Mental Health Exam 1

Lakukan tugas rumah & ujian kamu dengan baik sekarang menggunakan Quizwiz!

Somatic disorder

(Hypochondriasis) persistent psychological problem that converts to physical symptoms, no apparent physical cause

S/S of panic disorder

*Fear of impending doom, fear of future panic attacks, SOB* -tachy -sweating -chills -problems with breathing -tingling/numbness -chest pain -nausea/dizzy

The nurse should plan which goals of the termination stage of group development?

- the group evaluates the experience. - The group explores members' feelings about the group and the impending separation.

The nurse calls security and has physical restraints applied to a client who was admitted voluntarily when the client becomes verbally abusive, demanding to be discharged from the hospital. Which represents the possible legal ramifications for the nurse associated with these interventions? Select all that apply.

-Battery -Assault -False imprisonment

A patient is experiencing anxiety and alcohol addiction. What are the best courses of treatment?

-Buspar -Clonidine -Propranolol -Cognitive behavior therapy

Treatment for somatic disorder

-CBT -group

Treatment for PTSD

-EMDR (eye movement desensitization and reprocessing) -Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) -Benzos -Clonidine -Propranolol -antipsychotics (only for severe)

EMDR

-Eye-movement Desensitization & Reprocessing. -For PTSD -client imagines the traumatic event and processes it in a non-threatening manner.

The nurse in the mental health unit plans to use which therapeutic communication techniques when communicating with a client? Select all that apply.

-Restating - Listening - Maintaining neutral responses - Providing acknowledgment and feedback

Aspects of therapeutic milieu

-Safety (most important) -Structure (environment and regulations) -Normal (expectations) -Limit setting (limits to behaviors & consequences) -Balance (independence and dependence)

S/S of benzo withdrawal

-agitation -tremors -irritability -vomiting -convulsions -psychotic episodes

S/S of Xanax withdrawal

-agitation -tremors -irritability -vomiting -convulsions -psychotic episodes -insomnia -sweating

When to seek consent from guardians?

-change in meds -if pt needs to be admitted involuntarily

Laws affecting mental health nursing

-constitution -statutory law (state/federal) -common law (legal cases) -administrative law (joint commission) -centers for Medicare

S/S of PTSD

-nightmares -flashbacks -intrusive thoughts -hypervigilance -hyperarousal -irritability -angry outbursts

OCD is characterized by...

-repetition -ritualistic activities -recurrent intrusive thoughts -fear of losing control -interference with regular activities

If you stop a benzo you have been on for years, the nurse should initiate what type of precautions?

-weaning do not stop all the sudden. May cause seizures

Restraint/seclusion guidelines

1. Staff must be trained 2. Alternatives must be considered first 3. Physician order required within 1 hour of restraint or seclusion 4. Least restrictive method must be chosen 5. Nurses should complete all documentation 6. Orders must contain restraint type, rationale, and time limitations 7. PRN orders not permitted. Each episode based on eminent risk 8. Restraint/seclusion for shortest possible time; reevaluate every 2 hrs 9. Constant observation and Q15min documentation 10. Pts must be debriefed after 11. Pts have right to notify family 12. Death of pt in restraints must be recorded to FDA

Age of identity vs role confusion? Favorable/unfavorable outcomes?

13-21y Favorable: seeing oneself as unique and integrated Unfavorable: confusion over who and what really is

Age of autonomy vs shame and doubt? Favorable/unfavorable outcomes?

18 months to 3 years Favorable: sense of self/control and adequacy Unfavorable: feelings of shame/self-doubt

Buspar (buspirone)

1st line Anti-anxiety Long term Treat alcohol addiction

When planning the discharge of a client with chronic anxiety, the nurse directs the goals at promoting a safe environment at home. Which is the most appropriate maintenance goal? 1. Suppressing feelings of anxiety 2. Identifying anxiety-producing situations 3. Continued contact with a crisis counselor 4. Eliminating all anxiety from daily situations

2

When do SSRI's begin to work? When does it reach full potential?

2 weeks 4-6 weeks

How long does Ativan take to work?

20-30 min

Age of intimacy vs isolation? Favorable/unfavorable outcomes?

21-39y Favorable: ability to make commitments to others/love Unfavorable: inability to form affectionate relationships

Age of initiative vs guilt? Favorable/unfavorable outcomes?

3-5yrs Favorable: able to be self starter Unfavorable: sense of guilt/inadequacy to be on ones own

Age of generativity vs stagnation? Favorable/unfavorable outcomes?

40-65y Favorable: concern for family and society Unfavorable: concern only for self and ones prosperity

Age of industry vs inferiority? Favorable/unfavorable outcomes?

5-13y Favorable: ability to learn, understand and organize Unfavorable: sense of inferiority at understanding and organizing

Age of integrity vs despair? Favorable/unfavorable outcomes?

65+ Favorable: sense of fulfillment and willing to face death Unfavorable: dissatisfaction with life and despair over prospect of death

When does buspar begin to work? When does it reach full potential?

7-10 days 1-6 weeks

Client with GAD presents with restlessness, irritability, bp 140/90, pulse 96, RR 20. On the basis of these assessed data, which assumption would be correct?

A physical exam is needed to determine the etiology of the clients symptoms

Nurse doesn't speak, but he/she does maintain eye contact and nod their head when the patient speaks.

Active listening

Why is ativan only given PRN/when patient has panic attack?

Addicting and short acting

How does OCD affect the brain?

Affects surface area and thickness of the cortex in the brain unregulated serotonin

Silence (therapeutic communication)

Allow pts to think and say more

Goal of erikson model

Analyze developmental issues, fears, and barriers to growth to master skills

Client diagnosed with OCD. Which nursing diagnosis takes priority?

Anxiety R/T regression of ego development AEB ritualistic behaviors

A pt starts talking about spirits and how they talk to them. What should you ask?

Ask if they are spiritual. Do not assume they are hallucinating

Clarification (therapeutic communication)

Asking pts to restate, elaborate, or give examples of ideas or feelings

1st line treatment for panic disorder?

Benzos

Goal of Freud model

Bringing unconscious into the conscious

"What do you mean by..."

Clarification

Making observations (therapeutic communication)

Commenting on what is seen or heard to encourage discussion

Defense mechanism: Malcolm who is depressed and unable to share his feelings with others, writes and becomes known for his expression poetry.

Compensation

Factitious disorder

Condition in which a person acts as if he or she has a physical or mental illness when he or she is not really sick.

Pt States, "I really want to find ways to relax, but I don't have time for yoga or massages." Nurse states, "On one hand you want to relax, but on the other hand you are saying you don't have time. How do you feel about this conflict?"

Confrontation

Rationalize

Conscious or unconscious attempts to make or prove that one's feeling/actions are justifiable

Internationalization

Consciously or unconsciously using only logical explanations without feelings or an affective component

A client admitted voluntarily for treatment of an anxiety disorder demands to be released from the hospital. Which action should the nurse take initially?

Contact HCP

Defense mechanism: Student wakes up with a migraine the morning of a final exam and feels too ill to take a test. If she doesn't pass the exam, she will flunk out of nursing school.

Conversion

What is the guide book for working with psych patients?

DSM-5

Defense mechanism: Max who is alcohol dependent believes he can control his drinking if he desires

Denial

Goal of attachment model

Develop safe/secure emotional bonds

Defense mechanism: Mrs. Adams recalls that when her husband was yelling at her she didn't feel anything inside, she just went numb

Disassociation

Defense mechanism: A husband comes home from a hard day at work and yells at his wife and kids

Displacement

Tarasoff vs. region to the University of California

Duty to warn of threats of harm to others

How to respond to a patient regarding unit milieu

Educate pt on unit orientation -safety first

Attachment model

Emotion centered treatment method by developing safe and secure emotional bonds in relationships' "How does that make you feel"

Nurse states, "This must be very painful for you to discuss."

Empathy

Goal of recovery model

Empower consumer/family to manage treatment

A patient begins to have a panic attack. What is the first thing you do? What med do you give as next step?

Ensure they are safe and be there for them Ativan

Developmental model

Erikson Analyzing developmental issues, fears, and barriers to growth to facilitate mastery of developmental tasks "I can help you look at ways to develop your ability to trust others"

Norms

Expected behavior in milieu to promote safety and trust -hygiene -dont harm self -attend group -focus on treatment plan

Involuntary patients can be forced to take psych meds even if they refuse T/F

False

Least restrictive environment helps avoid what?

False imprisonment

Which S/S would nurse expect from client with agoraphobia?

Fear of standing in line Fear of being outside of home alone Fear of traveling in a car

Benzo overdose antidote

Flumazenil (Romazicon)

"explain more about..."

Focusing

Psychoanalytical model

Freud Personality centered treatment method Bringing unconscious to conscious by enhancing awareness of self and ones effect on others "Tell me about your relationship with your mother"

When a patient in the mileu requires seclusion, what should you consider for the other patients?

Heightened anxiety from the situation may require medication Ensure they are safe and doing okay

Confrontation (therapeutic communication)

Helping patient become aware of inconsistencies in his feelings, attitude, beliefs, behaviors

Defense mechanism: Kelly states to the nurse "When I get out of the hospital, I want to be a nurse just like you"

Identification

McNaughten Rule

If individual is declared insane they cannot be legally accountable for murder

Age of trust vs. mistrust? Favorable/unfavorable outcomes?

Infant-18 m Favorable: faith in environment/Future Unfavorable: suspicion/fear

The nurse is working with a client who despite making a heroic effort was unable to rescue a neighbor trapped in a house fire. Which client-focused action should the nurse engage in during the working phase of the nurse-client relationship?

Inquiring about and examining the client's feelings for any that may block adaptive coping

Defense mechanism: Rene talks about her sons death from cancer as being merciful and shows no signs of sadness or anger

Internationalization

Defense mechanism: Without realizing it Marie talks and acts similarly to her therapist, analyzing other pts

Introjection

Goal of Interpersonal model

Learn effective interpersonal skills using pt/nurse relationship to analyze interpersonal processes and test new skills

Interpersonal model

Learning effective interpersonal skills by using the nurse/pt relationship as a vehicle for analyzing interpersonal processes and testing new skills "Lets talk about what kind of tings make you nervous in your relationship with your father"

Nurse states, "You seem really upset today."

Making observations

What is the psychologist responsible for?

Meds

When reviewing pts chart she notices client was admitted involuntarily. What nursing intervention is priority?

Monitor closely for harm to self and others

Presenting reality (therapeutic communication)

Offering a view of what is real and what is not without arguing without the pt

Suggesting (therapeutic communication)

Offering help to solve problems

States, "I'll stay with you for a while."

Offering self

A client experiencing disturbed thought processes beliefs his food is poisoned. Which communication technique should the nurse use to encourage the client to eat?

Open ended questions and silence

Questioning (therapeutic communication)

Open ended questions to achieve relevance and depth in discussion

Therapeutic relationship phases

Orientation: -beginning of partnership between nurse/pt -nurse informs pt about role, completes assessment, agrees on goals/expectations Working: -works to achieve goals Termination: -goals have been met -sharing feelings related to ending of therapeutic relationship

Level 5 Anxiety

Panic -requires supervision -perceptions greatly disorganized -control of self is lost

Active listener (therapeutic communication)

Paying close attention to verbal and nonverbal communications

How long do panic attacks last?

Peak: 10 min Up to: 30 min

Which part of brain responsible for personality?

Prefrontal cortex in the frontal lobe

Nurse states, "I know the things you are seeing are real to you; however, I don't see them."

Presenting reality

Defense mechanism: Connie blames her husband for the fight last night, unable to recognize that she started it

Projection

Examples of SSRIs

Prozac Zoloft Luvox Paxil

Recovery model

Pt centered treatment method by empowering pt/family to define and manage treatment options "What are your treatment goals?"

Wyatt vs. Stickney

Pts have right for adequate treatment and cannot be treated like slaves

Rogers vs. Achen

Pts have right to refuse and cannot be forced to take meds against will

Focusing (therapeutic communication)

Pursuing a topic until meaning/importance is more clear

Nurse is assessing a client and states, "Tell me about your relationship with your husband."

Questioning

Defense mechanism: John tells his mom that he bit his sister because she pushed him first

Rationalization

Defense mechanism: Wren, whos parents are divorcing, tells her mother she doesnt want to spend time with her dad (so her mother doesnt get mad) even though she really misses him

Reaction formation

Empathy (therapeutic communication)

Recognizing/acknowledging pts feelings

Defense mechanism: 5 year old has been wetting his bed since the birth of his baby sister

Regression

Restating (therapeutic communication)

Repeating pt to remind them and let them know they are heard

Defense mechanism: Anna, a victim of incest, has limited memory of her childhood

Repression

Nurse states, "You say that you are an only child."

Restating

Summarizing (therapeutic communication)

Reviewing main points and conclusions

Best meds for treatment of OCD

SSRIS or clomipramine

What is the first line treatment for anxiety?

SSRIs/buspar

Side effects of Ativan

Sedation, dizziness

Level 4 Anxiety

Severe -fight/flight -disorganized -increase motor activity

Pt. states, "I am having trouble with my marriage. My husband doesn't understand me. He comes home from work and sits on the couch. I have to do everything around the house." Nurse sits quietly and listens to patient

Silence

A client is unwilling to go out of the house for fear of "making a fool of myself in public." Because of this fear, the client remains homebound. Based on these data, which mental health disorder is the client experiencing? 1. Agoraphobia 2. Social phobia 3. Claustrophobia 4. Hypochondriasis

Social phobia

What is the chaplain responsible for?

Spiritual concerns

Therapeutic Milieu

Stable, structured, and safe emotional and physical environment that provides ongoing therapy of various types for a psychiatric patient.

The client is experiencing a panic attack. He states "I'm losing control. I feel like I'm going crazy". Which nursing intervention takes priority?

Stay with client and offer support

Defense mechanism: Guy, a former heroin addict, starts a local narcotic anon meeting

Sublimation

Goal of cognitive behavioral model

Substitute rational beliefs for irrational ones

Cognitive-behavioral model

Substituting rational beliefs for irrational ones to reduce nonproductive behaviors "Lets make a list of advantages and disadvantages of thinking and acting that way"

Nurse asks, "Have you ever considered going for a massage?"

Suggesting

Nurse states, "So far you have said that..."

Summarizing

Defense mechanism: Aaron states to the nurse that his recent divorce is not a big deal

Suppression

T/F: Always ask for permission before hugging pt.

T

What is the most important skill a psych nurse can possess?

Therapeutic communication

What is the nurse responsible for?

Therapeutic communication

If a person requires a higher dose after an amount of time to receive the safe effect, what is that?

Tolerance

Defense mechanism: After accidently eating another pts cookies, Don apologizes to his peer, cleans the fridge, and labels everyone's snacks with their names.

Undoing

When to seclude patient

When they are at risk of harming self or others

Treatment for phobias

Xanax, ativan (short acting) SSRIs, SNRIs, clonidine, propranolol

Conversion disorder

a disorder in which a person experiences very specific genuine physical symptoms for which no physiological basis can be found

Reaction formation

conscious behavior that is the exact opposite of an unconscious feeling

Suppression

conscious exclusion from awareness anxiety-producing feelings, ideas, or situations

Identification

conscious or unconscious attempt to model oneself after a respected person

Compensation

consciously covering up for a weakness by overemphasizing or making up a desirable trait

Undoing

consciously doing something to counteract or make up for a transgression or wrongdoing

Sublimation

consciously or unconsciously channeling instinctual drives into acceptable activities

A client admitted to a medical nursing unit with a dx of acute blindness after being involved in hit and run. When dx testing cannot identify any reason why the client cannot see, a mh consult is prescribed. The nurse plans care based on which condition?

conversion disorder

Mileu

environment

Pyrophobia

fear of fire

Agoraphobia

fear of public spaces where it might be hard to escape quickly

Arachnophobia

fear of spiders

A culturally competent psychiatric nurse does what?

knowledge about the process of cultural competence but also incorporates cultural competence into interactions with peers, students, patients, families, and communities

Offering self (therapeutic communication)

making oneself available and showing interest/concern

Level 2 Anxiety

mild -can be healthy

Barriers to culturally competent care

miscommunication, failure to assess for a cultural perspective, and differences in worldview.

Level 3 Anxiety

moderate -learning can still take place but may need assistance

Are SSRIs effective for PTSD?

no

Level 1 Anxiety

none/little anxiety -helpful/motivating

Social phobia

overwhelming fears of social situations

Co-occurring inpatient units

pts with both mental health disorder and substance abuse

Utmost concern in psych?

safety

Nursing interventions related to spiritual needs

take a spiritual hx, show support and respect to pts beliefs, can pray with pt if nurse is comfortable and if pt requests, provide spiritual care by being kind, gentle, sensitive, and compassionate, refer to pastoral care

Repression

unconscious and involuntary forgetting of painful ideas, events, and conflicts

Conversion

unconscious expression of intrapsychic conflict symbolically through physical symptoms

Denial

unconscious refusal to admit an unacceptable idea or behavior

Regression

unconscious return to an earlier and more comfortable developmental level

Disassociation

unconscious separation of painful feelings and emotions from an unacceptable idea, situation, or object

Displacement

unconsciously discharging pent-up feelings to a less threatening object

Introjection

unconsciously incorporating values and attitudes of others as is they were your own

Projection

unconsciously or consciously attributing one's own repressed thoughts to someone else

How long do SSRIs take to work?

up to 10-12 weeks usually 4-6 weeks

Therapeutic Communication

verbal and nonverbal exchange which enhances trusting nurse pt relationship to client centered, goal specific, and theory based


Set pelajaran terkait

Biology 152 - Launchpad Quiz Terms

View Set

Chapter 4: The Tissue Level of Organization (multiple choice)

View Set

geometry b - unit 5: three-dimensional figures lessons 20-23

View Set