy?
the freedom to choose a course of action, act on that choice, and live with the consequences -let clients make choices -nurse helps client understand the information and options and then supports the client's choice
What is nonmaleficence?
the intention to do no wrong -actions motivated by helpfulness based on knowledge of psychiatric and mental health theory -caring for clients under this principle requires self-awareness
Sigmund Freud's psychoanalytic theory focuses on.....
the levels of consciousness and the role of conflict in the development of mental disorders
What occurs during the orientation phase?
the nurse and client begin to lay the foundation for trust and establish the contract for the relationship, including informing the client when the relationship will end
What occurs during the termination phase?
the nurse and client evaluate the progress of the relationship and whether the identified goals have been met (this phase is addressed throughout the nurse-client relationship).
What occurs during the pre-orientation phase?
the nurse reviews the client's chart and prepares for the first encounter
What happens during the conditional response stage?
the pairing of stimulus + response
What is beneficence?
the principle of promoting the good of others or trying to do things to benefit others -helping others
What is the function of the id?
the source of all drives and instinct; focuses on the pleasure principle and attempts to satisfy all of an individual's needs with no concerns for consequences
Depressive mood disorders are spectrum disorders because....
they can range from mild to severe
What actions of considered "good me" in the self system?
things that are shared with others becasue they bring a sense of pride
How does the nurse give care dependently?
to administer, assess response to, and watch for side effects from prescribed medications used to treat the client's illness.
What is the goal of ACT programs?
to prevent rehospitalization by providing comprehensive, integrated community services
What is the openness concept?
transcends time and place
T or F: The client must suffer harm that is directly linked to the nurse's failure to act in a reasonable and prudent manner for it to be considered negligence
true
nursng interventions during the depressed stage of bipolar disorders and cyclothymia are they same as they are for someone who has depression T or F
true!
T or F: The nurse should follow the client's expressed wishes regarding spiritual care
true: the nurse's role often focuses on respectign spiritual beliefs related to diet and nutrition, healing, dress, birth and death
The knowing attribute involves what nursing action?
trying to understand how the client views life
What is interpersonal psychotherapy?
used to identify and resolve client's interpersonal difficulties-- prolonged grief, social isolation, early development of dysfunctional social behavior
Cultural considerations for buddhists regarding mood disorders
view suffering as a positive feature in life
Trevor Green is a 50-year-old man in a mental health clinic. What phase of the nurse-client relationship are you in if you are addressing the client's issues of concern? (1.2 apply)
working
To understand and plan for the needs of a specific cultural group, a nurse must have an understanding of that group's ________
worldview
What 6 individual factors signify mental illness?
worries loss of meaning in life sense of disharmony fears anxiety biologic factors
A clinical group of nursing students is discussing whether all mentally ill clients should have access to the same quality of care. Which response best indicates an understanding of the ethical principle of justice? (1.3 posttest)
"Every client with a mental health illness is entitled to quality care."
You are working as a client advocate for Ms. Perillo, a single, 30-year-old woman who has major depressive disorder. Ms. Perillo is responding well to treatment, and after several months she tells you that she recently became engaged. She then tells you that her fiancé is a convict who is in prison for drunk driving, and she has never met him in person. Ms. Perillo asks you if you support her decision to marry the convict. What is your best response to Ms. Perillo's question? (1.1 apply)
"Let's talk about the decision you are making."
The client asks the nurse what the purpose of managed care is for inpatient treatment of the client's mental illness. What is the nurse's best response? (1.1 posttest)
"The costs and outcomes are carefully reviewed to ensure that treatment goals are achieved."
You are caring for Ms. Klee, a young woman who has been prescribed an antidepressant that is known to cause weight gain in some clients who take it. You feel that Ms. Klee could truly benefit from this antidepressant. However, in the past, Ms. Klee has expressed a desire not to take medication that causes weight gain. Ms. Klee asks you if the antidepressant causes weight gain. What is your best response to her question? (1.3 apply)
"This medication has been known to cause weight gain in some clients."
You are a nurse on a team that is treating Mr. Weldyn, a man with schizophrenia who recently became homeless. While you are making an assessment of Mr. Weldyn, he tells you that he used to be a store manager, but he lost his job due to his illness. Later, his wife divorced him, and he lost most of his friends. Mr. Weldyn asks you what the treatment team can do to help him with his problems. What is your best response to Mr. Weldyn's question? (1.1 apply)
"We will help you find a place to live and a job." (primary goals of a treatment team for a client with mental illness)
1.1 Pretest Q4: The nurse is discussing stress management strategies with a client who is experiencing extreme stress after surviving a tornado that damaged the client's home. The client asks why the neighbor, who lost everything, was coping and helping others. What is the nurse's best response to the client?
"Your neighbor has learned to adapt and to adjust to previous tragedies in life."
An adolescent client is involuntarily committed for attempting suicide. Which intervention can help the client identify healthy coping mechanisms? (9.5 post)
Cognitive-behavior therapy
Characteristics of seasonal affective disorder
-MDD that has seasonal pattern (periods of low natural light) -the longer the period of darkness, more prominent the symptoms -
What comorbid disorders increase risk of suicide or often are present in those who attempt suicide?
-MDD, other mood disorders, personality disorders, conduct disorder, and schizophrenia -substance abuse disorders -suffering from poor impulse control, depression, and altered consciousness
Which ethnicities have the highest rates of suicide?
-Whites and American Indians
What are the 3 most common forms of therapy for suicidal client
-one-on-one -group -family
List 10 descriptors of affect
1.) Appropriate 2.) Inappropriate 3.) Full range 4.) Stable 5.) Labile 6.) Elevated 7.) Depressed 8.) Overreactive 9.) Blunted 10.) Flat
What are the 10 clinical caritas processes?
1.) Forming a humanistic-altruistic system of values 2.) Instilling faith and hope 3.) Cultivating sensitivity to one's self and to others 4.) Developing a helping, trusting relationship 5.) Promoting and accepting the expression of positive and negative feelings 6.) Assisting with gratification of human needs 7.) Systematically using the scientific problem-solving method for decision making 8.) Promoting interpersonal teaching and learning 9.) Providing a supportive, protective, or corrective mental, physical, sociocultural, and spiritual environment 10.) Allowing for existential-phenomenologic forces
What two pieces of legislation have implications for mental health clients rights?
1.) The Americans with Disabilities Act (ADA) 2.) The Patient Self-Determination Act (PSDA)
What centry was the "era of psychiatry"?
20th
age range and characteristics of phallic/oedipal stage
3-6: attraction to parent of opposite sex; boys develop oedipal complex, girls Electra complex
Approx ____% of patients do not respond to antidepressants w/in 4-6 weeks
30
What constitutes a depressive episode?
5 or more symptoms in a 2-week period that demonstrate either a depressed mood or a decrease in pleasure or interest in daily activities
Roughly _____% of those who attempt suicide were depressed at the time of their suicide
67
What is adjustment disorder with depressed mood?
AKA situational depression; a dysfunctional response to a life-changing event that occurs within 3 months of onset of stressor and lasts less than 6 months -symptoms are similar but less severe than those seen in other depressive disorders but impair at least one of the following: school, work, relationships, daily life activities
The nurse leaves an electronic medical record (EMR) open on the computer in a client's room. The family reads the client's record, including lab test results that reveal the client has HIV. What are the legal ramifications of this action for the nurse? (1.3 pretest)
Accused of failing to maintain confidentiality
Stable?
Affect is resistant to sudden changes when there is no provocation in the environment
What is important to know about SSRIs relating to suicide?
Although they are given to try to prevent suicide, they may potentiate suicide ideation
What organization established the standards of care in psychiatric-mental health nursing?
American Nurse's Association (ANA)
What is mania?
An abnormal and persistent period of increased, expanded, or irritated mood characterized by increased energy for a time and may include psychotic symptoms, such as hallucinations or delusion. Flight of ideas (rapidly changing, fragmented thoughts) -lasts at least a week -impairs social or occupational functioning and often requires hospitalization