N340 Exam 2 Flashcards Combined

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Why learn evidence analysis? From mid to late ______: ○ Consensus scientific knowledge should be basis for nursing practice ○ Division of Nursing began funding research utilization projects ○ Nursing should be backed up by research and scientific evidence ○ This established nursing as more of a profession ○ Begins with educating our clients, we must be sure our education is backed by evidence

1970's

What is the focus of priority nursing interventions for the period immediately after electroconvulsive therapy (ECT) treatment? a.Nutrition and hydration b.Supporting physiological stability c.Reducing disorientation and confusion d.Assisting the patient to identify and test negative thoughts

When a nurse assesses a family, which family task has the highest priority for healthy family functioning? a.Allocation of family resources b.Physical maintenance and safety c.Maintenance of order and authority d.Reproduction of new family members

What depressive disorder is described below: Nursing Process ○ Assessment → SAFETY, SAFETY, SAFETY! ■ Nursing assessment or the facility ■ Screening tools (Hamilton Depression Scale, Beck Depression Inventory, Patient Health Questionnaire)

Major Depressive Disorder

When talking about the history of epidemiology: During the 19th Century: ___ ____ created vaccinations (what they can do and how they can help us)

Edward Jenner

first generation or second generation antipsychotics? ● Other side effects of typicals: ○ orthostatic hypotension - teach; ○ anticholinergic effects (dry mouth, constipation, etc.) ○ endocrine effects; ○ photosensitivity; ○ tachycardia; ○ sedation; ○ weight gain (metabolic syndrome); ○ agranulocytosis

1st generation

When talking about the history of epidemiology: During the ____ Century: ● Epidemiology shift from single cause (cause of cholera) to multifactorial ○ Can be mulitfactorial not just single cause ● Multifactorial (view contributing factors) ○ Some diseases can be prevented or delayed ○ Example: studying cardiovascular disease ■ Behavioral (things that can affect it, how did they eat?) ■ Environmental ● Development of genetic impact ○ Diabetes ○ Some cancers ● New infectious diseases (HIV/ AIDS, SARS) ○ Zika virus, Lyme disease, coronavirus, etc. ● Public health preparedness for bioterrorism ● Development of genetic and molecular techniques

20th

When talking about the history of epidemiology: During the ____ Century: ● Public health preparedness for bioterrorism ● Development of genetic and molecular techniques

20th

first generation or second generation antipsychotics? Side Effects: ○ Metabolic syndrome - teach patient how to minimize weight gain through proper nutrition & physical activity ○ Anticholinergic toxicity - delirium; altered mental status; ○ Prolongation of QT interval - SGAs quetiapine, risperidone, ziprasidone - can prolong QT interval. Also FGAs chlorpromazine, haloperidol , thioridazine ■ Get EKG before placed on antipsychotic med ○ Liver impairment - liver function studies

2nd generation

first generation or second generation antipsychotics? ○ , atypical ■ treat positive and help with the negative symptoms

2nd generation

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

22. A client is using a primary prevention strategy to prevent infectious disease. Which of the following actions is the client most likely taking? a.A client receives a tetanus booster every 10 years. b.A client receives a tetanus booster after stepping on a nail. c.A client receives tetanus immunoglobulin after stepping on a nail. d.A client with tetanus is given antibiotics and is placed on seizure precautions.

A Mexican immigrant mother tells the nurse she is concerned that people in the community will give her daughter mal de ojo. To which of the following folk illnesses is the nurse referring? a.Evil eye b.Fallen fontanel c.Soul loss d.Indigestion

A college student who attempted suicide by overdose was hospitalized. When the parents were contacted, they responded, "We should have seen this coming. We did not do enough." The parents' reaction reflects a.guilt. b.denial. c.shame. d.rescue feelings.

A community health nurse would like to implement an intervention to increase lasting resilience among new immigrants. Which of the following actions should be taken by the nurse? a.Direct clients to English-as-second-language courses. b.Give immigrant clients money to help them get settled. c.Identify areas in the city where housing is less expensive. d.Solicit donations for food, clothing, and other needs.

A migrant farmworker has been injured while working on the farm. Which of the following would provide assistance to care for this injury? a.Emergency department for immediate care b.Migrant Health Act clinics c.OSHA, because the man was injured by farm machinery d.Workers' Compensation, because injury was at work

A newly hospitalized patient experiencing psychosis says, "Red chair out town board." Which term should the nurse use to document this finding? a.Word salad b.Neologism c.Anhedonia d.Echolalia

A nurse asks a patient diagnosed with schizophrenia, "What is meant by the old saying 'You can't judge a book by looking at the cover.'?" Which response by the patient indicates concrete thinking? a."The table of contents tells what a book is about." b."You can't judge a book by looking at the cover." c."Things are not always as they first appear." d."Why are you asking me about books?"

A nurse is caring for a migrant farm worker who has been working in the agricultural industry for the past 10 years. When questioned about environmental hazards, the client reports regular exposure to pesticides. Which of the following disorders is the client most at risk to develop? a.Cancer b.Memory loss c.Skin rashes d.Headaches

A nurse is concerned about stress related to the heavy caregiving burden assumed by adult children of older clients. Which of the following actions by the nurse demonstrates the use of secondary prevention to limit caregiver stress? a.Asking caregivers how they are doing and suggesting coping strategies b.Encouraging caregivers to periodically leave the house for a couple of hours c.Establishing support groups for caregivers of older parents d.Referring some activities to neighbors and friends

A nurse is examining all of the various factors which can lead to disease. Which of the following models would the nurse most likely use? a.Epidemiologic triangle b.Health promotion c.Levels of prevention d.Natural history of disease

A nurse is providing care to a pregnant teenager. Which of the following principles is the most important for the nurse to consider when providing care? a.All teen pregnancies are considered high-risk. b.Limited self-care knowledge can lead to pregnancy complications. c.Pregnant teens are likely to receive prenatal care late in the pregnancy. d.Pregnant teens may have limited financial resources to pay for care.

A nurse is working as a case manager with a vulnerable population. Which of the following actions should the nurse do when providing care? a.Be willing to enter into a long-term relationship with families. b.Direct and control the client's care because the nurse knows what is most needed. c.Encourage families to become self-sufficient and less dependent on nursing personnel for advice and referrals. d.Rotate assignments periodically to prevent attachment and codependency.

A nurse just accepted a position in community health and has been assigned to a neighborhood very close to where she lives. Which of the following best describes the rationale for this assignment? a.To allow participant observation by the nurse b.To ensure that the nurse would care about her intervention outcomes c.To maximize convenience and minimize commuting time for the nurse d.To save gasoline in these difficult economic times

A nurse surveys medical records. Which finding signals a violation of patients' rights? a.A patient was not allowed to have visitors. b.A patient's belongings were searched at admission. c.A patient with suicidal ideation was placed on continuous observation. d.Physical restraint was used after a patient was assaultive toward a staff member.

A nurse would like to increase the accessibility to health care services for mentally ill homeless clients in the community. Which of the following actions should be taken by the nurse? a.Apply for a grant to fund a mobile clinic to take health care to the clients. b.Distribute flyers to the homeless that detail the location of various types of health care services. c.Refer homeless clients to areas that provide temporary housing. d. Solicit donations for food and clothing to be distributed to the homeless.

A nurse's Mantoux test is positive for exposure to tuberculosis. Which of the following conclusions should be drawn by the nurse? a.The nurse has been exposed to tuberculosis. b.The nurse has tuberculosis. c.The positive test result probably is due to a problem in the testing process. d.The test is inaccurate and needs to be repeated.

A patient diagnosed with schizophrenia begins to talks about "macnabs" hiding in the warehouse at work. The term "macnabs" should be documented as a.a neologism. b.concrete thinking. c.thought insertion. d.an idea of reference.

A patient diagnosed with schizophrenia is very disturbed and violent. After several doses of haloperidol, the patient is calm. Two hours later the nurse sees the patient's head rotated to one side in a stiff position, the lower jaw thrust forward, and drooling. Which problem is most likely? a.An acute dystonic reaction b.Tardive dyskinesia c.Waxy flexibility d.Akathisia

A patient was diagnosed with seasonal affective disorder (SAD). During which month would this patient's symptoms be most acute? a.January b.April c.June d.September

A resident in a rural community has been diagnosed with asthma. Which of the following providers will most likely provide care to this client? a.Advanced nurse practitioner b.Allergist c.Pediatrician d.Pulmonologist

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

A therapy group adds new members as others leave. What type of group is evident? a.Open b.Closed c.Homogeneous d.Heterogeneous

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

A 15-year-old is hospitalized after a suicide attempt. This adolescent lives with the mother, stepfather, and several siblings. When performing a family assessment, the nurse must first determine a.how the family expresses and manages emotion. b.names and relationships of the family's members. c.the communication patterns between the patient and parents. d.the meaning that the patient's suicide attempt has for family members.

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

A group has two more sessions before it ends. One member was previously vocal and has shown much progress but has now grown silent. What explanation most likely underlies this behavior? The silent member a.has participated in the group and now has nothing more to offer. b.is having trouble dealing with feelings about termination of this group. c.wants to give quieter members a chance to talk in the remaining sessions. d.is engaging in attention-seeking behavior aimed at continuation of the group.

A nurse interviews a homeless parent with two teenage children. To best assess the family's use of resources, the nurse should ask a."Can you describe a problem your family has successfully resolved?" b."What community agencies have you found helpful in the past?" c."What aspect of being homeless is most frightening for you?" d."Do you feel you have adequate resources to survive?"

A nurse is assessing a community's openness to change. Which of the following variables indicate that the community is ready? a.Commitment to current processes and policies b.High social-economic status in the community as a whole c.Long history of dependence on the community health agency and its staff d.Minimal level of social participation by community members

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

A nurse is employed as a nurse epidemiologist. Which of the following activities would most likely be completed by the nurse? a.Eliciting the health history of a client presenting with an illness b.Evaluating the number of clients presenting with similar diseases c.Performing a physical examination of an ill client d.Providing treatment and health education to a client with a disease

A nurse is using analytic epidemiology when conducting a research project. Which of the following projects is the nurse most likely completing? a.Reviewing communicable disease statistics b.Determining factors contributing to childhood obesity c.Analyzing locations where family violence is increasing d.Documenting population characteristics for healthy older citizens

A parent is admitted to a unit for treatment of addictions. The patient's spouse and adolescent children participate in a family session. What is the most important aspect of this family's assessment? a.Spouse's codependent behaviors b.Interactions among family members c.Patient's reaction to the family's anger d.Children's responses to the family sessions

A patient diagnosed with major depressive disorder repeatedly tells staff, "I have cancer. It's my punishment for being a bad person." Diagnostic tests reveal no cancer. Select the priority nursing diagnosis. a.Powerlessness b.Risk for suicide c.Stress overload d.Spiritual distress

A patient diagnosed with major depressive disorder says, "No one cares about me anymore. I'm not worth anything." Today the patient is wearing a new shirt and has neat, clean hair. Which remark by the nurse supports building a positive self-esteem for this patient? a."You look nice this morning." b."You're wearing a new shirt." c."I like the shirt you are wearing." d."You must be feeling better today."

A patient diagnosed with major depressive disorder tells the nurse, "Bad things that happen are always my fault." Which response by the nurse will best assist the patient to reframe this overgeneralization? a."I really doubt that one person can be blamed for all the bad things that happen." b."Let's look at one bad thing that happened to see if another explanation exists." c."You are being extremely hard on yourself. Try to have a positive focus." d."Are you saying that you don't have any good things happen?"

An adult diagnosed with schizophrenia lives with elderly parents. The patient was recently hospitalized with acute psychosis. One parent is very anxious, and the other is ill because of the stress. Which nursing diagnosis is most applicable to this scenario? a.Ineffective family coping related to parental role conflict b.Caregiver role strain related to the stress of chronic illness c.Impaired parenting related to patient's repeated hospitalizations d.Interrupted family processes related to relapse of acute psychosis

Priority interventions for a patient diagnosed with major depressive disorder and feelings of worthlessness should include a.distracting the patient from self-absorption. b.careful unobtrusive observation around the clock. c.allowing the patient to spend long periods alone in meditation. d.opportunities to assume a leadership role in the therapeutic milieu.

Select the example of primary prevention. a.Assisting a person diagnosed with a serious mental illness to fill a pill-minder b.Helping school-age children identify and describe normal emotions c.Leading a psychoeducational group in a community care home d.Medicating an acutely ill patient who assaulted a staff person

Which of the following components of the epidemiologic triangle contributes most to a female client developing a vaginal infection caused by fungi after successful treatment of her strep throat with antibiotics? a.Agent b.Environment c.Host d.Agent and host

6. A nurse uses lecturing as the primary method of educating clients. Which part of the education process is missing? a.Evaluation b.Experience c.Participation d.Understanding

A married couple has two biologic children who live with them as well as a child from the wife's first marriage. What type of family is evident? a.Homogeneous b.Extended c.Blended d.Nuclear

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

A nurse is trying to decrease the risk for depression among older adults. Which of the following interventions should the nurse implement? a.Encourage moving to a nursing home where others of the same age reside. b.Monitor for signs and symptoms of depression. c.Organize an exercise and health promotion program at the local senior citizen center. d.Teach older clients to focus on their strengths rather than their weaknesses.

A patient diagnosed with major depressive disorder began taking escitalopram 5 days ago. The patient now says, "This medicine isn't working." The nurse's best intervention would be to a.discuss with the health care provider the need to increase the dose. b.reassure the patient that the medication will be effective soon. c.explain the time lag before antidepressants relieve symptoms. d.critically assess the patient for symptoms of improvement.

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

When counseling patients diagnosed with major depressive disorder, an advanced practice nurse will address the negative thought patterns by using a.psychoanalytic therapy. b.desensitization therapy. c.cognitive-behavioral therapy. d.alternative and complementary therapies.

Which finding constitutes a negative symptom associated with schizophrenia? a.Hostility b.Bizarre behavior c.Poverty of thought d.Auditory hallucinations

What foodborne disease is described below: ■ Treatment ● Antitoxin ● Medical support as needed ● Ventilation usually needed ■ Prevention ● Boil food for 10 minutes ● Do not eat preserved food if its container is bulging or if the food smells spoiled In infants, protection

Clostridium Botulinum

What communicable disease is described below: ○ Severe symptoms ■ Watery diarrhea 10-15 times a day ■ Abdominal cramping and pain, which may become severe ■ Fever ■ Blood or puss in the stool ■ Nausea ■ Dehydration ■ Loss of appetite ■ Weight loss ■ Swollen abdomen ■ Kidney failure ■ Increased WBC count

Clostridium difficile (bacterial infection)

What communicable disease is described below: ● Bacteria found in soil, air, water, and human/animal wastes ● Some healthy individuals carry it in their intestines ● Passed through feces to food, objects, and surfaces ● Highly contagious ● Destroys healthy bacteria in the intestines ● Treatment: ○ Stop the use of abx ○ Metronidazole (mild case) ○ Vancomycin (severe or recurrent) ○ Surgery to remove diseased portion of the colon ● Symptoms: ○ Moderate ■ Watery diarrhea 3 times a day for 2 or more days ■ Mild abdominal cramping and tenderness ○ Severe ■ Watery diarrhea 10-15 times a day ■ Abdominal cramping and pain, which may become severe ■ Fever ■ Blood or puss in the stool ■ Nausea ■ Dehydration ■ Loss of appetite ■ Weight loss ■ Swollen abdomen ■ Kidney failure ■ Increased WBC count

Clostridium difficile (bacterial infection)

A nurse is assessing the status of a community's health. Which of the following will the nurse examine? a.Community awareness b.Health facilities c.Health care manpower d.Vital statistics

A nurse worked with a patient diagnosed with major depressive disorder, severe withdrawal, and psychomotor retardation. After 3 weeks, the patient did not improve. The nurse is most at risk for feelings of a.guilt and despair. b.over-involvement. c.interest and pleasure. d.ineffectiveness and frustration.

What communicable disease is described below: ● Inflammation of the liver ● Hep A, B, C ● Viral ● Autoimmune ● Metabolic abnormality ● Bacteria - Rare ● Statistics: ○ 3,000 new cases of Hep A annually in US (1.4 million worldwide) ○ 43,000 new cases of Hep B annually in US (2 billion people infected worldwide) 17,000 new cases of Hep C annually in US (3-4 million new cases each year)

Hepatitis

What communicable disease is described below: ○ Symptoms ■ Mild flu like ■ Jaundice ■ Extreme lethargy ■ Nausea ■ Fever ■ Joint pain

Hepatitis B

The following are examples of _______ objectives: Cognitive domain: ● Describe the health benefits of a low fat diet Psychomotor domain: ● Rewrite the family favorite recipe using low fat ingredients ● hands-on Affective Domain: ● Discuss possible solutions to family resistance to change

behavioral

What term describing membership is described below: a group in which membership is restricted; no new members are added when others leave

closed group

Rate, cure rate, attack rate, case fatality rate are all basic ____ concepts.

epidemiology

sources of data, rate adjustment, and comparison groups are basic methods in?

epidemiology

systematic and logical way to make decisions to improve the educational program

evaluation

effective and powerful medium to initiate and implement changes for individuals, families, organizations, and the community

groups

What term describing membership is described below: a group in which all members share central traits (ex: men's group, group of patients with bipolar disorder)

homogenous groups

What measures of incidence is described below: --rate of development of NEW CASES within a population at risk

incidence rate

The following are considerations for _____ care: : large percent comes to inpatient from ER- disabled- danger to self or other, sometimes police pick them up ● Entry to acute care - majority of inpatients admitted through Emergency Dept. or some type of crisis intervention service ● **Of 12 million Emergency dept. visits - nearly 13% due to mental health/substance use ● Patients do not lose their rights as citizens ○ Phone time, smoke breaks, visitation time, etc ● Teamwork & collaboration - formulate the treatment plan; each discipline responsible for gathering data (some questions repetive—but each discipline MUST DO assessment) ○ Treatment team; patient involved in plan of care ● Therapeutic milieu - surroundings & physical environment- promote healing-- read this paragraph carefully ○ Way chairs are placed: want optimal therapeutic environment ○ **read book carefully ○ Vital part of the team are UAP, so it is essential for the nurse to assure there is a therapeutic milieu so people can heal and go on ○ A main function of RN - includes rules, activities, environment >> even placement of tables/chairs/furniture ● Managing Behavioral Crisis - training for staff; learn skills to recognize & avoid crises & de-escalate behavioral emergencies; some facilities have special teams; seclusion/restraint/emergency medication actions of last resort (some hospitals have eradicated restraints completely, need to know how to deal with patients and de-escalate situations without them) ○ Crisis Prevention Intervention (CPI) - training to deescalate/ diffuse situation in a peaceful manner ○ Some places have a special team ● Safety - Patient Safety Goals - Table p.72 ○ 1) 2 identifiers 2) medicine safely 3) prevent infection 4)identify patient safety risk - determine which patients are most likely to attempt suicide -how?? ○ Perform suicide assessment tool ○ Should be a place on daily assessment ○ All belongings are inspected ○ Tracking patients - q 15 min checks ○ Monitoring visitation ○ Intimate relationships between patients are prohibited

inpatient

○ Insufficient financial resources to meet BASIC living expenses ○ 2014: 46.7 million at poverty or below levels ○ < 18 yo: 21.1% in poverty ○ US poverty guideline for family of four $24,300

poverty

leading cause of early death in this population (suicide)

schizophrenia

What level of prevention is described below: ● Refers to interventions which increase the probability that a person with a disease will have the disease diagnosed early and treatment will cure it ● EX: Screening, taking health history to identify risk factors

secondary

What level of prevention is described below: ○ AIM: ■ Reduce the prevalence of a condition ■ Reduce the pathological nature of a condition ○ Supportive and emergency housing ○ Case management ○ Prompt treatment to limit disability ○ Soup kitchens ○ Screening for depression ○ Comprehensive physical and mental health services

secondary prevention examples

What level of prevention is described below: ○ Prompt treatment to limit disability ○ Soup kitchens ○ Screening for depression ○ Comprehensive physical and mental health services

secondary prevention examples

The following are characteristics of ____-_____ persons: --lightheartedness sense of humor that indicates "we are in it together" and lacks sarcasm of hostility --fairness and respect for people of different races, ethnicities, religions, and political views --creativity, especially in managing their lives --resistance to conformity (enculturation). It results in autonomous, independent, and self-sufficient individuals.

self-actualized

○ true + (crucial when treatment is needed rigth away because we want to ID every case) **validity of reviewing a screening tool

sensitivity

What inpatient care setting is described below: serve most clinically ill; but varies from state to state; provide the forensic care (forensic/ court related care) → not guilty for reason of insanity ○ Some still exist, many have been shut down ○ Court Case ruling is insanity- they are sent to a state hospital

state hospitals

● - many who die by suicide have alcohol in the blood at the time of death & have used an illicit substance days before their death.

substance use

What group participant role is described below: group focused on main purpose - how easy is it to get "off-track"?

task

balancing between aesthetically pleasing AND safety>> NOT easy ○ Can't have things that can be used as weapons lmao ○ Can paint the rooms - SAFETY. DON'T LET THEM DRINK THE PAINT !! **** **consideration for inpatient settins

unit design

· What is the basis for a _____ _______? o Genetic compositions o Social and environmental resources o Support systems o Access to health care

vulnerable population

____1_____ does not equal ______2_____! ○ _____1_____→ normal human response; a real emotion ○ ______2______→ feels sad about everything; not necessarily trigger; in fact, life could be intact with a lot to be happy about **major depressive disorder

1. sad 2. depressed

first generation or second generation antipsychotics? ● Names of some of the traditional ○ Recognize specific drugs: Canned Fish Has Terrible Taste LPPT ■ Chlorpromazine ■ Fluphenazine ■ Haloperidol ■ Thioridazine ■ Trifluoperazine ■ Loxapine ■ Perphenazine ■ Pimozide ■ Thiothixene

1st generation

first generation or second generation antipsychotics? ● Side effects (214) ○ Sedation ○ Sexual dysfunction ○ Seizures ○ Increased mortality in elderly with dementia ○ Less likely to cause the significant EPS ○ Clozapine - agranulocytosis - draw white blood cell count to get absolute neutrophil count; symptoms include signs of infection - fever, chills, sore throat - blood draws but no EPS ○ Metabolic syndrome - teach patient how to minimize weight gain through proper nutrition & physical activity ○ Anticholinergic toxicity - delirium; altered mental status; ○ Prolongation of QT interval - SGAs quetiapine, risperidone, ziprasidone - can prolong QT interval. Also FGAs chlorpromazine, haloperidol , thioridazine ■ Get EKG before placed on antipsychotic med ○ Liver impairment - liver function studies

2nd generation

What medication for bipolar disorder is described below: ○ seem to have mood-stabilizing properties. ○ Most evidence supports: ■ Olanzapine ■ Risperidone

2nd generation antipsychotics

In addition to those barriers faced by many residents in rural areas, what additional barrier to health care is a Hispanic migrant farmworker likely to encounter? a.Absence of culturally competent care b.Availability of specialists c.Distance of health care facilities from the place of residence d.High cost of health care

Inpatient hospitalization for persons with mental illness is generally reserved for patients who a.present a clear danger to self or others. b.are noncompliant with medication at home. c.have limited support systems in the community. d.develop new symptoms during the course of an illness.

It has been 5 days since a suicidal patient was hospitalized and prescribed an antidepressant medication. The patient is now more talkative and shows increased energy. Select the highest priority nursing intervention. a.Supervise the patient 24 hours a day. b.Begin discharge planning for the patient. c.Refer the patient to art and music therapists. d.Consider discontinuation of suicide precautions.

Select the example of tertiary prevention. a.Helping a person diagnosed with a serious mental illness learn to manage money b.Restraining an agitated patient who has become aggressive and assaultive c.Teaching school-age children about the dangers of drugs and alcohol d.Genetic counseling with a young couple expecting their first child

A patient diagnosed with schizophrenia says, "My co-workers are out to get me. I also saw two doctors plotting to kill me." How does this patient perceive the environment? a.Disorganized b.Dangerous c.Supportive d.Bizarre

A student complains to the college health nurse that her academic work has been going downhill because of lack of sleep. "My 3-year-old probably misses her babysitter since she has started going to the big daycare center. She hasn't been sleeping well and keeps scratching her bottom. Hopefully, she'll adapt to daycare soon." Which of the following information should the nurse provide to the student? a."Dry skin in winter weather can cause itchiness; try to put on lotion before bedtime." b."Your daughter may have pinworms; let me teach you how to check for this." c."Perhaps your child is not developmentally ready for group play." d."Try to arrange more one-on-one time with your 3-year-old."

A woman is sitting in a corner of the clinical waiting room, crying audibly. The nurse asks, "What's wrong? Can I help?" The woman responds, "They just told me I have a positive mammogram and I need to see my doctor for follow-up tests. I know I'm going to die of cancer. How can I tell my family?" Which of the following information does the nurse need to know in order to help the woman cope with this finding? a.The negative predictive value of mammography b.The positive predictive value of mammography c.The reliability of mammography d.The validity of mammography

Parents of a teenager recently diagnosed with serious mental illness express dismay. One parent says, "Our hopes for our child's future are ruined. We probably won't ever have grandchildren." The nurse will use interventions to assist with a.denial. b.acceptance. c.acting out. d.manipulation.

Select the most critical question for the nurse to ask an adolescent who has threatened to take an overdose of pills. a."Why do you want to kill yourself?" b."Do you have access to medications?" c."Have you been taking drugs and alcohol?" d."Did something happen with your parents?"

Which level of prevention activities would a nurse in an emergency department employ most often? a.Primary b.Secondary c.Tertiary

Which of the following best describes the current goal in relation to communicable diseases? a.To control political borders so diseases cannot spread further b.To exterminate specific infectious agents one by one c.To expand health care facilities to improve infectious disease treatment d.To achieve worldwide immunization to control new cases

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

What public policy affecting vulnerable populations is described below: 1997; Influenced use of resources for providing health services

Balanced Budget Act

Bipolar 1 or Bipolar 2? ○ Have experienced at least 1 hypomanic episode & at least 1 major depressive episode

Bipolar 2

7. A nurse at the well child clinic realizes that many parents have misconceptions about effective ways of disciplining their children. The nurse decides to form a group to address this problem. What should be the focus of the group? a.Support b.Socialization c.Health education d.Symptom management

A college student who failed two tests cried for hours and then tried to telephone a parent but got no answer. The student then gave several expensive sweaters to a roommate and asked to be left alone for a few hours. Which behavior provides the strongest clue of an impending suicide attempt? a.Calling parents b.Excessive crying c.Giving away sweaters d.Staying alone in dorm room

A married couple has two children living in the home. Recently, the wife's mother moved in. This family should be assessed as a.nuclear. b.blended. c.extended. d.alternative.

A newly admitted patient diagnosed with schizophrenia says, "The voices are bothering me. They yell and tell me I am bad. I have got to get away from them." Select the nurse's most helpful reply. a."Do you hear the voices often?" b."Do you have a plan for getting away from the voices?" c."I'll stay with you. Focus on what we are talking about, not the voices. " d."Forget the voices and ask some other patients to play cards with you."

A nurse advises a client with osteoporosis to have three servings of milk or dairy products daily. Which of the following levels of prevention is being used by the nurse? a.Primary prevention b.Secondary prevention c.Tertiary prevention d.Treatment, but not prevention

A nurse is administering a tuberculosis skin test to a client who has AIDS. Which of the following results should the nurse anticipate when using this screening test? a.Decreased positive predictive value b.Decreased reliability c.Decreased sensitivity d.Decreased specificity

A nursing staff has successfully screened for diabetes in the community. Which of the following might best persuade the health board to increase funding for diabetic clinics in this community? a.An epidemic of diabetes is now recognized and must be addressed. b.The incidence of diabetes is now higher than previously recognized in the community. c.The prevalence of diabetes is now higher than previously recognized in the community. d.The risk for diabetes in the community could decrease if funding is received.

A patient being treated for depression has taken sertraline daily for a year. The patient calls the clinic nurse and says, "I stopped taking my antidepressant 2 days ago. Now I am having nausea, nervous feelings, and I can't sleep." The nurse will advise the patient to: a."Go to the nearest emergency department immediately." b."Do not to be alarmed. Take two aspirin and drink plenty of fluids." c."Take a dose of your antidepressant now and come to the clinic to see the health care provider." d."Resume taking your antidepressants for 2 more weeks and then discontinue them again."

A patient diagnosed with schizophrenia begins a new prescription for ziprasidone. The patient is 5'6'' and currently weighs 204 lbs. The patient has dry flaky skin, headaches about twice a month, and a family history of colon cancer. Which intervention has the highest priority for the nurse to include in the patient's plan of care? a.Skin care techniques b.Scheduling a colonoscopy c.Weight management strategies d.Teaching to limit caffeine intake

A patient shows a nurse this advertisement: "Our product is a scientific breakthrough helpful for depression, anxiety, and sleeplessness. Made from an ancient formula, it stimulates circulation and excretes toxins. Satisfaction guaranteed or your money back." Select the nurse's best response. a."Over-the-counter products for sleep problems are ineffective." b."Do not take anything unless it's prescribed by your doctor." c."Let's do some additional investigation of that product." d."It sounds like you are trying to self-medicate."

A patient usually watches television all day, seldom going out in the community or socializing with others. The patient says, "I don't know what to do with my free time." Which member of the treatment team would be most helpful to this patient? a.Psychologist b.Social worker c.Recreational therapist d.Occupational therapist

A suspicious, socially isolated patient lives alone, eats one meal a day at a local shelter, and spends the remaining daily food allowance on cigarettes. Select a community psychiatric nurse's best initial action. a.Explore ways to help the patient stop smoking. b.Report the situation to the manager of the shelter. c.Assess the patient's weight; determine foods and amounts eaten. d.Arrange hospitalization for the patient in order to formulate a new treatment plan.

A tearful, anxious patient at the outpatient clinic reports, "I should be dead." The initial task of the nurse conducting the assessment interview is to a.assess lethality of suicide plan. b.encourage expression of anger. c.establish trust with the patient. d.determine risk factors for suicide.

An instructor is reviewing Salmonella infections with her class. Which of the following comments indicates that the student needs further review on how Salmonella is spread? a."Certain pets and farm animals may be Salmonella carriers." b."It is possible to transmit Salmonella by person-to-person contact." c."Salmonella may be spread by spores that form once contaminated blood is exposed to the air." d."Salmonella outbreaks are usually due to contaminated meat, poultry, and eggs."

Major depressive disorder resulted after a patient's employment was terminated. The patient now says to the nurse, "I'm not worth the time you spend with me. I am the most useless person in the world." Which nursing diagnosis applies? a.Powerlessness b.Defensive coping c.Situational low self-esteem d.Disturbed personal identity

Persons in an auditorium may have been exposed to a disease. If they are infected, it is crucial that they receive immediate treatment and not take the disease home to their families. Which of the following characteristics would be most important to consider when selecting the screening test to be used? a.The negative predictive value b.The positive predictive value c.The sensitivity of the test d.The specificity of the test

This year 600 of 8000 young women ages 17 to 20 years at a university health center tested positive for a sexually transmitted infection (STI). Which of the following terms best describes this data? a.An epidemic b.Incidence c.Prevalence d.Risk

When assessing a patient's plan for suicide, what aspect has priority? a.Patient's financial and educational status b.Patient's insight into suicidal motivation c.Availability of means and lethality of method d.Quality and availability of patient's social support

Which intervention will the nurse recommend for the distressed family and friends of someone who has committed suicide? a.Participating in reminiscence therapy b.Psychological postmortem assessment c.Attending a self-help group for survivors d.Contracting for at least two sessions of group therapy

Which of the following actions would a nurse take to reduce the high incidence of coronary artery disease (CAD) in a community? a.Introduction of a heart-healthy curriculum beginning in the first grade, presentations on diet and exercise for the community at large, and special education sessions for high-risk populations b.Provision of online activities related to prevention of cardiac disease, smoking reduction programs, and blood pressure screenings c.Distribution of handouts, including age-appropriate games, self-assessments, and education on heart-healthy lifestyles; availability of community screenings for hyperlipidemia in persons age 35 and older; and walking programs for those affected with CAD d.Enrollment of clients with CAD into cardiac rehabilitation programs, routine evaluation of effectiveness of CAD treatment regimens, and participation in clinical trials that evaluate interventions for those diagnosed with CAD

Which of the following best describes a health professional shortage area (HPSA)? a.An area with inadequate health care facilities for residents b.An isolated area of underserved populations within an urban region c.A region with insufficient numbers of health care providers d.A rural region of the United States with a population density of less than 10,000

Which of the following data would most likely be collected in a syndromic surveillance system? a.Incidence of bioterrorism attacks b.Number of air travelers c.Incidence of school absenteeism d.Number of influenza vaccines administered

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

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

Which of the following statements describes how nursing in the community is more challenging than nursing in an acute care setting? a.There is limited access to information useful to the nurse in giving care in the community. b.More paperwork and forms are required when giving care in the home. c.It is more challenging to control the environment in the community. d.Specialization isn't possible in the community setting.

Which of the following types of study should the nurse researcher choose if the goal is to identify the long-term benefits and risks of a particular nursing intervention for senior citizens living in the community? a.Cross-sectional study b.Ecologic study c.Clinical trial d.Retrospective analysis

the following are examples of ______: · Study A --Found an association between gambling and lung cancer. The study may be confounded by smoking · Study B --Found a larger crude death rate in Florida than in Alaska. The rate may be confounded by differences in population age structure · When reading research be sure to consider possible cofounding variables that are not mentioned · Be sure to read how the sample was recruited and how they differ from each other

ConFounders

Which aspect of direct care is an experienced, inpatient psychiatric nurse most likely to provide for a patient? a.Hygiene assistance b.Diversional activities c.Assistance with job hunting d.Building assertiveness skills

Which individual in the emergency department should be considered at highest risk for completing suicide? a.An adolescent Asian American girl with superior athletic and academic skills who has asthma b.A 38-year-old single, African American female church member with fibrocystic breast disease c.A 60-year-old married Hispanic man with 12 grandchildren who has type 2 diabetes d.A 79-year-old single, white male diagnosed recently with terminal cancer of the prostate

Which measure would be considered a form of primary prevention for suicide? a.Psychiatric hospitalization of a suicidal patient b.Referral of a formerly suicidal patient to a support group c.Suicide precautions for 24 hours for newly admitted patients d.Helping school children learn to manage stress and be resilient

Which of the following factors predisposes many migrant farmworkers to disenfranchisement? a.Being a minority group member b.Inability to attend religious services because of work requirements c.Previous experiences of physical abuse d.Short length of time in the community

Which of the following infectious disease interventions best represents the use of secondary prevention? a.Clients with HIV infection are encouraged to use condoms to protect sexual partners. b.Clients with HIV infection are given medications to improve immunological response. c.Health care workers are encouraged to receive annual vaccinations for influenza. d.Health care workers are required to have a tuberculosis skin test or chest x-ray.

With clinical trials "___ _____" (experimental study) we have: ● Test group and control group ● Double blind study: neither the tester or the participant knows who is getting the intervention ○ Tester and participant do not know who is getting the intervention ● Placebo groups are used in drug testing (the placebo group believes they are getting the new drug but are actually getting a sugar pill: this can control or identify covariable in the study) ● Objective is to test interventions ● Clinical trials ○ Randomization to groups ○ Masking or "binding" treatment

Gold Standard

What medication for bipolar disorder is described below: **anticonvulsants - teach to seek medical attention for rash (Stevens-Johnson syndrome)

Lamotrigine

What depressive disorder is described below: DSM-5 Criteria: LEARN THIS WELL *** ○ B. → Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning ○ C. → Not attributable to effects of substance or medical condition

Major Depressive Disorder

What depressive disorder is described below: Psychological Risk Factors ● Cognitive Triad: ○ 1. A negative, self-deprecating view of self ○ 2. Pessimistic view of the world ○ 3. Belief that negative reinforcement will continue into the future (self is not validated)

Major Depressive Disorder

What depressive disorder is described below: ● Females more likely to be affected than males ● Although common in older adults IT IS NOT A NORMAL PART OF AGING ○ Major Depression is treatable! ● Accompany other psychiatric problems; one of the most common combination is anxiety and depression

Major Depressive Disorder

● Acquired through a hospital stay ○ Increased traffic of persons ○ Lax hygiene practices ○ Weakened immune system ● As many as 2 million persons are affected each year ● Not all nosocomial infections are resistant ○ Ex: UTI from catheter ● Initiatives and Preventions ○ Screening patients before being admitted to the hospital for surgical procedures ○ Once diagnosed with a particular contagious infection, chart should be flagged for future admissions ○ Medicare has enacted guidelines regarding contraction of such infections ○ Re-education of all health-care staff ■ Hand hygiene

Nosocomial infections

With major depressive disorder, we have pharmacological interventions to treat the disorder. What type of medications are described below to treat MDD: ○ Ex: Vidrine Decides Daily Lunches ■ Venlafaxine → popular next step after trying SSRIs ● Beth takes this!! ● Common; energizing effect ■ Desvenlafaxine → metabolite of venlafaxine ■ Duloxetine ■ Levomilnacipran → inhibits reuptake of norepinephrine more than serotonin ■ Keeps the neurotransmitters in the synapse

SNRIs

What public policy affecting vulnerable populations is described below: 1965; Title XXI of SSA - State Children's Health Insurance Program (SCHIP)

SSA Amendments of 1965 (Medicare and Medicaid)

What communicable disease is described below: ● Treatment: long term antibiotic therapy (IV therapy) or surgical removal

VRE (vancomycin resistant enterococci)

When talking about characteristics of andragogical and pedagogical approaches to teaching-learning, which approach is described below for READINESS TO LEARN: -students are told what they have to learn in order to advance to the next level of mastery

andragogical

What part of casual inference is described below: ○ Selection or the way subjects enter a study ○ Misclassification of subjects once they are in the study ○ Confounding variables not accounted for when you began the study

bias

What depressive disorder is described below: Biological Risk Factors: *unlikely that there is a single cause for depression* ■ Neurochemical abnormalities - genetic or medical conditions → cerebral infarction, Parkinson's, hypothyroidism, AIDS, drug use ■ Caused by dysregulation of neurotransmitters: serotonin and norepinephrine

biochemical

Agents of _____ include: ● Anthrax ● Smallpox ● Plague ● Botulism ● Selected hemorrhagic fevers

bioterrorism

The following is an assessment for someone with ______ disorder: ● Mood ● Behavior ● Thought processes & speech patterns ● Thought Content ● Cognitive function

bipolar

What Yalom's curative factor is described below: expression of deep emotions

catharsis

Learning occurs through 3 domains. What are they?

cognitive, affective, psychomotor

What part of disease development of communicable diseases is described below: : interval the infected host can transmit infection

communicable period

Manipulating, Distracting, Generalizing, blaming, and placating are examples of dysfunctional?

communication

What family function is described below: Healthy ________ - clear and comprehensive messages; thoughts and feelings can be expressed

communication

Core competencies for ____ _____ of educators includes: ____ _______: --communicates effectively both in writing and orally, including via email --solicits input from individuals and organizations --advocates for public health programs and resources --leads and participates in groups to address specific issues --uses the media, various technologies, and community networks to convey information --effectively presents accurate demographic, statistical, programmatic, and scientific info for professional and lay audiences ATTITUDES: --listens to others in an unbiased manner --respects points of view of others --promotes the expression of diverse opinions and perspectives

communication skills

What are the 3 types of poverty?

crisis, persistent, and neighborhood

What bipolar disorder is described below: ○ symptoms of hypomania alternate with symptoms of mild to moderate depression for at least 2 years in adults & 1 year in children.

cyclothymic

● diagnosis most closely associated with suicide

depression

What learning theory is described below: Provide a framework for thinking about human growth, development, and learning ● Erikson's stages of development - List

developmental theory

it is within; the power within, the power within, THE POWER WITHIN, YEAH **family function

emotional support

Basic ____ concepts includes: ● Proportion ○ Type of ratio in which the denominator includes the numerator ○ Example: ■ 10,000 deaths total ■ 1000 caused by heart disease so 1000 / 10,000 ■ 10% of deaths caused by heart disease ■ May be stated as 1 in 10 deaths are caused from heart disease

epidemiology

____ ____ ____ is the integration of: ○ Best medicine ○ Nursing expertise ○ Values and preferences of the client/patient ○ Research utilization ■ The process of transforming research into practice

evidence based practice

What type of immunity for communicable disease is described below: high proportion of the population is immune

herd immunity

What model under emergency care is described below: -- Do provide the triage and stabilization but psych clinicians available on call -- Provide triage and stabilization, but may not be specialized for psych; may have providers on call

hospital-based consultant model

What Yalom's curative factor is described below: instruction; lecture

imparting information

What measures of incidence is described below: number of new cases of disease or injury during specified period/ Time each person was observed totaled for all persons --rate of development of NEW CASES within a population at risk /= divided by

incidence rate

what vaccine preventable disease is described below: ○ Vaccine; effective 10-14 days after administration ■ Live (nasal spray) ● Don't give to < 2 y.o., pregnant or immunocompromised ■ Inactivated (shot) ● The regular seasonal flu shot is IM ○ Quad: 4 strains in 1 shot ● An intradermal vaccine for people 18-64 years of age which is injected into the "dermis" or skin

influenza (Flu)

What Yalom's curative factor is described below: ● leader shares optimism about success of group treatment; believe they will get better ○ Restored hope

installation of hope

· United States population · \cultural backgrounds · Culturally competent care · Different health promotion beliefs

introduction

With schizophrenia we have positive symptoms, one being alterations in speech. These include loose associations, word salad, clanging, neoglisms, echolia, magical thinking, paranoia, circumstantiality, tangentiality, cognitive retardation, pressured speech, flight of ideas, symbolic speech, magical thinking, and paranoia. Which of these is described below: ○ believe that their thoughts or actions affect others (usually nonpathological in children)

magical thinking

Lack of _____ includes: ● HEALTH BELIEF MODEL: WHAT MOTIVATES AN INDIVIDUAL ○ PERCEIVED SUSCEPTIBILITY ○ PERCEIVED SEVERITY ○ PERCEIVED BENEFITS ○ PERCEIVED BARRIERS ○ CUES TO ACTION ○ SELF-EFFICACY

motivation

_____ _____ is: --Designed to help clients verbalize their own motivations to change --Designed to help clients make their own choices --4 essential steps 1. Engaging 2. Empathetic listening 3. Guiding 4. Evoking (clients own motivation)

motivational interviewing

What basic epidemiology concept is described below: o Number of deaths under 28dys of age in a year o Total number of live births in the same year **case fatality rate

neonatal mortality ratio

What risk factor for schizophrenia is described below: ● 1st generation meds - block dopamine - 2 receptors and reduce hallucinations and delusions

neurobiological--dopamine theory (overactivity of dopamine)

nihilistic

The following are special issues in caring for the ___ ____: ○ Need early identification and follow up after birth ○ Violence § Greater risk during and postpartum § IPV (intimate partner violence) may peak postpartum § Know signs of abuse

pregnant teen

nail biting, pacing, finger tapping, or other tension-relieving activity **physical behavior of person with major depressive disorder

psychomotor agitation

What basic epidemiology concept is described below: ● estimation of the risk of acquiring a problem for those exposed compared with those unexposed compared to those that are NOT exposed

relative risk

○ core inner city and farms/villages/towns/cities and/or metro around **geographic location

rural-urban continuum

what level of prevention is described below: TB screening (to detect if they have it)

secondary

With schizophrenia we have positive symptoms. These include alterations in _____ which includes unusual ________ patterns; information processing is disrupted by abnormal brain processes. These include loose associations, word salad, clanging, neoglisms, echolia, magical thinking, paranoia, circumstantiality, tangentiality, cognitive retardation, pressured speech, flight of ideas, symbolic speech, magical thinking, and paranoia.

speech

With schizophrenia, there are 4 phases: prodromal, acute, stabilization, and maintenance/ residual. Which phase is described below: ○ symptoms diminishing & movement toward previous level of functioning; follow-up care varies

stabilization

With schizophrenia we have positive symptoms. These includes alterations in behavior. This includes catatonic, waxy flexibility, motor retardation, motor agitation, stereotypes behaviors, echopraxia, negativism, impaired impulse control, gesturing or posturing, and boundary impairment. Which one of these is described below: ○ - repetitive that do not serve a logical purpose - rocking back and forth for hours

stereotyped behaviors

· Leading cause of death in all ages · Males verses Females · Common Methods Risk Factors

suicide and mental illness

carrying out acts with intention of death; may or may not prove fatal

suicide attempt

● thinking about personal death, the wish to be dead, methods of accomplishing death, formulation of plans

suicide ideation (SI)

what level of prevention is described below: therapy group for severely mentally ill adults (helping them to cope with something they have)

tertiary

When talking about ____ of evidence: Research evidence ● Studies ● Synthesis of studies ○ Systematic review ○ Meta analysis ○ RCT: Randomized Control Trial ■ Ranks the highest level of evidence Non research Evidence ● Intuition ● Specialists who come in on a panel and give their opinion of what should be done

types

Anorexia, insomnia, self-care deficits, and constipation are the different ?

vegetative signs of depression

With schizophrenia we have positive symptoms. These includes alterations in behavior. This includes catatonic, waxy flexibility, motor retardation, motor agitation, stereotypes behaviors, echopraxia, negativism, impaired impulse control, gesturing or posturing, and boundary impairment. Which one of these is described below: ○ others can move the limbs - person holds limbs in position for hours

waxy flexibility

● When an animal transmits a disease to a human ○ EX: rabies, rocky mountain spotted fever, shigellosis ● 75% of recent emerging disease have been ______ ● Avian, Ebola, Anthrax ● Bird flu crisis ● Flu virus jumping species

zoonosis

A depressed patient says, "Nothing matters anymore." What is the most appropriate response by the nurse? a."Are you having thoughts of suicide?" b."I am not sure I understand what you are trying to say." c."Try to stay hopeful. Things have a way of working out." d."Tell me more about what interested you before you became depressed."

A patient in a support group says, "I'm tired of being sick. Everyone always helps me, but I will be glad when I can help someone else." This statement reflects a.altruism. b.universality. c.cohesiveness. d.corrective recapitulation.

Assertive Community Treatment (ACT) teams

● ___ ____ _____ teams work intensively with patients in their homes or agencies>>wherever patient needs ● On call/ creative problem solving; if someone starts acting up in the middle of the night, they are called to work with patient ● May visit 3 - 5 times per week in order to keep them high functioning and out of the hospital

Assertive Community Treatment (ACT) teams

A patient diagnosed with schizophrenia has received fluphenazine decanoate twice a month for 3 years. The clinic nurse notes that the patient grimaces and constantly smacks both lips. The patient's neck and shoulders twist in a slow, snakelike motion. Which problem would the nurse suspect? a.Agranulocytosis b.Tardive dyskinesia c.Tourette's syndrome d.Anticholinergic effects

A patient diagnosed with schizophrenia has taken a conventional antipsychotic medication for a year. Hallucinations are less intrusive, but the patient continues to have apathy, poverty of thought, and social isolation. The nurse would expect a change to which medication? a.Haloperidol b.Olanzapine c.Chlorpromazine d.Diphenhydramine

A patient has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today this patient shouts, "They're all plotting to destroy me. Isn't that true?" Select the nurse's most therapeutic response. a."Everyone here is trying to help you. No one wants to harm you." b."Feeling that people want to destroy you must be very frightening." c."That is not true. People here are trying to help you if you will let them." d."Staff members are health care professionals who are qualified to help you."

A patient in a detoxification unit asks, "What good it will do to go to Alcoholics Anonymous and talk to other people with the same problem?" The nurse's best response would be to explain that self-help groups such as AA provide opportunities for a.newly discharged alcoholics to learn about the disease of alcoholism. b.people with common problems to share their experiences with alcoholism and recovery. c.patients with alcoholism to receive insight-oriented treatment about the etiology of their disease. d.professional counselors to provide guidance to individuals recovering from alcoholism.

A patient insistently states, "I can decipher codes of DNA just by looking at someone." Which problem is evident? a.Visual hallucinations b.Magical thinking c.Idea of reference d.Thought insertion

A patient previously hospitalized for 2 weeks committed suicide the day after discharge. Which initial nursing measure will be most important regarding this event? a.Request the information technology manager to verify the patient's medical record is secure in the hospital information system. b.Hold a meeting for staff to provide support, express feelings, and identify overlooked clues or faulty judgments. c.Consult the hospital's legal department regarding potential consequences of the event. d.Document a report of a sentinel event in the patient's medical record.

A patient tells the nurse, "I get sick so much, so I started taking ginseng to boost my immune system." The patient's only other medication is warfarin daily. Which potential complication should be included in the nursing assessment? a.Gastrointestinal distress b.Spontaneous bleeding c.Thromboembolism d.Drowsiness

A patient's care plan includes monitoring for auditory hallucinations. Which assessment findings suggest the patient may be hallucinating? a.Detachment and overconfidence b.Darting eyes, tilted head, mumbling to self c.Euphoric mood, hyperactivity, distractibility d.Foot tapping and repeatedly writing the same phrase

The nurse is planning a new sexuality group for patients. Which location would best enhance the effectiveness of this group? a.The hospital auditorium b.A small conference room c.A common area, such as a day room d.The corner of the music therapy room

Which of the following is the most rapidly growing group of homeless? a.Adolescents b.Families with children c.Persons in crisis d.Single men

Which of the following racial groups experiences the highest incidence of poverty? a.Non-Hispanic Whites b.Blacks c.Hispanics d.Asians

A member of a community weight-loss group has maintained a healthy weight for 2 years through healthy eating and daily exercise. Which of the following steps of the affective domain is this participant demonstrating? a.Analysis b.Application c.Evaluation d.Knowledge

A patient diagnosed with major depressive disorder began taking a tricyclic antidepressant 1 week ago. Today the patient says, "I don't think I can keep taking these pills. They make me so dizzy, especially when I stand up." The nurse will a.limit the patient's activities to those that can be performed in a sitting position. b.withhold the drug, force oral fluids, and notify the health care provider. c.teach the patient strategies to manage postural hypotension. d.update the patient's mental status examination.

A patient diagnosed with major depressive disorder refuses solid foods. In order to meet nutritional needs, which beverage will the nurse offer to this patient? a.Tomato juice b.Orange juice c.Hot tea d.Milk

A patient wants to learn more about integrative therapies. Which resource should the nurse suggest for the most reliable information? a.Internet b.American Nurses Association (ANA) c.Food and Drug Administration (FDA) d.National Center for Complementary and Integrative Health (NCCIH)

What foodborne disease is described below: ■ Large and diverse group of bacteria ■ May be in water that contains contaminated human or animal feces ■ Incubation period → 3-4 days ● Can be a day to 10 days but most common is 3-4 ■ Symptoms vary and begin slowly; most improve in 5-7 days. (develops 72 hours after infection) ● Severe stomach cramps ● Diarrhea - bloody tinged ● Vomiting ● Low-grade fever ○ 101 or less

E. coli

When talking about the history of epidemiology: During the 4th Century BC, ______ was the: ○ 1st person to use the ideas that are now part of epidemiology ○ Used descriptive approach and how it influenced by personal characteristics your place and time. ○ examined : geography, climate, seasons of year, food, water, habits, and behaviors

Hippocrates

T or F. Poverty and homelessness affect people's health status.

What medication for bipolar disorder is described below: **anticonvulsants ○ has surpassed lithium in treating acute mania. Do liver function studies & platelet count periodically

Valproate and Valproic Acid

without pleasure; inability to feel happy **type of mood of person with major depressive disorder

anhedonia

Monopolizing, demoralizing, and silent are _____ behaviors with group therapy.

challenging

The following are effects on _____: ○ More illness ○ Fever ○ Ear infection ○ Diarrhea ○ Asthma ○ Poor nutrition ○ High anxiety ○ Poor health behavior ○ School issue: § Absenteeism § Academic failure

children

What thought processes and speech pattern of a patient with bipolar disorder is described below: ● unnecessary details >>eventually gets to the point **

circumstantial speech

With schizophrenia, we have 4 main categories in an assessment: positive, negative, cognitive, and affective. What category is described below: subtle/obvious impairment in memory, attention, thoughts ○ Inattention, easily distracted, impaired memory, poor problem-advising skills, poor decision making skills, illogical thinking, impaired judgement

cognitive

Group ______ is conversation, interactions on the surface Example: minutes of a meeting.

content

What expected outcome of therapeutic group is described below: demonstration of certain knowledge ○ Example- Patient identifies three significant side effects of prescribed medication Look for measurable outcome after group meeting

education group

much greater than normal occurrence of a condition

epidemic

When developing effective health education programs: ● MESSAGE: sending a clear message to the learner ○ What is our point we want to get across ● FORMAT: selecting the most appropriate learning format ● ENVIRONMENT: creating the best possible learning environment ● ______: organizing positive and meaningful learning experiences; research and discover ● PARTICIPATION: engaging the learner in participatory learning ● EVALUATION: evaluating and giving objective feedback to the learner

experience

What risk factor for schizophrenia is described below: ● inherited - about 80% of risk from genetic factors; concordance rates (percentage of shared disorder in twins) - 50% in identical twins

genetic

What factor contributing to vulnerability is described below: o all strengths, knowledge, and skills to allow individuals to live prosperous and happy

human capital

The following is the formula for ____ ____: The number of new cases of a disease (time period)/ The population at risk of the disease (time period) /= divided by

incidence rate

What part of disease development of communicable diseases is described below: ● entry and development of the infectious agent

infection

With schizophrenia, we have outcomes in the different assessment phases. (prodromal, acute, stabilization, and maintenance). which one of these is described below: ● Maintaining & increasing symptom control and insight ○ Example - patient will demonstrate an increase in reality-based thinking with fewer hallucinations and delusions ○ If problem is adherence - patient will take prescribed medications ○ Example—patient will report decrase in voices. ■ If problem is adherence—patient will adhere to prescribed medication regimen

maintenance

What groups concept and definition is described below: help members affirm, accept, and support each other

maintenance function

What term describing membership is described below: a group in which new members are added as others leave (ex: inpatient group with transient membership)

open group

what type of poverty is described below: § Refers to individuals and families who remain poor for long periods § Pass poverty on to their descendants § Temporary Assistance to Needy Families (TANF), WIC, Medicaid, LA CHIP

persistent

proportion of persons with positive test who actually have the disease **validity of reviewing a screening tool

positive predictive value

proportion of population with a condition

prevalence

What type of immunity for communicable disease is described below: "ability to resist disease RT immune system/ vaccinations"

resistance

rural

The following is nursing care in _____ environments: ***Case Management and community health primary health care (COPHC)**** ○ Define and characterize the community ○ Identify the community's health problems ○ Develop or modify health care services in response to the community's identified needs ○ Monitor and evaluate program process and client outcomes

rural

the following are _____ characteristics: Lower income o ¼ of all rural live at or near poverty levels o 40% of children are impoverished o Higher risk for being underinsured or uninsured Healthcare insurance issues o "Working uninsured" § Self-employed § Seasonal workers § Small companies may not offer insurance o Preexisting health conditions

rural

What thought disorder is described below: ● : major depressive, manic, mixed episode presenting concurrently with symptoms of schizophrenia

schizoaffective disorder

The following are nursing diagnoses for _______: ● Positive symptoms >> Altered thought processes - non-NANDA ○ Disturbed sensory perception ○ Impaired verbal communication ● Negative symptoms ○ Social isolation ○ Impaired social interaction ○ Risk for self-directed violence ○ Self- care deficit (bathing/hygiene, dressing/grooming) **** ● Other ○ Caregiver role strain*** ○ Compromised family coping

schizophrenia

What thought disorder is described below: ● essential features just like schizophrenia - except less than 6 months ○ May NOT have impaired social/occupational functioning ○ Some actually return to previous level of functioning

schizophreniform

Injectable antipsychotics include: ○ ______-________ >> treat agitation, behavioral emergencies

short-acting

What groups concept and definition is described below: _____ of the group can influence and bring about change

structure

What thought processes and speech pattern of a patient with bipolar disorder is described below: ● - similar to circumstantial - may lose point and NOT find it again **

tangential speech

tangentiality

What EPS side effect of 1st generation antipsychotics is described below: ● persistent EPS side effect involving involuntary movements - lip smacking, neck twisting, facial grimacing, chewing . Usually after prolonged treatment.

tardive dyskinesthia

○ susceptibility to a negative event; increased "risk" ○ 80% of people will experience vulnerability / homelessness

vulnerability

The family of a patient diagnosed with schizophrenia is unfamiliar with the illness and family's role in recovery. Which type of therapy should the nurse recommend? a.Psychoeducational b.Psychoanalytic c.Transactional d.Family

What medication for bipolar disorder is described below: **anticonvulsants ○ - seems to work better in patients with RAPID CYCLING & in severely paranoid angry patients experiencing manias rather than in euphoric, overactive over friendly patients experiencing mania; weekly liver enzymes x8 weeks- can increase; CBC - cause leukopenia and aplastic anemia

Carbamazepine

When talking about the history of epidemiology: During the 19th Century: ___ ____ used antiseptics in surgery ○ "listerine"

Joseph Lister

rate or risk of developing a condition

incidence

What are the 4 phases of group development?

planning, orientation, working, termination

What level of prevention is described below: ● Promote health and prevent the occurence of disease, injury, or disability ● EX: education, immunizations

primary

Effective health educational ______ include: ● Remember that emotions can interfere with the learner hearing the message ● Speak in terms that the learner can understand ● Young learners like interactive learning ○ Easy for them to understand and relate to ● Most people have short attention spans ○ RT ● Provide written take home material ● Allow for activity that increases learner participation

programs

With step 3: approaches to evaluating evidence, determining quality there are 3 domains for evaluation of systems. which domain is described below: how well was it done, minimal bias

quality

Why learn evidence analysis? During the _____ shift: ○ Clinical experience crucial but not sufficient ○ Need systemic, unbiased clinical observations: EBP term created ● Before educating clients in communitites, must first know how to analyze the content teaching ● Not all research is sound ● Should not promote it if it does not support what it claims

1990's

What are the 2 categories of thought process medications ? 1) First generation antipsychotics (FGAs), traditional, typical or neuroleptics ■ affect the positive symptoms = the hallucinations & delusions 2) Second generation antipsychotics, atypical ■ treat positive and help with the negative symptoms

1st and 2nd generation antipsychotics

first generation or second generation antipsychotics? (FGAs), traditional, typical or neuroleptics ■ affect the positive symptoms = the hallucinations & delusions

1st generation

first generation or second generation antipsychotics? ● More side effects than SGAs; just as effective against positive symptoms & cheaper; STILL AN APPROPRIATE CHOICE IF COST OR METABOLIC SYNDROME A CONCERN ● Blockage of D2 receptors cause extrapyramidal side effects - EPS****** ● 1)Acute dystonia - sudden, sustained contraction of 1 or more muscle groups - usually head & neck. ○ Treatment - IM/IV benztropine or diphenhydramine 25-50 mg ● 2) Akathisia - severe motor restlessness that causes pacing, repetitive movements, inability to stay still. ○ Treatment - benztropine or lorazepam ● 3) Pseudoparkinsonian symptoms - tremors, reduced accessory movements, gait impairment, reduced facial expressiveness (mask facies), bradykinesia ○ Treatment - reducing dosage, trying different drug ● 4) tardive dyskinesia - persistent EPS side effect involving involuntary movements - lip smacking, neck twisting, facial grimacing, chewing . Usually after prolonged treatment. ● **Remember the video during orientation. National Institute of Mental Health (NIMH) developed the Abnormal Involuntary Movement Scale (AIMS) to identify & track involuntary movements.

1st generation

first generation or second generation antipsychotics? ● Round Crowns On Queens Zebras Play In Luxurious African Alleys ● risperidone ● clozapine ● olanzapine ● quetiapine ● ziprasidone ● paliperidone ● iloperidone ● lurasidone ● Asenapine - ● Aripiprazole (may see called 3rd generation)

2nd generation

With evidence based practice, step 2 includes _____ approaches to finding evidence: "searching for the best evidence to answer the question" 1. Systematic review ● Research that is relevant to one topic ● All research that is available on the topic ● Aim: evaluate and interpret all available research to 1 question 2. Meta-analysis ● Results of several studies are quantifies ● May provide stronger evidence than the randomized control study as it includes all RCTs performed overtime in a particular topic ● EX: Cochrane Public Health Group 3. Integrative Review ● Form of a systematic review that does not have the summary statistics due to limitations of studies 4. Narrative Review ● Review done on published papers that support point of view or opinion ● Usually does not include systematic review process **Either one of these provide stronger evidence than a single RCT **

A patient became depressed after the last of the family's six children moved out of the home 4 months ago. Select the best initial outcome for the nursing diagnosis Situational low self-esteem related to feelings of abandonment. The patient will a.verbalize realistic positive characteristics about self by (date). b.agree to take an antidepressant medication regularly by (date). c.initiate social interaction with another person daily by (date). d.identify two personal behaviors that alienate others by (date).

After one of their identical twin daughters commits suicide, the parents express concern that the other twin may also have suicidal tendencies. Which reply should the nurse provide? a."Genetics are associated with suicide risk. Monitoring and support are important." b."Apathy underlies suicide. Instilling motivation is the key to health maintenance." c."Your child is unlikely to act out suicide when identifying with a suicide victim." d."Fraternal twins are at higher risk for suicide than identical twins."

An adult diagnosed with major depressive disorder was treated with medication and cognitive-behavioral therapy. The patient now recognizes how passivity contributed to the depression. Which intervention should the nurse suggest? a.Social skills training b.Relaxation training classes c.Desensitization techniques d.Use of complementary therapy

Nursing students have been assigned to set up a health fair for the homeless population in a large urban setting. Without any funds to pay for space, where should the health fair be located, assuming that all of the following sites are available at no cost? a.At the city's homeless shelter, which is, by policy, vacant during the day b.At a large medical center, where the students could get permission to use an empty clinic in the evening c.At the largest inner-city police station, where there was a large empty space available d.At the local community college, where there are plenty of tables and chairs

The feeling experienced by a patient that should be assessed by the nurse as most predictive of elevated suicide risk is a.hopelessness. b.sadness. c.elation. d.anger.

What assessment findings mark the prodromal stage of schizophrenia? a.Withdrawal, misinterpreting, poor concentration, and preoccupation with religion b.Auditory hallucinations, ideas of reference, thought insertion, and broadcasting c.Stereotyped behavior, echopraxia, echolalia, and waxy flexibility d.Loose associations, concrete thinking, and echolalia neologisms

Which scenario best depicts a behavioral crisis? A patient is a.waving fists, cursing, and shouting threats at a nurse. b.curled up in a corner of the bathroom, wrapped in a towel. c.crying hysterically after receiving a phone call from a family member. d.performing push-ups in the middle of the hall, forcing others to walk around.

Which statement provides the best rationale for closely monitoring a severely depressed patient during antidepressant medication therapy? a.As depression lifts, physical energy becomes available to carry out suicide. b.Patients who previously had suicidal thoughts need to discuss their feelings. c.For most patients, antidepressant medication results in increased suicidal thinking. d.Suicide is an impulsive act. Antidepressant medication does not alter impulsivity.

hen evaluating an educational program, the nurse discovers that only 25% of community members met the learning objectives. Which of the following parts of the program should be improved? a.Educator b.Content c.Learners d.Objectives

A patient diagnosed with major depressive disorder shows vegetative signs of depression. Which nursing actions should be implemented? (Select all that apply.) a.Offer laxatives if needed. b.Monitor food and fluid intake. c.Provide a quiet sleep environment. d.Eliminate all daily caffeine intake. e.Restrict intake of processed foods.

A,B,C

nurse's family has moved to a rural area to be near her spouse's aging parents. Which of the following would the nurse most likely notice about the family's new environment? (Select all that apply.) a.It is very difficult to obtain continuing education, except for online programs. b.Neighbors seem to expect the nurse to know everything about all health care and illness conditions. c.Neighbors ask questions about health concerns any time they see the nurse, regardless of where they are. d.People come to the health clinic before their situation becomes relatively serious.

A,B,C

A nurse can best address factors of critical importance to successful community treatment by including making assessments relative to (Select all that apply) a.housing adequacy. b.family and support systems. c.income adequacy and stability. d.early psychosocial development. e.substance abuse history and current use.

A,B,C,E

Which of the following explains why contagious infections are becoming a central focus of public health? (Select all that apply.) a.Americans are fearful of terrorists using biological agents. b.Awareness of human susceptibility to animal diseases has been publicized. c.Drug-resistant strains of "old" diseases have evolved. d.Media coverage exaggerates the dangers of exposure to crowds.

A,C

Which statements by a nurse demonstrate understanding of the unique needs of vulnerable groups? (Select all that apply.) a."I always address the problem that the client believes is the most important." b."I avoid asking clients for income or financial information, because this is an invasion of privacy." c."I try to observe the client's cultural traditions as I probe for signs of abuse." d."I make sure to do a complete assessment, since we often don't know when the person will return to the clinic."

A,C

A nurse caring for a patient diagnosed with major depressive disorder reads in the patient's medical record, "This patient shows vegetative signs of depression." Which nursing diagnoses most clearly relate to this documentation? (Select all that apply.) a.Imbalanced nutrition: less than body requirements b.Chronic low self-esteem c.Sexual dysfunction d.Self-care deficit e.Powerlessness f.Insomnia

A,C,D,F

Which of the following best describes why health professionals would be particularly concerned about the health needs of residents in rural areas? (Select all that apply.) a.About 25% of all U.S. residents live in rural settings. b.People in rural areas are especially susceptible to acute illnesses rather than chronic diseases. c.Diagnoses in rural areas are usually for physical injuries, not mental health concerns. d.A high prevalence of poverty exists among rural families.

A,D

patient being treated with paroxetine 50 mg po daily reports to the clinic nurse, "I took a few extra tablets earlier today and now I feel bad." Which assessments are most critical? (Select all that apply.) a.Vital signs b.Urinary frequency c.Psychomotor retardation d.Presence of abdominal pain and diarrhea e.Hyperactivity or feelings of restlessness

A,D,E

A parent is admitted to a unit for treatment of addictions. The patient's spouse and adolescent children attend a family session. Which initial assessment question should the nurse ask of family members? a."What changes are most important to you?" b."How are feelings expressed in your family?" c."What types of family education would benefit your family?" d."Can you identify a long-term goal for improved functioning?"

The nurse is making a postpartum visit to a teenage mother and her month-old infant. Which of the following assessments would be most important? a.Assessing for mother's ability to fulfill her own growth and development tasks b.Assessing for mother's knowledge about normal infant growth and development c.Assessing how much the teenage mother's own mother is helping her cope with child care d.Assessing whether the baby's father is being helpful to the mother

Which of the following statistics is used by countries to compare the success of their health care systems? a.Attack rate b.Infant mortality rate c.Cause-specific morbidity rate d.Cause-specific mortality rate

school health nurse presents a program on preventing teen pregnancy to a group of parents. Following the presentation, which of the following comments by a parent would cause concern? a."I do not know if my son is sexually active; however, I have decided I'm going to talk to him about it." b."My daughter is too intelligent to get involved with boys, even if her friends do sleep around." c."My daughter and I have often discussed sexuality, and when she's ready, I'll pay for her birth control pills. d."I have spoken to my son about birth control. He says he's not ready to be a father and support a baby. He wants to go to college."

A nurse is caring for Mexican migrant farmworkers. Which of the following conditions are of greatest importance for the nurse to assess? (Select all that apply.) a.Cholera b.Hepatitis c.High blood level of lead d.Malaria

B,C

A nurse is concerned about the high incidence of STDs in the community college population and sets up a special STD screening. Which of the following groups of students would be encouraged to attend? (Select all that apply.) a.Sexually active students currently receiving treatment for an STD b.Sexually active students who had been screened the previous year c.Students who claimed to not be sexually active and do not plan to become sexually active d.Students who are sexually active but never "go all the way"

B,C,D

A nurse is concerned about a teenage mother who does not seem to know how to play with an infant. Which of the following behaviors would the nurse want to role-model as good parenting behaviors? (Select all that apply.) a.Allow the baby to cry for 10 or 15 minutes before reacting so that the infant can learn to self-soothe. b.Cuddle and hold the baby while smiling and gazing into the baby's eyes. c.Teach the mother to keep her face about 4 or 5 inches from the baby and to gently blow on the infant's face. d.Sing to baby with different melodies until baby seems to listen and shows a preference for certain tunes.

B,D

A nurse is planning to host a health screening at a large urban mall. Which of the following variables will help the nurse determine which screenings should be included? (Select all that apply.) a.Adequate space for persons to lie down after testing until side effects are reduced b.Health problems for which the specific population is at risk c.Whether adequate privacy can be obtained for the invasive or embarrassing procedures d.Whether health care providers are available to follow up on any positive screening results

B,D

The leader of an Alzheimer's support group surveys the members of the group to determine the best time for the group to meet. Which of the following norms is being supported through this action? a.Group norms b.Task norms c.Maintenance norms d.Reality norms

The nurse assesses a patient diagnosed with schizophrenia. Which assessment finding would the nurse regard as a negative symptom of schizophrenia? a.Auditory hallucinations b.Delusions of grandeur c.Poor personal hygiene d.Psychomotor agitation

Bipolar 1

A community health nurse is implementing a tertiary prevention activity related to tuberculosis. Which of the following interventions is the nurse most likely completing? a.Administration of skin tests to identify persons who have been infected with tubercle bacilli b.Assessing for signs and symptoms of active tuberculosis c.Directly observing clients with active tuberculosis as they take their antitubercular medications d.Interpretation of tuberculosis skin test findings

A patient diagnosed with major depressive disorder received six ECT sessions and aggressive doses of antidepressant medication. The patient owns a small business and was counseled not to make major decisions for a month. Select the correct rationale for this counseling. a.Antidepressant medications alter catecholamine levels, which impairs decision-making abilities. b.Antidepressant medications may cause confusion related to limitation of tyramine in the diet. c.Temporary memory impairments and confusion may occur with ECT. d.The patient needs time to readjust to a pressured work schedule.

A patient diagnosed with schizophrenia exhibits little spontaneous movement and demonstrates waxy flexibility. Which patient needs are of priority importance? a.Self-esteem b.Psychosocial c.Physiological d.Self-actualization

A patient diagnosed with schizophrenia has taken fluphenazine 5 mg po bid for 3 weeks. The nurse now observes a shuffling propulsive gait, a mask-like face, and drooling. Which term applies to these symptoms? a.Neuroleptic malignant syndrome b.Hepatocellular effects c.Pseudoparkinsonism d.Akathisia

The unit secretary receives a phone call from the health insurer for a hospitalized patient. The caller seeks information about the patient's projected length of stay. How should the nurse instruct the unit secretary to handle the request? a.Obtain the information from the patient's medical record and relay it to the caller. b.Inform the caller that all information about patients is confidential. c.Refer the request for information to the patient's case manager. d.Refer the request to the health care provider.

Which of the following is the most accurate description of a migrant farmworker? a.A person who does farm work as the primary means of employment, although other work may be done when the seasonal work ends b.A person who immigrates to the United States to "follow the crops" in performing seasonal farm work c.A person who moves from place to place to earn money performing seasonal agricultural work d.A person who specializes in the development of rural land for the purpose of farming

Which of the following is the most common vector-borne disease in the United States? a.Babesiosis b.Ehrlichiosis c.Lyme disease d.Rocky Mountain spotted fever

What foodborne disease is described below: ■ Causes ● Home canned foods ○ Low acid content so it is able to grow ● Fermented seafood ● Chili peppers ● Foil wrapped potatoes ● Oil infused with garlic

Clostridium Botulinum

What foodborne disease is described below: ■ Paralytic toxin ● Nerve toxin ■ Group of bacteria found in soil ■ 5 different types ● Food borne ● Wound borne ● Infant intestine ■ Require low oxygen levels to survive

Clostridium Botulinum

What foodborne disease is described below: ■ Symptoms (develop after 12 to 36 hours for food borne) ● Difficulty swallowing or speaking ● Dry mouth ● Facial weakness ● Double vision ● Drooping eyelids ● Trouble breathing ● Nausea, vomiting, and abdominal cramps ● Paralysis

Clostridium Botulinum

Clostridium difficile (bacterial infection)

6. Which information is the nurse most likely to find when assessing the family of a patient with a serious mental illness? a.The family exhibits many characteristics of dysfunctional families. b.Several family members have serious problems with their physical health. c.Power in the family is maintained in the parental dyad and rarely delegated. d.Stress from living with a mentally ill member has challenged the family's function.

29. A teacher recommends that surveys to obtain data on drug use be given to high school students when they meet for various school organizations. Which of the following best describes why the nurse would reject this suggestion? a.This method of data collection would result in classification bias. b.This method of data collection would result in confounding bias. c.This method of data collection would result in personal bias. d.This method of data collection would result in selection bias.

A patient diagnosed with schizophrenia anxiously says, "I can see the left side of my body merging with the wall, then my face appears and disappears in the mirror." While listening, the nurse should a.sit close to the patient. b.place an arm protectively around the patient's shoulders. c.place a hand on the patient's arm and exert light pressure. d.maintain a normal social interaction distance from the patient.

A patient diagnosed with schizophrenia anxiously tells the nurse, "The voice is telling me to do things." Select the nurse's priority assessment question. a."How long has the voice been directing your behavior?" b."Does what the voice tell you to do frighten you?" c."Do you recognize the voice speaking to you?' d."What is the voice telling you to do?"

A patient diagnosed with schizophrenia has been stable for a year; however, the family now reports the patient is tense, sleeps 3 to 4 hours per night, and has difficulty concentrating. The patient says, "My computer is sending out infected radiation beams." The nurse can correctly assess this information as an indication of a.the need for psychoeducation. b.medication nonadherence. c.chronic deterioration. d.relapse.

A patient diagnosed with schizophrenia says, "Contagious bacteria are everywhere. When they get in your body, you will be locked up with other infected people." Which problem is evident? a.Poverty of content b.Concrete thinking c.Neologisms d.Paranoia

A patient diagnosed with schizophrenia says, "It's beat. Time to eat. No room for the cat." What type of verbalization is evident? a.Neologism b.Idea of reference c.Thought broadcasting d.Associative looseness

The nurse is developing a plan for psychoeducational sessions for a small group of adults diagnosed with schizophrenia. Which goal is best for this group? Members will a.gain insight into unconscious factors that contribute to their illness. b.explore situations that trigger hostility and anger. c.learn to manage delusional thinking. d.demonstrate improved social skills.

The nurse should refer which of the following patients to a partial hospitalization program? A patient who a.has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up. b.needs psychoeducation for relaxation therapy related to agoraphobia and panic episodes. c.spent yesterday in a supervised crisis care center and continues to have active suicidal ideation. d.states, "I'm not sure I can avoid using alcohol when my spouse goes to work every morning."

Which of the following terms is used to describe aggregates who are at high risk for having poor health outcomes because of limited resources? a.Disadvantaged families b.Multi-problem families c.Resilient populations d.Vulnerable populations

Which patient would be most appropriate to refer for assertive community treatment (ACT)? A patient diagnosed with a.a phobic fear of crowded places. b.a single episode of major depressive disorder. c.a catastrophic reaction to a tornado in the community. d.schizophrenia and four hospitalizations in the past year.

Which remark by a group participant would the nurse expect during the working stage of group therapy? a."My problems are very personal and private. How do I know people in this group will not tell others what you hear?" b."I have enjoyed this group. It's hard to believe that a few weeks ago I couldn't even bring myself to talk here." c."One thing everyone seems to have in common is that sometimes it's hard to be honest with those you love most." d."I don't think I agree with your action. It might help you, but it seems like it would upset your family."

What foodborne disease is described below: ■ Prevention ● Hand washing!!!!!!!!! ● Cooking meats ● Avoiding raw food/wash well ● Keep raw food separate ● Prevent cross contamination

E. coli

What foodborne disease is described below: ■ Treatment ● No current treatments can cure the infection, relieve symptoms, or prevent complications ● For most people, treatment includes supportive therapy ○ Fluids ● Antidiarrheal medications are not always recommended! Want the germs to leave the body!

E. coli

When talking about the history of epidemiology: During the 19th Century: ____ ____ worked in the Crimean War ○ Showed improved environmental conditions and added nursing care decreased mortality rates of soldiers

Florence Nightingale

What public policy affecting vulnerable populations is described below: 1996; Intended to help people keep health insurance when moving

Health Insurance Portability and Accountability Act (HIPAA)

--Objectives relevant to rural & migrant populations Consider: ○ Sparse population, remoteness, scarce resources, personnel shortages, & physical/emotional & social isolation --Community must be involved in developing the plan and assume some ownership of it. Consider how to use resources ○ Mobile health clinic

Healthy People 2020

Objectives: ○ Emphasizes improving health by modifying the individual social and environmental determinants of health ○ Having a primary care provider who coordinates health services and provides preventative services

Healthy People 2020

What communicable disease is described below: ● Statistics: ○ 3,000 new cases of Hep A annually in US (1.4 million worldwide) ○ 43,000 new cases of Hep B annually in US (2 billion people infected worldwide) ○ 17,000 new cases of Hep C annually in US (3-4 million new cases each year)

Hepatitis

What communicable disease is described below: ○ Spread through blood or body fluids ○ Most common chronic bloodborne infection ○ Leading cause of chronic liver disease, end stage liver disease, liver cancer, and liver transplants in the US

Hepatitis C

what is the treatment of acute dystonia as an EPS side effect of 1st generation antipsychotics?

IM/IV benztropine or diphenhydramine 25-50 mg

Intensive Outpatient Programs and Partial Hospitalization Programs

● Structured activities, group therapy, individual therapies, other types of therapy, pharmacological management ○ Usually one therapist has them all day ○ Will still be seen by a psychiatrist/NP; will still get treatment team ● (Visions - associated with Vermilion; some attend 5 days/week and others 3 days/week)

Intensive Outpatient Programs and Partial Hospitalization Programs

When talking about the history of epidemiology: During the 19th Century: _____ ____ was the: ● "the father of epidemiology" ○ Studies how clusters of cholera outbreak and how they were related to where the water came from in household distribution

John Snow

What medication for bipolar disorder is described below: PATIENT AND FAMILY TEACHING: ● Not addictive ● Consistent fluid intake - 1500-3000 ml/day ● Consistent sodium intake- sodium intake affects lithium levels>> high sodium = lower _______ level; low sodium = higher _______ level; aim for consistency in sodium intake ● Note - stop taking _________ if excessive diarrhea, vomiting, sweating. Can lead to dehydration which can increase lithium to toxic levels. Inform provider. ● Care with OTC meds ● Take with meals to avoid stomach irritation ● **1st week may gain up to 5 lbs of water weight.

Lithium

What medication for bipolar disorder is described below: ○ Draw lithium levels according to agency policy to ensure therapeutic level reached. ■ Blood may be drawn every month - after 6 months to year of stability - drop to every 3 months. Draw blood in the AM, 10-12 hours after last dose ○ Contraindications - cardiovascular disease, brain damage, renal disease, thyroid disease, myasthenia gravis; pregnancy, breastfeeding

Lithium

When talking about the history of epidemiology: During the 19th Century:____ _____ developed the germ theory and pasteurization

Louis Pasteur

With major depressive disorder, we have pharmacological interventions to treat the disorder. What type of medications are described below to treat MDD: ● Hypertensive crisis: *** immediate medical attention is crucial! *** ○ Early symptoms include severe headache, irritability, anxiety, flushing, sweating ○ Then becomes anxious, restless, and develops a fever ○ If fever becomes severe, seizures occur; coma or death is possible ○ **immediate medical attention is crucial

MAOIs

Medicaid or Medicare? ○ Paid for short-term hospitalizations in general hospitals and long-term care in nursing homes ○ Did NOT cover care for most in psychiatric hospitals ○ These incentives>>1) development of psychiatric units within general hospitals 2) transfer of geriatric patients from 100% state-paid psychiatric hospitals to Medicaid-reimbursed nursing homes ○ Thus....decrease in number in state-managed psychiatric hospitals

Medicaid

What syndrome from antipsychotics is described below: ● Generalized muscular rigidity ● Reduced consciousness & responsiveness ● Elevated temperature ● Hypertension, tachycardia, diaphoresis ● Admitted to ICU ● Medication >> bromocriptine & dantrolene (muscle relaxant)

Neuroleptic malignant syndrome (NMS)

With evidence based practice, step 1 includes _____ format which stands for: P - Population of interest (who we are looking at) I - Intervention of practice strategy in question (what do we want to do) C - Comparison (of population or of intervention used) (those who are educated about STDs vs those who are not) O - Outcome desired (what you want your end to be) T - Time frame (put an end date to our implementation)

PICOT

What public policy affecting vulnerable populations is described below: 2010; Has provisions for reducing growth of future Medicare expenditures

Patient Protection and Affordable Care Act

● Developed in response to fragmented care 5 key characteristics 1) Patient-centered --Takes into account unique needs 2) Comprehensive care --Preventative, acute, chronic needs are addressed 3) Coordination of care --Coordinate with broader facilities, hospitals, home health --If someone needs to go to a hospital it should be coordinated through these homes 4) Improved access -- Extended hours 5) Systems approach -- Evaluation and quality improvement -- Give feedback to facility

Patient-centered Medical Homes

What depressive disorder is described below: ● Depression occurs in majority of their days. To have this it has to have occurred for 2 years in adults and 1 year in children and adolescents and have to have 2 of the listed items (decreased appetite, insomnia, etc.) ● It is like bubbling up but under the surface they are not necessarily suicide but just hae this low level depression

Persistent Depressive Disorder

When talking about the history of epidemiology: During the 19th Century: ___ _____ investigated causes of TB, anthrax, and cholera

Robert Koch

With major depressive disorder, we have pharmacological interventions to treat the disorder. What type of medications are described below to treat MDD: ○ Risk of serotonin syndrome-possibly lethal ■ Symptoms include: hyperactivity/restlessness, tachycardia (leading to cardiovascular shock), fever (hyperpyrexia), elevated blood pressure, seizures, myoclonus (muscle spasm), incoordination, tonic rigidity, altered mental status, irrationality, mood swings, hostility, abdominal pain, diarrhea, bloating, apnea, death ■ Prevention: ● Do not take ______ with another serotonin enhancing agent ○ No St. John's wort! ○ *note if patient takes St. John's wort, herbal taken for depression* ● If switching from certain drugs, provider should allow a "washout" period; discontinue all SSRIs for 2-5 weeks ■ Interventions: ● Stop medication ● Symptomatic treatment ○ Medication that blocks serotonin ○ Cooling blankets; chlorpromazine has hypothermia effect ○ Dantrolene, diazepam - for muscle rigidity ○ Anticonvulsants

SSRIs

What public policy affecting vulnerable populations is described below: 1935; created largest federal support program for elderly and poor Americans

Social Security Act (SSA)

What is a serotonin enhancing agent that should NOT be taken with SSRIs? **pharmacological internention for pt with MDD ○ *note if patient takes ___ _____ ____, herbal taken for depression*

St. John's Wort

In 1999, the ___ ____ stated that keeping people in psychiatric hospitals was "UNJUSTIFIED ISOLATION.". The court opinion stated that mental illness is a disability. Institutionalization is in violation of the Americans with Disability Act. All people with disabilities have a right to live in the community. **HIGHLIGHTED IN BOLD RED IN NOTES.

Supreme Court

What communicable disease is described below: ● Treatment ○ Patient centered case management ○ Adherence plan ○ Directly observed therapy (DOT) ○ Usually a combination of drugs ■ Latent ● Isoniazid (INH) ● Rifampin (RIF) ● Rifapentine (RPT) ■ Active ● Isoniazid (INH) ● Rifampin (RIF) ● Ethambutol (EMB) ● Pyrazinamide (PZA)

With major depressive disorder, we have pharmacological interventions to treat the disorder. What type of medications are described below to treat MDD: ○ Adverse reactions: ■ Anticholinergic actions, weight gain, postural orthostatic hypotension, tachycardia, sedative effect (administer at night) ■ Serious → cardiac effects (patient should have thorough cardiac workup prior to initiating) ■ *******Lethal in overdose; use cautiously in older adults; be sure patient not suicidal for home use** VERY IMPORTANT ● Prescriber must be confident that they are not suicidal!*******VERY IMPORTANT

TCAs (tricyclic antidepressants)

What communicable disease is described below: ● Caused by varicella-zoster virus ● Spread via ○ Respiratory ○ Fluid from blister ● Treatment ○ Immunoglobulins (IG) ○ Acyclovir: most common ● Symptom management ○ Treat fever ● Prevention → vaccination ● Shingles

Varicella (Chicken Pox)

What communicable disease is described below: ● Treatment ○ Immunoglobulins (IG) ○ Acyclovir: most common ● Symptom management ○ Treat fever ● Prevention → vaccination ● Shingles

Varicella (Chicken Pox)

What communicable disease is described below: ○ Prevention ■ Vaccination - rates have decreased ■ Good hand hygiene ○ Treatment ■ Immune globulin ● Give within 2 weeks of Dx

Viral Hepatitis A

What communicable disease is described below: ○ Spread: fecal → oral route ■ Sex with someone who is infected ■ Contamination of food or water ■ Found in feces ■ Brief presence in blood ○ Prevention ■ Vaccination - rates have decreased ■ Good hand hygiene ○ Treatment ■ Immune globulin ● Give within 2 weeks of Dx ○ Symptoms ■ Acute onset ■ Fever ■ Malaise ■ Nausea ■ Lack of appetite ■ Abdominal discomfort ■ Light colored bowel movements

Viral Hepatitis A

What communicable disease is described below: ○ Symptoms ■ Acute onset ■ Fever ■ Malaise ■ Nausea ■ Lack of appetite ■ Abdominal discomfort ■ Light colored bowel movements

Viral Hepatitis A

What communicable disease is described below: ○ Spread: fecal → oral route ■ Sex with someone who is infected ■ Contamination of food or water ■ Found in feces ■ Brief presence in blood

Viral Hepatitis B

What are necessary for change to occur in therapeutic groups? (this what's supposed to be happening in group for healing to occur)?

Yalom's curative factors

____ _____ ______ are necessary for change to occur in therapeutic groups and the following things need to happen: ● Corrective recapitulation of primary family group - learn about their own behavior in their family ● Socializing techniques - learn new social skills based on feedback ● Imitative behavior ● May copy behavior from leader or peers & adopt healthier habits ○ Imitate good role model

Yalom's curative factors

____ _____ ______ are necessary for change to occur in therapeutic groups and the following things need to happen: ● Group cohesiveness -each member feels connected to others; can accept positive feedback & constructive criticism ○ Feel "plugged in" by people who understand, feel like they can speak freely, must learn to accept positive feedback and constructive criticism ● Existential resolution- examine aspects of life - mortality, responsibility, loneliness

Yalom's curative factors

____ _____ ______ are necessary for change to occur in therapeutic groups and the following things need to happen: ● Interpersonal learning-gain insight into themselves ● Catharsis - expression of deep emotions ● Installation of hope -leader shares optimism about success of group treatment; believe they will get better ○ Restored hope ● Universality - others have similar problems ○ They realize they are not alone alone alone - spongebob ○ Teach one another from past experience ● Imparting information - instruction; lecture ● Altruism - Members gain from giving support to others ○ Spirit of good will, they gain from giving support to others, giving and receiving ● Corrective recapitulation of primary family group - learn about their own behavior in their family ● Socializing techniques - learn new social skills based on feedback ● Imitative behavior ● May copy behavior from leader or peers & adopt healthier habits ○ Imitate good role model ● Group cohesiveness -each member feels connected to others; can accept positive feedback & constructive criticism ○ Feel "plugged in" by people who understand, feel like they can speak freely, must learn to accept positive feedback and constructive criticism ● Existential resolution- examine aspects of life - mortality, responsibility, loneliness

Yalom's curative factors

The following are trends in ____ sexual behavior and pregnancy: --Support needed during and after pregnancy from family and friends and from the father of the baby --Background factors—invincible --Sexual activity, use of birth control, peer and partner pressure, STD's, drugs, embarrassed to discuss

adolescent

____ _____ ______ are necessary for change to occur in therapeutic groups and the following things need to happen: ● Universality - others have similar problems ○ They realize they are not alone alone alone - spongebob ○ Teach one another from past experience ● Imparting information - instruction; lecture ● Altruism - Members gain from giving support to others ○ Spirit of good will, they gain from giving support to others, giving and receiving

Yalom's curative factors

The following is information concerning ___a__ and __b___ workers: o 85% of ___b____ workers are ___a_____ o Seasonal workers vs ____b_____ workers o ___b_____ workers have unpredictable and difficult lifestyles uncertain housing, traveling long distances o Undocumented workers are at high risk o 75% earn less than $10,000 a year o Many farm workers are seasonal, but do not travel o 3 or 4 families will share one small house o Earn less and send some of their earnings to family members in other countries o Housing may be in camps, cabins, trailers or tents, cars o As many as 50 persons may be in one house o Illnesses seen: gastritis, Hepatitis, TB

a. minorities b. migrant

The following is information concerning ___a__ and __b___ workers: o Many farm workers are seasonal, but do not travel o 3 or 4 families will share one small house o Earn less and send some of their earnings to family members in other countries o Housing may be in camps, cabins, trailers or tents, cars o As many as 50 persons may be in one house o Illnesses seen: gastritis, Hepatitis, TB

a. minorities b. migrant

The following is the differences between __a__ and __b____ areas: ● Geographic location ○ ___a____-___b____ Continuum: core inner city and farms/villages/towns/cities and/or metro around ● Population density ○ ___a____: <20,000 or <99 per square mile § Farm residency ○ ____b_____: at least 20,000 but <50,000 § Nonfarm residence ○ Metropolitan area: core urban area of 50,000 or more ○ Micropolitan area: core 10,000 to <50,000 ● Why would this be a concern for community nurses?

a. rural b. urban

What type of immunity for communicable disease is described below: ● passive/active

acquired immunity

With schizophrenia, there are 4 phases: prodromal, acute, stabilization, and maintenance/ residual. Which phase is described below: ○ symptoms appear & vary - few>many; mild>disabling; hospitalization may be needed

acute

What part of the epidemiologic triangle is described below: animate or inanimate factor that must be present or lacking for a disease or condition to develop ○ Biologic (bacteria, viruses), chemical (poison, alcohol, smoke), physical (trauma, radiation, fire), nutritonal (lack, excess) ○ Infectivity ○ Pathogenicity ○ Virulence ○ Immunogenicity ○ Antigenic stability survival ○ Attack rate

agent

With integrative care what basic term is described below: instead of standard medical care

alternative

What core function of public health (ethics) is described below: of community and public domains ○ Finding the needs of the community

assessment

With schizophrenia we have positive symptoms. These includes alterations in _______. This includes catatonic, waxy flexibility, motor retardation, motor agitation, stereotypes behaviors, echopraxia, negativism, impaired impulse control, gesturing or posturing, and boundary impairment.

behavior

What family function is described below: ○ Clear - adaptive, healthy, firm, yet flexible ○ Diffuse - unclear and lack of independence - everyone - therefore no one is in charge - overly involved with one another; enmeshment; discouraged from expressing own views; differentiation discouraged → ability to possess strong identity and sense of self ○ Rigid - opposite of diffuse, demand adherence to rules and roles, communication is minimal, members rarely share thoughts; isolation may be marked feature; do not learn intimacy in the family setting and do not develop insights???? May have hard time bonding with others when they leave

boundary delineation

With schizophrenia we have positive symptoms. These includes alterations in behavior. This includes catatonic, waxy flexibility, motor retardation, motor agitation, stereotypes behaviors, echopraxia, negativism, impaired impulse control, gesturing or posturing, and boundary impairment. Which one of these is described below: ○ - impaired ability to sense where one' s body ends and another's begins; may stand too close

boundary impairment

What thought disorder is described below: ● Sudden onset of 1 of the following: ○ Delusions ○ Hallucinations ○ Disorganized speech ○ Disorganized or catatonic (severely decreased motor activity) behavior ● Symptoms must LAST LONGER THAN 1 DAY, BUT NO LONGER THAN 1 MONTH with the expectation of returning to normal

brief psychotic disorder

With analytical epidemiology we have ___ ____ _____ which includes: ● odds ratio ○ Two groups are selected ○ One of people with the disease or outcome of interest (cases) ○ The other group of people with the same general characteristic but without the disease (controls) ○ Compare the past exposures of both groups

case control study

What basic epidemiology concept is described below: · Number of deaths from a specific disease o Number of persons diagnosed · Ex. 20 out of 100 diagnosed with skin cancer will die within 5 years 5yr ____ _____ _____ is 20% 5 yr survival rate is 80% · Also known as probability of surviving

case fatality rate

What thought processes and speech pattern of a patient with bipolar disorder is described below: ● - stringing words together according to their rhyming sounds - not meaning

clang associations

2 types of experimental studies?

clinical trials and community trials

the following is a ______ of communicable diseases: ● Nurses are the forefront of prevention ● Know how to implement primary and secondary prevention ● In the case of infectious disease, know the treatments and alert the proper personnel ASAP ● Be aware of what diseases or infectious elements are present ● Be familiar with how they are transmitted and the signs and symptoms ● Protect yourself while treating those who are ill ● Educate ● Implement strategies to reduce or eliminate the spread

conclusion

With schizophrenia we have negative symptoms which includes cognitive symptoms. These include concrete thinking, impaired memory, impaired formation processing, and impaired executive functioning. which one of these is described below: - impaired ability to think abstractly; perceive things in literal manner

concrete thinking

What term central to therapeutic groups is described below: open disagreement among members. Positive conflict resolution within a group is key to successful outcomes

conflict

With step 3: approaches to evaluating evidence, determining quality there are 3 domains for evaluation of systems. which domain is described below: ● similar findings amongst different studies, examining the same topic

consistency

Integrative health in the US includes: focuses on what is done TO the patient

conventional medicine

What Yalom's curative factor is described below: learn about their own behavior in their family

corrective recapitulation of primary family group

When using the nursing process for someone concerning suicide ____ statements include: ○ Not directly said ■ "It's okay now. Soon everything will be fine." ■ "Things will never work out." ■ "I won't be a problem much longer." ■ "Nothing feels good to me anymore and probably never will." ■ "How can I give my body to medical science?"

covert

what type of poverty is described below: § Lives marked by hardship and struggle: Employment, DV § Homelessness is transient or episodic, brief shelter stays

crisis

What inpatient care setting is described below: overnight, short term—1 to 3 days; MHERE at UHC (Mental Health Emergency Room Extension) ○ "Boarding psych patients" ○ Send to MHERE (from UHC) not d/c (still considered ER patients) but can see psych specialist ○ If this unit doesn't exist, they can't leave ER until they find placement in proper psych facility; can take hours, holds up beds for other patients waiting for treatment

crisis stabilization/ observation units

What learning theory is described below: ● Aim to dig beneath the surface. of social life and uncover the assumptions that keep us from a full and true understanding of how the world works

critical theory

What learning theory is described below: ● Type of social theory ○ Oriented toward critiquing and changing society as a whole in contrast to traditional theory oriented only to understanding or exploring it ● Aim to dig beneath the surface. of social life and uncover the assumptions that keep us from a full and true understanding of how the world works

critical theory

What basic epidemiology concept is described below: the ____ ____ ____ for a person is: o ***Number of death from any cause during time interval*** o Estimated mid-year population ***Estimate of risk for death per person in a given population

crude mortality rate

--Poor living & social conditions · Result: Legislation & advocacy o CMHC's - Community Mental Health Centers o But still lack necessary services § Continuous daily monitoring not available for acute episodes § Transitional care after discharge from acute care not available

deinstitutionalization

· Goal: improve quality of life for people with mental disorders --Move away from state inpatient facilities --Community based services- but not available in all areas --More family burden -not prepared to care for discharged patients --Poor living & social conditions · Result: Legislation & advocacy o CMHC's - Community Mental Health Centers o But still lack necessary services § Continuous daily monitoring not available for acute episodes § Transitional care after discharge from acute care not available

deinstitutionalization

When talking about _____ epidemiology we have: The environment/ Place · Examination of disease by geographical place and patterns · Variations may be due to --chemical , physical, or biological environment --Difference in population densities, culture, etc --Reservoir --Mode of transmission: Direct and Indirect · EX: tic, rocky mountain spotted fever

descriptive

elimination or eradication? irreversible termination of all transmission of infection (smallpox)

eradication

______ of health and behavior includes: ● ___________: systematic and logical way to make decisions to improve the educational program ● What is a behavior change? ● What is a knowledge change? ● What is an attitude change? ● The goals determine the type of evaluation ● The __________ can be done through surveys, direct observation, and follow-up calls or testing ● The questions used in the survey determine the type of change and measurement used

evaluation

The following is ________ at the BSM level for family function: ● Evaluate knowledge of therapeutic regimen ● Accessing outside support ● Improved family coping

evaulation

What Yalom's curative factor is described below: examine aspects of life - mortality, responsibility, loneliness

existential resolution

Task, maintenance, and individual are the different?

group participant roles

○ wide variations in health services and health status among certain populations

health disparities

With schizophrenia we have negative symptoms which includes cognitive symptoms. These include concrete thinking, impaired memory, impaired formation processing, and impaired executive functioning. which one of these is described below: delayed responses; misperceptions, difficulty understanding others

impaired information processing

What key characteristic of Patient-centered medical homes is described below: ● Extended hours

improved access

What groups concept and definition is described below: (ex: democratic, patriarchal)

leadership of the group

With schizophrenia we have _______ symptoms which includes ______ dimension. ______ dimension (591-594) ○ Affective flattening/blunting - reduced intensity of expression & response, do not change expressions in response to circumstances; movements lack spontaneity; gestures slow; voice lacks inflection; slow speech ○ Apathy - decreased interest in activities/beliefs that would otherwise be important ○ Alogia (poverty of speech) - reduction in speech

negative

With schizophrenia, we have 4 main categories in an assessment: positive, negative, cognitive, and affective. What category is described below: - absence of something that should be present ○ Blunted affect, poverty of thoughts (alogia), loss of motivation (avolition), inability to experience pleasure of joy (anhedonia)

negative

○ proportion of persons with a negative test who are actually disease free **validity of reviewing a screening tool

negative predictive value

what type of poverty is described below: § Refers to geographically defined areas of high poverty, § Characterized by dilapidated housing and high levels of unemployment

neighborhood

What risk factor for schizophrenia is described below: 2nd generation - block both serotonin and dopamine - reduce symptoms

other neurochemical

What key characteristic of Patient-centered medical homes is described below: ● Takes into account unique needs

patient centered care

What example of dysfunctional communication is described below: family members pretend to be well meaning to keep peace in the family "Do not yell at the children, dear, I put the shoes on the stair."

placating

The following are skills of the effective educator: ● GAIN the attention, send clear message ● TELL the objectives of instruction and ensured ● ASK learners to recall knowledge related to the topic ● PRESENT the essential material ● HELP in application of new knowledge and guidance ● ENCOURAGE demonstration and participation ● ________ feedback, assessment of performance, evaluation of transfer of knowledge

provide

With step 3: approaches to evaluating evidence, determining quality there are 3 domains for evaluation of systems. which domain is described below: ● the number of studies on topic, magnitude of the effect, the sample size ○ The bigger the sample size, the more it will be supported

quantity

What bipolar disorder is described below: ○ at least four mood episodes in 12-month period . The cycling can also occur within the course of a month or even a 24 hour period.

rapid cycling

What Yalom's curative factor is described below: learn new social skills based on feedback

socializing techniques

What is the 10th leading cause of death according to the CDC in the US?

suicide

Support groups or self-help groups? --bereavement groups for those who have experienced the loss of a loved one --suicide survivor groups for those who have lost a loved one to suicide --NAMI groups for patient/family support, education, and advocacy --cancer ______ groups for families and patients coping with the ramifications of this terminal illness --virtual ____ groups for growing number of people, providing online, synchronous interaction and support, which may be percieved as more private --veteran ____ groups

support

______ of communicable disease includes: ● _________: gather the who, when, where, and what ● _____________ for agents of bioterrorism ○ Syndromic surveillance systems ■ Early Aberration Reporting System (EARS) ● Lists of reportable diseases varies by state

surveillance

● Research that is relevant to one topic ● All research that is available on the topic ● Aim: evaluate and interpret all available research to 1 question **step 2: 4 approaches to finding evidenec

systematic review

The following is learning _____: ● Behavioral theory ● Cognitive theory ● Critical theory ● Developmental theory ● Social learning theory

theories

What consideration for inpatient care is described below: surroundings & physical environment- promote healing-- READ THIS PARAGRAPH VERY CAREFULLY. ○ Way chairs are placed: want optimal therapeutic environment ○ **read book carefully ○ Vital part of the team are UAP, so it is essential for the nurse to assure there is a therapeutic milieu so people can heal and go on ○******* A main function of RN - includes rules, activities, environment >> even placement of tables/chairs/furniture*********

therapeutic Milieu

any group of people who meet together for personal development and psychotherapeutic growth ○ Not just to satisfy schedule: psychoeducational groups *****IMPORTANT ****

therapeutic group

What expected outcome of therapeutic group is described below: outcomes focus more on insights, behavior changes, reduction in symptoms ○ Example - alcohol treatment group - Patient develops insight into the connection between drinking and negative consequences. ○ CBT, REBT, therapist leads them to change mind set

therapy groups

The following are diseases of _____ (individuals traveling outside the US): ● Malaria ● Foodborne and waterborne diseases ● Diarrheal diseases

travelers

With emergency care, the primary goal is?

triage and stabilization

1 member will not communicate directly with another family member, but will communicate with a 3rd family member. This forces the 3rd family member to be part of the triangle & communication is routed through the 3rd person.

triangulation (family triangles)

What depressive disorder is described below: ● Formerly known as Dysthymia** ● Feelings of depression that occur most of the day in the majority of days ● Low-level depression ○ 2 years in adults ○ 1 year in children/adolescents ● Have 2 of the following: ○ Decreased appetite/overeating ○ insomnia/hypersomnia (sleeping too much or too little) ○ Low energy ○ Poor self esteem ○ Difficulty thinking (concentrating, focused) ○ Hopelessness (RED FLAG) ● Onset: usually teen years; may feel they have "always felt this way" ● Depression occurs in majority of their days. To have this it has to have occurred for 2 years in adults and 1 year in children and adolescents and have to have 2 of the listed items (decreased appetite, insomnia, etc.) ● It is like bubbling up but under the surface they are not necessarily suicide but just hae this low level depression

Persistent Depressive Disorder

What depressive disorder is described below: ● Have 2 of the following: ○ Decreased appetite/overeating ○ insomnia/hypersomnia (sleeping too much or too little) ○ Low energy ○ Poor self esteem ○ Difficulty thinking (concentrating, focused) ○ Hopelessness (RED FLAG) ● Onset: usually teen years; may feel they have "always felt this way"

Persistent Depressive Disorder

T or F. All antipsychotics take about 2-6 weeks to achieve desired results

T or F. All health care professionals are obligated to read, understand, and implement the latest research findings consistent with the area of practice ******

T or F. Antipsychotics are NOT addictive

T or F. MAJOR DEPRESSION is treatable! **major depressive disorder

T or F. Not all proportions deal with death.

T or F. Of 12 million Emergency dept. visits - nearly 13% due to mental health/substance use. ******

T or F. Other integrative care includes: ● Aromatherapy ● Music ● Art ● Bioelectromagnetic - based & bright-light therapy ● Prayer

Mental health individuals and children are the two populations?

at risk in rural

T or F. The IOM has set forth that by 2020 90% of all decisions will be based on the most recent and sound evidence. ******

T or F. Urban children more likely to see a pediatrician when they are ill

the self injurious acts result in death

completed suicide

What at risk population for mental illness is described below: o Minorities o Work within community

cultural diversity

What are the 2 types of epidemiology?

descriptive and analytical

There are tools that assess family function. Name 2.

genograms and ecomap

T or F. risk for suicide increases within 1st 2-3 weeks after starting medication - client's mood has not lifted as fast as energy has returned- HAS ENERGY TO CARRY OUT A PLAN

What group participant role is described below: create sense of group cohesion

maintenance

A nurse offers homeless clients yearly tuberculosis (TB) screening and free treatment for those who test positive for TB. Which of the following levels of prevention is being used? a.Primary prevention b.Secondary prevention c.Tertiary prevention d.Secondary and tertiary prevention

What is the main focus of both descriptive and analytical epidemiology?

populations

Rural or Urban? ○ : <20,000 or <99 per square mile § Farm residency

rural

What assessment tool to assess family function is described below: ● efficient format that provides information & defines relationships across at least 3 generations

genograms

A nurse performed these actions while caring for patients in an inpatient psychiatric setting. Which action violated patients' rights? a.Prohibited a patient from using the telephone b.In patient's presence, opened a package mailed to patient c.Remained within arm's length of patient with homicidal ideation d.Permitted a patient with psychosis to refuse oral psychotropic medication

A community mental health nurse has worked for months to establish a relationship with a delusional, suspicious patient. The patient recently lost employment and could no longer afford prescribed medications. The patient says, "Only a traitor would make me go to the hospital." Select the nurse's best initial intervention. a.With the patient's consent, contact resources to provide medications without charge temporarily. b.Arrange a bed in a local homeless shelter with nightly on-site supervision. c.Hospitalize the patient until the symptoms have stabilized. d.Ask the patient, "Do you feel like I am a traitor?"

A group of teenagers with diabetes become upset and angry because they cannot agree on whether or not to have meetings during summer vacation. Which of the following should the nurse do to be effective in helping the teenagers resolve the conflict? a.Admit that it is difficult for everyone to agree on everything; then ask whether the group can try to decide how to agree on the issue. b.Assume adult authority and announce that meetings will be suspended until fall. c.Recognize that most of the teenagers want to have the meetings, but two are being stubborn; ask the two deviant members to leave the group. d.Suggest that the group avoid discussing it further but rather think about it over the next week and try to discuss the situation more rationally next week.

A homeless family brought their father to the public health clinic after he reported bleeding when he went to the bathroom. Which of the following nursing actions would be most appropriate? a.Begin tests to determine the cause of the bleeding while asking about other family concerns from nutrition to shelter for the night. b.Refer the man to a urologist to address the urinary bleeding. c.Suggest that the family take him to an urgent care center immediately. d.Treat the urinary infection and give the man medication to take to prevent the return of infection.

A leader plans to start a new self-esteem building group. Which intervention would be most helpful for assuring mutual respect within the group? a.Describe the importance of mutual respect in the first session and establish it as a group norm. b.Exclude potential members whose behavior suggests they are likely to be disrespectful of others. c.Give members a brochure describing the purpose, norms, and expectations of the group. d.Explain that mutual respect is expected and confront those who are not respectful.

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

A nurse established an ongoing group meeting of teenagers with diabetes. In the early stages, the nurse was very directive in arranging location, providing low-carbohydrate drinks and snacks, steering the discussion, and trying to meet all the teenagers' needs. After the group had been meeting for about 3 months, the nurse noticed that the group members no longer simply accepted everything the nurse suggested. Instead, the teenagers began making decisions themselves, and eventually, the nurse no longer controlled the group. Which of the following most likely happened to cause this shift? a.The group became cohesive enough to share leadership tasks. b.Teenagers don't like feeling dependent on adults with power. c.Teenagers often rebel against adult authority. d.The nurse was overwhelmed and lost control of task process.

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

A nurse has invited community members to participate as full partners in creating changes to improve the health of the community. Which of the following may be an unexpected consequence of this action? a.A change in the distribution or redistribution of power and influence b.An increase in awareness of the importance of health c.Continued ongoing interest in community health activities d.Improved family functioning and involvement in health activities

A nurse leads a psychoeducational group for patients in the community diagnosed with schizophrenia. A realistic outcome for group members is that they will a.discuss ways to manage their illness. b.develop a high level of trust and cohesiveness. c.understand unconscious motivation for behavior. d.demonstrate insight about development of their illness.

A nurse makes an initial visit to a homebound patient diagnosed with a serious mental illness. A family member offers the nurse a cup of coffee. Select the nurse's best response. a."Thank you. I would enjoy having a cup of coffee with you." b."Thank you, but I would prefer to proceed with the assessment." c."No, but thank you. I never accept drinks from patients or families." d."Our agency policy prohibits me from eating or drinking in patients' homes."

A nurse who is providing diabetes screening at a community clinic discovers that a new client has type 2 diabetes mellitus. The nurse provides counseling, refers the client to an endocrinologist for initial assessment and treatment, arranges for the client to see someone regarding financial assistance, contacts the mobile van to arrange transportation, and sets up a follow-up appointment. Which of the following types of service do these actions represent? a.Case management b.Client advocacy c.Holistic care d.Wrap-around services

A patient asks, "What is the major difference between conventional health care and complementary and alternative medicine (CAM)?" The nurse's best reply is that conventional health care a.focuses on what is done to the patient, whereas CAM focuses on body-mind interaction with an actively involved patient. b.has been tested by research so less regulation is needed, but CAM is religiously based and highly regulated. c.is controlled by the health care industry, but CAM is the people's medicine and not motivated by profit. d.is holistic and focused on health promotion, whereas CAM treats illnesses and is symptom-specific.

A patient diagnosed with major depressive disorder does not interact with others except when addressed, and then only in monosyllables. The nurse wants to show nonjudgmental acceptance and support for the patient. Which communication technique will be effective? a.Make observations. b.Ask the patient direct questions. c.Phrase questions to require yes or no answers. d.Frequently reassure the patient to reduce guilt feelings.

A patient diagnosed with major depressive disorder tells the nurse, "I want to try supplementing my selective serotonin reuptake inhibitor (SSRI) with St. John's wort." Which action should the nurse take first? a.Advise the patient of the danger of serotonin syndrome. b.Suggest that aromatherapy may produce better results. c.Assess the patient for depression and risk for suicide. d.Suggest the patient decrease the antidepressant dose.

A patient diagnosed with schizophrenia has been stable for 2 months. Today the patient's spouse calls the nurse to report the patient has not taken prescribed medication and is having disorganized thinking. The patient forgot to refill the prescription. The nurse arranges a refill. Select the best outcome to add to the plan of care. a.The patient's spouse will mark dates for prescription refills on the family calendar. b.The nurse will obtain prescription refills every 90 days and deliver to the patient. c.The patient will call the nurse weekly to discuss medication-related issues. d.The patient will report to the clinic for medication follow-up every week.

A patient has talked constantly throughout the group therapy session, often repeating the same comments. Other members were initially attentive then became bored, inattentive, and finally sullen. Which comment by the nurse leader would be most effective? a.Say to everyone, "Most of you have become quiet. I wonder if it might be related to concerns you may have about how the group is progressing today." b.Say to everyone, "One person has done most of the talking. I think it would be helpful for everyone to say how that has affected your experience of the group." c.Say to everyone, "I noticed that as our group progressed, most members became quiet, then disinterested, and now seem almost angry. What is going on?" d.Say to the talkative patient, "You have been doing most of the talking, and others have not had a chance to speak as a result. Could you please yield to others now?"

A patient is experiencing psychomotor agitation associated with major depressive disorder. Which observation would the nurse associate with this symptom? The patient a.paces aimlessly around the room. b.asks the nurse to repeat instructions. c.complains of prickly skin sensations. d.demonstrates slowed verbal responses.

A patient reports good results from taking an herb to manage migraine headache pain. The nurse confirms there are no hazardous interactions between the herb and the patient's current prescription drugs. Select the nurse's best comment to the patient. a."Thanks for telling me. I'll make a note in your medical record that you take it." b."You are experiencing a placebo effect. When we believe something will help, it usually does." c."Self-management of health problems can be dangerous. You should have notified me sooner." d."Research studies show that herbals actually increase migraine pain by inflaming nerve cells in the brain."

An acutely violent patient diagnosed with schizophrenia received several doses of haloperidol. Two hours later the nurse notices the patient's head rotated to one side in a stiffly fixed position, the lower jaw thrust forward, and drooling. Which intervention by the nurse is indicated? a.Administer diphenhydramine 50 mg IM from the prn medication administration record. b.Reassure the patient that the symptoms will subside. Practice relaxation exercises with the patient. c.Give trihexyphenidyl 5 mg orally at the next regularly scheduled medication administration time. d.Administer atropine sulfate 2 mg subcut from the prn medication administration record.

During group therapy, one patient says to another, "When I first started in this group, you were unable to make a decision, but now you can. You've made so much progress that I am beginning to think maybe I can conquer my fears too." Which therapeutic factor is evident by this statement? a.Hope b.Altruism c.Catharsis d.Cohesiveness

For which patient would it be most important for the nurse to urge immediate discontinuation of kava? A patient with a comorbid diagnosis of a.cirrhosis. b.osteoarthritis. c.multiple sclerosis. d.chronic back pain.

Statistics clearly demonstrate that there are significantly more cases of a disease in one particular neighborhood than in all the rest of the city. Assuming all else is the same, which of the following is the most likely explanation for a single neighborhood having such a different pattern of illness? a.A cultural or ethnic concentration in the neighborhood b.The geographical location of the neighborhood within the city c.A statistical fluke without meaning d.The time of year the different statistics were collected throughout the city

The administration at a local medical center examines the trends in health problems when developing long-range plans for staffing and space allocation. Which of the following sources of information would be most helpful? a.Local data drawn from a professional survey in the city b.The National Health Interview Survey c.The National Hospital Discharge Survey d.The state's vital statistics

Three members of a therapy group share covert glances as other members of the group describe problems. When one makes a statement that subtly criticizes another speaker, the others nod in agreement. Which group dynamic should the leader suspect? a.Some members are acting as a subgroup instead of as members of the main group. b.Some of the members have become bored and are disregarding others. c.Three members are showing their frustration with slower members. d.The leadership of the group has been ineffective.

Two women seem to agree on almost everything from favorite music to favorite media stars to the best way to prepare a meal. Which of the following best explains this similarity in the two women? a.They are both members of the same birth cohort. b.They are close friends. c.They attended the same school. d.They both go the same church.

When a patient diagnosed with schizophrenia was discharged 6 months ago, haloperidol was prescribed. The patient now says, "I stopped taking those pills. They made me feel like a robot." What are common side effects the nurse should validate with the patient? a.Sedation and muscle stiffness b.Sweating, nausea, and diarrhea c.Mild fever, sore throat, and skin rash d.Headache, watery eyes, and runny nose

Which documentation for a patient diagnosed with major depressive disorder indicates the treatment plan was effective? a.Slept 6 hours uninterrupted. Sang with activity group. Anticipates seeing grandchild. b.Slept 10 hours uninterrupted. Attended craft group; stated "project was a failure, just like me." c.Slept 5 hours with brief interruptions. Personal hygiene adequate with assistance. Weight loss of 1 pound. d.Slept 7 hours uninterrupted. Preoccupied with perceived inadequacies. States, "I feel tired all the time."

Which documentation of family assessment indicates a healthy and functional family? a.Members provide mutual support. b.Power is distributed equally among all members. c.Members believe there are specific causes for events. d.Under stress, members turn inward and become enmeshed.

Which of the following best represents an example of infectious disease spreading via a vector? a.Being bitten by an infected mosquito b.Disease spreading from infected mother to infant via the placenta c.A group of partygoers hugging and shaking hands d.Two persons, one of whom is infected, sharing a glass of soda

Which of the following biological warfare agents poses the greatest bioterrorism threat to a community? a.Anthrax b.Botulism c.Smallpox d.Tularemia

Which of the following is the most probable cause of the increase in new emerging infectious diseases? a.Activities or behavior of humans, including changes in the environment b.Increasing urbanization and growth in new housing materials c.New infectious agents are evolving throughout the world d.Overpopulation in many areas, creating a need to reduce global population

Which of the following places best describes where the incidence of Vancomycin-resistant Staphylococcus aureus (VRSA) and methicillin-resistant S. aureus (MRSA) is currently rising? a.Areas where people share dressing or bathing facilities b.Daycare centers and schools c.Long-term care facilities d.Senior citizen centers

Which of the following statements regarding the Health Belief Model is accurate? a.Cues to action are an important component of the model. b.Multiple methods of education should be used when implementing this model. c.The first stage experienced in this model is the pre-contemplation stage. d.To successfully implement this model, ongoing maintenance of the behavior must be considered.

Which principle has the highest priority when addressing a behavioral crisis in an inpatient setting? a.Resolve the crisis with the least restrictive intervention possible. b.Swift intervention is justified to maintain the integrity of a therapeutic milieu. c.Rights of an individual patient are superseded by the rights of the majority of patients. d.Patients should have opportunities to regain control without intervention if the safety of others is not compromised.

A nurse believes a new mouth care procedure (MCP) is causing more mouth problems than it is helping to avoid. Which of the following must be present for the nurse to go to administration with confidence that the new mouth care procedure (MCP) is causing problems? (Select all that apply.) a.A plausible explanation of how the new MCP could cause harm b.A strong feeling that the MCP is the cause c.Consistently seeing mouth inflammation in many of the patients who have received the MCP d.Documentation from patient records that mouth inflammation in clients did not occur until after the new procedure was implemented

A,C,D

A nurse tells her nursing supervisor that her family is moving from the urban area where they both live to a rural area to be near her spouse's parents, who are becoming less independent. Which of the following suggestions would the nursing supervisor provide to the nurse? (Select all that apply.) a."Community members will probably hold you in higher regard and will look up to you." b."Expect to have less autonomy in a small town than you have working as a nurse in a medical center." c."You may feel like an isolated outsider, because the community may not immediately accept you." d."You will have to be very sensitive about the differences in the rural lifestyle."

A,C,D

Integrative health in the US includes: patient participates with provider to heal body & mind

integrative

● Intense type of case management teams developed in 1970s—multidisciplinary ● Those with serious, persistent psychiatric symptoms. Often unable or unwilling to participate in traditional treatment. So...have expensive repeat hospitalizations ○ Work with people with serious/severe mental illness (SMI) ○ Hard to keep them on their medications and compliant with treatment; end up having to be involuntarily committed again; answer to this issue, keeps them on an even field, keeps them from decompensating ● ___ ____ _____ teams work intensively with patients in their homes or agencies>>wherever patient needs ● On call/ creative problem solving; if someone starts acting up in the middle of the night, they are called to work with patient ● May visit 3 - 5 times per week in order to keep them high functioning and out of the hospital

Assertive Community Treatment (ACT) teams

35. A client says, "Facebook has a new tracking capacity. If I use the Internet, Homeland Security will detain me as a terrorist." Select the nurse's best initial action. a.Tell the client, "Facebook is a safe website. You don't need to worry about Homeland Security." b.Tell the client, "You are in a safe place where you will be helped." c.Administer a prn dose of an antipsychotic medication. d.Tell the client, "You don't need to worry about that."

A man is diagnosed with prostate cancer. Which of the following data should the nurse know to answer the man when he asks, "What are the chances I'll survive this thing?" a.Attack rate b.Case fatality rate c.Cause-specific morbidity rate d.Crude mortality rate

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

A newly admitted patient diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The patient states, "I saw two doctors talking in the hall. They were plotting to kill me." The nurse may correctly assess this behavior as a.echolalia. b.an idea of reference. c.a delusion of infidelity. d.an auditory hallucination.

A nurse inspects an inpatient psychiatric unit and finds that exits are free of obstructions, no one is smoking, and the janitor's closet is locked. These observations relate to a.coordinating care of patients. b.management of milieu safety. c.management of the interpersonal climate. d.use of therapeutic intervention strategies.

A nurse instructs a patient taking a medication that inhibits the action of monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of a.hypotensive shock. b.hypertensive crisis. c.cardiac dysrhythmia. d.cardiogenic shock.

A nurse is using the technique of motivational interviewing when working with a client. Which of the following statements by the client indicates the client is ready to make the change? a."I should change." b."I am willing to change." c."It's important to change." d."I want to change."

A nurse is working to ensure long-term positive health outcomes of poor pregnant teens and their children. Which of the following actions would the nurse most likely take? a.Assist teen mothers to learn about their body changes during pregnancy. b.Develop programs that allow teen mothers to complete their education. c.Offer courses in proper care of babies and how to be a parent. d.Monitor pregnant teens to detect early problems with pregnancy.

A nurse is working toward an objective to "Increase to at least 90% the proportion of all pregnant women who receive first trimester prenatal care." During which of the following phases of the nursing process would determination of the objective occur? a.Assessment phase b.Planning phase c.Implementation phase d.Evaluation phase

A nurse is working with Mexican immigrants. Which of the following behaviors would most likely lead to a positive interaction for the nurse? a.Avoiding touching the client except when necessary as part of the physical examination b.Calling the client by name, socializing before addressing the problem, and being very respectful c.Keeping all interactions direct, to the point, and targeted on the reason for presentation d.Maintaining a non-confrontational relationship by avoiding any disagreement even if the nurse does disagree with what the client is saying

A nurse leads a psychoeducational group about first-generation antipsychotic medications with six adult men diagnosed with schizophrenia. The nurse will monitor for concerns regarding body image with respect to which potential side effect of these medications? a.Constipation b.Gynecomastia c.Visual changes d.Photosensitivity

A nurse observes a catatonic patient standing immobile, facing the wall with one arm extended in a salute. The patient remains immobile in this position for 15 minutes, moving only when the nurse gently lowers the arm. What is the name of this phenomenon? a.Echolalia b.Waxy flexibility c.Depersonalization d.Thought withdrawal

With integrative care what basic term is described below: uses non-mainstream medicine in conjunction with standard medical care in a coordinated way

integrative

A nurse planned a presentation about the latest trends in disaster planning for the senior nursing students at the local college. However, when the nurse began to share the information, the students were talking to one another and essentially ignoring the nurse. Which of the following actions should be taken by the nurse? a.Ask the students why they are being so rude. b.Explain why the information is crucial to their current clinical practice. c.Nothing; let the instructor of the course handle the problem. d.Tell a joke to get the students' attention.

A nurse receives these three phone calls regarding a newly admitted patient. • The psychiatrist wants to complete an initial assessment. • An internist wants to perform a physical examination. • The patient's attorney wants an appointment with the patient. The nurse schedules the activities for the patient. Which role has the nurse fulfilled? a.Advocate b.Case manager c.Milieu manager d.Provider of care

A nurse taught a patient about a tyramine-restricted diet. Which menu selection would the nurse approve? a.Macaroni and cheese, hot dogs, banana bread, caffeinated coffee b.Mashed potatoes, ground beef patty, corn, green beans, apple pie c.Avocado salad, ham, creamed potatoes, asparagus, chocolate cake d.Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast rolls

A nurse was shocked when late one night she saw a former high school friend going through a trash bin outside a fast-food restaurant and pulling out half-eaten food. Which of the following is the most likely explanation for a healthy young adult engaging in such behavior? a.He ate his meal but wanted more and had no more money. b.He had full-time employment, but with such a low salary it was inadequate to meet basic expenses. c.A friend had thrown his meal away, and he thought he could find his friend's untouched food. d.He was doing this to fulfill an obligation of fraternity initiation at the college.

A patient diagnosed with schizophrenia demonstrates little spontaneous movement and has waxy flexibility. The patient's activities of daily living are severely compromised. An appropriate outcome would be that the patient will a.demonstrate increased interest in the environment by the end of week 1. b.perform self-care activities with coaching by the end of day 3. c.gradually take the initiative for self-care by the end of week 2. d.accept tube feeding without objection by day 2.

A patient has tried a variety of CAM approaches to manage health concerns. The nurse asks, "How is going to CAM practitioners different from seeing your medical doctors?" The patient is most likely to respond, "The CAM practitioners a.usually prescribe a course of invasive and sometimes painful treatments." b.spend more time talking with me and not just about my symptoms." c.say I need to become much more spiritual to be well." d.order many tests to determine my diagnoses."

A patient says, "I have taken mega doses of vitamins for 3 months to improve my circulation, but I think I feel worse." Which action should the nurse take first? a.Explain to the patient that vitamin mega doses may be harmful and advise caution. b.Assess the patient for symptoms and signs of toxicity from excess vitamin exposure. c.Assess for signs of circulatory integrity to determine whether improvement has occurred. d.Educate the patient that research has not shown that megadoses of vitamins produce benefits.

A patient tells the nurse, "I've been having problems getting a good night's sleep. I read some information on the Internet and started taking kava kava." Select the nurse's priority response. a."The Internet does not have reliable health information for consumers." b."The Food and Drug Administration warned against using it due to the link to severe liver damage." c."Melatonin has been shown to have better effects for treating sleep disturbances." d."Your sleep disturbances are related to your problems with anxiety. Herbs will not help."

A school nurse was talking to the teacher of an 8-year-old child who was living with her mother in their car. Which of the following concerns would lead the nurse to talk to the teacher about the child? a.Concern that the child is being mistreated by other children b.Concern that the child has developmental delays c.Concern that the child is given adequate food during lunch d.Concern that the child may need to sit in the front in order to be able to see well

A student comes to the college health clinic with typical cold symptoms of fever, sneezing, and coughing, but the nurse also notes small white spots on the inside of the student's cheeks. Which of the following actions should be taken by the college health nurse? a.Inform all students, staff, and faculty of a possible rubella epidemic b.Inform all students, staff, and faculty of a possible measles epidemic c.Reassure the student that it is just a bad cold and will soon pass d.Tell the student to take two acetaminophen and drink lots of fluids

After a Category 5 tornado hits a community and destroys many homes and businesses, a community mental health nurse encourages victims to describe their memories and feelings about the event. This action by the nurse best demonstrates a.triage. b.primary prevention. c.psychosocial rehabilitation. d.psychiatric case management.

An adult outpatient diagnosed with major depressive disorder has a history of several suicide attempts by overdose. Given this patient's history and diagnosis, which antidepressant medication would the nurse expect to be prescribed? a.Amitriptyline b.Fluoxetine c.Desipramine d.Tranylcypromine sulfate

An adult, recently diagnosed with AIDS, is hospitalized with pneumonia. The patient and family are very anxious. Select the best outcome to add to the plan of care for this family. a.Describe the stages of the anticipatory grieving process. b.Identify and describe effective methods for coping with anxiety. c.Recognize ways dysfunctional communication is expressed in the family. d.Examine previously unexpressed feelings related to the patient's sexuality.

An older male patient has suffered with episodic pruritus and skin eruptions for over 2 years. This patient tells the nurse, "When my skin gets better for a few days, I start worrying that it's going to start itching again soon. I think my worry may actually trigger the problems to start all over again." Which self-help technique should the nurse consider suggesting for this patient? a.Melatonin b.Meditation c.Purification d.Acupuncture

Guidelines followed by the leader of a therapeutic group include focusing on recognizing dysfunctional behavior and thinking patterns, followed by identifying and practicing more adaptive alternate behaviors and thinking. Which theory is evident by this approach? a.Behavioral b.Interpersonal c.Psychodynamic d.Cognitive-behavioral

During a psychiatric assessment, the nurse observes a patient's facial expression is without emotion. The patient says, "Life feels so hopeless to me. I've been feeling sad for several months." How will the nurse document the patient's affect and mood? a.Affect depressed; mood flat b.Affect flat; mood depressed c.Affect labile; mood euphoric d.Affect and mood are incongruent.

During a support group, a patient diagnosed with schizophrenia says, "Sometimes I feel sad that I will never have a good job like my brother. Then I dwell on it and maybe I should not." Select the nurse leader's best comment to facilitate discussion of this issue. a."It is often better to focus on our successes rather than our failures." b."How have others in the group handled painful feelings like these?" c."Grieving for what is lost is a normal part of having a mental disorder." d."I wonder if you might also experience feelings of anger and helplessness."

During a therapy group that uses existential/Gestalt theory, patients shared feelings that occurred at the time of their admission. After a brief silence, one member says, "Several people have described feeling angry. I would like to hear from members who had other feelings." Which group role is evident by this comment? a.Energizer b.Encourager c.Compromiser d.Self-confessor

In a particular community, several high school students were diagnosed with diabetes mellitus Type 2 during the annual high school health fair. Over the next few years, the nursing staff developed and implemented educational programs about the risk factors for diabetes mellitus Type 2 and proper nutrition. Which of the following would be most useful for the nurses to use to determine if they are having any impact? a.The epidemic of diabetes in the high school is gradually ending. b.The incidence of diabetes is slowly decreasing during screening events. c.The prevalence of diabetes is slowly decreasing during screening events. d.The risk for diabetes is slowly increasing over time.

Nurses at a homeless clinic are concerned that homeless clients rarely return to have the nurses assess the findings of their tuberculosis (TB) skin tests. Which of the following is the most appropriate policy for the clinic to have regarding the screening test findings? a.Call all homeless clients 48 hours after TB skin testing to remind them to return to the clinic for test interpretation. b.Have homeless individuals read their TB skin test, if necessary, and mail in results on a postage-paid card coded to protect privacy. c.Re-administer the TB skin test if the client returns later than scheduled for test interpretation. d.Routinely refer all homeless clients for chest x-rays.

The nurse gives a very informative and engaging presentation and then gives everyone in the audience a handout that outlines the presentation. Later, the nurse discovers that many of the handouts were thrown away before the audience left the building. Which of the following educational principles has the nurse forgotten? a.Audiences expect PowerPoint or video presentations, not lectures. b.Many Americans do not have a high reading level. c.People want photographs and images, not wordy outlines. d.The nurse gave them too much information too fast for them to want to cope with it all.

The nurse who works at a homeless clinic wants to improve healing of chronic wounds in clients living on the streets. Which of the following would be the best action to take to improve client outcomes? a.Provide antibiotics to all homeless persons with chronic, nonhealing wounds b.Offer daily access to a room with soap, water, and bandages c.Hand out free bandaging supplies following each clinic visit d.Perform regular monitoring of the client's wound condition

The nursing staff has attempted to screen the entire African-American population in the community for diabetes. Which of the following would provide immediate verification of the success of the nursing staff's efforts? a.An epidemic of diabetes will be recognized. b.The incidence of diabetes will increase in the community. c.The prevalence of diabetes will decrease in the community. d.The risk for diabetes in the community will increase.

Transcranial Magnetic Stimulation (TCM) is scheduled for a patient diagnosed with major depressive disorder. Which comment by the patient indicates teaching about the procedure was effective? a."They will put me to sleep during the procedure so I won't know what is happening." b."I might be a little dizzy or have a mild headache after each procedure." c."I will be unable to care for my children for about 2 months." d."I will avoid eating foods that contain tyramine."

Two divorced people plan to marry. The man has a teenager, and the woman has a toddler. This family will benefit most from a.role-playing opportunities for conflict resolution regarding discipline. b.guidance about parenting children at two developmental levels. c.formal teaching about problem-solving skills. d.referral to a family therapist.

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

Which activity is appropriate for a nurse engaged exclusively in community-based primary prevention? a.Medication follow-up b.Teaching parenting skills c.Substance abuse counseling d.Making a referral for family therapy

Which change in the brain's biochemical function is most associated with suicidal behavior? a.Dopamine excess b.Serotonin deficiency c.Acetylcholine excess d.`γ-aminobutyric acid deficiency

Which characteristic would be more applicable to a community mental health nurse than to a nurse working in an operating room? a.Kindness b.Autonomy c.Compassion d.Professionalism

Which hallucination necessitates the nurse to implement safety measures? The patient says, a."I hear angels playing harps." b."The voices say everyone is trying to kill me." c."My dead father tells me I am a good person." d."The voices talk only at night when I'm trying to sleep."

Which of the following actions by Florence Nightingale demonstrates her role as an epidemiologist? a.She convinced other women to join her in giving nursing care to all the soldiers. b.She demonstrated that a safer environment resulted in decreased mortality rate. c.She obtained safe water and better food supplies and fought the lice and rats. d.She met with each soldier each evening to say goodnight, thereby giving psychological support.

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

Which of the following bills would the nurse lobbyist, who believes strongly in social justice, encourage legislators to support? a.A bill that establishes policies requiring all persons to pay the same cost for services regardless of income b.A bill that promotes universal health insurance coverage c.A bill that requires all health care providers to give care to uninsured persons without charge d.A bill that requires health care workers to report undocumented immigrants who present for treatment

Which of the following conditions of the rural environment provides increased opportunities for teaching? a.Increased interaction among residents due to neighbors visiting neighbors on the family farms b.Involvement in rural community activities provides more contact with community residents than in urban areas c.Nursing responsibilities in these areas stress the importance of primary, secondary, and tertiary prevention d.Increased illnesses and injuries of rural residents require that they see nurses more often

Which of the following groups is most at risk for suicide? a.Adolescents under age 20 b.Men over age 85 c.Females 25 to 45 years of age d.Women over age 65

Which of the following is the most common vector-borne disease worldwide? a.Dengue b.Malaria c.Onchocerciasis (river blindness) d.Yellow fever

Which of the following is the number one cause of death worldwide? a.Chronic diseases (heart disease, cancer, stroke) b.Infectious diseases c.Injuries (accidental or purposeful) d.Terrorism

Which of the following is the primary cause of vulnerability to health problems? a.Breakdown of family structures b.Poverty c.Prejudice d.Social isolation

Which of the following objectives is most appropriate for the development of a community-oriented nursing care plan? a.All monitored patients will receive abortive therapy for lethal dysrhythmias within 3 minutes of dysrhythmia recognition. b.Of mothers receiving nutrition counseling, 80% will identify five sources of calcium by the end of class. c.95% of children will be immunized by 1 year of age. d.There will be a 25% reduction in health disparities by 2015.

Which statement by a depressed patient will alert the nurse to the patient's need for immediate, active intervention? a."I am mixed up, but I know I need help." b."I have no one to turn to for help or support." c."It is worse when you are a person of color." d."I tried to get attention before I cut myself last time."

Which type of group is a staff nurse with 2 months' psychiatric experience best qualified to conduct? a.Psychodynamic/psychoanalytic group b.Medication education group c.Existential/Gestalt group d.Family therapy group

hich assessment finding for a patient diagnosed with serious and persistent mental illness and living in the community merits priority intervention by the psychiatric nurse? The patient a.receives social security disability income plus a small check from a trust fund every month. b.was absent from two of six planned Alcoholics Anonymous meetings in the past 2 weeks. c.lives in an apartment with two patients who attend partial hospitalization programs. d.has a sibling who was recently diagnosed with a mental illness.

patient says to the nurse, "My life doesn't have any happiness in it anymore. I once enjoyed holidays, but now they're just another day." The nurse documents this report as an example of a.dysthymia. b.anhedonia. c.euphoria. d.anergia.

A man loudly protests his increased property tax bill right after the public health department has made a plea for more funds. "Why," he asks, "should my tax dollars be used to pay for their children to be immunized?" Which of the following would be the best response by the nurse? a."Immunizations are required by law, and if their parents can't afford it, you and I will have to pay for it." b."It's just the right thing to do." c."Only by making sure most kids are immunized can we stop epidemics that might hurt all of us." d."We're a religious God-fearing community, and we take care of each other."

Bipolar 1 or Bipolar 2? ○ DSM5 criteria: depicted page 223 ■ A. Distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting 1 week & present most of the day, nearly every day (or any duration of hospitalized) ■ B. During the period of mood disturbance & increased energy or activity, 3 (or more) of the following symptoms (four if the mood is only irritable) are present to significant degree & represent a noticeable change from usual behavior ● 1. Inflated self-esteem or grandiosity ● 2. Decreased need for sleep ● 3. More talkative than usual; pressure to keep talking ● 4. Flight of ideas or subjective experience that thoughts are racing ● 5. Distractibility ● 6. Increase in goal-directed activity (socially, at work, or school, sexually) psychomotor agitation (purposeless, non-goal directed activity) ● 7. Excessive involvement in activities that have high potential for painful consequences (buying sprees, sexual indiscretions, foolish business investments) ■ C. Mood disturbance is severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self/others or there are psychotic features ■ D. Not attributable to drug abuse, a medication, other treatment or condition

Bipolar 1

Bipolar 1 or Bipolar 2? ○ Most severe bipolar disorder - have to have experienced AT LEAST 1 MANIC EPISODE. The manic episode may be preceded by & may be followed by hypomanic or major depressive episodes (old name manic-depressive) ○ Must meet criteria for manic episode. Manic episode may preceded by and may be followed by hypomanic or major depressive episodes. ○ DSM5 criteria: ■ A. Distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting 1 week & present most of the day, nearly every day (or any duration of hospitalized) ■ B. During the period of mood disturbance & increased energy or activity, 3 (or more) of the following symptoms (four if the mood is only irritable) are present to significant degree & represent a noticeable change from usual behavior ● 1. Inflated self-esteem or grandiosity ● 2. Decreased need for sleep ● 3. More talkative than usual; pressure to keep talking ● 4. Flight of ideas or subjective experience that thoughts are racing ● 5. Distractibility ● 6. Increase in goal-directed activity (socially, at work, or school, sexually) psychomotor agitation (purposeless, non-goal directed activity) ● 7. Excessive involvement in activities that have high potential for painful consequences (buying sprees, sexual indiscretions, foolish business investments) ■ C. Mood disturbance is severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self/others or there are psychotic features ■ D. Not attributable to drug abuse, a medication, other treatment or condition ○ (old name manic-depressive)

Bipolar 1

A man says, "I just can't get myself to leave the house and go for a 30-minute walk each day. I wish I could think of some way to motivate myself." Which of the following would be the best action for the nurse to take? a.Establish a written contract between him and his employer that states walking is required each day. b.Recognize the reasons why 30 minutes of walking each day is one of the best health promotion activities he can choose. c.Join a group that walks early each morning. d.Set up rewards for himself, such as a nice snack after he gets back from walking.

11. A public health nurse found that out of the 70 people who ate the potato salad at a school picnic, 63 developed symptoms of food poisoning. Which of the following best describes the attack rate? a.63% b.70% c.90% d.100%

17. A group is in the working phase. One member says, "That is the stupidest thing I've ever heard. Everyone whines and tells everyone else what to do. This group is a total waste of my time." Which comment by the group leader would be most therapeutic? a."You seem to think you know a lot already. Since you know so much, perhaps you can tell everyone why you are back in the hospital?" b."I think you have made your views clear, but I wonder if others feel the same way. How does everyone else feel about our group?" c."It must be hard to be so angry." Direct this comment to another group member, "You were also angry at first but not now. What has helped you?" d."I would like to remind you that one of our group rules is that everyone is to offer only positive responses to the comments of others."

A community health nurse drives through her assigned community before visiting the community groups scheduled for the day. She then drives through the community again that evening before going home. Which of the following best describes the nurse's reason for driving through the community twice in the same day? a.On the second trip, the nurse can carefully confirm the results of the first assessment. b.Repeating the experience ensures that the nurse absorbed all the relevant details. c.Driving through twice allows the nurse to see the community when many residents are at work or at school and then again when most are at home. d.When leaving in the evening, the nurse has more time to write down the results of the earlier assessment.

A community is experiencing an epidemic of the measles. The nurse is trying to determine if this problem is happening in other communities as well. Which of the following resources should the nurse use to answer this question? a.Centers for Disease Control and Prevention Weekly Report b.Communicable Diseases Weekly Report c.Morbidity and Mortality Weekly Report d.Weekly National Report of Communicable Diseases

A community mental health nurse is working within the community to help prevent youth violence. Which of the following interventions would most likely be implemented by the nurse? a.Distributing literature that associates violence with a lack of intelligence b.Explaining to youth why youth violence is detrimental to society c.Partnering with associations to provide alternative activities that improve social skills d.Recommending increased funding to prosecute and jail teens associated with violent activity

A group is in the working phase. One member states, "That is the stupidest thing I've ever heard. Everyone whines and tells everyone else what to do. This group is a waste of my time." Which initial action by the group leader would be most therapeutic? a.Advise the member that hostility is inappropriate. Remove the member if it continues. b.Keep the group's focus on this member so the person can express the anger. c.Meet privately with the member outside of group to discuss the anger. d.Change to a more positive topic of discussion in this group session.

A nurse uses the SAD PERSONS scale to interview a patient. This tool provides data relevant to a.current stress level. b.mood disturbance. c.suicide potential. d.level of anxiety.

A migrant farmworker brings his daughter into the clinic with severe heat stroke from being out in the sun. The nurse explains the danger signs and stresses staying cool and drinking lots of water. The man seems to know this already. Which of the following best describes the most likely reason that this happened? a.It was a rare occurrence, which probably won't be repeated. b.The daughter either disobeyed her father and went out to play in the sun or just did not realize how hot she was. c.Children may work on small farms because the family may need the additional income. d.The parents were busy working and didn't realize the child was outside so long.

A migrant farmworker presents to the clinic reporting an acute onset of severe abdominal pain, nausea, vomiting, diarrhea, and headache with difficulty concentrating. Which of the following conditions would cause such symptoms? a.Appendicitis b.Bacterial gastroenteritis c.Pesticide poisoning d.Viral illness

A new nurse is overwhelmed with the needs of the community. Which of the following should be the first priority of the nurse? a.A problem that affects the most disadvantaged residents in the community b.A problem that is very easy and inexpensive to address c.A problem that is of high concern to the community d.A problem in an area in which the nurse has a great deal of expertise

A nurse and patient construct a no-suicide contract. Select the preferable wording. a."I will not try to harm myself during the next 24 hours." b."I will not make a suicide attempt while I am hospitalized." c."For the next 24 hours, I will not in any way attempt to harm or kill myself." d."I will not kill myself until I call my primary nurse or a member of the staff."

A nurse assesses a patient who reports a 3-week history of depression and periods of uncontrolled crying. The patient says, "My business is bankrupt, and I was served with divorce papers." Which subsequent statement by the patient alerts the nurse to a concealed suicidal message? a."I wish I were dead." b."Life is not worth living." c."I have a plan that will fix everything." d."My family will be better off without me."

A nurse educates a patient about the antipsychotic medication regime. Afterward, which comment by the patient indicates the teaching was effective? a."I will need higher and higher doses of my medication as time goes on." b."I need to store my medication in a cool dark place, such as the refrigerator." c."Taking this medication regularly will reduce the severity of my symptoms." d."If I run out or stop taking my medication, I will experience withdrawal symptoms."

A nurse interacts with an outpatient who has a history of multiple suicide attempts. Select the most helpful response for a nurse to make when the patient states, "I am considering committing suicide." a."I'm glad you shared this. Please do not worry. We will handle it together." b."I think you should admit yourself to the hospital to keep you safe." c."Bringing up these feelings is a very positive action on your part." d."We need to talk about the good things you have to live for."

A nurse is assessing a young, single pregnant woman. Which of the following findings would be of most concern? a.Elevated blood pressure b.First prenatal visit at 5 months' gestation c.Persistent homelessness d.Positive STD test

A nurse is focusing on the process dimension of a community's health. Which of the following interventions will the nurse most likely implement? a.Assessing the health care services available in a community b.Establishing screening programs to diagnosis diseases as early as possible so treatment can begin c.Implementing health promotion activities such as education programs d.Planning for new programs to be developed based on identified needs

A nurse is investigating a bacterial illness that has caused a health problem in the community. Only some of the people exposed to the bacteria have become ill. Which of the following factors best explains why this would have happened? a.Chemical agent factors b.Environmental factors c.Host factors d.Physical agent factors

A nurse is practicing in the community but also has the community as the target of practice. Which of the following best describes the activities of this nurse? a.Providing care to an active caseload of 50 families in the neighborhood b.Inviting all the parents of asthmatic children in the school to meet together for mutual support c.Sharing assessment findings and health goals with every community group that will listen d.Writing articles for the local newspaper highlighting the various programs and services of the local health department

A nurse is providing an educational program about testicular self-examination (TSE). Which of the following would be the best learning objective for this program? a.Each participant will state why TSE is important and explain how to do it. b.Each participant will describe how to do TSE and discuss the dangers of testicular cancer. c.90% of the men will correctly demonstrate testicular self-examination. d.100% of the men will do a testicular examination correctly on a model.

A nurse is working to improve her self-awareness in order to provide better client-centered care to clients living in poverty. Which of the following questions should the nurse ask herself? a.What would I do if I lived in poverty? b.What can be done to get poor people motivated to work? c.How have the media images of poor persons shaped my image of poverty? d.How can community resources assist those living in poverty?

A nurse just finished teaching breast self-examination to a large group of women at a professional conference. During the session, she distributed literature and used culturally appropriate visual aids. However, the session was not as effective as it could have been. Which of the following was the most important thing omitted by the nurse? a.Time for audience members to ask questions and clarify the information b.Explanation of why culturally appropriate images are more acceptable c.Opportunity for the women to practice what they learned d.Use of simple language instead of printed material

A nurse reports that in comparison to all the children in a particular school, the children who are members of the Cub Scouts have 0.3 risk for obesity before entering the sixth grade. Which of the following recommendations would the nurse make to the new parents of two boys who had just moved into this school's neighborhood? a.Discourage the parents from enrolling their sons in Cub Scouts because of the risk. b.Don't say anything about Cub Scouts, because it isn't relevant to nursing care. c.Encourage the parents to enroll their sons in Cub Scouts. d.Share the finding and let the parents draw whatever conclusions they feel appropriate.

A patient diagnosed with schizophrenia had an exacerbation related to medication non-adherence and was hospitalized for 5 days. The patient's thoughts are now more organized and discharge is planned. The patient's family says, "It's too soon for discharge. We will just go through all this again." The nurse should a.ask the case manager to arrange a transfer to a long-term care facility. b.notify hospital security to handle the disturbance and escort the family off the unit. c.explain that the patient will continue to improve if the medication is taken regularly. d.contact the health care provider to meet with the family and explain the discharge rationale.

A patient in a group therapy session listens to others and then remarks, "I used to think I was the only one who felt afraid. I guess I'm not as alone as I thought." This comment is an example of a.altruism. b.ventilation. c.universality. d.group cohesiveness.

A patient tells the nurse, "I prefer to treat my physical problems with herbs and vitamins. They are natural substances, and natural products are safe." Which response by the nurse would be most appropriate? a."Natural substances tend to be safer than conventional medical remedies." b."Natural remedies give you the idea that you are controlling your treatment." c."The word natural can be a marketing term used to imply a product is healthy, but that's not always true." d."You should not treat your own physical problems. You should see your health care provider for these problems."

A patient was hospitalized for 24 hours after a reaction to a psychotropic medication. While planning discharge, the case manager learned that the patient received a notice of eviction immediately prior to admission. Select the case manager's most appropriate action. a.Postpone the patient's discharge from the hospital. b.Contact the landlord who evicted the patient to further discuss the situation. c.Arrange a temporary place for the patient to stay until new housing can be arranged. d.Determine whether the adverse medication reaction was genuine because the patient had nowhere to live.

A person intentionally overdosed on antidepressants. Which nursing diagnosis has the highest priority? a.Powerlessness b.Social isolation c.Risk for suicide d.Compromised family coping

A school nurse wants to decrease the incidence of obesity in elementary school children. Which of the following describes a secondary prevention intervention that the nurse could implement? a.Giving a presentation on the importance of exercise and physical fitness b.Designing a game in which students select healthy food choices c.Weighing students to identify those who are overweight d.Putting students on a diet if they weigh greater than 20% of their ideal weight

A school nurse was caring for an 8-year-old child who had been hurt on the school playground. During the nurse's assessment, the child admitted that her mother was working but didn't make much money so the girl and her mother were living in their car. Based on this information, which of the following would the nurse most likely suspect? a.The child is accident-prone and clumsy. b.The child is being bullied and pushed around by other children. c.The child is more likely to have school absences. d.The child is in need of a vision screening.

A staff member is orienting a new nurse to a health clinic that serves primarily vulnerable populations. Which of the following statements indicates a need for additional staff education? a."If a client who does not speak English comes in, you must obtain an interpreter right away." b."We try to take care of as many problems as possible in one visit, so when you interview the client ask about additional concerns." c."You will like working with Hispanic immigrants because they have close-knit family structures." d."You will need to assist the client by scheduling any referral or follow-up appointments around their work schedules."

Acupuncture is a traditional Chinese medical treatment based on the belief that a.insertion of needles in key locations will drain toxic energies. b.pressure on meridian points will correct problems in energy flow. c.insertion of needles modulates the flow of energy along body meridians. d.taking small doses of noxious substances will alleviate specific symptoms.

Which of the following is the leading cause of disability for Americans 15 to 44 years of age? a.Accidents b.Arthritis c.Major depressive disorder d.Workplace injuries

Which of the following public health actions has been particularly instrumental in reducing childhood infectious diseases in the United States? a.Answering parents' questions about the safety and importance of vaccines today b.Educational campaigns to all health care providers about the importance of immunizations whenever a child is seen c."No shots, no school" legislation, which legally requires children be immunized before school d.Offering all immunizations to all children free of any charge

he case manager plans to discuss the treatment plan with a patient's family. Select the case manager's first action. a.Determine an appropriate location for the conference. b.Support the discussion with examples of the patient's behavior. c.Obtain the patient's permission for the exchange of information. d.Determine which family members should participate in the conference.

A teenager who has just come in for her prenatal visit appears to be about 6 months pregnant. Which of the following best describe why the teenage girl has waited so long to come in for prenatal care? (Select all that apply.) a.Her friends were suggesting ways to make the problem go away. b.She knew she could not be pregnant because her boyfriend said he used a condom. c.She was afraid her parents would pressure her to terminate the pregnancy. d.She kept hoping the pregnancy would just go away.

C,D

The admission note indicates a patient diagnosed with major depressive disorder has anergia and anhedonia. For which measures should the nurse plan? (Select all that apply.) a.Channeling excessive energy b.Reducing guilty ruminations c.Instilling a sense of hopefulness d.Assisting with self-care activities e.Accommodating psychomotor retardation

C,D,E

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

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

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

A disheveled patient in the acute phase of major depressive disorder is withdrawn, has psychomotor retardation, and has not showered for several days. The nurse will a.bring up the issue at the community meeting. b.calmly tell the patient, "You must bathe daily." c.make observations about the patient's poor personal hygiene. d.firmly and neutrally assist the patient with showering.

A health care provider considers which antipsychotic medication to prescribe for a patient diagnosed with schizophrenia who has auditory hallucinations and poor social function. The patient is also overweight and hypertensive. Which drug should the nurse advocate? a.Clozapine b.Ziprasidone c.Olanzapine d.Aripiprazole

A health care provider prescribed long acting antipsychotic medication injections every 3 weeks at the clinic for a patient with a history of medication nonadherence. For this plan to be successful, which factor will be of critical importance? a.The attitude of significant others toward the patient b.Nutrition services in the patient's neighborhood c.The level of trust between the patient and nurse d.The availability of transportation to the clinic

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

A large financial grant was being offered to whichever health facility wanted to accept the responsibility for giving care to local vulnerable populations. Which of the following actions would most likely be taken by the local medical centers? a.Agree to collaboratively apply for the funds in a cooperative proposal. b.Individually compete eagerly for the additional funds now available. c.Reach out enthusiastically to this previously underserved population group. d.Strongly consider not applying, because this population will be expensive to treat.

A mother and her son are in the emergency department. The mother is extremely upset. Earlier, the son had become so angry that he put his hand through a glass window and had to have stitches. The physician suggested a psychiatric consult. Now the mother asks, "Do you think my son is crazy?" Which of the following is the most appropriate response by the nurse? a."Absolutely not. But a psychiatrist can help your son realize more appropriate ways of displaying anger." b."Have you had other reasons to think your son is crazy? Perhaps the psychiatrist can reassure you that your son is just an adolescent coping with hormones." c."Your son is having problems coping with anger. And naturally you're upset. Let the psychiatrist determine whether your son is crazy or not." d."Your son is having problems with behavior, which is distressing all of you. A psychiatrist may be able to help your son cope with life in a more acceptable way."

A nurse assesses a patient for inclusion in group therapy. This patient has a childhood history of neglect and ridicule by parents. The patient says to the nurse, "My boss always expects more of me than the others, but talking to him would only make it worse." Which type of group would best address the patient's needs? a.Support b.Self-Help c.Psychoeducational d.Cognitive-behavioral

A nurse counsels a patient with recent suicidal ideation. Which is the nurse's most therapeutic comment? a."Let's make a list of all your problems and think of solutions for each one." b."I'm happy you're taking control of your problems and trying to find solutions." c."When you have bad feelings, try to focus on positive experiences from your life." d."Let's consider which problems are very important and which are less important."

A nurse has only a regular blood pressure cuff when conducting a health screening for all of the residents of a community. Which of the following may be lacking when obtaining blood pressure readings? a.Reliability b.Sensitivity c.Specificity d.Validity

A nurse invited all the teenagers who were newly diagnosed with diabetes to a group meeting to discuss issues they all had in common. One teenager replied, "I don't know if I want to share all the problems I'm having with strangers." Which of the following is the best nurse response? a."Don't share anything with anyone until you're comfortable doing so." b."I can understand what you are saying." c."No one will require you to do anything you don't want to do." d."The purpose of the group is to have a safe place to share problems with others who may be having similar problems."

A nurse is assessing the structure of a community's health. Which of the following data will the nurse examine? a.Health facilities and their staffing patterns b.Health risk profiles of selected aggregates c.Statistics of morbidity and mortality in comparison with similar communities d.Treatment and service use patterns from local health agencies and care providers

A nurse is examining the various factors that lead to disease and suggests several areas where nurses could intervene to reduce future incidence of disease. Which of the following models would the nurse most likely use? a.Epidemiologic triangle b.Health promotion c.Levels of prevention d.Web of causality

A nurse is implementing a tertiary prevention strategy related to pesticide exposure. Which of the following activities would the nurse complete? a.Observe farmworkers for evidence of unsafe handling of pesticides. b.Provide teaching on how to handle pesticides to avoid or decrease exposure. c.Teach farmworkers how to recognize signs and symptoms of pesticide poisoning. d.Treat a client who has pesticide exposure to prevent complications.

A nurse is meeting to discuss problems and solutions with a group of teenagers who have been newly diagnosed with diabetes. One teenager states, "My mom found this particular brand of popcorn that has only 15 carbohydrates in the whole giant bag." Which of the following best describes the group purpose that is being served by the teenager's statement? a.Maintenance function of encouraging everyone to continue the discussion b.Maintenance function of helping everyone feel comfortable talking about food c.Task function of resolving problems about what to nibble during movies d.Task function of sharing information and resources

A nurse is planning an educational program about cardiovascular disease. Which of the following would be the optimal time for the nurse to elicit feedback from program participants? a.At the beginning of the program b.At the program midpoint c.Immediately following program completion d.Throughout the program

A nurse leads a psychoeducational group about problem solving with six adults diagnosed with schizophrenia. Which teaching strategy is likely to be most effective? a.Suggest analogies that might apply to a common daily problem. b.Assign each participant a problem to solve independently and present to the group. c.Ask each patient to read aloud a short segment from a book about problem solving. d.Invite participants to come up with solution to getting incorrect change for a purchase.

A nurse provided medication education for a patient diagnosed with major depressive disorder who began a new prescription for phenelzine (Nardil). Which behavior indicates effective learning? The patient a.monitors sodium intake and weight daily. b.wears support stockings and elevates the legs when sitting. c.can identify foods with high selenium content that should be avoided. d.confers with a pharmacist when selecting over-the-counter medications.

A nurse sits with a patient diagnosed with schizophrenia. The patient starts to laugh uncontrollably, although the nurse has not said anything funny. Select the nurse's most therapeutic response. a."Why are you laughing?" b."Please share the joke with me." c."I don't think I said anything funny." d."You're laughing. Tell me what's happening."

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

A patient became severely depressed when the last of the family's six children moved out of the home 4 months ago. The patient repeatedly says, "No one cares about me. I'm not worth anything." Which response by the nurse would be the most helpful? a."Things will look brighter soon. Everyone feels down once in a while." b."Our staff members care about you and want to try to help you get better." c."It is difficult for others to care about you when you repeatedly say the same negative things." d."I'll sit with you for 10 minutes now and 10 minutes after lunch to help you feel that I care about you."

A patient diagnosed with major depressive disorder is receiving imipramine 200 mg qhs. Which assessment finding would prompt the nurse to collaborate with the health care provider regarding potentially hazardous side effects of this drug? a.Dry mouth b.Blurred vision c.Nasal congestion d.Urinary retention

A patient diagnosed with schizophrenia tells the nurse, "I eat skiller. Tend to end. Easter. It blows away. Get it?" Select the nurse's most therapeutic response. a."Nothing you are saying is clear." b."Your thoughts are very disconnected." c."Try to organize your thoughts and then tell me again." d."I am having difficulty understanding what you are saying."

A patient receiving risperidone (Risperdal) reports severe muscle stiffness at 1030. By 1200, the patient has difficulty swallowing and is drooling. By 1600, vital signs are 102.8° F; pulse 110; respirations 26; 150/90. The patient is diaphoretic. Select the nurse's best analysis and action . a.Agranulocytosis; institute reverse isolation. b.Tardive dyskinesia; withhold the next dose of medication. c.Cholestatic jaundice; begin a high-protein, high-cholesterol diet. d.Neuroleptic malignant syndrome; notify health care provider stat.

A patient tells members of a therapy group, "I hear voices saying my doctor is poisoning me." Another patient replies, "I once heard voices too. They sounded real, but I found out later they were not. The voices you hear are not real either." Which therapeutic factor is exemplified in this interchange? a.Catharsis b.Universality c.Imitative behavior d.Interpersonal learning

A patient with a history of asthma says, "I've been very nervous lately. I think aromatherapy will help. I am ordering $250 worth of oils from an Internet site that promised swift results." Select the nurse's best action. a.Support the patient's efforts to become informed and to find health solutions. b.Suggest the patient check with friends who have tried aromatherapy for treatment of anxiety. c.Remind the patient, "If you spend that much on oils, you may not be able to buy your prescribed medication." d.Tell the patient, "Aromatherapy can complicate respiratory problems such as asthma. Let's consider some other options."

A person who attempted suicide by overdose was treated in the emergency department and then hospitalized. The initial outcome is that the patient will a.verbalize a will to live by the end of the second hospital day. b.describe two new coping mechanisms by the end of the third hospital day. c.accurately delineate personal strengths by the end of first week of hospitalization. d.exercise suicide self-restraint by refraining from attempts to harm self for 24 hours.

Four individuals have given information about their suicide plans. Which plan evidences the highest suicide risk? a.Turning on the oven and letting gas escape into the apartment during the night b.Cutting the wrists in the bathroom while the spouse reads in the next room c.Overdosing on aspirin with codeine while the spouse is out with friends d.Jumping from a railroad bridge located in a deserted area late at night

A principal comments to the school nurse that it seems there are a lot more problems with asthma among the students than there were before the school was remodeled a couple of years ago. The nurse investigates the principal's observation by reviewing all the school records to determine visits to the health office because of asthma by week and month for the past 5 years. Which of the following best describes the type of study the nurse is conducting? a.Descriptive epidemiological study b.Ecological study c.Prospective cohort study d.Retrospective cohort study

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

A student engages in unprotected sex under the influence of alcohol. The student decides to have an HIV test completed the next day. Which of the following results will most likely occur? a.The results will probably be negative for HIV. b.The results will probably be positive for HIV. c.The probability of disease is so low there is no reason to be tested. d.The test results won't be reliable so soon after exposure.

A young female member in a therapy group says to an older female member, "You are just like my mother, always trying to control me with your observations and suggestions." Which therapeutic factor of a group is evident by this behavior? a.Instillation of hope b.Existential resolution c.Development of socializing techniques d.Corrective recapitulation of the primary family group

An employer provides a migrant farm family the day off to visit the health clinic in a nearby community and tells them to take all of the time they need. However, the family arrives at the clinic appearing very stressed. In addition to the health issue, which of the following would most likely be a fear experienced by the family? a.Their personal belongings may be stolen while they are at the clinic. b.Immigration officials will send them back to their home country. c.The clinic personnel will look down on them and be biased against them. d.They weren't getting paid for that day, and continued employment is never certain.

An immigrant from China needs a colonic resection but is anxious and reluctant about surgery. This patient usually follows traditional Chinese health practices. Which comment by the nurse would most likely reduce the patient's anxiety and reluctance? a."Surgery will help rebalance the yin and yang forces and return you to harmony." b."The surgery we are recommending will help you achieve final transformation." c."I know this is new to you, but you can trust us to take very good care of you." d."If you would like, we could investigate using acupuncture to help control pain."

At a town meeting with public health officials to discuss a communicable disease outbreak, a nurse is asked to explain what is meant by the phrase "a virulent organism." The nurse explains that this means the organism causing the disease is able to do which of the following? a.Bypass normal immunological response mechanisms b.Invade major organ systems c.Produce toxins and poisons that weaken the body d.Produce very severe physical reactions

Before beginning to survey the community to assess its health needs and strengths, the nurse reviews various documents, including local statistical data and the minutes of the previous meeting of the health care agency. Which of the following best explains why the nurse would start with this activity? a.To avoid confronting the community until the nurse is thoroughly oriented b.To become familiar with previous goals and priorities of the agency c.To help get a better understanding of the assigned community d.To save time and effort and perhaps have new insights

Between 2000 and 2005, 1000 of 10,000 young women ages 17 to 20 years at a university tested positive for a sexually transmitted infection (STI). Of the 1000 diagnosed STIs, 300 were gonorrhea and 500 were chlamydia. Which of the following statements best summarizes these findings? a.The proportion of cases of gonorrhea to all STIs was 300:1300. b.The proportion of cases of gonorrhea to chlamydia was 300:500. c.The proportion of cases of gonorrhea to all STIs was 50%. d.The proportion of STIs to the total population was 100:1000.

Clinical pathways are used in managed care settings to a.stabilize aggressive patients. b.identify obstacles to effective care. c.relieve nurses of planning responsibilities. d.streamline the care process and reduce costs.

During a group therapy session, a newly admitted patient suddenly says to the nurse, "How old are you? You seem too young to be leading a group." Select the nurse's most appropriate response. a."I am wondering what leads you to ask. Please tell me more." b."I am old enough to be a nurse, which qualifies me to lead this group." c."My age is not pertinent to why we are here and should not concern you." d."You are wondering whether I have enough experience to lead this group?"

During an outbreak of hepatitis A, nurses are giving injections of hepatitis A immunoglobulin to selected susceptible persons. Which of the following best describes the type of immunity that will follow the administration of these injections? a.Active immunity b.Long-lasting immunity c.Natural immunity d.Passive immunity

During the assessment phase, the nurse compiles and interprets available data and draws conclusions as to the community's strengths and concerns. Which of the following best describes why the nurse would also conduct interviews with key informants? a.To ensure that others agree with the nurse's plans for interventions b.To confirm the nurse's initial findings and conclusions c.To encourage community partners to feel they "own" the data d.To generate nonstatistical data such as values, beliefs, and perceived needs

During which of the following activities is the nurse in community health acting as a partner in change? a.Administering vaccinations to preschoolers b.Analyzing community problems to determine the best interventions c.Establishing an elder-care center for older adults living with family members who work d.Teaching anger management skills to a group of teens in a halfway house

Persons often point out that smokers choose to light their cigarettes, alcoholics lift the glass to their mouth, and drug addicts inject or ingest their drugs. Which of the following statements best describes why nurses don't simply focus on helping persons who engage in poor health behaviors to behave appropriately? a.Addicts don't have the willpower to change their behavior. b.It is too rewarding to continue the behavior for a person to be able to change. c.Laws and policies must reward good healthy behaviors and punish unhealthy behaviors to help individuals recognize the importance of change. d.Society must offer healthy choices, offer support, and practice helpful policies.

Several small communities have applied for grant funding from the state department of health to help decrease their teenage pregnancy rate. Which of the following communities should the nurse suggest receive funding first? a.Community A—with 23 single teenage pregnancies in a city of 500 b.Community B—with 45 single teenage pregnancies in a city of 1000 c.Community C—with 90 single teenage pregnancies in a city of 2000 d.\Community D—with 90 single teenage pregnancies in a city of 1500

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

The nurse assigned to ACT should explain the program's treatment goal as a.assisting patients to maintain abstinence from alcohol and other substances of abuse. b.providing structure and a therapeutic milieu for mentally ill patients whose symptoms require stabilization. c.maintaining medications and stable psychiatric status for incarcerated inmates who have a history of mental illness. d.providing services for mentally ill individuals who require intensive treatment to continue to live in the community.

The parent of an adolescent diagnosed with mental illness asks the nurse, "Why do you want to do a family assessment? My teenager is the patient, not the rest of us." Select the nurse's best response. a."Family dysfunction might have caused the mental illness." b."Family members provide more accurate information than the patient." c."Family assessment is part of the protocol for care of all patients with mental illness." d."Every family member's perception of events is different and adds to the total picture."

The patients below were evaluated in the emergency department. The psychiatric unit has one bed available. Which patient should be admitted? The patient a.feeling anxiety and a sad mood after separation from a spouse of 10 years. b.who self-inflicted a superficial cut on the forearm after a family argument. c.experiencing dry mouth and tremor related to taking antipsychotic medication. d.who is a new parent and hears voices saying, "Smother your baby."

There is great concern in the nurse's community over three local cases of West Nile virus. Which of the following actions should the nurse take to get the community involved in addressing this problem? a.Ask the state department of health for assistance b.Demand that everyone over age 65 become immunized immediately c.Encourage immunization of all children under 12 d.Have an educational campaign to remove any containers of standing water

Which of the following is the best brief definition of community? a.A geographic area or political division under common leadership b.A group sharing a common bond such as a profession or occupation c.A group working together to confront a common problem d.A social group with common goals within a geographic area

Which of the following statements best describes an outcome of the Balanced Budget Act of 1997? a.Additional funding was provided to the State Children's Health Insurance Program (SCHIP). b.Individuals were able to keep their health insurance when moving from one place to another. c.Patient privacy and security of health information was enhanced. d.A prospective payment system for home health services was created.

Which of the following statements best describes why health care of the homeless is so expensive to the community? a.Health conditions of the homeless require increased preventive services. b.Homeless clients typically make more clinic visits for multiple health problems. c.Homeless people spread contagious diseases to those they pass on the street. d.Most care to homeless people takes place in hospital emergency departments.

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

Which outcome would be most appropriate for a symptom-management group for persons diagnosed with schizophrenia? Group members will a.state the names of their medications. b.resolve conflicts within their families. c.rate anxiety at least two points lower. d.describe ways to cope with their illness.

When talking about the history of epidemiology: During the 20th Century: ● Epidemiology shift from single cause (cause of cholera) to ________ ○ Can be ________ not just single cause

multifactorial

● May hear - IOP or PHP (longer/ more often) ○ Designated time period for each one: some may go to program and leave early, but some are individualized ● Intermediate steps between inpatient care & outpatient ● Main difference -TIME ● Structured activities, group therapy, individual therapies, other types of therapy, pharmacological management ○ Usually one therapist has them all day ○ Will still be seen by a psychiatrist/NP; will still get treatment team ● (Visions - associated with Vermilion; some attend 5 days/week and others 3 days/week)

Intensive Outpatient Programs and Partial Hospitalization Programs

What medication for bipolar disorder is described below: ○ Anticonvulsant drugs ○ 2nd generation antipsychotics ○ LiCO3; Li+ ○ Therapeutic level - 0.6 - 1.2 mEq/L ○ Should not go over 1.5 to avoid serious toxicity ○ Start at 600-1200 mg/day in 2-3 divided doses. May increase every few days by 300 mg/day - max dose 1800 mg/day ○ Draw lithium levels according to agency policy to ensure therapeutic level reached. ■ Blood may be drawn every month - after 6 months to year of stability - drop to every 3 months. Draw blood in the AM, 10-12 hours after last dose ○ Contraindications - cardiovascular disease, brain damage, renal disease, thyroid disease, myasthenia gravis; pregnancy, breastfeeding

Lithium

With major depressive disorder, we have pharmacological interventions to treat the disorder. What type of medications are described below to treat MDD: ■ If tyramine is not broken down and patient eats foods rich in tyramine, it can lead to hypertensive crisis which OCCURS WITHIN 15-90 MINUTES OF INGESTION OF CONTRAINDICATED SUBSTANCE*** ● Hypertensive crisis: *** immediate medical attention is crucial! *** ○ Early symptoms include severe headache, irritability, anxiety, flushing, sweating ○ Then becomes anxious, restless, and develops a fever ○ If fever becomes severe, seizures occur; coma or death is possible ○ **immediate medical attention is crucial

MAOIs

With major depressive disorder, we have pharmacological interventions to treat the disorder. What type of medications are described below to treat MDD: ○ Fewer amines get inactivated (such as norepinephrine, serotonin, dopamine, tyramine), resulting in increase of mood elevating neurotransmitters ○ Ex: Pies Taste Insanely Sweet ■ Phenelzine ■ Tranylcypromine ■ Isocarboxazid ■ Selegiline (transdermal patch; does not require strict dietary restrictions) ■ NOTE—OTC cold/congestion meds can interact

MAOIs

What depressive disorder is described below: Biological Risk Factors: *unlikely that there is a single cause for depression* ○ Diathesis-Stress Model ■ Diathesis - vulnerabilities such as genetic predispositions, biochemical makeup, personality structure; how somebody is ■ Stress - life events that impact the vulnerabilities ■ Psychosocial stressors and interpersonal events → intense events can cause brain changes in people especially young people ■ Early life trauma → brain changes → exaggerated stress response in adulthood

Major Depressive Disorder

What depressive disorder is described below: Biological Risk Factors: *unlikely that there is a single cause for depression* ○ Hormonal ■ Hyperactivity of the hypothalamic-pituitary-adrenal cortical axis (review p. 39) ■ Depression rates about equal prior to puberty and in older adults ■ Rates of depression between prepubescent males and females are equal; after, higher risk in females ○ Inflammation ■ Inflammation as a result of psychological injury? ■ New Studies have shown that just like physical injury, inflammation can result from psychological injury

Major Depressive Disorder

What depressive disorder is described below: Biological Risk Factors: *unlikely that there is a single cause for depression* ○ Genetic ■ twin studies point to genetics; genetic markers related to depression when accompanied with early child maltreatment ○ Biochemical ■ Neurochemical abnormalities - genetic or medical conditions → cerebral infarction, Parkinson's, hypothyroidism, AIDS, drug use ■ Caused by dysregulation of neurotransmitters: serotonin and norepinephrine ○ Hormonal ■ Hyperactivity of the hypothalamic-pituitary-adrenal cortical axis (review p. 39) ■ Depression rates about equal prior to puberty and in older adults ■ Rates of depression between prepubescent males and females are equal; after, higher risk in females ○ Inflammation ■ Inflammation as a result of psychological injury? ■ New Studies have shown that just like physical injury, inflammation can result from psychological injury ○ Diathesis-Stress Model ■ Diathesis - vulnerabilities such as genetic predispositions, biochemical makeup, personality structure; how somebody is ■ Stress - life events that impact the vulnerabilities ■ Psychosocial stressors and interpersonal events → intense events can cause brain changes in people especially young people ■ Early life trauma → brain changes → exaggerated stress response in adulthood

Major Depressive Disorder

What depressive disorder is described below: DSM-5 Criteria: LEARN THIS WELL *** ○ ** Criteria A-C represent a major depressive episode **

Major Depressive Disorder

What depressive disorder is described below: DSM-5 Criteria: LEARN THIS WELL *** ○ A. → 5 or more of the following symptoms present during the same three week period; change from previous functioning; ■ (One of the 5 symptoms must be either #1 or #2): ■ 1. Depressed mood (sad, empty, hopeless, tearful) ■ 2. Marked diminished interest or pleasure in all or almost all activities most of the day, nearly every day (anhedonia) ■ 3. Significant weight loss (without dieting) or gain; or decrease/increase in appetite ● Ask, monitor, and record % eaten ● So, are these percentages recorded important? Just recorded without serious observation? How? ■ 4. Insomnia or hypersomnia nearly every day ● How to assess? ● Use q15 sheets to add hours slept (if done exactly q 15 min → 32 times from 11pm to 7am) ■ 5. Psychomotor agitation or retardation nearly every day (observable) ■ 6. Fatigue or loss of energy nearly every day ■ 7. Feelings of worthlessness/excessive or inappropriate guilt nearly every day ■ 8. Diminished ability to think or concentrate or indecisiveness nearly every day ■ 9. Recurrent thoughts of death, thoughts of suicide with/without a plan; suicide attempts

Major Depressive Disorder

What depressive disorder is described below: DSM-5 Criteria: LEARN THIS WELL *** ○ D. → Symptoms not better explained by another psychiatric disorder ○ E. → Never has been manic or had hypomanic episode**** ■ Separates depression from bipolar disorder

Major Depressive Disorder

What depressive disorder is described below: INTERVENTIONS: Biological Interventions: ● Electroconvulsive therapy (ECT) ○ Nursing interventions similar to person undergoing surgical procedure - pre & post-op care ○ Assurance that necessary consents completed ○ Pre - ECT workup > Chest X-ray, EKG, Urinalysis, Complete blood count (CBC), other labs. Benzodiazepines discontinued - interfere with seizure induction ○ General anesthetic & muscle -paralyzing agent ○ Often wake up confused/ disoriented - orient patient ○ Used for depression that fails to respond to other modalities ○ Done under general anesthesia; induces seizures ○ Nurse responsibilities: informed consent, labs, urinalysis

Major Depressive Disorder

What depressive disorder is described below: INTERVENTIONS: Biological Interventions: ● Transcranial magnetic stimulation ● Vagus nerve stimulation ● Deep brain stimulation ● Light therapy → Seasonal Affective Disorder ● St. John's Wort (educate about increased risk for serotonin syndrome) ● Exercise (increases availability of serotonin in the brain) ● Advanced practice nurse → individual and group therapy

Major Depressive Disorder

What depressive disorder is described below: INTERVENTIONS: Pharmacological Interventions Monoamine Oxidase Inhibitors (MAOIs) ○ Fewer amines get inactivated (such as norepinephrine, serotonin, dopamine, tyramine), resulting in increase of mood elevating neurotransmitters ■ If tyramine is not broken down and patient eats foods rich in tyramine, it can lead to hypertensive crisis WHICH OCCURS WITHIN 15-90 MINUTES OF INGESTION OF CONTRAINDICATED SUBSTANCE. ● Table 14.7 - foods that patients must avoid ● Hypertensive crisis: *** immediate medical attention is crucial! *** ○ Early symptoms include severe headache, irritability, anxiety, flushing, sweating ○ Then becomes anxious, restless, and develops a fever ○ If fever becomes severe, seizures occur; coma or death is possible ○ **immediate medical attention is crucial ○ Ex: Pies Taste Insanely Sweet ■ Phenelzine ■ Tranylcypromine ■ Isocarboxazid ■ Selegiline (transdermal patch; does not require strict dietary restrictions) ■ NOTE—OTC cold/congestion meds can interact

Major Depressive Disorder

What depressive disorder is described below: INTERVENTIONS: Pharmacological Interventions Selective Serotonin Reuptake Inhibitors (SSRIs): ○ Ex: Caring Essential For Patient Safety ■ Citalopram ■ Escitalopram ■ Fluoxetine ■ Paroxetine ■ Seraline ○ Frequently first line → low side effect profile ■ Some can include GI issues, headache, sexual dysfunction ■ Few to no anticholinergic effects ○ Discontinuation syndrome → taper slowly! ■ Abrupt discontinuation can lead to rebound symptoms and return of depression symptoms ■ Need slow taper—educate patients Risk of serotonin syndrome-possibly lethal ■ Symptoms listed pg 260—discontinue the medication ■ Symptoms include: hyperactivity/restlessness, tachycardia (leading to cardiovascular shock), fever (hyperpyrexia), elevated blood pressure, seizures, myoclonus (muscle spasm), incoordination, tonic rigidity, altered mental status, irrationality, mood swings, hostility, abdominal pain, diarrhea, bloating, apnea, death ■ Prevention: ● Do not take SSRIs with another serotonin enhancing agent ○ No St. John's wort! ○ *note if patient takes St. John's wort, herbal taken for depression* ● If switching from certain drugs, provider should allow a "washout" period; discontinue all SSRIs for 2-5 weeks ■ Interventions: ● Stop medication ● Symptomatic treatment ○ Medication that blocks serotonin ○ Cooling blankets; chlorpromazine has hypothermia effect ○ Dantrolene, diazepam - for muscle rigidity ○ Anticonvulsants

Major Depressive Disorder

What depressive disorder is described below: INTERVENTIONS: Pharmacological Interventions Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) ○ Ex: Vidrine Decides Daily Lunches ■ Venlafaxine → popular next step after trying SSRIs ● Beth takes this!! ● Common; energizing effect ■ Desvenlafaxine → metabolite of venlafaxine ■ Duloxetine ■ Levomilnacipran → inhibits reuptake of norepinephrine more than serotonin ■ Keeps the neurotransmitters in the synapse

Major Depressive Disorder

What depressive disorder is described below: INTERVENTIONS: Pharmacological Interventions Tricyclic Antidepressants (TCAs) ○ Inhibit reuptake of norepinephrine and serotonin: ○ Full effect not seen for 4-8 weeks ○ Adverse reactions: ■ Anticholinergic actions, weight gain, postural orthostatic hypotension, tachycardia, sedative effect (administer at night) ■ Serious → cardiac effects (patient should have thorough cardiac workup prior to initiating) ■ *******Lethal in overdose; use cautiously in older adults; be sure patient not suicidal for home use******** ● Prescriber must be confident that they are not suicidal! ○ Amitriptyline ○ Amoxapine ○ Desipramine ○ Doxepin ○ Imipramine ○ Maprotiline ○ Nortriptyline ○ Protriptyline ○ Trimipramine

Major Depressive Disorder

What depressive disorder is described below: INTERVENTIONS: Pharmacological Interventions ● ***Combination of psychotherapy and medication is more effective than either alone!*** ● The goal of antidepressant therapy is complete remission of symptoms ● Drawback → takes 1-3 weeks longer for mood improvement ● All antidepressants work to increase availability of 1 or more transmitters

Major Depressive Disorder

What depressive disorder is described below: Nursing Process: Implementation ■ Health teaching and health promotion ● Allows patient to make informed choices; depression can be managed ■ Promotion of self-care activities ■ Teamwork and safety ● Nurses, prescribers, mental health technicians, social workers, etc.; care with sharps

Major Depressive Disorder

What depressive disorder is described below: Nursing Process: Implementation ■ Be aware of phases ● 1. Acute → 6-12 weeks : reduction of symptoms and restoration of psychological work function. Hospitalization may be required ● 2. Continuation → 4-9 months : prevent relapse through psychotherapy, education, and pharmacotherapy ● 3. Maintenance → 1 year or more: prevention of further episodes of depression. Meds may be phased out or continued ■ Counseling and communication techniques - table 14.4 and 14.3 ● Health with cognitive distortions ● No platitudes ("Things will get better") ● Identify coping skills ● Identify resources that are available to them in their community; allows them to have as much follow-up care as they need ■ Health teaching and health promotion ● Allows patient to make informed choices; depression can be managed ■ Promotion of self-care activities ■ Teamwork and safety ● Nurses, prescribers, mental health technicians, social workers, etc.; care with sharps

Major Depressive Disorder

What depressive disorder is described below: Nursing Process: Implementation ■ Counseling and communication techniques - table 14.4 and 14.3 ● Health with cognitive distortions ● No platitudes ("Things will get better") ● Identify coping skills ● Identify resources that are available to them in their community; allows them to have as much follow-up care as they need

Major Depressive Disorder

What depressive disorder is described below: Nursing Process: Suicide assessment ● Suicidal thoughts are a major reason for hospitalization for patients with major depression ● Suicidal ideation: preoccupation with death; own funeral; dreams about death; thoughts about wanting to die ○ Emergency requiring immediate intervention! ● Page 248 - sample questions about suicide ● Use the facility's policy on how to proceed for pt. stating suicidal ○ Continue q 15 checks - may state thoughts are passive ○ Q 5 minute checks ○ LOS - Line of sight (while awake or 24 hours) ○ 1:1 - while awake or 24 hours

Major Depressive Disorder

What depressive disorder is described below: Nursing Process: ■ Key findings: ● Depressed mood ● Anhedonia ● Others: anxiety, slowed thinking, focus on faults/failures rather than strengths/successes, delusions of being punished for bad deeds, worthlessness, hopelessness, guilt, anger, helplessness, chronic pain

Major Depressive Disorder

What depressive disorder is described below: Nursing Process: ○ Evaluation: ■ Adjust nursing diagnoses, goals, and interventions based on nurse's evaluation ■ Ex: ● Suicide → Are thoughts still present? How frequently? Have a plan? ● Severe depression → Are hallucinations/delusions present? ● Evaluate basic self care (eating, sleep, hygiene/grooming) ● Thought processes, self esteem, social interactions; compare from when person was admitted to now

Major Depressive Disorder

What depressive disorder is described below: Nursing Process: Areas to assess- affect Affect: outward representation of a person's internal state; (what we as nurses observe) objective finding assessed by observing facial expression along with other nonverbal cues; read paragraph p. 251 ○ Glossary: the observable components of an emotion—objective ■ Ex: ● Bright → happy, cheerful ● Flat → absence or near absence of expression ● Apathetic → lack of feeling, emotion, interest ○ Assess for congruence ○ Sees world through gray-colored glasses ○ Poor posture ○ Facial expressions - convey sadness , dejection ○ May have frequent weeping//or may state feels numb & unable to cry ○ Hopelessness, despair ○ May not make eye contact ○ Flat affect - little or no facial expression ○ Just answer yes/ no ○ Frequent sighing Thought processes ○ Poor judgement, leading to indecisiveness → difficulty in making simple decisions such as what to wear or what to eat ○ Poor memory and concentration ○ May complain of intrusive negative thoughts ○ Extreme depression → person may become mute ○ Severe depression → may have delusional thoughts ○ *Note: may see major depressive disorder with psychosis Mood, feelings, or cognitive changes ○ Mood: patient's subjective experience of sustained emotions or feelings (What they tell us) ■ Ask patient how he feels ■ Anhedonia → without pleasure; inability to feel happy ○ Feelings: worthlessness, guilt, hopelessness, helplessness, anger ■ Guilt → ruminate or think over and over; present or past feelings; "I was never a good patient" ○ Cognitive changes ■ Helplessness → inability to carry out even simple tasks ■ Hopelessness → correlated to suicidality ● Negative expectations for the future ● Loss of control over future outcomes ● Passive acceptance of futility of planning to achieve goals ● Emotional negativism: despair, despondency, depression Physical behavior ○ Anergia: abnormal lack of energy ■ Psychomotor retardation → movements are extremely slowed ■ Psychomotor agitation → nail biting, pacing, finger tapping, or other tension-relieving activity Vegetative signs of depression ○ Activities necessary to support life and growth ○ Grooming, dressing, hygiene, decline in sexual interest ○ Table 14.5—interventions for vegetative signs of depression ○ Facility must have methods to assess—appetite, sleep

Major Depressive Disorder

What depressive disorder is described below: Nursing Process: Areas to assess- affect Physical behavior ○ Anergia: abnormal lack of energy ■ Psychomotor retardation → movements are extremely slowed ■ Psychomotor agitation → nail biting, pacing, finger tapping, or other tension-relieving activity

Major Depressive Disorder

What depressive disorder is described below: Nursing Process: Areas to assess- affect Vegetative signs of depression ○ Activities necessary to support life and growth ○ Grooming, dressing, hygiene, decline in sexual interest ○ Table 14.5—interventions for vegetative signs of depression ○ Facility must have methods to assess—appetite, sleep

Major Depressive Disorder

What depressive disorder is described below: Nursing Process: Areas to assess- affect ● Affect: outward representation of a person's internal state; (what we as nurses observe) objective finding assessed by observing facial expression along with other nonverbal cues; ○ Glossary: the observable components of an emotion—objective ■ Ex: ● Bright → happy, cheerful ● Flat → absence or near absence of expression ● Apathetic → lack of feeling, emotion, interest ○ Assess for congruence ○ Sees world through gray-colored glasses ○ Poor posture ○ Facial expressions - convey sadness , dejection ○ May have frequent weeping//or may state feels numb & unable to cry ○ Hopelessness, despair ○ May not make eye contact ○ Flat affect - little or no facial expression ○ Just answer yes/ no ○ Frequent sighing

Major Depressive Disorder

What depressive disorder is described below: Nursing Process: Areas to assess- affect ● Mood, feelings, or cognitive changes ○ Mood: patient's subjective experience of sustained emotions or feelings (What they tell us) ■ Ask patient how he feels ■ Anhedonia → without pleasure; inability to feel happy ○ Feelings: worthlessness, guilt, hopelessness, helplessness, anger ■ Guilt → ruminate or think over and over; present or past feelings; "I was never a good patient" ○ Cognitive changes ■ Helplessness → inability to carry out even simple tasks ■ Hopelessness → correlated to suicidality ● Negative expectations for the future ● Loss of control over future outcomes ● Passive acceptance of futility of planning to achieve goals Emotional negativism:despair, despondency, depression

Major Depressive Disorder

What depressive disorder is described below: Nursing Process: Areas to assess- affect ● Thought processes ○ Poor judgement, leading to indecisiveness → difficulty in making simple decisions such as what to wear or what to eat ○ Poor memory and concentration ○ May complain of intrusive negative thoughts ○ Extreme depression → person may become mute ○ Severe depression → may have delusional thoughts *Note: may see major depressive disorder with psychosi

Major Depressive Disorder

What depressive disorder is described below: Nursing Process: ○ Diagnosis—pg 254 provides some common ones ■ Risk for suicide ■ Ineffective coping ■ Social isolation ■ Hopelessness ■ Alteration in mood

Major Depressive Disorder

What depressive disorder is described below: Nursing Process: ○ Outcomes ■ Recovery model → healing is possible and attainable; focus on strengths ■ Table 14.2 has some examples: ● Attends group meetings, interacts spontaneously with others, talks with nurse 1:1, demonstrates interest in engaging with family and others, identifies ineffective and effective coping ■ Others: ● Patient will report improved mood ● Patient will have adequate food & water intake or % of meals ● Balanced rest, sleep, activity / will sleep so many hours Attend groups as scheduled

Major Depressive Disorder

What depressive disorder is described below: Nursing Process: ○ Planning ■ Stay aware of potential for suicide; ongoing assessment for this ■ Effective approach → combination of therapy and psychopharmacology ■ Safety → always highest priority

Major Depressive Disorder

What depressive disorder is described below: Primary Risk Factors: ○ Female ○ Adverse childhood experiences (ACE) ■ Contribute to changes in the brain that affects a person later in life ○ Stressful life events ○ First-degree family members with major depressive disorder ■ Has some genetic traits ○ Neuroticism - negative personality trait; anxiety, fear, moodiness, worry, envy, frustration, jealousy, loneliness ○ Other disorders → substance abuse, anxiety, personality disorders ○ Chronic/disabling medical conditions

Major Depressive Disorder

What depressive disorder is described below: Primary Risk Factors: ○ Neuroticism - negative personality trait; anxiety, fear, moodiness, worry, envy, frustration, jealousy, loneliness ○ Other disorders → substance abuse, anxiety, personality disorders ○ Chronic/disabling medical conditions

Major Depressive Disorder

What depressive disorder is described below: Psychological Risk Factors ○ Cognitive - underlying assumption that a person's thoughts will result in emotions ■ Looks at life in a positive way → positive emotions ■ Looks at life in a negative way → negative emotions (sorrow, anger, hopelessness) ■ Aaron Beck ● Patients with depression tend to have a certain combination of similar negative attitudes ● People with depression process information in a negative way; tend to ignore positive aspects of their lives ● Cognitive Triad: ○ 1. A negative, self-deprecating view of self ○ 2. Pessimistic view of the world ○ 3. Belief that negative reinforcement will continue into the future (self is not validated)

Major Depressive Disorder

What depressive disorder is described below: Psychological Risk Factors ■ Aaron Beck ● Patients with depression tend to have a certain combination of similar negative attitudes ● People with depression process information in a negative way; tend to ignore positive aspects of their lives

Major Depressive Disorder

What depressive disorder is described below: ● One of the most common psychiatric disorders ● TREATABLE disorder and does not have to be accepted in any particular age group as "oh it just happens" ● 16 million adults in the US; about 7% of population ○ Worldwide, numbers are very high ● Leading cause of disability in US ● Females more likely to be affected than males ● Although common in older adults IT IS NOT A NORMAL PART OF AGING ○ Major Depression is treatable! ● Accompany other psychiatric problems; one of the most common combination is anxiety and depression

Major Depressive Disorder

What depressive disorder is described below: ● TREATABLE disorder and does not have to be accepted in any particular age group as "oh it just happens" ● 16 million adults in the US; about 7% of population ○ Worldwide, numbers are very high ● Leading cause of disability in US

Major Depressive Disorder

With major depressive disorder, we have pharmacological interventions to treat the disorder. What type of medications are described below to treat MDD: ○ Ex: Caring Essential For Patient Safety ■ Citalopram ■ Escitalopram ■ Fluoxetine ■ Paroxetine ■ Seraline

SSRIs

With major depressive disorder, we have pharmacological interventions to treat the disorder. What type of medications are described below to treat MDD: ○ Frequently first line → low side effect profile ■ Some can include GI issues, headache, sexual dysfunction ■ Few to no anticholinergic effects ○ Discontinuation syndrome → taper slowly! ■ Abrupt discontinuation can lead to rebound symptoms and return of depression symptoms ■ Need slow taper—educate patients

SSRIs

What medication for bipolar depression is described below: approved for this type of depression - combination of olanzapine & fluoxetine (SSRI)

Symbyax

T or F. *** History of suicide attempt puts a person at high probability of completing suicide in the future***

T or F. **Psychiatric disorders are factors for suicide -- these disorders are present at the time of 90% of completed suicides.***

T or F. **suicidal behavior is result of interpersonal turmoil**

T or F. *need to understand that screening and diagnosing are NOT identical. When we look at screening test, we have to look at reliability, validity, and sensitivity to testing. An example is: those who have low immune response may get a negative TB skin test even though they are infected. This is due to the fact that the sensitivity that identifies those that have condition get examined and get a false negative. In book it gives details of explanation of this.

T or F. Alcohol is a depressant. Drugs and alcohol increase risk of suicide by decreasing inhibitions, increasing aggressiveness, impairing judgment

With major depressive disorder, we have pharmacological interventions to treat the disorder. What type of medications are described below to treat MDD: ○ Inhibit reuptake of norepinephrine and serotonin: ○ Full effect not seen for 4-8 weeks ○ Amitriptyline ○ Amoxapine ○ Desipramine ○ Doxepin ○ Imipramine ○ Maprotiline ○ Nortriptyline ○ Protriptyline ○ Trimipramine

TCAs (tricyclic antidepressants)

Primary, Active, or Passive primary prevention? ● Requires behavior change on part of subject ○ Wearing protective devices ■ if it is a respiratory mask or earplugs if they are working in loud factory environments ○ Obtaining vaccinations ● Must be willing to do!

active primary prevention

With schizophrenia, we have implementation in the different assessment phases. (prodromal, acute, stabilization, and maintenance). which one of these is described below: ● Hospitalization - monitor for suicide risk ○ Medication ○ Psychoeducation -help patient recognize & self-manage symptoms

acute

With schizophrenia, we have outcomes in the different assessment phases. (prodromal, acute, stabilization, and maintenance). which one of these is described below: ● patient safety & stabilization ○ Example - Patient refrains from self-injury

acute

With schizophrenia, we have planning in the different assessment phases. (prodromal, acute, stabilization, and maintenance). which one of these is described below: ● Hospitalization if patient a danger to self or others

acute

The following are sample nursing diagnoses outcomes and interventions for patients in _____ _____ settings: 1. Risk for self directed violence 2. Risk for other directed violence. 3. Impaired mood regulation.

acute care

What EPS side effect of 1st generation antipsychotics is described below: ● sudden, sustained contraction of 1 or more muscle groups - usually head & neck. ○ Treatment - IM/IV benztropine or diphenhydramine 25-50 mg

acute dystonia

The following are trends in ____ sexual behavior and pregnancy: --Teens are making better decisions about sex Reproductive health care services to teens ○ Requires sensitivity of special needs: § Know state laws about confidentiality and services for birth control, pregnancy, abortion, and adoption Factors can influence whether a young girl becomes pregnant ○ EX: history of sexual victimization, family dysfunction, substance use, and failure to use birth control can influence whether a girl becomes pregnant --Support needed during and after pregnancy from family and friends and from the father of the baby --Background factors—invincible --Sexual activity, use of birth control, peer and partner pressure, STD's, drugs, embarrassed to discuss Other factors ○ Sexual victimization ○ Sexual abuse ○ May feel that it brings happiness ○ Family issues --Young men and paternity Early identification of the pregnant teen - complex medical issues ○ Delay seeking treatment ○ Be aware of subtle cues ○ Follow up § Negative results § Positive results ● Physical assessment ● Counseling

adolescent

The following are trends in ____ sexual behavior and pregnancy: Early identification of the pregnant teen - complex medical issues ○ Delay seeking treatment ○ Be aware of subtle cues ○ Follow up § Negative results § Positive results ● Physical assessment ● Counseling Other factors ○ Sexual victimization ○ Sexual abuse ○ May feel that it brings happiness ○ Family issues --Young men and paternity

adolescent

The following are trends in ____ sexual behavior and pregnancy: Reproductive health care services to teens ○ Requires sensitivity of special needs: § Know state laws about confidentiality and services for birth control, pregnancy, abortion, and adoption Factors can influence whether a young girl becomes pregnant ○ EX: history of sexual victimization, family dysfunction, substance use, and failure to use birth control can influence whether a girl becomes pregnant

adolescent

What learning theory is described below: ● Self directed learners ● Past experiences as resources ● Learning relates to social roles ● Apply lessons/ solve problems immediately ● Internal motivation to learn

adult learning theory

What at risk population for mental illness is described below: o Stress major factor o Depression o Anxiety o Co-occurrences o Adults with Serious Mental Illness § Healthy People 2020 focus on tertiary care

adults

affect

With major depressive disorder we use the nursing process. Under assessment, we have certain areas to assess which includes affect (glossary), thought processes, mood, feelings, or cognitive changes, physical behavior, and vegetative signs of depression. Which one of these ares are described below: ○ Assess for congruence ○ Sees world through gray-colored glasses ○ Poor posture ○ Facial expressions - convey sadness , dejection ○ May have frequent weeping//or may state feels numb & unable to cry ○ Hopelessness, despair ○ May not make eye contact ○ Flat affect - little or no facial expression ○ Just answer yes/ no ○ Frequent sighing ○ Glossary: the observable components of an emotion—objective ■ Ex: ● Bright → happy, cheerful ● Flat → absence or near absence of expression ● Apathetic → lack of feeling, emotion, interest

affect

With schizophrenia we have negative symptoms which includes ______ which is external expression of person's internal emotional state. It includes the following: ■ Flat - immobile or blank ■ Blunted - reduced or minimal emotional response ■ Constricted - reduced in range or intensity (shows sadness or anger but no other moods) ■ Inappropriate - incongruent with actual emotional state or situation (laughing in response to tragedy) ■ Bizarre - odd, illogical, inappropriate or unfounded; grimacing

affect

The following are examples of behavioral objectives: ________ Domain: ● Discuss possible solutions to family resistance to change

affective

The following is a sample lesson plan content: Content ● Purpose of vaccination for prevention ● Myths and beliefs about vaccine 7 illness ● CDC recommendations for vaccine Methods Lecture presentation and/ or group discussion

affective

What learning domain is described below: (feeling; professional domain, value domain) ● Changes in attitude and values ● Involves steps: ○ Knowledge - receiving information ○ Comprehension - responding ○ Application - value the info ○ Analysis - info makes sense ○ Synthesis -organizing info. ○ Evaluation - adopting behaviors

affective

With schizophrenia we have negative symptoms which includes _____ symptoms. These include the following: ● Involve experience and expression of emotions ● Mood >> unstable, erratic, labile (changing rapidly), incongruent ● Often with schizophrenia is depression*** ● Anosognosia - inability to realize they are ill...caused by the illness itself

affective

With schizophrenia, we have 4 main categories in an assessment: positive, negative, cognitive, and affective. What category is described below: expression of emotions/ symptoms involving emotions> hopelessness ○ Dysphoria, suicidality, hopelessness

affective

With schizophrenia we have negative symptoms which includes negative dimension. Negative dimension includes affective flattening/blunting, apathy, and alogia. Which one of these is described below: ○ reduced intensity of expression & response, do not change expressions in response to circumstances; movements lack spontaneity; gestures slow; voice lacks inflection; slow speech

affective flattening/blunting

What factor influencing disease transmission is described below: ● "animate or inanimate factor that must be present or lacking for a disease or condition to occur" ○ Ex: bacteria

agent

What part of the epidemiologic triangle is described below: ○ Biologic (bacteria, viruses), chemical (poison, alcohol, smoke), physical (trauma, radiation, fire), nutritonal (lack, excess) ○ Infectivity ○ Pathogenicity ○ Virulence ○ Immunogenicity ○ Antigenic stability survival ○ Attack rate

agent

What EPS side effect of 1st generation antipsychotics is described below: ● - severe motor restlessness that causes pacing, repetitive movements, inability to stay still. ○ Treatment - benztropine or lorazepam

akathisia

alogia

What Yalom's curative factor is described below: ● Members gain from giving support to others ○ Spirit of good will, they gain from giving support to others, giving and receiving

altruism

Descriptive or Analytical epidemiology? ○ Distribution ○ Concerned with terms of ■ Why are some people affected more than others ● Why are others not affected with it? ■ How does it occur ● How does the disease occur?

analytical

Descriptive or Analytical epidemiology? ○ Etiology: Exposures, characteristics, and behaviors or contexts that determine or influence factors. They may be individual, social, communal, or environmental.

analytical

Descriptive or Analytical epidemiology? ● looks at the etiology (origins or causes) of the disease and deals with distribution of health and disease

analytical

Descriptive or Analytical epidemiology? ● looks at the etiology (origins or causes) of the disease and deals with distribution of health and disease ○ Distribution ○ Concerned with terms of ■ Why are some people affected more than others ● Why are others not affected with it? ■ How does it occur ● How does the disease occur? ○ Etiology: Exposures, characteristics, and behaviors or contexts that determine or influence factors. They may be individual, social, communal, or environmental.

analytical

_____ epidemiology studies desings observational designs. --Examines the HOW and WHY of observed patterns of health and disease. Interested in the cause when reviewing triangle of common association and this is where we create the intervention. It deals with the pattern of health and disease. **includes cohort study, case control study, study designs: observational design (cross sectional study and ecological study)

analytical

When talking about characteristics of andragogical and pedagogical approaches to teaching-learning, which approach is described below for MOTIVATION FOR LEARNING: -primarily motivated by external pressures, competition for grades, and the consequences of failure

andragogical

When talking about characteristics of andragogical and pedagogical approaches to teaching-learning, which approach is described below for ORIENTATION TO LEARNING: -learning is process of acquiring prescribed subject matter -content units are sequenced according to the logic of the subject matter

andragogical

When talking about characteristics of andragogical and pedagogical approaches to teaching-learning, which approach is described below for ROLE OF THE LEARNER'S EXPERIENCE: -the learner comes to the activity with little experience that could be tapped as a resource for learning -the experience of the instructor is most influential

andragogical

When talking about characteristics of andragogical and pedagogical approaches to teaching-learning, which approach is described below for THE LEARNER: -the learner is dependent upon the instructor for all learning -the teacher/instructor assumes full responsibility for what is taught and how it is learned -the teacher/instructor evaluates lerning

andragogical

There are 2 approaches to how theories are developed: _____ and ______.

andragogy and pedagogy

○ abnormal lack of energy **physical behavior of person with major depressive disorder

anergia

With schizophrenia we have negative symptoms which includes anhedonia, avolition, and associality. Which one of these is described below: ● - loss of capacity to experience pleasure; may describe feeling empty

anhedonia

With schizophrenia we have negative symptoms which includes affective symptoms. _____ is the inability to realize they are ill...caused by the illness itself

anosognosia

What medication for bipolar disorder is described below: Very Cool Llamas ○ Valproate & valproic acid - has surpassed lithium in treating acute mania. Do liver function studies & platelet count periodically ○ Carbamazepine - seems to work better in patients with rapid cycling & in severely paranoid angry patients experiencing manias rather than in euphoric, overactive over friendly patients experiencing mania; weekly liver enzymes x8 weeks- can increase; CBC - cause leukopenia and aplastic anemia ○ Lamotrigine - teach to seek medical attention for rash (Stevens-Johnson syndrome) ○ May have seen trileptal, topomax used as well

anticonvulsants

What type of thought process medications are described below: ● Fall risk - orthostatic hypotension, sedation, gait impairment ● Injectable ___________ ○ Short-acting >> treat agitation, behavioral emergencies ○ Long-acting injectable (LAI)- administered every 2-4 weeks ; Paliperidone palmitate is every 3 months

antipsychotics

What type of thought process medications are described below: ● Should be discontinued gradually to avoid discontinuation syndrome - dizziness, nausea, tremors, insomnia, electric-shock pains, anxiety ● Unlikely to be lethal in overdose ● May cause impaired swallowing - drooling & risk of choking

antipsychotics

With schizophrenia we have negative symptoms which includes negative dimension. Negative dimension includes affective flattening/blunting, apathy, and alogia. Which one of these is described below: ○ decreased interest in activities/beliefs that would otherwise be important

apathy

The following are skills of the effective educator: ● GAIN the attention, send clear message ● TELL the objectives of instruction and ensured ● ______ learners to recall knowledge related to the topic ● PRESENT the essential material ● HELP in application of new knowledge and guidance ● ENCOURAGE demonstration and participation ● PROVIDE feedback, assessment of performance, evaluation of transfer of knowledge

ask

During an _____ of a vulnerable population: Questions to ask: ○ What are the client's preventative health needs? ○ Are there genetic or congenital issues? ○ Are there multiple stressors? ○ What is their living environment like? ○ What is the neighborhood like? ○ Ask questions which consider the patient's perception § SES § People who can provide support and financial resources § Amount of stress

assessment

During an _____ of a vulnerable population: ○ Nurses work as partners with vulnerable clients to ID client strengths and needs and develop intervention strategies designed to break the cycle of vulnerability _______ should include client evaluation of: ○ Socioeconomic resources ○ Preventative health needs ○ Congenital and genetic predisposition to illness ○ Living environment and neighborhood surroundings Questions to ask: ○ What are the client's preventative health needs? ○ Are there genetic or congenital issues? ○ Are there multiple stressors? ○ What is their living environment like? ○ What is the neighborhood like? ○ Ask questions which consider the patient's perception § SES § People who can provide support and financial resources § Amount of stress

assessment

With schizophrenia we have negative symptoms which includes anhedonia, avolition, and associality. Which one of these is described below: - decreased desire for, or comfort during social interaction

associality

What core function of public health (ethics) is described below: making sure essential community health services are available to all, even those who cannot afford them

assurance

What basic epidemiology concept is described below: ● Used in infectious disease ● The proportion of persons exposed to an agent and develop the disease ● Often specific to an exposure ● EX: a food specific _____ _____ and so you may have 100 people exposed and only 50% develop. So, 50/100 would be 50% which would be your ____ ______.

attack rate

● amount of subjects who dropped from the study **variable to consider in determining quality

attrition

With schizophrenia we have positive symptoms. These includes alterations in perception.These alterations include auditory and visual hallucinations. Which one of these is described below: (most common) - varies ● Vague sounds ● Clear voices OR ● Command - direct the person to take action → monitor carefully as this could be dangerous ○ As a nurse, be mindful of this ● Can be supportive, accusatory, derogatory (think about voices stimulation); subtle and unobtrusive or intrusive and distressing

auditory

With schizophrenia we have negative symptoms which includes anhedonia, avolition, and associality. Which one of these is described below: ● - loss of motivation; can not sustain work or self-care; not same as laziness - loss of basic drive

avolition

What model under emergency care is described below: --clinical space and specialty staffing for psychiatric patients -- Dedicated staff and hospital space in ED just for psych care --Designated space within emergency department**

comprehensive emergency service model

What are the 3 models under emergency care?

comprehensive emergency service model, hospital-based consultant model, and mobile crisis team

The following are LEARNER RELATED ______: ● Lack of motivation ● Technology ● Cultural background ● Age or generation of the learner ● Consider vision, hearing, and mobility issues

barriers

The following are educated-related ______: ● Difficulty getting participation ● Timing concerns ● Overly dependent on notes and unable to adjust instruction ● Having difficulty with Q and A - not able to give feedback ● Concern with media, materials, and facilities

barriers

The following are educated-related ______: ● Fear of public speaking ● Lack of credibility with respect to topic ● Limited professional experience related to topic ● Dealing with difficult clients/ participants ● Difficulty getting participation ● Timing concerns ● Overly dependent on notes and unable to adjust instruction ● Having difficulty with Q and A - not able to give feedback ● Concern with media, materials, and facilities

barriers

When talking about mood and behavior of someone with bipolar disorder, _____ is: ○ Involved in get-rich schemes ○ Excessive phone calls, emails ○ Busy all hours of day /night; grandiose plans & schemes ○ May give away money, possessions, spend excessively ○ **********Distractibility = a hallmark symptom of mania**************** ○ Hyperactivity , push limits >> alienates others ○ Clothing - outlandish, bizarre, colorful, noticeably inappropriate; makeup gaudy & overdone

behavior

When writing _____ objectives, follow the following steps: 1. Begin with an action verb 2. State the objective as a learner outcome 3. One outcome per objective 4. Objective should be appropriate to learner needs EX: client will demonstrate proper hand washing at the end of class EX: Clients will answer 70% correctly on post test

behavioral

What learning theory is described below: ● Focus: Helping an individual understand how changing their behavior can lead to changes in how they are feeling ● Goal: increasing the person's engagement in positive or socially reinforcing activities ● A structured approach that carefully measures what the person is doing and then seeks to increase chances for positive experience

behavioral theory

What learning theory is described below: ● Goal: increasing the person's engagement in positive or socially reinforcing activities ● A structured approach that carefully measures what the person is doing and then seeks to increase chances for positive experience

behavioral theory

what is the treatment of akathisia as an EPS side effect of 1st generation antipsychotics?

benztropine or lorazepam

Risk factors for ______ disorders includes: ● Imaging - reveals dysfunction in ○ prefrontal cortical region (executive decision making, personality, social behavior) ○ hippocampus (memory) ○ amygdala ( memory, decision making, emotion) ● All of this dysregulation - results in the characteristic emotional lability

bipolar

The following is the thought processes and speech patterns for patients with ______ disorder: ● Pressured speech - fast, loud, inappropriate sense of urgency, may talk nonstop, no interest in feedback or conversation ● Circumstantial speech - unnecessary details >>eventually gets to the point ** ● Tangential speech - similar to circumstantial - may lose point and NOT find it again ** ● Loose associations - disordered way person processing information; thought loosely connected in the conversation ● Flight of ideas - continuous flow of accelerated speech with abrupt changes from topic to topic; play on words - listener can follow - even though direction changes quickly. When condition is severe - speech may be incoherent. ● Clang associations - stringing words together according to their rhyming sounds - not meaning

bipolar

______ and related disorders includes: ● Percentage of population with either bipolar I or II = 4% ● Men- legal problems & commit acts of violence ● Women - abuse alcohol, commit suicide, develop thyroid disease ● Men & women have nearly equal rates of bipolar disorders ● _________ in late adolescence - 1 in 5 with mania + depression will attempt suicide ● About 75% of those with _________ I & II - have comorbid anxiety disorders

bipolar

the following is healthy teaching for someone with a _____ disorder: ● _______- chronic and highly recurrent ● Good Sleep hygiene- changes in sleep patterns- usually accompany or precede mania- even just 1 night of unexplainable sleep loss ● Medication- can cause weight gain- metabolic syndrome ● Importance of adhering to medication ● Use of alcohol, drugs of abuse, caffeine (energy drinks ) and OTC medications can cause relapse ● Coping skills- work for this patient

bipolar

What bipolar disorder is described below: ○ Treatment of bipolar with an antidepressant alone increases risk of bringing on a manic episode. *** ○ *****Use antidepressant with mood stabilizer***** ○ Approved: ■ 2nd generation antipsychotics - lurasidone & quetiapine ○ Symbyax- approved for this type of depression - combination of olanzapine & fluoxetine (SSRI)

bipolar depression

With schizophrenia we have negative symptoms which includes affect which is external expression of person's internal emotional state. It includes the following: flat, blunted, constricted, inappropriate, and bizarre. Which one of these is described below: odd, illogical, inappropriate or unfounded; grimacing

bizarre

What example of dysfunctional communication is described below: family members blame others for failures, errors, or negative consequences of an action to deflect the focus from them

blaming

blunted

The following are ______ in family functions: · Distinctions among family members & between family & external individuals · Appropriate _______ are essential to healthy family functioning · Clear ________ - adaptive & healthy · Diffuse _________ - family members actually have problems defining who they are; individuals tend to become overly involved with one another>>>enmeshment · Rigid - demand adherence to rules & roles regardless of circumstances or outcomes. ___________ can be so closed - members are disengaged & avoid one another. Communication is minimal. Lead separate lives. Hard time bonding with others when they leave.

boundaries

What population at risk in rural is described below: ○ Urban ______ more likely to see a pediatrician when they are ill ○ Rural adults and ______ more likely to have a general practitioner as regular caregiver (parents will do what they can before bringing them to professional) ○ Children who work on farms ○ School nurses

children

The following are guidelines for ___ _____: 2. CONSISTENCY OF FINDINGS: repeated findings of an association with different study designs and in different populations strengthen a ___ ____. 3. BIOLOGICAL PLAUSIBILITY: demonstration of a physiological mechanism by which the risk factor acts to cause disease enhances the casual hypothesis. Conversely, an association that does not initially seem biologically defensible may later be discovered to be so

casual inference

The following are guidelines for ___ _____: 1. STRENGTH OF ASSOCIATION: a strong association between a potential risk factor and an outcome supports a casual hypothesis (ex: a relative risk of 7 provides stronger evidence of a casual association than a relative risk of 1.5) 2. CONSISTENCY OF FINDINGS: repeated findings of an association with different study designs and in different populations strengthen a ___ ____. 3. BIOLOGICAL PLAUSIBILITY: demonstration of a physiological mechanism by which the risk factor acts to cause disease enhances the casual hypothesis. Conversely, an association that does not initially seem biologically defensible may later be discovered to be so 4. DEMONSTRATION OF CORRECT TEMPORAL SEQUENCE: for a risk factor to cause an outcome, it must precede the onset of the outcome 5. DOSE-RESPONSE RELATIONSHIP: the risk for developing an outcome should increase with increasing exposure (either in duration or quantity) to the risk factor of interest. For example, studies have shown that the more a woman smokes during pregnancy, the greater is the risk for delivering a low-weight infant 6. SPECIFICITY OF THE ASSOCIATION: the presence of one to one relationship between an agent and a disease (ex: the idea that a disease is caused by only one agent and that agent results in only one disease leads to support to a casual hypothesis but its absence does not rule out causality). This criterion grows out of the infectious disease model in which it is more often though not always satisfied and is less applicable in chronic diseases. 7. EXPERIMENTAL EVIDENCE: experimental designs provide the strongest epidemiological evidence for casual associations but they are not feasible or ethical to conduct for many risk factor disease associations

casual inference

The following are guidelines for ___ _____: 4. DEMONSTRATION OF CORRECT TEMPORAL SEQUENCE: for a risk factor to cause an outcome, it must precede the onset of the outcome 5. DOSE-RESPONSE RELATIONSHIP: the risk for developing an outcome should increase with increasing exposure (either in duration or quantity) to the risk factor of interest. For example, studies have shown that the more a woman smokes during pregnancy, the greater is the risk for delivering a low-weight infant

casual inference

What at risk population for mental illness is described below: o Factors § Biological § Psychosocial § environmental o Intellectual Disorders o Chronic Disorders o Adolescent Problems o Prevent problems during developmental period o Physical fights & bullying

children and adolescents

The following are guidelines for ___ _____: 6. SPECIFICITY OF THE ASSOCIATION: the presence of one to one relationship between an agent and a disease (ex: the idea that a disease is caused by only one agent and that agent results in only one disease leads to support to a casual hypothesis but its absence does not rule out causality). This criterion grows out of the infectious disease model in which it is more often though not always satisfied and is less applicable in chronic diseases. 7. EXPERIMENTAL EVIDENCE: experimental designs provide the strongest epidemiological evidence for casual associations but they are not feasible or ethical to conduct for many risk factor disease associations

casual inference

● Factors which affect statistical significance ○ Sample size: when doing any studies or interventions, the bigger the sample size the better ○ Variance of the measures ○ Covariables ● Bias ○ Selection or the way subjects enter a study ○ Misclassification of subjects once they are in the study ○ Confounding variables not accounted for when you began the study

casual inference

With schizophrenia we have positive symptoms. These includes alterations in behavior. This includes catatonic, waxy flexibility, motor retardation, motor agitation, stereotypes behaviors, echopraxia, negativism, impaired impulse control, gesturing or posturing, and boundary impairment. Which one of these is described below: ○ in a ______ stupor, are fully conscious but unresponsive to questions, mute, immobile ■ Most common is when person moves or not at all

catatonic

What basic epidemiology concept is described below: · from a disease o An estimate of risk of death from some specific disease in a population o Looking at particular disease such as coronavirus because it is a cause specific **case fatality rate

cause specific mortality rate

The following are _____ concepts in family function: ● Identified patient - 1st task of therapist is to address the presenting problem ***Often belongs to the identified patient. Regarded by the family as "the problem."**** ● May be the problem - or may divert from other hidden problems of the family. May be a stabilizing mechanism to bring some cohesion to family in distress ● A court may mandate family therapy if criminal behavior involved

central

______ _____ includes the following: --Darn cat Preparing ____ ______ ● Desire- i want to change ● Ability- i can change ● Reason- it's important to change ● Need- i should change Implementing _____ _____ ● Commitment - i will make changes ● Activation- i am ready ● Taking steps- i will do...

change talks

The following are effects of poverty on the health of ______: --higher rates of prematurity, low birth weight, and birth defects --higher infant mortality rates --increased incidence of chronic disease --increased incidence of traumatic death and injuries --increased incidence of nutritional deficits --increased incidence of growth restriction and developmental delays --increased incidence of iron deficiency anemia --increased incidence of elevated blood lead levels --increased incidence of infections --increased risk for homelessness --decreased opportunities for education, income, and occupation

children

The following are effects of poverty on the health of ______: --increased incidence of chronic disease --increased incidence of traumatic death and injuries --increased incidence of nutritional deficits --increased incidence of growth restriction and developmental delays

children

The following are effects of poverty on the health of ______: --increased incidence of iron deficiency anemia --increased incidence of elevated blood lead levels --increased incidence of infections --increased risk for homelessness --decreased opportunities for education, income, and occupation

children

With integrative care what basic term is described below: non-mainstream medicine in conjunction with standard medical care

complementary

circumstantiality

With schizophrenia we have positive symptoms, one being alterations in speech. These include loose associations, word salad, clanging, neoglisms, echolia, magical thinking, paranoia, circumstantiality, tangentiality, cognitive retardation, pressured speech, flight of ideas, symbolic speech, magical thinking, and paranoia. Which of these is described below: ○ sound of a word rather than its meanings gives direction to the following words; compulsive rhyming; alliteration = same 1st consonant sound

clanging

What part of boundary delineation (clear, diffuse, or rigid) is described below: adaptive, healthy, firm, yet flexible **family function

clear

The following are examples of behavioral objectives: _______ domain: ● Describe the health benefits of a low fat diet

cognitive

The following is a sample lesson plan content: Content ● Symptoms ● Methods of acquiring the flu virus ● Importance of reducing exposure ● Use of hand washing as prevention Method ● Lecture or group discussion

cognitive

What depressive disorder is described below: Psychological Risk Factors ○ underlying assumption that a person's thoughts will result in emotions ■ Looks at life in a positive way → positive emotions ■ Looks at life in a negative way → negative emotions (sorrow, anger, hopelessness)

cognitive

What depressive disorder is described below: Psychological Risk Factors ● _______ Triad: ○ 1. A negative, self-deprecating view of self ○ 2. Pessimistic view of the world ○ 3. Belief that negative reinforcement will continue into the future (self is not validated)

cognitive

What learning domain is described below: ● Knowledge - recall ● Comprehension - recall and understanding ● Application - incorporate ● Analysis- reasoning ● Synthesis- problem solving ● Evaluation *thinking

cognitive

With schizophrenia we have negative symptoms which includes _____ symptoms. These include the following: ● Concrete thinking - impaired ability to think abstractly; perceive things in literal manner ● Impaired memory - impacts ability to learn ● Impaired information processing - delayed responses; misperceptions, difficulty understanding others ● Impaired executive functioning - difficulty in setting priorities, comparing options, placing in logical order, planning

cognitive

_____ function of a patient with bipolar disorder includes: ● Deficits - similar to schizophrenia - but milder ● Greater in bipolar I than bipolar II ● Early diagnosis & treatment crucial to prevent illness progression, cognitive deficits, & poor outcomes

cognitive

With major depressive disorder we use the nursing process. Under assessment, we have certain areas to assess which includes affect (glossary), thought processes, mood, feelings, or cognitive changes, physical behavior, and vegetative signs of depression. Which one of these ares are described below: ■ Helplessness → inability to carry out even simple tasks ■ Hopelessness → correlated to suicidality ● Negative expectations for the future ● Loss of control over future outcomes ● Passive acceptance of futility of planning to achieve goals ● Emotional negativism: despair, despondency, depression

cognitive changes

With schizophrenia we have positive symptoms, one being alterations in speech. These include loose associations, word salad, clanging, neoglisms, echolia, magical thinking, paranoia, circumstantiality, tangentiality, cognitive retardation, pressured speech, flight of ideas, symbolic speech, magical thinking, and paranoia. Which of these is described below: generalized slowing of thinking; difficulty in finishing thoughts

cognitive retardation

What learning theory is described below: ● Aims: help patient recognize and reassess his patterns of negative thoughts and replace them with positive thoughts

cognitive theory

What learning theory is described below: ● Makes assumption - thoughts precede moods and false self- beliefs lead to negative emotions ● Aims: help patient recognize and reassess his patterns of negative thoughts and replace them with positive thoughts

cognitive theory

What groups concept and definition is described below: the attraction between members (values and common goals)

cohesion

With analytical epidemiology we have ___ ____ which includes: ○ A group of persons who are born about the same time, generally sharing some characteristic or interest. ○ In the study this group is followed over time ○ EX: same age and height individuals over 10 years to measure their height. We would take 1st graders and track them over 10 years and track their height.

cohort studty

What key characteristic of Patient-centered medical homes is described below: ● Preventative, acute, chronic needs are addressed

comprehensive care

cohort study

With analytical epidemiology we have ___ ____ which includes: ● The standard observational design is closes to what we have in our ideas of natural experience. Has specific factors studies in a limited time. ■ Prospective studies: longitudinal or follow up study where you study group over time. Subjects are classified over exposures of interest ■ Retrospective studies: rely on existing records to define your cohort that is classified as exposed or unexposed at some point in time. ● Ex: hospital records ○ A group of persons who are born about the same time, generally sharing some characteristic or interest. ○ In the study this group is followed over time ○ EX: same age and height individuals over 10 years to measure their height. We would take 1st graders and track them over 10 years and track their height.

cohort study

In the shift from hospital to ______: ● Pharmacological breakthroughs - chlorpromazine - 1st antipsychotic in 1950s ○ Before, there was nothing to treat them with; mental illness wasn't understood ● Contributed to hospital discharges; didn't have to stay in the asylums/hospitals ● General practitioners began to feel comfortable prescribing medication & managing symptoms ○ Children may get meds from pediatrician instead of a psychiatrist

community

The following are offers made by _______ centers: ● Emergency services ● Outpatient services ● Medication-prescribing/administration ● Individual therapy ● Psychoeducational & therapy groups ● Family therapy ● Dual-diagnosis treatment ○ has to do with people who have some sort of addiction along with another psychiatric problem ● Rehabilitation ● Vocational services ○ help with job interviewing skills, getting a job that they are suited for ● Residential services ● Psychiatric case management ● Use multidisciplinary teams

community

The following are offers made by _______ centers: ● Rehabilitation ● Vocational services ○ help with job interviewing skills, getting a job that they are suited for ● Residential services ● Psychiatric case management ● Use multidisciplinary teams

community

The following falls under _____ health and evidence based practice Methods: ● Communities are specific ○ One method does not fit all ● Nurse must understand the community they seek to help ● Must be aware of cultural differences ● Ethical practice requires attention to the differences

community

The following falls under _____ health and evidence based practice Methods: ● Implore all types of evidence - focus on both qualitative (verbal) and quantitative (data) studies ○ Qualitative data must be backed by quantitative data ● Review costs of implementing findings ● CAUTION in implementing EBP if ○ Community differences ○ Environmental differences ○ SES differences ○ These are not usually included in the evidence ● It is essential to evaluate the evidence and where it was procured ○ Who paid for the study? (how was it funded) ○ What website did you find it on? (who funds it?) ○ What journal published it? (Is it peer reviewed?) ○ Is there any bias? ○ What is the quality of the study? ○ Was an ethics board consulted prior to the study? (IRB) ■ Must have approval ○ Were all variables considered? ● Communities are specific ○ One method does not fit all ● Nurse must understand the community they seek to help ● Must be aware of cultural differences ● Ethical practice requires attention to the differences

community

● In 1960s, patients diverted from state-funded hospitals to federally funded ____ _____ _____ _____. ● Mainstay for those who lack funding for mental healthcare. Offer free or low-cost sliding scale care ○ Some small towns do not have the resources available to them - have to go to a neighboring town

community mental health centers

what type of experimental study is described below: ● Typically deal with health promotion and disease prevention, rather than treatment (medication) ● Your interventions are NOT medications or treatment

community trials

An important nursing role in relation to group therapy is Referral to _____-____ ______ including: ○ National Alliance on Mental Illness - NAMI ○ AA (Alcoholics Anonymous) ○ NA (Narcotics Anonymous) ○ OA (Overeaters Anonymous - other eating disorder groups) ok me ○ Suicide groups ○ Many support groups!!!!!!! Learn those in your community (Extra Mile - Buchanan St. Lafayette)

community-based groups

Applications of epidemiology in _____-____ nursing includes: ● Examples of nursing positions that use epidemiology: ○ Nurse epidemiologist ○ School nurses ○ Communicable disease nurse ○ Environmental risk communicators ○ Hospital infections control nurse ○ All nursing documentation on patient charts and records is important source of data for the epidemiologic reviews ● Across practice settings nurses are involved in activities related to primary, secondary, and tertiary prevention

community-oriented

The following falls under _____ of suicide: ● **Psychiatric disorders are factors for suicide -- these disorders are present at the time of 90% of completed suicides.*** ● Depression - diagnosis most closely associated with suicide ● Schizophrenia - leading cause of early death in this population ● Substance use - many who die by suicide have alcohol in the blood at the time of death & have used an illicit substance days before their death. ● Alcohol is a depressant. Drugs and alcohol increase risk of suicide by decreasing inhibitions, increasing aggressiveness, impairing judgment

comorbidity

What basic method in epidemiology is described below: · to decide if rate of disease is the result of suspected risk factor; compare exposed group to group that is unexposed. In tracking of it that is when we look at that we had questions in the coronavirus in how it spreads. · To decide if the rate of disease is the result of a suspected risk factor, compare the exposed group with a group comparable unexposed persons --EX: Compare one parish to another to see if there is a specific issue in one area

comparison groups

The following are groups ______ and definitions: ● Group: effective and powerful medium to initiate and implement changes for individuals, families, organizations, and the community ○ Cohesion: the attraction between members (values and common goals) ○ Task Function: deliberate contribution of a group member ○ Maintenance function: help members affirm, accept, and support each other ○ Norms of the group: standards of the group (maintenance norms, reality norms) ○ Leadership of the group (ex: democratic, patriarchal) ○ Structure of the group can influence and bring about change

concepts

With schizophrenia we have negative symptoms which includes affect which is external expression of person's internal emotional state. It includes the following: flat, blunted, constricted, inappropriate, and bizarre. Which one of these is described below: ■ - reduced in range or intensity (shows sadness or anger but no other moods)

constricted

When talking about thought ______ of patients with bipolar disorder, ______ is sexually explicit, brilliant business ability, artistic talents. ● Mania brings about distorted & generally false thoughts = delusions ○ Grandiose - highly inflated self-regard; exaggerate achievements ■ Know famous people ■ Special powers ■ Religious themes -keep in mind some people have valid experiences ■ Science fiction type themes - abducted by aliens ■ Supernatural themes - "I am possessed by my dead father." ○ Persecutory - FBI is spying on them; someone is harassing them - untrue ■ As mania escalates, may progress to hallucination

content

The ____ of psychiatric mental health treatment is as follows from the LEAST RESTRICTIVE TO MOST ACUTE: 1. Primary care 2. Specialty care 3. Patient-centered Medical homes 4. Community mental health centers 5. psychiatric home care 6. assertive community treatment 7. intensive outpatient programs 8. partial hospitalization programs 9. emergency care 10. crisis stabilization/ observation units 11. general and private hospitals 12. state hospital

continuum

● Movement along the ______ of psychiatric mental health care/treatment is fluid - patients may be moving in either direction. If symptoms do not improve, may be referred to a higher level of care - to prevent decompensation - deterioration of mental health ○ Someone with a chronic mental illness → one inpatient stay is not realistic; will have more than one

continuum

● from least restrictive to most acute "there is an excellent diagram in your book" ○ Least restrictive → outpatient ○ "Crisis stabilization" - will be more restricted for a shorter amount of time to get through current crisis and then will be discharged and be treated as outpatient ● Movement along the continuum is fluid - patients may be moving in either direction. If symptoms do not improve, may be referred to a higher level of care - to prevent decompensation - deterioration of mental health ○ Someone with a chronic mental illness → one inpatient stay is not realistic; will have more than one

continuum of care

With schizophrenia we have positive symptoms. These include delusion types: persecutory, referential, grandiose, erotomanic, nihilistic, somatic, and control. Which of these is described below: believing that another person, group, or external force controls thoughts, feelings, impulses or behavior—such as aliens

control

What key characteristic of Patient-centered medical homes is described below: ● Coordinate with broader facilities, hospitals, home health ● If someone needs to go to a hospital it should be coordinated through these homes

coordination of care

· There is a health problem. What would you do? · What would you do first? · What information do you need to gather? · What are you initial guesses about the cause of illness? · How would you know who has the disease, for sure? · What studies could you do to figure out what caused the outbreak? · How would you know if your studies were right? · If your studies were correct, what steps would you take to protect everybody else? · Review box 9.3 on page 167

critical thinking

With analytical epidemiology we have study designs: observational design--> ___ ____ _____ which includes: ○ prevalence studies ■ Snapshot or cross section of a population information is gathered on current health status, personal characteristics, and potential risk factors ■ Gathered on current health status, personal characteristics, and persistent health factors ■ Ex: if we gather 1000 teachers from across the states and examine their health history at one point of time (June 1st of this year) and you look at their medical status at that point in time.

cross sectional study

: beliefs & perspectives that a society value ○ Perspectives about individual responsibility for health and well-being are influenced by prevailing cultural attitudes. **attitudes, beliefs, and media communication about vulnerable groups

cultural attitudes

What basic epidemiology concept is described below: ● Example. 3:5 for a year for a particular disease given a specific remedy ● Rate may change if we specify age as a factor ● _____ ______ for people 20-40 vs. cure rate for people 50-70 ● May then become 4:5 for ages 20-40 and 2:5 for ages 50-70

cure rate

When talking about descriptive epidemiology we have concepts of time. Which concept of time is described below: this is your seasonal fluctuation is a common type (calendar events, travel, holiday). o Seasonal variation o Christmas time, travel time where diseases will peak in Christmas because you have increase in flying, it is cold outside and people tend to stay inside and have close contact with each other

cyclic trends

Descriptive or Analytical epidemiology? ● describes a disease according to its person, place, or time ○ Determinants of those health factors, exposures, characteristics, behaviors, and contexts that determine (or influence) the patterns ○ Considered in terms of ■ WHAT is disease ■ WHO is affected ■ WHERE are they ■ WHEN do events occur

descriptive

With schizophrenia we have positive symptoms which includes alterations in reality testing. This includes _____ which are false beliefs - lack of evidence to support.

delusions

What challenging behavior in group therapy is described below: self-centered, angry, depressed may lack empathy, hope or concern for others in the group - speak to them in private

demoralizing

With schizophrenia we have positive symptoms. These includes alterations in perception.These alterations include auditory and visual hallucinations. Visual hallucinations includes: ● feeling of being unreal or having lost identity. Body parts do not belong to the body or have changed. ○ Ex: sees fingers as being smaller or not there

depersonalization

The following are guidelines for counseling people with ______: 1. help the pt question underlying assumptions and beliefs and consider alternate explanations to problems. RATIONALE: --reconstructing a healthier and more helpful attitude about the future can alter depression 2. work with the patient to ID cognitive distortions that result in a negative self-perception. For example: a. overgeneralizations b. self blame c. mind reading d. discounting of positive attributes RATIONALE: --cognitive distortions reinforce a negative inaccurate perception of self and world a. taking one fact or event and making a general rule out of it ("he always...") b. consistently blaming self c. despite a lack of evidence, assumes that other do not like him or her d. focusing on the negative 3. Help the pt to ID current coping skills and explore alternate coping skills RATIONALE: --many depressed people use ineffective coping skills. Exploring and adopting alternative coping skills wil improve the patient's outlook. 4. Encourage exercise such as running and/or weight lifting RATIONALE: --exercise can improve self-concept and improve the brain's neurochemistry 5. Encourage formation of supportive relationships such as individual therapy, support groups, and peer support RATIONALE: --such relationship reduce social isolation and enable the pt to work on personal relationship needs 6. Provide info referrals, when needed, for religous or spiritual support (ex: pastoral visits, readings, programs, tapes, community resources) RATIONALE: --spiritual and existenial issues may be heightened during depressive episodes; many people find strength, support, and comfort in spirituality or religion

depression

Other ______ disorders include: ● Substance/Medication-Induced Depressive Disorder ● Depressive disorder due to another medical condition ○ Whoever is doing initial interview would need to split all that out and make sure they are not coming DUE TO something else Postpartum Depression ○ Between 2-12 months after delivery ○ At risk if: ■ previous postpartum depression ■ history of depression or bipolar ■ increase in stressful events ■ inadequate support ■ marital conflict ● Postpartum psychosis - dramatic symptoms - break from reality; considered a psychiatric emergency*****

depressive

With schizophrenia we have positive symptoms. These includes alterations in perception.These alterations include auditory and visual hallucinations. Visual hallucinations includes: ● feeling that the environment has changed ○ Ex: familiar somehow seems strange or unfamiliar

derealization

Descriptive or Analytical epidemiology? ○ Considered in terms of ■ WHAT is disease ■ WHO is affected ■ WHERE are they ■ WHEN do events occur

descriptive

When talking about _____ epidemiology we have: the person/group/population: · What were they doing when they became ill / infected · Who do they interact with? · What does the group have in common? · Does the group have special characteristics?

descriptive

With _____ epidemiology we also have concept of time which includes: · Secular trends --Long term patterns of morbidity or mortality- over years or decades --Short term patterns --Outbursts of disease or conditions for a given period of time · Point epidemics (short term) a concentration over space and time of a disease or event o Point epidemics: space rlated patterns and is important in infectious diseases. o Investigations are indicators for things such as toxic exposures and peak exposure. · Cyclic trends: this is your seasonal fluctuation is a common type (calendar events, travel, holiday). o Seasonal variation o Christmas time, travel time where diseases will peak in Christmas because you have increase in flying, it is cold outside and people tend to stay inside and have close contact with each other · Change of frequency of a disease over time (over years or decades)

descriptive

________ epidemiology: a picture of how thins are or have been includes: · Person "who" --Race, sex, age, education, occupation, income, and marital status · Place "where" --Examine geographic patterns · Time "when" --Secular trends · Point epidemic · Cyclical time patterns · Non-simultaneous, event- related clusters

descriptive

_______ of a patient with bipolar disorder includes: ● Altered thought processes - non-NANDA ● Self-care deficit - (feeding, bathing, dressing) ○ Nutrition concerns - if really manic, may not be sitting long enough to finish meal. Be aware of nutritional needs - have finger foods on hand - food can eat "on the go" ● Sleep deprivation ● Impaired social interaction ● If applies - Risk for injury; risk for other - directed violence

diagnosis

What depressive disorder is described below: Biological Risk Factors: *unlikely that there is a single cause for depression* ■ ___1______ - vulnerabilities such as genetic predispositions, biochemical makeup, personality structure; how somebody is ■ _______2____ - life events that impact the vulnerabilities ■ Psychosocial stressors and interpersonal events → intense events can cause brain changes in people especially young people ■ Early life trauma → brain changes → exaggerated stress response in adulthood

diathesis-stress model

What part of boundary delineation (clear, diffuse, or rigid) is described below: unclear and lack of independence - everyone - therefore no one is in charge - overly involved with one another; enmeshment; discouraged from expressing own views; differentiation discouraged → ability to possess strong identity and sense of self *family function

diffuse

What factor contributing to vulnerability is described below: o feeling separation from mainstream society

disenfranchisement

disruptive mood dysregulation disorder

When talking about the history of epidemiology: During the 20th Century: ● Development of ______ impact ○ Diabetes ○ Some cancers ● New infectious diseases (HIV/ AIDS, SARS) ○ Zika virus, Lyme disease, coronavirus, etc.

genetic

What depressive disorder is described below: ● New - introduced in 2013 in response to alarming number of children/adolescents diagnosed with bipolar disorder ○ Put on medications that were not helping ○ Now have a label of serious mental illness (SMI) ● Symptoms: ○ Constant, severe irritability and anger between the ages of 6 and 18 ■ Onset before age 10 ○ Temper tantrums → verbal/behavioral outburst out of proportion; 3 times/week (or more) ■ Diagnosis requires these outbursts to occur in at least 2 of these settings: home, school, or with peers ● Treatment: ○ Medication according to symptoms Parent training to predict and reduce aggression by consistency

disruptive mood dysregulation disorder

What depressive disorder is described below: ● Symptoms: ○ Constant, severe irritability and anger between the ages of 6 and 18 ■ Onset before age 10 ○ Temper tantrums → verbal/behavioral outburst out of proportion; 3 times/week (or more) ■ Diagnosis requires these outbursts to occur in at least 2 of these settings: home, school, or with peers

disruptive mood dysregulation disorder

What depressive disorder is described below: ● Treatment: ○ Medication according to symptoms Parent training to predict and reduce aggression by consistency

disruptive mood dysregulation disorder

Endemic and pandemic are different time

distinctions

What is the hallmark symptom of mania for bipolar disorders?

distractibility

What example of dysfunctional communication is described below: to avoid functional problem solving and resolving conflicts within the family, family members introduce irrelevant details into problematic issues

distracting

● neither the tester or the participant knows who is getting the intervention ○ Tester and participant do not know who is getting the intervention **clinical trial "gold standard" (experimental study)

double bind study

With schizophrenia we have positive symptoms, one being alterations in speech. These include loose associations, word salad, clanging, neoglisms, echolia, magical thinking, paranoia, circumstantiality, tangentiality, cognitive retardation, pressured speech, flight of ideas, symbolic speech, magical thinking, and paranoia. Which of these is described below: - parrot-like repetition of words or fragments of speech

echolalia

echopraxia

With analytical epidemiology we have study designs: observational design--> ___ ____ which includes: ■ Bridges both descriptive and analytic epidemiology ● Descriptive: Person place and time ● Analytic: Relation of the disease based on risk and rate variations ■ Descriptive looks at person, place, and time. The analytic tries to determine if there is a relation of disease based on rate and risk variation

ecological study

What assessment tool to assess family function is described below: family assessment tools; another example)

ecomap

What factor contributing to vulnerability is described below: o status (ex: poverty) § Primary cause - Poverty § Higher rates of chronic illness & infant morbidity/mortality, shorter life expectancy, & complex health problems § Child poverty rates are twice as high as those in single parent homes compared to those living with both parents § Poverty level for a family of 4 is $23,550

economic status

Education or Learning? ● An activity "undertaken or initiated by one or more agents that is designed to effect changes in knowledge, skill and attitudes of individuals, groups, and communities." ● Establishment and arrangement of events to facilitate learning, including providing knowledge and skills

education

The following is how to use plain language in health ______: 1. Organize the audience. --know your audience and purpose before you begin --put the most important message first --present other info in order of importance to the audience --break text into logical chunks and use headings 2. Choose words carefully --write in the active voice --choose words and numbers the audience knows; do not use jargon or technical or slang words --keep words, sentences, and paragraphs short --include "you" and other pronouns --use upper and lowercase words --use examples 3. Make info easy to find. --use headings and text boxes --delete unnecessary words sentences and paragraphs --create lists and tables

education

The following is talking about _____ in action: --Teach back: immediate demonstration and teaching another -Reaffirms knowledge and retention ACTS ● Assess: clients main concern: learning needs ● Collaborate: family needs, system in place ● Train: teach the audience ● Survey: were needs accomplished

education

The following is the nursing role with group _____: ● Supporting ● Collaborating ● Clarifying ● Keeping group focused ● Maintaining member self - esteem ● Anal( anal ahah)yzing ● Evaluating

education

Use of technology in health _____ includes: ● Examples: computer games, videos, CDs, internet ○ May want to use a variety of technology tools ● These technologies may: ○ Enable the learner to control the pace of instruction ○ Offer flexibility in the time and location of learning ○ Be engaging ○ MY BRAIN HURTS, HELP ○ Provide immediate feedback ○ Be more consistent with how learner prefers to receive other kinds of information

education

Use of technology in health _____ includes: ● These technologies may: ○ Enable the learner to control the pace of instruction ○ Offer flexibility in the time and location of learning ○ Be engaging ○ MY BRAIN HURTS, HELP ○ Provide immediate feedback ○ Be more consistent with how learner prefers to receive other kinds of information

education

When promoting health through group _____/ choosing groups for health change: ● Health behavior is influenced by the groups to which people belong ● Groups who will support an individual's health changes are unavailable to some people because of their social or emotional isolation ● Choosing groups for health change ● Establish groups ● Beginning interactions ● Conflict ● Strategies for change ● Evaluation of group progress

education

The following are the 3 ____ principles: ● Nature of learning ● Educational process ● Skills of effective educators

educational

The following are skills of the effective _______: ● GAIN the attention, send clear message ● TELL the objectives of instruction and ensured ● ASK learners to recall knowledge related to the topic ● PRESENT the essential material ● HELP in application of new knowledge and guidance ● ENCOURAGE demonstration and participation ● PROVIDE feedback, assessment of performance, evaluation of transfer of knowledge

educator

The following falls under _____ ______: ● Primary goal - triage & stabilization**** ● ____ ______ department - often bridge from community to more intensive services ● Voluntary or involuntary

emergency care

The following falls under _____ ______: 3 models: 1) Comprehensive emergency service model --clinical space and specialty staffing for psychiatric patients -- Dedicated staff and hospital space in ED just for psych care --Designated space within emergency department 2) Hospital-based consultant model -- Do provide the triage and stabilization but psych clinicians available on call -- Provide triage and stabilization, but may not be specialized for psych; may have providers on call 3) Mobile crisis team -- stabilization in the community

emergency care

The following falls under _____ ______: ● Primary goal - triage & stabilization**** ● ____ ______ department - often bridge from community to more intensive services ● Voluntary or involuntary 3 models: 1) Comprehensive emergency service model --clinical space and specialty staffing for psychiatric patients -- Dedicated staff and hospital space in ED just for psych care --Designated space within emergency department 2) Hospital-based consultant model -- Do provide the triage and stabilization but psych clinicians available on call -- Provide triage and stabilization, but may not be specialized for psych; may have providers on call 3) Mobile crisis team -- stabilization in the community

emergency care

The following are skills of the effective educator: ● GAIN the attention, send clear message ● TELL the objectives of instruction and ensured ● ASK learners to recall knowledge related to the topic ● PRESENT the essential material ● HELP in application of new knowledge and guidance ● ________ demonstration and participation ● PROVIDE feedback, assessment of performance, evaluation of transfer of knowledge

encourage

Endemic or Pandemic? ○ Constant long term presence of an event at about the frequency expected from the past history of the community

endemic

● normal occurrence of a condition ○ Ex: West Nile Virus in Louisiana EX: flu season

endemic

What factor influencing disease transmission is described below: ● "Everything internal or external to a specific agent and host, including humans and animals" (can be physical, biological and/or social factors) ○ Ex: working conditions, can also be within your own body

environment

What part of the epidemiologic triangle is described below: · everything internal or external to a given host or agent that is influenced and influences the host and or agent ○ Temperature, humidity, altitutde, crowding, housing, neighborhood, water, milk, food, radiation, pollution, noise ○ Weather ○ Housing ○ Geography ○ Occupational setting ○ Air quality ○ Food

environment

What part of the epidemiologic triangle is described below: ○ Temperature, humidity, altitutde, crowding, housing, neighborhood, water, milk, food, radiation, pollution, noise ○ Weather ○ Housing ○ Geography ○ Occupational setting ○ Air quality ○ Food

environment

When developing effective health education programs: ● MESSAGE: sending a clear message to the learner ○ What is our point we want to get across ● FORMAT: selecting the most appropriate learning format ● _______: creating the best possible learning environment ● EXPERIENCE: organizing positive and meaningful learning experiences; research and discover ● PARTICIPATION: engaging the learner in participatory learning ● EVALUATION: evaluating and giving objective feedback to the learner

environment

The ______ ____ Includes: · Host = Living species (human or animal) capable of being infected or affected by an agent · Agent = animate or inanimate factor that must be present or lacking for a disease or condition to develop · Environment = everything internal or external to a given host or agent that is influenced and influences the host and or agent · *one can cause the other. LOOK AT THE WEB OF COVALITY MODEL. Here it goes beyond the triangle and recognizes that there are inter-relationships among many factors that increase or decrease a disease.

epidemiologic triangle

A basic ____ concept includes: # of cases (numerator)/ # of people in population at risk (denominator)

epidemiology

Basic ____ concepts includes: # of cases (numerator)/ # of people in population at risk (denominator)

epidemiology

Nursing implication and ____ includes: ● Know ○ What diseases are prevalent in your area ○ Risk factors for the population you serve ○ Environmental elements which could cause or enhance a disease event ○ Up to date of the latest research pertinent to your community and your area of practice ○ Governmental agencies to contact when an unusual event is encountered ○ The social service industries available to your community ○ How to handle events using primary, secondary, and tertiary prevention techniques ● Protect ○ Always protect yourself from possible contagions

epidemiology

The following are key terms of _____: ● Morbidity = related to disease or disability. The frequency with which a disease appears in a population: ○ Ex: comorbidities ; one may be being treated for diabetes flare up but also has neuropathy, neuropathy would be the co-morbidity ○ Ex: diabetes is accruing a high morbidity rate ○ Ex : morbid obesity is associated with multiple health complications ● Mortality = related to death ***Rates:153-154 ● Endemic = normal occurrence of a condition ○ Ex: West Nile Virus in Louisiana ○ EX: flu season ● Epidemic = much greater than normal occurrence of a condition ● Pandemic = an epidemic on multiple continents ○ Ex: coronavirus ● Incidence = rate or risk of developing a condition ● Prevalence = proportion of population with a condition

epidemiology

The following is an example of application of _____: FLU ● There may be a high incidence of the flu at a particular time ● But the prevalence rate is low because the flu runs a short course of illness and then the person returns to wellness DIABETES ● There may be an increase in incidence (because new cases are being diagnosed) ● And the prevalence increases as well because diabetes is a chronic disease with no cure, and most patients live for a long time with the diagnosis PROPORTION Proportion ● Ratio ● EX. in 2000 - 2,404,624 deaths recorded ○ 709,894 were caused by heart disease ● Proportion of deaths caused by heart disease is 709,894 divided by 2,404,624 which = 0.295 or 29.5% ● Because this deals with death- can also be called a proportionate mortality rate (PMR) ● Not all proportions deal with death ****Will not need to calculate detailed problems on exam; understand what the definitions are and what they consist of. If there is any questions on breakdown, it is not going to be anything that you have to sit there and have to do a calculation. *****

epidemiology

What is ______? ● Study of health events in populations ● Distribution of patterns of health events ○ EX: coronavirus moving from China to other countries and the US ● Determinants or factors that determine patterns ● Use of information to control health problems ● We use __________ in the community setting and with family and populations because it not like in the hospital setting where environment is controlled (who comes in and out, who is in what room, know their diagnosis and testing). In the community setting, we have no control over the surroundings and that is why we use epidemiology in public health.

epidemiology

The following are factors to successful implementation of ____ ____ ____: ● Individual professional characteristics: willingness/view ● Time restraints ● The hierarchy of the practice environment and the level of support ○ Will it continue to be supported by the community

evidence based practice

______ contributions to public health include: ● Understanding the factors that contribute to development of health promotion and disease prevention measures ● Development of health promotion and disease prevention measures ● Detection and characterization of emerging infectious agents ● Evaluation of health services and policies ○ ________ nurse evaluating diseases. She would also look at the number of clients presenting with similar diseases. ● The practice of community nursing in community health

epidemiology

________ is the study of populations to ● Determine the causes of health and disease in a population ● Monitor the health of the population ● Identify the determinants of health and disease communities ● Investigate and evaluate interventions to prevent disease and maintain health

epidemiology

● Study of health events in populations ● Distribution of patterns of health events ○ EX: coronavirus moving from China to other countries and the US ● Determinants or factors that determine patterns ● Use of information to control health problems

epidemiology

● We use __________ in the community setting and with family and populations because it not like in the hospital setting where environment is controlled (who comes in and out, who is in what room, know their diagnosis and testing). In the community setting, we have no control over the surroundings and that is why we use epidemiology in public health.

epidemiology

erotomanic

What is the CORE function of public health? ● Assessment- of community and public domains ○ Finding the needs of the community ● Policy development- to decrease difference between individuals and groups of individuals ○ Once you find the need of the community ● Assurance - making sure essential community health services are available to all, even those who cannot afford them

ethics

With evidence based practice, step 3 includes approaches to _____ evidence, determining quality: --Patient oriented evidence that matters (POEM)-pronounced differently than poem -What are results? Are they important? Are results valid? How can results be applied to client care The evidence is assigned a "grade" based on: ● Quality of the evidence ● Number of well designed studies ● Presence of similar findings in all of the studies

evaluating

With evidence based practice, step 3 includes approaches to _____ evidence, determining quality: The evidence is assigned a "grade" based on: ● Quality of the evidence ● Number of well designed studies ● Presence of similar findings in all of the studies Three domains for evaluation systems ● Quality- how well was it done, minimal bias ● Quantity- the number of studies on topic, magnitude of the effect, the sample size ○ The bigger the sample size, the more it will be supported ● Consistency - similar findings amongst different studies, examining the same topic --Patient oriented evidence that matters (POEM)-pronounced differently than poem -What are results? Are they important? Are results valid? How can results be applied to client care

evaluating

When developing effective health education programs: ● MESSAGE: sending a clear message to the learner ○ What is our point we want to get across ● FORMAT: selecting the most appropriate learning format ● ENVIRONMENT: creating the best possible learning environment ● EXPERIENCE: organizing positive and meaningful learning experiences; research and discover ● PARTICIPATION: engaging the learner in participatory learning ● ________: evaluating and giving objective feedback to the learner

evaluation

When using the nursing process for a patient with schizophrenia we use ________ which includes: ● Progress reevaluated regularly & treatment adjusted as needed. ● Has functioning improved? ● Decrease in hallucinations/delusions? ● More logical & reality-based thought processes? ● Improved concentration? ● Improved interaction? ● More appropriate affect/mood?

evaluation

The following is ____ in order of importance: ● The double blind, RCT (Randomized Controlled Trial) ○ The subjects in the study and the person doing the testing do not know who is in the controlled group or the uncontrolled group. ● Nonrandomized clinical trials ● Quasi- experimental studies ● Prospective cohort studies ● Case control reports ● Qualitative studies ● Expert opinions

evidence

CAUTION in implementing ___ ___ ___ if: ○ Community differences ○ Environmental differences ○ SES differences ○ These are not usually included in the evidence **community health and EBP methods

evidence based practice

Public health application of ___ ___ ____ includes: ● 1994 - Minnesota Department of Health nursing staff aimed to develop a model of public health nursing interventions ● The model received input from public health nurses, clinicians and educators, and a national expert panel ● Intervention wheel ○ Contains 3 major levels of practice: ■ The community ■ The systems ■ The individual and the family ○ 17 interventions grew out of analysis ■ The intervention is defined ■ Assumptions about the intervention are given ■ Practice examples are given for type of client ■ How the intervention relates to other interventions is explained ■ Basic steps are given for implementing the intervention ■ Best practices are explained ■ The evidence used to develop the intervention is given

evidence based practice

The following are driving factors to ____ ____ _____: ● Cost containment ○ At whose expense? Facility or patient? ● Legal liability - reduce harm ○ Does it decrease harm or increase harm to patient/community ● Outcomes ○ Client and community satisfaction ○ Safety of care ● Focus on client's individuality ● Evaluation information obtained from a website

evidence based practice

The following are factors to successful implementation of ____ ____ ____: ● Knowledge of research and current evidence ● Ability to interpret the meaning of the evidence ● Individual professional characteristics: willingness/view ● Time restraints ● The hierarchy of the practice environment and the level of support ○ Will it continue to be supported by the community ● Philosophy of the practice environment ● Availability of resources ● Practice characteristics ● Links to outside supports ● Political constraints ● Lack of relevant and timely public health practice research

evidence based practice

The following are factors to successful implementation of ____ ____ ____: ● Philosophy of the practice environment ● Availability of resources ● Practice characteristics ● Links to outside supports ● Political constraints ● Lack of relevant and timely public health practice research

evidence based practice

The following are the 7 steps in the ___ ____ ____ process: 0. cultivating a spirit of inquiry 1.asking compelling, clinical questions 2. searching for the best evidence 3. Critically appraising the evidence 4. Integrating the evidence with clinical expertise and client preferences and values 5. Evaluating the outcomes of the practice decisions or changes based on evidence 6. Disseminating EBP results

evidence based practice

____ ____ _____ does the following: ● Assist in the decision making process ● Presented in easy to understand format ● Informs of pros and cons ● Based on client values ● Always consider what your community is because not all measures will be good for that community or individual.

evidence based practice

The following are the ___ ____ of therapeutic groups: ● Education group - demonstration of certain knowledge ○ Example- Patient identifies three significant side effects of prescribed medication ○ Look for measurable outcome after group meeting ● Therapy groups - outcomes focus more on insights, behavior changes, reduction in symptoms ○ Example - alcohol treatment group - Patient develops insight into the connection between drinking and negative consequences. ○ CBT, REBT, therapist leads them to change mind set

expected outcomes

test an intervention ● Investigator initiates a treatment or intervention to influence the risk or course of disease (in contrast to previously discussed study designs that were observational studies) ● In contrast where others discussed were more on the observation whereas here we are actually doing. ● Goal is to evaluate the effectiveness of an intervention and best show the causality of it

experimental studies

what is the primary cause of relapase for thought disorders like schizophrenia?

failure to take prescribed medications

The following is an overview of _____ therapy: ● 2 major aims - ○ 1) Improve the skills of the individual members ○ 2) Strengthen the functioning of the family as a whole ● Family therapists - have advanced degree ● BSN level - could lead ______ group for education or support - not actual therapy

family

_______ therapists explore: ● Cohesiveness ● Communication ● Appreciation ● Commitment ● Coping ● Beliefs & values

family

Management, Boundary Delineation, and Communication are the different? ● Management - resource allocation, rule-making, etc. Usually adults make these decisions. In chaotic families, an inappropriate member making these decision such as teen ● Boundary delineation ○ Clear - adaptive, healthy, firm, yet flexible ○ Diffuse - unclear and lack of independence - everyone - therefore no one is in charge - overly involved with one another; enmeshment; discouraged from expressing own views; differentiation discouraged → ability to possess strong identity and sense of self ○ Rigid - opposite of diffuse, demand adherence to rules and roles, communication is minimal, members rarely share thoughts; isolation may be marked feature; do not learn intimacy in the family setting and do not develop insights???? May have hard time bonding with others when they leave ● Communication -Box 35.1 p.624 - Healthy communication - clear and comprehensive messages; thoughts and feelings can be expressed

family functions

What inpatient care setting is described below: may have dedicated floor in general hospital; Private hospitals are freestanding such as Vermilion North and South ○ General: From ER could send straight to hospital if bed was available ○ Private: freestanding - not associated with hospitals, so if there is a physical emergency they may not have tools needed to treat them like they would at a psych unit in a hospital (EX: oxygen, EKG, crash cart, lab work); if there is a need to go to a hospital, the patient will be sent with a tech

general hospital and private hospital (freestanding)

What term central to therapeutic groups is described below: providing group members with awareness about how they affect one another

feedback

feelings

flat

What thought processes and speech pattern of a patient with bipolar disorder is described below: ● - continuous flow of accelerated speech with abrupt changes from topic to topic; play on words - listener can follow - even though direction changes quickly. When condition is severe - speech may be incoherent.

flight of ideas

With schizophrenia we have positive symptoms, one being alterations in speech. These include loose associations, word salad, clanging, neoglisms, echolia, magical thinking, paranoia, circumstantiality, tangentiality, cognitive retardation, pressured speech, flight of ideas, symbolic speech, magical thinking, and paranoia. Which of these is described below: - moving rapidly from 1 thought to the next; hard to follow the conversations

flight of ideas

When developing effective health education programs: ● MESSAGE: sending a clear message to the learner ○ What is our point we want to get across ● ______: selecting the most appropriate learning format ● ENVIRONMENT: creating the best possible learning environment ● EXPERIENCE: organizing positive and meaningful learning experiences; research and discover ● PARTICIPATION: engaging the learner in participatory learning ● EVALUATION: evaluating and giving objective feedback to the learner

format

The following are examples of learning ______: ● Presentation ● Health fair ● Demonstration ● Lecture ● Nonnative language sessions ● Small informal groups

formats

The following are skills of the effective educator: ●_______ the attention, send clear message ● TELL the objectives of instruction and ensured ● ASK learners to recall knowledge related to the topic ● PRESENT the essential material ● HELP in application of new knowledge and guidance ● ENCOURAGE demonstration and participation ● PROVIDE feedback, assessment of performance, evaluation of transfer of knowledge

gain

General hospital or Private (freestanding) hospital? ○ From ER could send straight to hospital if bed was available **inpatient care setting **may have dedicated floor in general hospital; Private hospitals are freestanding such as Vermilion North and South

general hospital

What example of dysfunctional communication is described below: members use global statements such as "always" and "never" instead of dealing with specific problems and areas of conflict. Family members may state "Harry is always angry" instead of exploring why Harry is upset.

generalizing

gesturing or posturing

glossary

Nursing health and education ____ and functions includes: ● Promote health ● Retain health ● Restore health ● Client ● Use different strategies ● Evaluate ○ Learning ○ Behavior

goals

With a health education program, establish _____: ● Promote health ● Retain health ● Restore health ● Client ● Use different strategies ● Evaluate

goals

When talking about thought content of a patient with bipolar disorders, mani brings about disorted and generally false thoughts (delusions). _______ is when they have: ○ highly inflated self-regard; exaggerate achievements ■ Know famous people ■ Special powers ■ Religious themes -keep in mind some people have valid experiences ■ Science fiction type themes - abducted by aliens ■ Supernatural themes - "I am possessed by my dead father."

grandiose

With schizophrenia we have positive symptoms. These include delusion types: persecutory, referential, grandiose, erotomanic, nihilistic, somatic, and control. Which of these is described below: ○ - believing that one is very powerful/important; falsely believe have great wealth, talent, influence, power or beauty

grandiose

The following are ethical issues with _____ therapy: ● Informed Consent ○ About disadvantages or advantages of group ● Confidentiality ○ Have to agree that what happens in group vEGAS stays in group Vegas --When member may be asked to leave

group

What Yalom's curative factor is described below: ● each member feels connected to others; can accept positive feedback & constructive criticism ○ Feel "plugged in" by people who understand, feel like they can speak freely, must learn to accept positive feedback and constructive criticism

group cohesiveness

What term central to therapeutic groups is described below: all that is said in the group (ex: the group topic)

group content

What term central to therapeutic groups is described below: expectations for behavior in the group that develop over time and provide structure (ex: rules about starting on time, not interrupting)

group norms

What term central to therapeutic groups is described below: the dynamics of interaction among the members (ex: who talks to whom, facial expressions, body language, and progression of group work)

group process

What term central to therapeutic groups is described below: members' expressed ideas or feelings that recur and share a common thread. The leader may clarify a theme to help members recognize it more fully

group themes

The following are the ADVANTAGES of ____ ____: 1. Multiple people at 1 time 2. Members benefit from knowledge, insights from life experiences of both leader and participants 3. Feelings of cohesiveness

group therapy

The following are the DISADVANTAGES of ___ _____: ○ Individual may feel cheated from participation time - especially if group is large ○ Privacy concerns ○ Disruptive behavior ■ Manic or extreme psychosis - not suitable for group ○ Group identity may discourage dissent ○ May encourage unacceptable/illegal behavior ○ Not all patients benefit from group treatment ○ Note >> acutely psychotic, acutely manic, intoxicated are not appropriate for group therapy

group therapy

The following are the advantages of ______ _____: --multiple members can be in treatment at the same time --members of a therapeutic group benefit from the knowledge, insights, and life experiences of both the leader and the participants --a therapeutic group can be a safe setting to learn new ways of relating to other people and to practice new communication skills --groups can promote feelings of cohesiveness

group therapy

The following are the disadvantages of ______ _____: --individual members may feel cheated for participation time, particularly in large groups --there may be concerns about privacy --a member of the group may become disruptive during an emotionally vulnerable point --group identity may discourage dissent --cohesiveness may bind group members together and encourage unacceptable/illegal behaviors --not all patients benefit from group treatment

group therapy

When working to effectively educate _____: ● _______ can be used to initiate and implement changes ● Community ________ represent the collective interests, needs, and values of individuals; they provide a link between the individual and the larger social system ● Provide a link between the individual and the larger social system ● ________ can bring about changes to improve the health and well-being of individuals and communities ○ Some individual changes for health care are difficult or impossible to achieve without group support and encouragement ● Through community ______, nurses help people identify priority health needs and capabilities and make valuable community changes

groups

When working to effectively educate _____: ● ________ can bring about changes to improve the health and well-being of individuals and communities ○ Some individual changes for health care are difficult or impossible to achieve without group support and encouragement ● Through community ______, nurses help people identify priority health needs and capabilities and make valuable community changes

groups

■ → ruminate or think over and over; present or past feelings; "I was never a good patient" **feelings of patient with major depressive disorder

guilt

Nursing care for patients who are experiencing ______ includes: 1. watch the pt for hallucinating cues such as eyes tracking an unheard speaker, muttering, or talking to self, appearing distracted, suddenly stopping conversing as if interrupted or intently watching a vacant area of the room 2. ask about the content of the ______ and how he is reacting to them. assess for command _____ and if the ______ are causing fear or distress. 3. avoid referring to _____ as if they are real. Do not ask, "what are the voices saying to you?" Ask "what are you hearing?" 4. be alert to signs of anxiety which may indicate that ____ are intensifying or that they are of a command type 5. do not negate the patient's experience but offer your own perceptions and convey empathy. "i dont hear angry voices that you hear, but that must be very frightening for you." 6. focus on reality based "here and now" activities such as conversations or simple projects. tell the patient "the voice you hear is part of your illness and it cannot hurt you. try to listen to me and the others you can see around you."

hallucination

nursing care for patients experiencing ____ includes: · Ask about the content of the hallucinations & how patint reacting to them. Assess for command hallucinations and if causing fear or distress. · Avoid referring to hallucinations as though they are real - not "What are the voices saying?" but rather ask "What are you hearing?" · Do not negate their experience - but offer own perceptions - "I do not hear the voices, but that must be frightening to you." · Use other sounds to compete - headphones with music if allowed · ***Tell the voices to go away*** · Tell yourself that the voices are a symptom & not real · Never debate delusions · Validate the part of the delusion that is true - "Yes, there was a man at the nurse's station, but I did not hear him talk about you." · Focus on reality-based topics. Promote reality testing by questioning - "I wonder if there might be another explanation for ____________."

hallucination

The following are steps in developing a ____ ____ program: ● IDENTIFY a population - specific learning need ● SELECT one or more learning theories ● CONSIDER educational principles ● EXAMINE educational issues: cultural concerns, limited literacy, age, etc. ● DESIGN and implement the educational program ● EVALUATE the effects ● The steps used in educational programs parallel those of the nursing process which include assessment, planning, implementation, and evaluation

health education

When developing effective ____ ____ programs: ● MESSAGE: sending a clear message to the learner ○ What is our point we want to get across ● FORMAT: selecting the most appropriate learning format ● ENVIRONMENT: creating the best possible learning environment ● EXPERIENCE: organizing positive and meaningful learning experiences; research and discover ● PARTICIPATION: engaging the learner in participatory learning ● EVALUATION: evaluating and giving objective feedback to the learner

health education

The following are _____ needs; --Health professional shortage areas (HPSA) Nurses and NPs are key in combatting ○ Live and practice in communities ○ Small staff --School nurse importance --Less revenue for services in areas due to less taxes being collected --Review barriers to health care (BOX 22.2)

healthcare

A _____ family is: ● Socialized to manage stress with direct, open communication ● Well-organized activities ● Firm yet flexible boundaries ● Emotional support ● Appropriate socialization within family **provide tool to members to facilitate functioning for present and future

healthy

The following are skills of the effective educator: ● GAIN the attention, send clear message ● TELL the objectives of instruction and ensured ● ASK learners to recall knowledge related to the topic ● PRESENT the essential material ● ______ in application of new knowledge and guidance ● ENCOURAGE demonstration and participation ● PROVIDE feedback, assessment of performance, evaluation of transfer of knowledge

help

■ inability to carry out even simple tasks **cognitive changes of person with major depressive disorder

helplessness

What term describing membership is described below: a group in which a range of differences exists among groups

heterogeneous group

What basic epidemiology concept is described below: ● Persons: because of their exposure, lifestyle, family history, or other factors, are at > risk for disease than population at large ○ EX: the risk of developing cancer ○ Women who carry the breast cancer gene are at higher risk of developing breast cancer than those who do not (would place them in a high risk population) ● EX: geriatric population is at higher risk for contracting a disease

high risk population

● American Nurses Association (ANA) - recognizes ____ ______ as official specialty ● American Holistic Nurses Association with ANA - has standards of care.

holistic nursing

Poverty can lead to _______ - 2 ways to determine the number homeless: (difficult to get exact number) ○ Point-in-time-counts: # of homeless on a given day or during given week ○ Period prevalence counts - # homeless over a given period of time ○ Weather considerations January 2015 ○ estimated 564,708 homeless; believed to be understated number

homelessness

The following influence ______: --Increase in poverty --Emergency demands on income --Alcohol and drugs --Limited treatment facilities for the chronic mental illness --Increase in teenage pregnancy **Families with children - FASTEST growing population

homelessness

the following are the effects of _______: Effects of ________ on health ○ Hypothermia and heat-related illnesses ○ Infestations and poor skin integrity ○ Peripheral vascular disease and hypertension ○ Diabetes and nutritional deficits ○ Respiratory infection and chronic obstructive pulmonary diseases ○ Tuberculosis (TB) ○ HIV/AIDS ○ Trauma ○ Mental illness ○ Use and abuse of tobacco, alcohol, and illicit drugs

homelessness

the following are the effects of _______: Physical ○ Acute & chronic illness ○ AIDS ○ Trauma ○ Decreased access to healthcare services ■ Crisis oriented - ER visits Psychological ○ Chaos ○ Confusion ○ Fear Social ○ Loss of friends --Spiritual well-being Effects of ________ on health ○ Hypothermia and heat-related illnesses ○ Infestations and poor skin integrity ○ Peripheral vascular disease and hypertension ○ Diabetes and nutritional deficits ○ Respiratory infection and chronic obstructive pulmonary diseases ○ Tuberculosis (TB) ○ HIV/AIDS ○ Trauma ○ Mental illness ○ Use and abuse of tobacco, alcohol, and illicit drugs ________ and at-risk populations ○ Pregnant women ○ Children ○ Adolescents ○ Older adults

homelessness

the following are the effects of _______: ________ and at-risk populations ○ Pregnant women ○ Children ○ Adolescents ○ Older adults Social ○ Loss of friends --Spiritual well-being

homelessness

Introduction --4 groups of vulnerable populations ○ 1. the poor ○ 2. the homeless ○ 3. pregnant teens ○ 4. mentally ill ○ present complex nursing needs --Understand your own beliefs about these groups --Understand the issues surrounding client's personal situation --Identify health care needs, barriers to care, and essential health care services for each of these groups & at times even families

homelessness, poverty, mental illness, and teen pregnancy

What is the central emotional psychological factor for suicide?

hopelessness

■ correlated to suicidality ● Negative expectations for the future ● Loss of control over future outcomes ● Passive acceptance of futility of planning to achieve goals Emotional negativism:despair, despondency, depression **cognitive changes of person with major depressive disorder

hopelessness

What depressive disorder is described below: Biological Risk Factors: *unlikely that there is a single cause for depression* ■ Hyperactivity of the hypothalamic-pituitary-adrenal cortical axis ■ Depression rates about equal prior to puberty and in older adults ■ Rates of depression between prepubescent males and females are equal; after, higher risk in females

hormonal

What factor influencing disease transmission is described below: ● "Living species capable of being infected or affected by the agent" ○ Ex: human

host

What part of the epidemiologic triangle is described below: Living species (human or animal) capable of being infected or affected by an agent ○ Age, sex, race, genetic profile, previous diseases, immune status, religion, customs, occupation, marital status, family background ○ Species ○ Age ○ Sex ○ Race ○ Genotype ○ Behavior ○ Nutritional status ○ Health status

host

What part of the epidemiologic triangle is described below: ○ Age, sex, race, genetic profile, previous diseases, immune status, religion, customs, occupation, marital status, family background ○ Species ○ Age ○ Sex ○ Race ○ Genotype ○ Behavior ○ Nutritional status ○ Health status

host

what are the 3 factors influencing disease transmission? **also makes up the epidemiologic triangle

host, agent, and environment

What bipolar disorder is described below: ○ low level & less dramatic mania ○ Hospitalization is rare*******

hypomania

What bipolar disorder is described below: ○ euphoric & increases functioning; accompanied by excessive activity & energy for at least 4 days. Must have 3 of the behaviors listed under Criterion B. There is never psychosis with the mania -but may accompany the depressive side of the disorder ○ Manic episode = 7 days******** ○ ________ episode = 4 days, less dramatic********

hypomanic

What National Patient Safety Goals in Behavioral Healthcare is described below: Process: determine which patients are most likely to attempt suicide Example: routinely administer a screening tool such as the Beck Scale for Suicidal Ideation, a 21 item tool and that takes 5-10 minutes to complete.

identify patient safety risk

What National Patient Safety Goals in Behavioral Healthcare is described below: Process: use at least 2 identifiers when providing care, treatment, or services Example: use the patient's name and date of birth for identification before drawing blood.

identify patients correctly

With schizophrenia we have positive symptoms. These includes alterations in perception.These alterations include auditory and visual hallucinations. Visual hallucinations includes: - misinterpretation of real ○ Ex: sees coat on coat rack and thinks it is a bear

illusions

With schizophrenia we have negative symptoms which includes cognitive symptoms. These include concrete thinking, impaired memory, impaired formation processing, and impaired executive functioning. which one of these is described below: ● difficulty in setting priorities, comparing options, placing in logical order, planning

impaired executive functioning

impaired impulse control

impaired memory

The following is ______ for evidence based practice: ● Ask clinical questions ○ Problem ○ Population ○ Intervention ○ Comparison ● Collect evidence ● Appraise and evaluate evidence ● Make the change ● Evaluate the change

implementation

With schizophrenia we have negative symptoms which includes affect which is external expression of person's internal emotional state. It includes the following: flat, blunted, constricted, inappropriate, and bizarre. Which one of these is described below: ■ - incongruent with actual emotional state or situation (laughing in response to tragedy)

inappropriate

Incidence, incidence rate, incidence population, and prevalence proportion are measures of ?

incidence

What measures of incidence is described below: · refers to the occurrence of new cases of disease or injury in a population over a specified period of time Measure the number of new cases of events in a population at risk during a specified time

incidence

What measures of incidence is described below: o NUMBER OF CASES OF DISEASE OR INJURY DURING SPECIFIED PERIOD o Size of population at start of period **denominator: "population at risk" and new cases

incidence population

What measures of incidence is described below: o Proportion of that population at risk that actually experience the event over a specified time o EX: how many women who have the breast cancer gene actually developed breast cancer in 1 year, 5 years, or 10 years after they found out, or at a specific age

incidence population

What measures of incidence is described below: · measure the risk of disease or the probability of developing disease during the specified period o "attack rate, risk, probability developing disease, cumulative incidence" o NUMBER OF CASES OF DISEASE OR INJURY DURING SPECIFIED PERIOD o Size of population at start of period **denominator: "population at risk" and new cases o Proportion of that population at risk that actually experience the event over a specified time o EX: how many women who have the breast cancer gene actually developed breast cancer in 1 year, 5 years, or 10 years after they found out, or at a specific age

incidence population

What group participant role is described below: personal agendas, etc. for having personal needs met Ex: blocker may throw up roadblocks to disrupt group progress or avoid doing his/her own real work- hey my names trey i have a basketball game tomorrow BLOCK

individual

What basic epidemiology concept is described below: used around world as indicator of overall health; how they judge healthcare and wellness around the world

infant mortality ratio

What basic epidemiology concept is described below: o Number of deaths of infants >1yr of age in a year o Number of live births in the same year **used around world as indicator of overall health; how they judge healthcare and wellness around the world **case fatality rate

infant mortality ratio

What is the nurses responsibilities of electroconvulsive therapy (biological intervention for patient with MDD)>

informed consent, labs, and urinalysis

The following are considerations for _____ care: ● Entry to acute care - majority of inpatients admitted through Emergency Dept. or some type of crisis intervention service ● **Of 12 million Emergency dept. visits - nearly 13% due to mental health/substance use ● Patients do not lose their rights as citizens ○ Phone time, smoke breaks, visitation time, etc ● Teamwork & collaboration - formulate the treatment plan; each discipline responsible for gathering data (some questions repetive—but each discipline MUST DO assessment) ○ Treatment team; patient involved in plan of care

inpatient

The following are considerations for _____ care: ● Managing Behavioral Crisis - training for staff; learn skills to recognize & avoid crises & de-escalate behavioral emergencies; some facilities have special teams; seclusion/restraint/emergency medication actions of last resort (some hospitals have eradicated restraints completely, need to know how to deal with patients and de-escalate situations without them) ○ Crisis Prevention Intervention (CPI) - training to deescalate/ diffuse situation in a peaceful manner ○ Some places have a special team

inpatient

The following are considerations for _____ care: ● Therapeutic milieu - surroundings & physical environment- promote healing-- read this paragraph carefully ○ Way chairs are placed: want optimal therapeutic environment ○ **read book carefully ○ Vital part of the team are UAP, so it is essential for the nurse to assure there is a therapeutic milieu so people can heal and go on ○ A main function of RN - includes rules, activities, environment >> even placement of tables/chairs/furniture

inpatient

The following are considerations for _____ care: ● Safety - Patient Safety Goals - Table p.72 ○ 1) 2 identifiers 2) medicine safely 3) prevent infection 4)identify patient safety risk - determine which patients are most likely to attempt suicide -how?? ○ Perform suicide assessment tool ○ Should be a place on daily assessment ○ All belongings are inspected ○ Tracking patients - q 15 min checks ○ Monitoring visitation ○ Intimate relationships between patients are prohibited

inpatient

Crisis Stabilization/ Observation units, General Hospital and Private Hospital (freestanding), and State Hospitals are the different?

inpatient care settings

Under steps in the evidence based process we have step 0: spirit of _____, curiosity-- what is the best practice? (cultivating spirit of ______ curiosity-best practices?) ○ Ex. heparin lock; patients would bleed out from too much heparin; nurses researched if there was a better and safer solution to flush IV lines and found that saline worked and was safer ○ 1. Asking compelling, clinical questions ○ 2. Search for the best evidence ○ 3. Critically Appraising the evidence ○ 4. Integrating the evidence ○ 5. Evaluating the outcomes of the practice decisions or decision changes ○ 6. Disseminating the EBP results ■ Ex: publications, presentations

inquiry

What are the 3 steps to evidence based practice process?

integrate, evaluate, disseminate

______ care in the United States includes: ● Conventional medicine - focuses on what is done to the patient ● ________ - patient participates with provider to heal body & mind ● Western medicine - defines health as absence of disease ● ________ health - views health by how well the physical, emotional, mental, environmental, spiritual, & social components interrelate

integrative

Integrative health in the US includes: views health by how well the physical, emotional, mental, environmental, spiritual, & social components interrelate

integrative health

● Form of a systematic review that does not have the summary statistics due to limitations of studies **step 2: 4 approaches to finding evidenec

integrative review

The following is criteria for assessment of the quality of _____ health information: ● AUTHORSHIP: what are the credentials? ● CAVEATS: what is the function of the site? ● CONTENT: is the information accurate? ● CREDIBILITY: what is the source for the information? ● CURRENCY: is the information the most current? ● DESIGN: is it accessible? ● DISCLOSURE: is profiling or data sharing done regarding the users? ● INTERACTIVE: does the site provide feedback? ● LINKS:

internet

With the ____ _____ there are 17 interventions that grew out of analysis: ■ The intervention is defined ■ Assumptions about the intervention are given ■ Practice examples are given for type of client ■ How the intervention relates to other interventions is explained ■ Basic steps are given for implementing the intervention ■ Best practices are explained ■ The evidence used to develop the intervention is given **public health application of EBP

intervention wheel

The following are ______ at the BSN level for family function: ● Counseling using problem-solving approach ● Effective Listening skills ● View family members in nonjudgmental manner ● Respond to cues that indicate amount of stress family system experiencing ● Using informal conversation as appropriate ● How does patient's medical regimen impact the family's function? ● Explain treatment in understandable manner ● Elicit perspective of each family member

interventions

The following are nursing ______ for vulnerable populations: --Movement *trend toward providing more comprehensive, family-centered services *Comprehensive Services: focus on more than one problem or concern *Helpful to be in locations where people work and live --Multiple services in a single location (Ex: STD clinic, mobile outreach) *May include social and economic services +"Wrap around services" comprehensive health AND social & economic services --Advocacy * Health literacy --Social justice --Culturally and linguistically appropriate healthcare

interventions

______ of a patient with bipolar disorder includes: ● **Major cause of relapse - not adhering to mood-stabilizing medications ● Communication - firm, calm, short concise ○ Act on legitimate complaints ○ Redirect energy into constructive channels ● Milieu - may need less stimuli ○ Redirect aggression as is needed ● Self-Care Needs - fluids, nutrition ○ Finger foods ; agency shakes ● Sleep, Hygiene, other needs

interventions

The following is an _____ to chapter 11: using health education and groups in the community: ● Nurses provide information to enable clients to ○ Attain optimal health ○ Prevent health problems ○ Identify and treat health problems early and minimize disability ● Education allows individuals to ○ Make informed responsibility for their health ○ Assume personal responsibility for their health ○ Cope effectively with alterations in their health and lifestyles

introduction

Education or Learning? ● Process of gaining knowledge and skills that lead to behavioral changes ● Most definitions of the learning process include measurable change in behavior that continues over time

learning

The following are ______ strategies: ● POPULATION CONSIDERATIONS ● AGE ● CULTURAL & ETHNIC BACKGROUNDS ● PEDAGOGICAL & ANDRAGOGICAL****

learning

______ is based on: ● Previous knowledge ● Previous experience ● Beliefs ● Culture ● Values ● Attention ● Importance

learning

the following are influences on ______: ● Be prepared -appear credible ● Give examples ● Appropriate terminology ● Open ended questions ● Small groups ● Timing ● Visual ● Return demonstration

learning

The following are sample ____ _____ content: Cognitive -Content ● Symptoms ● Methods of acquiring the flu virus ● Importance of reducing exposure ● Use of hand washing as prevention -Method ● Lecture or group discussion Psychomotor -Content ● How to select and uses OTC meds to provide comfort for the flu ● Use of a thermometer and recommendation of when to call physician ● Use of hand gel to prevent transmission -Method: ● Brainstorming activity to create a "flu list" ● Demonstration and return demonstration of thermometer use and hand gel Affective -Content ● Purpose of vaccination for prevention ● Myths and beliefs about vaccine 7 illness ● CDC recommendations for vaccine -Methods ● Lecture presentation and/ or group discussion

lesson plan

Injectable antipsychotics include: ○ _______-________ injectable (LAI)- administered every 2-4 weeks ; Paliperidone palmitate is every 3 months

long-acting

What thought processes and speech pattern of a patient with bipolar disorder is described below: ● disordered way person processing information; thought loosely connected in the conversation

loose associations

With schizophrenia we have positive symptoms, one being alterations in speech. These include loose associations, word salad, clanging, neoglisms, echolia, magical thinking, paranoia, circumstantiality, tangentiality, cognitive retardation, pressured speech, flight of ideas, symbolic speech, magical thinking, and paranoia. Which of these is described below: ○ haphazard, illogical thinking, poor concentration; no apparent relationship between thoughts

loose associations

magical thinking

With schizophrenia, there are 4 phases: prodromal, acute, stabilization, and maintenance/ residual. Which phase is described below: ○ stabilized & new baseline established

maintenance/ residual

What family function is described below: - resource allocation, rule-making, etc. Usually adults make these decisions. In chaotic families, an inappropriate member making these decision such as teen

management

What consideration for inpatient care is described below: training for staff; learn skills to recognize & avoid crises & de-escalate behavioral emergencies; some facilities have special teams; seclusion/restraint/emergency medication actions of last resort (some hospitals have eradicated restraints completely, need to know how to deal with patients and de-escalate situations without them) ○ Crisis Prevention Intervention (CPI) - training to deescalate/ diffuse situation in a peaceful manner ○ Some places have a special team

managing behavioral crisis

When talking about mood and behavior of someone with bipolar disorder, _____ is: ● described as expansive mood >elevated & unrestrained emotional expressiveness; euphoric; overly joyous ○ Unstable - can change quickly to irritation & anger

mania

What example of dysfunctional communication is described below: instead of asking directly for what is wanted, family members manipulate others to get what they want. For example, a child starts a fight with a sibling to get attention. Another example is when a request is granted with "strings attached" so that the other person has a difficult time refusing the request: "if you clean my room for me, i will not tell Daddy you are getting bad grades in school."

manipulating

_____ practices include chiropractice medicine and massage therapy.

manipulative

The following is the role of the nurse with someone that has a ____ _____: ● Focus on prevention ● Know when to walk beside the client and when to encourage the client to walk ahead ● Develop a network of support for yourself ● Work with resources available

mental illness

When talking about the history of epidemiology: During the 20th Century: ● _________ (view contributing factors) ○ Some diseases can be prevented or delayed ○ Example: studying cardiovascular disease ■ Behavioral (things that can affect it, how did they eat?) ■ Environmental

multifactorial

communicate thoughts and attitudes through literature, film, art, television, and newspapers ○ Can be positive, negative, true or false **attitudes, beliefs, and media communication about vulnerable groups

media

Difference between epidemiology and ________: ● _________ focuses on diagnosis and treatment of disease in individuals and your epidemiology, the nurse will evaluate the actual number of clients presenting with a similar disease ● Do not look at treatments, just numbers of those affected

medicine

What population at risk in rural is described below: ○ Delay seeking care until crisis ○ Depression endemic levels among rural residents § High rate of poverty § Geographic isolation § Insufficient number of mental health services ○ Domestic violence ○ Alcohol, tobacco, & other drug use and abuse

mental health

--Alteration in thinking - mood - or behavior --Impaired functioning --Occurs across the life span --Approx. 40.5% of the adult population suffer from a mental disorder (AMI) --Only 33% of persons with a mental disorder obtain help for their illness --stress

mental illness

The following is the role of the nurse with someone that has a ____ _____: ● Create a trusting environment ● Show respect, compassion, and concern ● Do not make assumptions ● Coordinate a network of service providers ● Advocate for accessible health care services for all ● Focus on prevention ● Know when to walk beside the client and when to encourage the client to walk ahead ● Develop a network of support for yourself ● Work with resources available

mental illness

____ _____ in the United States: --High prevalence rates --Deinstitutionalization At risk ○ Children and adolescents ○ Adults ○ Adults with serious mental illness ○ Older adults ○ Cultural diversity --Prevalence rates for mental health problems are very high, and people are at risk for threats to mental health at all ages across the lifespan. --Deinstitutionalization: involves moving many people from state psychiatric hospitals to communities with the goal of improving the quality of life for those persons; however, the community-based services were often not in place and continuity of care became a problem. --At-risk populations for ____ ______ --Low income and minority groups are often at increased risk for ____ _____ because they may lack access to services.

mental illness

the following are at-risk populations for ___ _____: · 1. Children and Adolescents o Factors § Biological § Psychosocial § environmental o Intellectual Disorders o Chronic Disorders o Adolescent Problems o Prevent problems during developmental period o Physical fights & bullying · 2. Adults o Stress major factor o Depression o Anxiety o Co-occurrences o Adults with Serious Mental Illness § Healthy People 2020 focus on tertiary care · 3. Older adults o Usually occurs with other health issues o Depression and dementia related problems o Metabolize medications differently o Life changes · 4. Cultural Diversity o Minorities o Work within community

mental illness

the following are at-risk populations for ___ _____: · 2. Adults o Stress major factor o Depression o Anxiety o Co-occurrences o Adults with Serious Mental Illness § Healthy People 2020 focus on tertiary care

mental illness

the following are at-risk populations for ___ _____: · 3. Older adults o Usually occurs with other health issues o Depression and dementia related problems o Metabolize medications differently o Life changes · 4. Cultural Diversity o Minorities o Work within community

mental illness

When developing effective health education programs: ● _______: sending a clear message to the learner ○ What is our point we want to get across ● FORMAT: selecting the most appropriate learning format ● ENVIRONMENT: creating the best possible learning environment ● EXPERIENCE: organizing positive and meaningful learning experiences; research and discover ● PARTICIPATION: engaging the learner in participatory learning ● EVALUATION: evaluating and giving objective feedback to the learner

message

● Results of several studies are quantifies ● May provide stronger evidence than the randomized control study as it includes all RCTs performed overtime in a particular topic ● EX: Cochrane Public Health Group **step 2: 4 approaches to finding evidence

meta-analysis

Metropolitan area or micropolitan area? ○ : core urban area of 50,000 or more

metropolitan

Metropolitan area or micropolitan area? ○ : core 10,000 to <50,000

micropolitan

The following are issues in _____ health: ● Higher incidence of TB Pesticide poisoning ○ May not have been given information regarding protection from pesticides or care (language barrier, frequently changing jobs) ○ Entire families at risk due to "drift" of pesticides ○ See HOW TO on pesticide exposure p. 379 ● Heat Exposure

migrant

The following are issues in _____ health: ● Poor unsanitary working and housing ● Susceptible to health issues that are not commonly seen in the general public ● Higher incidence of TB Pesticide poisoning ○ May not have been given information regarding protection from pesticides or care (language barrier, frequently changing jobs) ○ Entire families at risk due to "drift" of pesticides ○ See HOW TO on pesticide exposure p. 379 ● Heat Exposure

migrant

________ workers have unpredictable and difficult lifestyles uncertain housing, traveling long distances

migrant

____ _____ approaches are considered mainstream: ○ Cognitive - behavioral therapy ○ Relaxation techniques ○ Support groups ○ Exercise

mind body

What model under emergency care is described below: -- stabilization in the community

mobile crisis team

What challenging behavior in group therapy is described below: do not pass go, do not collect $200; start with them, end group with the monopolizer - to give everyone else a chance ○ 1) remind about equal chance to contribute ○ 2) speak to monopolizer in private ○ 3) limit times to speak

monopolizing

mood

What medications are given to patients with bipolar disorders?

mood stabilizers (Lithium), anticonvulsants, 2nd generation antipsychotics

● related to disease or disability. The frequency with which a disease appears in a population: ○ Ex: comorbidities ; one may be being treated for diabetes flare up but also has neuropathy, neuropathy would be the co-morbidity ○ Ex: diabetes is accruing a high morbidity rate ○ Ex : morbid obesity is associated with multiple health complications

morbidity

● related to death ***Rates:153-154

mortality

motor agitation

motor retardation

● Review done on published papers that support point of view or opinion ● Usually does not include systematic review process **step 2: 4 approaches to finding evidenec

narrative review

When talking about ______ history disease: Primary Prevention ● Exposure ● Preclinical Stage: ○ Exposure to causative agent. No symptoms present Secondary Prevention ● Symptom Development ● Clinical Stage: ○ Symptoms present Tertiary Prevention ● Resolution Stage ○ Problem resolved. Returned to health or chronic state or death

natural

Positive or negative symptoms of schizophrenia? ● Most intractable (resistant to treatment) & difficult to treat; absence of essential human qualities ● Anhedonia - loss of capacity to experience pleasure; may describe feeling empty ● Avolition - loss of motivation; can not sustain work or self-care; not same as laziness - loss of basic drive ● Associality - decreased desire for, or comfort during social interaction

negative

negativism

neoglisms

Research or Non-research evidence? ● Intuition ● Specialists who come in on a panel and give their opinion of what should be done

non-research

A _____-_____ self injury is: ● Deliberate, direct attempts to inflict shallow, yet painful injuries to body without intending to end one's life ● Cutting, burning, scraping/scratching skin, biting, hitting, skin picking, interfering with wound healing ● REASONS: ALLEVIATE PSYCHIC PAIN OR TO PIERCE THE PSYCHIC NUMBNESS EXPERIENCING***** ● Peaks -20 - 29; decline after that age ● (Not a DSM-5 diagnosis)

non-suicidal

Group _____ are expectations of what is supposed to happen

norms

What groups concept and definition is described below: standards of the group (maintenance norms, reality norms)

norms of the group

● Family consultation - mentor families; point to NAMI & other family organizations; support families; refer to clinical services ● NAMI .org

nurse helping families

______ involvement in epidemiology includes: ● Care of clients ○ Implementing care plans for the community (how we will address these issues) ■ Vaccination ■ Education ■ Care of these individuals ■ REVIEW genetics in practice pg. 150 ○ As student ______, our responsibility is the university is a community.

nurses'

______ involvement in epidemiology includes: ● Look at health and disease causation ○ How both prevent and treat illness ● Surveillance and monitoring of disease trends. Would evaluate people presenting with similar symptoms. Data collection is collected through the CDC. This can be our: ○ Homes ○ Schools ○ Workplaces ○ Clinics ● Care of clients ○ Implementing care plans for the community (how we will address these issues) ■ Vaccination ■ Education ■ Care of these individuals ■ REVIEW genetics in practice pg. 150 ○ As student ______, our responsibility is the university is a community.

nurses'

The following are ___ _____ for rural areas: --Increase and support the nurse-client relationship --Positive interaction, respect --Know the cultural differences --Validate understanding of communication Health values & practices ○ Be familiar with Mexican family values and practices in areas where they are more common --Avoid stereotyping

nursing considerations

The following are ____ ____ for family function: ● Families experience stress - times of anticipated developmental change or unanticipated change. ● Examples of ____ ______: ○ Caregiver Role Strain ○ Dysfunctional family processes ○ Ineffective role performance

nursing diagnoses

The following are ____ and _______ health problems in RURAL areas: --Lack of OSHA regulation for farming and ranching because small enterprises & no workers comp Common injuries ○ machinery & vehicular accidents, trauma, dermatitis, eye problems, CA, resp. disease Exposure to chemicals ○ Pesticide, toxin, & herbicide exposure

occupational and environmental

The following are ____ and _______ health problems in RURAL areas: High-risk industries found primarily in rural areas: ○ Forestry ○ Mining ○ Fishing ○ Agriculture --Lack of OSHA regulation for farming and ranching because small enterprises & no workers comp Common injuries ○ machinery & vehicular accidents, trauma, dermatitis, eye problems, CA, resp. disease Exposure to chemicals ○ Pesticide, toxin, & herbicide exposure

occupational and environmental

What at risk population for mental illness is described below: o Usually occurs with other health issues o Depression and dementia related problems o Metabolize medications differently o Life changes

older adults

What phase of group development is described below: ● - group is forming, introduction, members encouraged to get to know each other, ground rules for respectful interaction, talk to each other rather than group leader, confidentiality, turn off phones ○ CLARIFICATION: ■ _______ - group is forming; 1st session> leader structures attitude of respect, confidentiality, trust; points out similarities among members; policy about phones; rules about arrival time

orientation

The following are _____ for nursing diagnoses related to family function: ● Through education, nurses reinforce strengths, help identify resources, and strengthen coping skills: ● Family teaching assists members as they: ○ Learn to accept mental or physical illness of a family member ○ Learn to deal effectively with an ill member's symptoms, such as hallucinations delusions, poor hygiene, physical limitations, disfigurement ○ Learn about the medication ○ Learn what community resources are available & how to access ○ Regain a sense of control & balance in family life

outcomes

______ of a patient with bipolar disorder includes: ● Demonstrates improved impulse control ● Sleeps 4 - 6 hours per night ● Completes __% of meals ● Attending to hygiene; dresses in clean clothes ● Demonstrates improved verbal interactions ; avoids violating others' space ● Patient is compliant with prescribed medication

outcomes

Primary care providers and specialized psychiatric care providers fall under _____ settings.

outpatient

The following are other _____ venues: ● Mobile mental health crisis units ● Telephone crisis counseling - hotlines ● Telepsychiatry- telehealth ○ NP/psychiatrists are able to have visits with patients online ○ Gives patients who live in rural areas access to care that they may not have been able to receive

outpatient

The following are the ways of prevention in ______ care: Community approach to prevention ○ Primary - before problem manifests; reduce the incidence or rate of new cases. -- Ex. - teaching coping strategies, stress management techniques * Maladaptive: drugs/ETOH, anger/aggression (domestic violence, [boom a]child/elder abuse) -- Catch before it manifests ○ Secondary - aimed at reducing the prevalence; early identification of problems, screening; delay or avert progression ○ Tertiary - focus on preventing progression; aim to preserve/restore functional ability Has Dx., want to prevent progression - restore function of ability

outpatient

The following falls under _____ settings: 1. Primary Care Providers - physician, advanced practice nurse, physician assistant ○ Some people comfortable with this; mental disorders have accompanying physical symptoms ○ Disadvantages - ■ 1) time constraints - 15 minute appointment usually not adequate for psychiatric evaluation- normally not even 5 minutes: NOT enough time to do a proper psych eval ■ 2) primary care providers have limited training in psychiatry & lack expertise ● Some may be better than others; luck of the draw with who you get and how much experience they have 2. Specialized Psychiatric Care Providers ● Psychiatrists, psychiatric-mental health advanced practice nurses, psychologists, social workers, counselors, other licensed therapists ● Subspecialties- such as working with veterans who have PTSD, survivors of domestic abuse, etc. ● Very interprofessional

outpatient

With schizophrenia we have positive symptoms. These includes alterations in _____ which is an error in how one interprets perceptions or perceives reality. Most common = hallucinations → sensory experience for which there is no external stimulus; real to the person***. These alterations include auditory and visual hallucinations.

perceptions

_____ psychiatric nursing care includes: ● Nurses require flexibility & comfort in functioning more autonomously ● Nurses are adept at understanding the system & coordinating care; understanding of resources ● ******Role → Service provision in a variety of settings********* ● Example - criminal justice system; includes juvenile facilities- care in a nontraditional facility

outpatient

When using the nursing process for someone concerning suicide ____ statements include: ○ actually saying it ■ "I can't take it anymore." ■ "Life isn't worth living anymore." ■ "I wish I were dead." ■ "Everyone would be better off if I died."

overt

The following is an ___ of this unit: ● Nurses assist clients in dealing with decisions ● Decisions may be "life changing" ● Ethical decision making is based on ethical principles and codes ● Good decisions and based on client's interest and maintenance on integrity

overview

Endemic or Pandemic? ○ Presence of an event in epidemic proportions, involving many communities and countries in a relatively short period of time

pandemic

● an epidemic on multiple continents ○ Ex: coronavirus

pandemic

With schizophrenia we have positive symptoms, one being alterations in speech. These include loose associations, word salad, clanging, neoglisms, echolia, magical thinking, paranoia, circumstantiality, tangentiality, cognitive retardation, pressured speech, flight of ideas, symbolic speech, magical thinking, and paranoia. Which of these is described below: ○ - irrational fear ranging from mild (wary, guarded) to profound (irrational fear that someone wants to kill you). May result in some defensive actions

paranoia

With schizophrenia we have positive symptoms, one being alterations in speech. These include loose associations, word salad, clanging, neoglisms, echolia, magical thinking, paranoia, circumstantiality, tangentiality, cognitive retardation, pressured speech, flight of ideas, symbolic speech, magical thinking, and paranoia. Which of these is described below: ○ irrational fear ranging from mild (wary, guarded) to profound (irrational fear that someone wants to kill you). May result in defensive actions.

paranoia

When developing effective health education programs: ● MESSAGE: sending a clear message to the learner ○ What is our point we want to get across ● FORMAT: selecting the most appropriate learning format ● ENVIRONMENT: creating the best possible learning environment ● EXPERIENCE: organizing positive and meaningful learning experiences; research and discover ● _______: engaging the learner in participatory learning ● EVALUATION: evaluating and giving objective feedback to the learner

participation

Primary, Active, or Passive primary prevention? ● Does not require behavior change ○ Vitamin fortified foods ■ We are not taking the vitamins but they are added to things that we eat so it is more of a passive primary prevention ○ Fluoridation of public water supplies ■ Primary prevention but not something active individuals are doing because it is already in there for us ● Active and passive are terms from previous semesters used to build knowledge

passive primary prevention

What are the 5 key characteristics of patient-centered medical homes?

patient-centered, comprehensive care, coordination of care, improved access, systems approach

When talking about characteristics of andragogical and pedagogical approaches to teaching-learning, which approach is described below for MOTIVATION FOR LEARNING: -internal motivators, self-esteem, recognition, better quality of life, self-confidence, self-actualization

pedagogical

When talking about characteristics of andragogical and pedagogical approaches to teaching-learning, which approach is described below for ORIENTATION TO LEARNING: -learners want to perform a task, solve a problem, and live in a more satisfying way -learning must have relevance to these tasks -learning is organized around life/work situations rather that subject matter units

pedagogical

When talking about characteristics of andragogical and pedagogical approaches to teaching-learning, which approach is described below for READINESS TO LEARN: -any change is likely to trigger a readiness to learn -the need to know in order to perform more effectively in some aspect of one's life -possesses the ability to assess gaps between where one is now and where one wants and needs to be

pedagogical

When talking about characteristics of andragogical and pedagogical approaches to teaching-learning, which approach is described below for ROLE OF THE LEARNER'S EXPERIENCE: -learner brings a greater volume and quality of experience -adults are the richest resources for one another -different experiences assure diversity in groups of adults -experience becomes the source of self-identity

pedagogical

When talking about characteristics of andragogical and pedagogical approaches to teaching-learning, which approach is described below for THE LEARNER: -the learner is self-directed -the learner is responsible for her own learning -self-evaluation is characteristic of this approach

pedagogical

With schizophrenia we have positive symptoms. These includes alterations in _______. The following are unusual in mental illness: ● Olfactory - smelling odors ● Gustatory - taste ● Tactile - feeling bodily sensations

perception

when understanding the concept of homelessness, ___ ____ ___ is # homeless over a given period of time

period prevalence counts

When talking about thought content of a patient with bipolar disorders, mani brings about disorted and generally false thoughts (delusions). _______ is when they have: ○ FBI is spying on them; someone is harassing them - untrue ■ As mania escalates, may progress to hallucination

persecutory

With schizophrenia we have positive symptoms. These include delusion types: persecutory, referential, grandiose, erotomanic, nihilistic, somatic, and control. Which of these is described below: being singled out for harm; others are "out to get me;" thinking neighbors, family, etc. are planning harm, are spying ,etc.

persecutory

The following is how to recognize the signs and symptoms of ______ exposure: --signs and symptoms of ____ exposure vary according to the amount and length of time of the exposure. the majority of body systems can be affected by _____ exposure. --symptoms of acute poisoning include neuromuscular (ex: headache, dizziness, irritability, twitching muscles, muscle weakness), respiratory (ex: SOB, difficulty breathing, nasal and pharyngeal irritation), and GI (ex: N/V, diarrhea, stomach cramps) --symptoms of chronic exposure can be related to illnesses and conditions such as cancers, Parkinson-like symptoms, infertility or sterility, liver damage, and polyneuropathy, and neurobehavioral problems --if symptoms of _____ exposure are suspected, the nurse should develop a ____ exposure history.

pesticide

physical behavior

_____ groups are used in drug testing (the placebo group believes they are getting the new drug but are actually getting a sugar pill: this can control or identify covariable in the study) **clinical trial "gold standard" (experimental study)

placebo

The following is ______ for nursing diagnoses for family function: ● A priority - address the safety needs of family; determine if protective services are needed ● Nurses are adept at ○ 1) assisting family members to learn about the physical/mental illness of an afflicted family member ○ 2)understand medication ○ 3) help identify support groups & community resources

planning

What phase of group development is described below: ● name, objectives, types of patients (age, diagnosis, etc.), schedule, physical setting, seating configuration, leader and member responsibilities, how do we evaluate outcomes? ○ Even think about room temperature (can be distraction), size of the room, external noise, chairs in circle conveys equality ○ CLARIFICATION: ■ ______ —name of the group, objectives of the group, who (age, diagnosis), schedule of meetings, setting, how to evaluate outcomes

planning

______ of a patient with bipolar disorder includes: ● Acute mania - stabilizing the patient while maintaining safety ● Nursing care geared toward: ○ Medications ○ Decreased physical activity - such as pacing ○ Adequate food & fluid intake ○ Goal of 4 - 6 hours sleep per night ○ Intervening so self- care needs met ○ Others as appropriate

planning

When talking about descriptive epidemiology we have concepts of time. Which concept of time is described below: (short term) a concentration over space and time of a disease or event o _____ _______: space related patterns and is important in infectious diseases. o Investigations are indicators for things such as toxic exposures and peak exposure.

point epidemics

when understanding the concept of homelessness, ____ __ ____ ___ is the # of homeless on a given day or during given week.

point in time counts

What core function of public health (ethics) is described below: - to decrease difference between individuals and groups of individuals ○ Once you find the need of the community

policy development

the following are factors affecting the growing number of _____ persons: o Employment Issues/Job Market o Inadequate education and job skills o Increase in female-headed households o Weak enforcement of child support statutes o Dwindling Social Security payments to children o Inadequate antipoverty programs & welfare benefits

poor

With schizophrenia, we have 4 main categories in an assessment: positive, negative, cognitive, and affective. What category is described below: 2. Alterations in Speech ● Delusions ○ Thought blocking - reduction or stoppage of thought ○ Thought insertion - someone has inserted thoughts into their brain; their thoughts are not their own but rather the thoughts of others that have become implanted in their heads ○ Thought deletion - thoughts are being removed from their heads ○ Thought broadcasting - believe others can perceive their thoughts **Delusions can vary according to culture - in USA, worry about CIA or FBI

positive

What thought processes and speech pattern of a patient with bipolar disorder is described below: ● fast, loud, inappropriate sense of urgency, may talk nonstop, no interest in feedback or conversation

pressured speech

With schizophrenia, we have 4 main categories in an assessment: positive, negative, cognitive, and affective. What category is described below: 1. Alterations in reality testing - automatic process by which we determine what is real/not real - without impairment this works; with impaired reality testing - person believes the hallucination/delusion IS real ● Delusion - false beliefs - lack of evidence to support ● Delusion types ○ Persecutory - being singled out for harm; others are "out to get me;" thinking neighbors, family, etc. are planning harm, are spying ,etc. ○ Referential - events or circumstances that have no connection to patient are somehow related to patient; believe newspaper articles, TV shows, songs are directed directly at them ○ Grandiose - believing that one is very powerful/important; falsely believe have great wealth, talent, influence, power or beauty ○ Erotomanic - Believing another desires you romantically ○ Nihilistic - major catastrophe will occur ○ Somatic - body is changing in unusual ways; body part Is rotting ○ Control - believing that another person, group, or external force controls thoughts, feelings, impulses or behavior—such as aliens

positive

With schizophrenia, we have 4 main categories in an assessment: positive, negative, cognitive, and affective. What category is described below: 1. alterations in reality testing 2. alterations in speech 3. alterations in perception 4. alterations in behavior

positive

With schizophrenia, we have 4 main categories in an assessment: positive, negative, cognitive, and affective. What category is described below: 2. Alterations in speech - unusual speech patterns; information processing is disrupted by abnormal brain processes ○ Loose associations - haphazard, illogical thinking, poor concentration; no apparent relationship between thoughts ○ Word salad yummy yummy - use of totally unrelated words ○ Clanging - sound of a word rather than its meanings gives direction to the following words; compulsive rhyming; alliteration = same 1st consonant sound ○ Neoglisms - made up words; meaning known to only the person ○ Echolalia - parrot-like repetition of words or fragments of speech ○ Magical thinking - believe that their thoughts or actions affect others ■ Hat will make them invisible, wear a "lucky" hat or shirt ○ Paranoia - irrational fear ranging from mild (wary, guarded) to profound (irrational fear that someone wants to kill you). May result in some defensive actions ○ Circumstantiality - many details in speech but does get to the point ○ Tangentiality - wandering off topic and does not get to the point ○ Cognitive retardation - generalized slowing of thinking; difficulty in finishing thoughts ○ Pressured speech - urgent or intense speech; resists allowing comments from others ○ Flight of ideas - moving rapidly from 1 thought to the next; hard to follow the conversations ○ Symbolic speech - using symbols instead of direct communication ■ Ex: demons are sticking needles in me, meaning feeling a sharp pain ○ Magical thinking- believe that their thoughts or actions affect others (usually nonpathological in children) ○ Paranoia- irrational fear ranging from mild (wary, guarded) to profound (irrational fear that someone wants to kill you). May result in defensive actions. ● Delusions ○ Thought blocking - reduction or stoppage of thought ○ Thought insertion - someone has inserted thoughts into their brain; their thoughts are not their own but rather the thoughts of others that have become implanted in their heads ○ Thought deletion - thoughts are being removed from their heads ○ Thought broadcasting - believe others can perceive their thoughts **Delusions can vary according to culture - in USA, worry about CIA or FBI

positive

With schizophrenia, we have 4 main categories in an assessment: positive, negative, cognitive, and affective. What category is described below: 3. Alterations in perception - error in how one interprets perceptions or perceives reality. Most common = hallucinations → sensory experience for which there is no external stimulus; real to the person*** ○ Hallucinations ■ Auditory (most common) - varies ● Vague sounds ● Clear voices OR ● Command - direct the person to take action → monitor carefully as this could be dangerous ○ As a nurse, be mindful of this ● Can be supportive, accusatory, derogatory (think about voices stimulation); subtle and unobtrusive or intrusive and distressing ■ Visual -2nd most common; distortion of visual stimuli or formed and realistic. Seeing individual and animals are most common. ● Illusions - misinterpretation of real ○ Ex: sees coat on coat rack and thinks it is a bear ● Depersonalization - feeling of being unreal or having lost identity. Body parts do not belong to the body or have changed. ○ Ex: sees fingers as being smaller or not there ● Derealization - feeling that the environment has changed ○ Ex: familiar somehow seems strange or unfamiliar ■ These are unusual in mental illness: ● Olfactory - smelling odors ● Gustatory - taste ● Tactile - feeling bodily sensations

positive

With schizophrenia, we have 4 main categories in an assessment: positive, negative, cognitive, and affective. What category is described below: 4. Alterations in behavior ○ Catatonic - in a catatonic stupor, are fully conscious but unresponsive to questions, mute, immobile ■ Most common is when person moves or not at all ○ Waxy flexibility - others can move the limbs - person holds limbs in position for hours ○ Motor retardation - pronounced slowing ○ Motor agitation - running, pacing rapidly ○ Stereotyped behaviors - repetitive that do not serve a logical purpose - rocking back and forth for hours ○ Echopraxia - mimicking of movements of another ○ Negativism - resistant; oppositional ○ Impaired impulse control - interrupting in group ○ Gesturing or posturing - unusual and illogical expressions - often grimaces ○ Boundary impairment - impaired ability to sense where one' s body ends and another's begins; may stand too close

positive

With schizophrenia, we have 4 main categories in an assessment: positive, negative, cognitive, and affective. What category is described below: ● something that is present but should not be (hallucinations, delusions, paranoia, disorganized thought/ speech) ○ Hallucinations, delusions, disorganized speech (associative looseness), bizarre behavior

positive

What depressive disorder is described below: ○ Between 2-12 months after delivery ○ At risk if: ■ previous ______ ________ ■ history of depression or bipolar ■ increase in stressful events ■ inadequate support ■ marital conflict ● Postpartum psychosis - dramatic symptoms - break from reality; considered a psychiatric emergency*****

postpartum depression

What depressive disorder is described below: dramatic symptoms - break from reality; considered a psychiatric emergency*****

postpartum psychosis

poverty

: Varies depending on the source. ○ Federal Income Poverty Guidelines is on the basis of income, family size, age of the head of household, and number of children younger than 18 years. ○ The poor insist poverty has less to do with income and more to do with a lack of family, friends, love, and support ○ Insufficient financial resources to meet BASIC living expenses ○ 2014: 46.7 million at poverty or below levels ○ < 18 yo: 21.1% in poverty ○ US poverty guideline for family of four $24,300

poverty

The following are effects of _____ on health: --Higher rates of chronic illness --Higher infant morbidity & mortality --Shorter life expectancy --More complex health problems --More significant complications & physical limitations resulting from chronic disease --Hospitalization rates 3x more than for persons with higher incomes Poor health outcomes often secondary to barriers that impede access to health care ○ inability to pay for health care, lack of insurance, geographical location, language, inability to find a health care provider, transportation difficulties, inconvenient clinic hours, and negative attitudes of health care providers toward poor clients.

poverty

The following are effects of _____ on health: Poor health outcomes often secondary to barriers that impede access to health care ○ inability to pay for health care, lack of insurance, geographical location, language, inability to find a health care provider, transportation difficulties, inconvenient clinic hours, and negative attitudes of health care providers toward poor clients.

poverty

_______ has an especially negative effect on: ○ Children § More likely to decreased brain development § Increased exposure to toxins, abuse, trauma, lower quality of care § 2x more likely if single parent family ○ Members of the 5H Club § Hungry § Homeless § Hugless § Hopeless § Health care lacking

poverty

_______ has an especially negative effect on: ○ Women of childbearing age adolescent women § 4x more likely to have below average academic skills § 3x more likely to drop out of school § More likely to get pregnant § More likely to have preemie babies ○ Older Adults § 3 million households with a senior over 65 has food insecurity § Cannot afford medication ○ Children § More likely to decreased brain development § Increased exposure to toxins, abuse, trauma, lower quality of care § 2x more likely if single parent family ○ Members of the 5H Club § Hungry § Homeless § Hugless § Hopeless § Health care lacking

poverty

The ___ ____: --Get caught in a cycle of poverty --They do not recognize related risks of their behavior --Half of first-time pregnancies occur within 6 months of first sexual experience --Delay seeking pregnancy services or healthcare --High risk pregnancy Early labor with small babies ○ Lower birth rates or premature instants § Greater risk for death in first year § Long term problems § May be difficult to care for --Strained family relationships --More likely to experience violence and abuse than older women during pregnancy --Malnutrition of mother and fetus is more common --Difficult transition to the 24-hour care of a newborn infant Mental health issues such as depression Continuation of education

pregnant teen

The following are special issues in caring for the ___ ____: ○ High risk ○ Face barriers ○ Lower birth weights or premature infants § Greater risk for death in 1st year § Long-term problems § May be difficult to care for ○ Need early identification and follow up after birth ○ Violence § Greater risk during and postpartum § IPV (intimate partner violence) may peak postpartum § Know signs of abuse ○ Nutrition § poor nutrition/ eating habits § lifestyle § adolescent growth spurt and pregnancy ○ Infant care § poor birth outcomes, low birth weight, & pre-term § 24 hour care ○ Schooling and educational needs

pregnant teen

The following are special issues in caring for the ___ ____: ○ Nutrition § poor nutrition/ eating habits § lifestyle § adolescent growth spurt and pregnancy ○ Infant care § poor birth outcomes, low birth weight, & pre-term § 24 hour care ○ Schooling and educational needs

pregnant teen

What depressive disorder is described below: ● Cluster of symptoms that occur in last week before onset of woman's period ● DSM diagnosis ● Interferes with ability to work/interact

premenstrual Dysphoric Disorder (PMS)

What depressive disorder is described below: ● Cluster of symptoms that occur in last week before onset of woman's period ● DSM diagnosis ● Interferes with ability to work/interact ● Symptoms: ○ Mood swings ○ Irritability ○ Depression ○ Anxiety ○ Feeling overwhelmed ○ Difficulty concentrating ● Physical Symptoms: ○ Lack of energy (anergia) ○ Overeating ○ Hypersomnia/insomnia (sleeping too much or too little) ○ Breast tenderness ○ Aching ○ Bloating ○ Weight gain ● Symptoms should decrease significantly/disappear with onset of period

premenstrual Dysphoric Disorder (PMS)

What depressive disorder is described below: ● Physical Symptoms: ○ Lack of energy (anergia) ○ Overeating ○ Hypersomnia/insomnia (sleeping too much or too little) ○ Breast tenderness ○ Aching ○ Bloating ○ Weight gain ● Symptoms should decrease significantly/disappear with onset of period

premenstrual Dysphoric Disorder (PMS)

What depressive disorder is described below: ● Symptoms: ○ Mood swings ○ Irritability ○ Depression ○ Anxiety ○ Feeling overwhelmed ○ Difficulty concentrating ● Physical Symptoms: ○ Lack of energy (anergia) ○ Overeating ○ Hypersomnia/insomnia (sleeping too much or too little) ○ Breast tenderness ○ Aching ○ Bloating ○ Weight gain

premenstrual Dysphoric Disorder (PMS)

What risk factor for schizophrenia is described below: ● - infection in pregnancy increases risk of mental illness in child

prenatal

The following are skills of the effective educator: ● GAIN the attention, send clear message ● TELL the objectives of instruction and ensured ● ASK learners to recall knowledge related to the topic ● ______ the essential material ● HELP in application of new knowledge and guidance ● ENCOURAGE demonstration and participation ● PROVIDE feedback, assessment of performance, evaluation of transfer of knowledge

present

With schizophrenia we have positive symptoms, one being alterations in speech. These include loose associations, word salad, clanging, neoglisms, echolia, magical thinking, paranoia, circumstantiality, tangentiality, cognitive retardation, pressured speech, flight of ideas, symbolic speech, magical thinking, and paranoia. Which of these is described below: urgent or intense speech; resists allowing comments from others

pressured speech

What measures of incidence is described below: ○ Population during the same time period ○ Ex: the prevalence of diabetes has increased over the last 10 years ○ Based on both incidences and duration of illness. If you have a high prevalence of disease in a population, it may reflect high prevalence or long survival. Low prevalence may indicate low incidence or rapidly fatal process or rapid recovery.

prevalence proportion

What measures of incidence is described below: ○ A measure of EXISTING DISEASE in a population at a particular time ○ It can be affected by how long one can live with the disease because that case is included in the number of cases and new cases ○ ALL NEW AND PRE-EXISTING CASES DURING A GIVEN TIME PERIOD ○ Population during the same time period ○ Ex: the prevalence of diabetes has increased over the last 10 years ○ Based on both incidences and duration of illness. If you have a high prevalence of disease in a population, it may reflect high prevalence or long survival. Low prevalence may indicate low incidence or rapidly fatal process or rapid recovery. ○ Often measured by CHRONIC diseases such as diabetes or arthritis that have long durations and dates that are difficult to pinpoint. ○ Looking at new and pre-existing cases

prevalence proportion

What measures of incidence is described below: ○ Often measured by CHRONIC diseases such as diabetes or arthritis that have long durations and dates that are difficult to pinpoint. ○ Looking at new and pre-existing cases

prevalence proportion

The following is the formula for ____ ____: Total number of cases of a disease over given time/ Total population at risk at that time /= divided by

prevalence rate

What National Patient Safety Goals in Behavioral Healthcare is described below: Process: use the hand cleaning guidelines either from the CDC or the WHO Example: wet hands first; apply an amount of product recommended by the manufacturer to hands and rub hands together for at least 15 seconds covering all surfaces of the hands and fingers. Rinse with water and dry thoroughly with a disposable towel. Use towel to turn off the faucet.

prevent infection

The following are the different levels of _______: --Primary: influenza vaccinations (prevention) --Secondary: TB screening (to detect if they have it) --Tertiary: therapy group for severely mentally ill adults (helping them to cope with something they have)

prevention

Primary, Active, or Passive primary prevention? · Promote health and prevent the occurrence of disease, injury, or disability o Examples: Education, immunizations · Have active and primary prevention

primary

When talking about natural history disease what level of prevention is described below: ● Exposure ● Preclinical Stage: ○ Exposure to causative agent. No symptoms present

primary

what level of prevention is described below: influenza vaccinations (prevention)

primary

What outpatient setting is described below: ○ Disadvantages - ■ 1) time constraints - 15 minute appointment usually not adequate for psychiatric evaluation- normally not even 5 minutes: NOT enough time to do a proper psych eval ■ 2) ___ _____ _____ have limited training in psychiatry & lack expertise ● Some may be better than others; luck of the draw with who you get and how much experience they have

primary care providers

What outpatient setting is described below: ● physician, advanced practice nurse, physician assistant ○ Some people comfortable with this; mental disorders have accompanying physical symptoms

primary care providers

What outpatient setting is described below: ● physician, advanced practice nurse, physician assistant ○ Some people comfortable with this; mental disorders have accompanying physical symptoms ○ Disadvantages - ■ 1) time constraints - 15 minute appointment usually not adequate for psychiatric evaluation- normally not even 5 minutes: NOT enough time to do a proper psych eval ■ 2) ___ _____ _____ have limited training in psychiatry & lack expertise ● Some may be better than others; luck of the draw with who you get and how much experience they have

primary care providers

What level of prevention in outpatient care is described below: before problem manifests; reduce the incidence or rate of new cases. -- Ex. - teaching coping strategies, stress management techniques * Maladaptive: drugs/ETOH, anger/aggression (domestic violence, [boom a]child/elder abuse) -- Catch before it manifestsf

primary prevention

What level of prevention is described below: ○ Affordable housing ○ Job training ○ Birth control services ○ Preventative health services ○ Safe sex education ○ Needle exchange program ○ Parent education and counseling services

primary prevention examples

What level of prevention is described below: ○ Safe sex education ○ Needle exchange program ○ Parent education and counseling services

primary prevention examples

what are the 3 levels of prevention?

primary, secondary, tertiary

What outpatient setting is described below: ● Psychiatrists, psychiatric-mental health advanced practice nurses, psychologists, social workers, counselors, other licensed therapists ● Subspecialties- such as working with veterans who have PTSD, survivors of domestic abuse, etc. Very interprofessional

specialized psychiatric care providers

General hospital or Private (freestanding) hospital? ○ - not associated with hospitals, so if there is a physical emergency they may not have tools needed to treat them like they would at a psych unit in a hospital (EX: oxygen, EKG, crash cart, lab work); if there is a need to go to a hospital, the patient will be sent with a tech **inpatient care setting **may have dedicated floor in general hospital; Private hospitals are freestanding such as Vermilion North and South

private (freestanding) hospital

Group _____ is the way group interact with each other, supportive, interruptive, judgmental, silent. Group ______ is the art of doing group work.

process

With schizophrenia, there are 4 phases: prodromal, acute, stabilization, and maintenance/ residual. Which phase is described below: ○ symptoms appear 1 month to more than 1 year before 1st full-blown episode; speech & thought may be odd/eccentric

prodromal

What basic epidemiology concept is described below: o Number of deaths from a specific disease o Total number of deaths in same period **case fatality rate

proportionate mortality ratio

With analytical epidemiology we have cohort study which includes: ● The standard observational design is closes to what we have in our ideas of natural experience. Has specific factors studies in a limited time. ■ ________ studies: longitudinal or follow up study where you study group over time. Subjects are classified over exposures of interest ■ Retrospective studies: rely on existing records to define your cohort that is classified as exposed or unexposed at some point in time. ● Ex: hospital records

prospective

What EPS side effect of 1st generation antipsychotics is described below: ● tremors, reduced accessory movements, gait impairment, reduced facial expressiveness (mask facies), bradykinesia ○ Treatment - reducing dosage, trying different drug

pseudoparkinsonism

With _______ home care, Medicare allows: 1) Social workers with master's degree 2) Psychiatric registered nurses—make home visits—adept at assessing agitation/ potential for violence Help with med management, symptom management

psychiatric

With _______ home care, Medicare will cover if 4 elements are present: 1) Homebound status -- Doesn't mean that they never leave home, but it is very hard/difficult for them to 2) Psychiatric diagnosis 3) Need for skills of a psychiatric registered nurse -- Someone skilled in working w/ psychiatric patients 4) Plan of care under orders of physician or advanced practice registered nurse Medicare allows: 1) Social workers with master's degree 2) Psychiatric registered nurses—make home visits—adept at assessing agitation/ potential for violence Help with med management, symptom management

psychiatric

With family ________: ● Primary goal >> sharing of mental healthcare information ○ Help family better understand the family member's illness, prodromal symptoms, medications ○ Share feelings and strategies for dealing with these feelings>>painful issues of anger, loss, stigma, sadness, helplessness ○ Other families support families coping with member who has severe psychiatric disorder ○ Parent management>>example - teaching parent to work with child who has conduct disorder ● (skip advanced practice section)

psychoeducation

The following are examples of behavioral objectives: ________ domain: ● Rewrite the family favorite recipe using low fat ingredients ● hands-on

psychomotor

The following is a sample lesson plan content: Content ● How to select and uses OTC meds to provide comfort for the flu ● Use of a thermometer and recommendation of when to call physician ● Use of hand gel to prevent transmission Method: ● Brainstorming activity to create a "flu list" ● Demonstration and return demonstration of thermometer use and hand gel

psychomotor

What learning domain is described below: (Physical action domain) ● Performance of skills that require neuromuscular coordination ● Requires conditions: ○ Necessary ability to perform ○ Sensory image of how to carry out the skill Opportunity to practice skill

psychomotor

movements are extremely slowed **physical behavior of person with major depressive disorder

psychomotor retardation

What risk factor for schizophrenia is described below: schizophrenia manifests at times of developmental and family stress

psychosocial stressors

Epi and the Foundation of ___ ____ Recap includes: ● Epidemiology involves application of scientific methods for describing the frequency and pattern of health related states or events ● Epidemiology identifies causes of health related states or events and modes of transmission ● Epidemiology guides public health planning and decision making ● Epidemiology assists individuals/ groups in making informed health behavior changes

public health

The following are ____ ______ affecting vulnerable populations: 1935 - Social Security Act (SSA) ○ created largest federal support program for elderly and poor Americans 1965 - SSA Amendments of 1965 (Medicare and Medicaid) ○ Title XXI of SSA - State Children's Health Insurance Program (SCHIP) 1996 - Health Insurance Portability and Accountability Act (HIPAA) ○ Intended to help people keep health insurance when moving 1997 - Balanced Budget Act ○ Influenced use of resources for providing health services 2010 - Patient Protection and Affordable Care Act ○ Has provisions for reducing growth of future Medicare expenditures

public policies

The following are variable to consider in determining ______: ● Randomization ● Blinding ○ Researcher does not know which group receives treatment ● Sample size: ○ Large enough to show an effect, the larger the better ● Description of the intervention - should be replicable from description ● Outcomes - accurate measurement

quality

The following are variable to consider in determining ______: ● Length of follow-up ○ Better understanding of outcomes and effects of outcomes ● Attrition- amount of subjects who dropped from the study ● Co-founding variables ○ Could affect the outcomes; must be mentioned ● Statistical analysis ○ Should be appropriate for the type of study and measurement

quality

The following are variable to consider in determining ______: ● Sample selection (unbiased) ○ Random selection ■ Randomly assigned a control group or an intervention group ○ Convenience sampling ● Randomization ● Blinding ○ Researcher does not know which group receives treatment ● Sample size: ○ Large enough to show an effect, the larger the better ● Description of the intervention - should be replicable from description ● Outcomes - accurate measurement ● Length of follow-up ○ Better understanding of outcomes and effects of outcomes ● Attrition- amount of subjects who dropped from the study ● Co-founding variables ○ Could affect the outcomes; must be mentioned ● Statistical analysis ○ Should be appropriate for the type of study and measurement

quality

rate

What basic epidemiology concept is described below: ● A MEASURE OF FREQUENCY of a health event in different populations at certain periods ● A ratio but NOT a proportion ● Deals with number of events, over specific times ● _______s change over time and with additional specifics ● Concerned with well to/become ill, or ill to/become cured

rate

What basic epidemiology concept is described below: ● Deals with number of events, over specific times ● _______s change over time and with additional specifics ● Concerned with well to/become ill, or ill to/become cured

rate

What basic method in epidemiology is described below: · these are things that we look at in the fact of age --Age adjusted rate --Direct adjusted rate --Indirect adjusted rate o Ex: coronavirus and those diagnosed with in it Washington and was exposure in nursing home; mortality rate was much higher (elderly risk factor)

rate adjustment

With schizophrenia we have positive symptoms which includes alterations in _____ ____ which is an automatic process by which we determine what is real/not real - without impairment this works; with impaired reality testing - person believes the hallucination/delusion IS real.

reality testing

"process of change through which individuals improve their health & wellness, live a self-directed life, and strive to reach their full potential" (SAMSHA) ○ Idea of psychiatric _______ is a fairly new concept- can be functional in society - least restrictive environment for highest potential

recovery

When promoting _______, ● Nurses help patient recognize side effects, interactions >>help patient self-advocate ● Patient-centered care - respectful & responsive care that incorporates patient preferences, needs, values. ● (Note - SAMSHA=Substance Abuse and Mental Health Services Administration)

recovery

With schizophrenia we have positive symptoms. These include delusion types: persecutory, referential, grandiose, erotomanic, nihilistic, somatic, and control. Which of these is described below: ○ events or circumstances that have no connection to patient are somehow related to patient; believe newspaper articles, TV shows, songs are directed directly at them

referential

● The precision of the measure; consistency or repeatability of the measurement → How often does it work? What is the efficacy? → Does it work 60% of the time? 75% of the time? 100% of the time? *variation in trait being measured. --There can also be observer variation as well as the consistency in the instrument being used. The variation inherent and the trait being measured. We have reliability in screening and then the next thing is validity. **reviewing a screening test

reliability

The goal of antidepressant therapy is to complete? **MDD pharmacological interventions ● Drawback → takes 1-3 weeks longer for mood improvement

remission of symptoms

Research or Non-research evidence? ● Studies ● Synthesis of studies ○ Systematic review ○ Meta analysis ○ RCT: Randomized Control Trial ■ Ranks the highest level of evidence

research

○ resist/manage the effects of vulnerability ○ What makes people more resilient?

resilience

With analytical epidemiology we have cohort study which includes: ● The standard observational design is closes to what we have in our ideas of natural experience. Has specific factors studies in a limited time. ■ Prospective studies: longitudinal or follow up study where you study group over time. Subjects are classified over exposures of interest ■ ______ studies: rely on existing records to define your cohort that is classified as exposed or unexposed at some point in time. ● Ex: hospital records

retrospective

What part of boundary delineation (clear, diffuse, or rigid) is described below: opposite of diffuse, demand adherence to rules and roles, communication is minimal, members rarely share thoughts; isolation may be marked feature; do not learn intimacy in the family setting and do not develop insights???? May have hard time bonding with others when they leave *family function

rigid

What basic epidemiology concept is described below: ● Refers to PROBABILITY that an event will occur within a specified time frame ○ Ex: flu exposure

risk

○ higher probability of illness or event than others

risk

children need parents less, later parents may need children ○ Tragedy in the family or parent in the hospital may require the children to step up and do more

role changes

The following are barriers to healthcare in ____ areas: --lack of HCPs and services and great distances to obtain services --lack of personal transportation --unavailable public transportation --lack of telephone services --unavailable outreach services --inequitable reimbursement policies for providers --unpredictable weather or travel conditions --inability to pay for care or lack of health care insurance --lack of know-how to procure publicly funded entitlements and services --inadequate provider attitutes and understanding about ____ populations --language barriers (caregivers are not linguistically competent) --care and services not culturally and linguistically appropriate

rural

The following are characteristics of _____ life: --lack of anonymity --challenges in maintaining confidentiality stemming from familitarity among residents --small (often family) enterprises, fewer large industries --economic orientation to land and nature (ex: agriculture, mining, lumbering, fishing, marine related)

rural

The following are characteristics of _____ life: --more high risk occupations --town as the center of trade --churches are schools as socialization centers --preference for interacting with locals (insiders) --mistrust of newcomers to the community (outsiders)

rural

The following are characteristics of _____ life: --more space; greater distance between residents and services --cyclical or seasonal work and leisure activities --informal social and professional interactions --access to extended kinship systems --residents who are related or acquanted --lack of anonymity --challenges in maintaining confidentiality stemming from familitarity among residents --small (often family) enterprises, fewer large industries --economic orientation to land and nature (ex: agriculture, mining, lumbering, fishing, marine related) --more high risk occupations --town as the center of trade --churches are schools as socialization centers --preference for interacting with locals (insiders) --mistrust of newcomers to the community (outsiders)

rural

The following are issues and barriers to care in _____ health care delivery: ● Available, affordable, accessible, or acceptable services and professionals ○ Remote ○ Won't see as many providers in these areas ● Providers' attitudes, insights, and knowledge ○ Reflect on our feelings ○ EX: CAC, we have to look at communities' concern for them to be invested in it. Must be a priority to the community ● Designing community health programs that mesh with client's belief system

rural

The following are issues and barriers to care in _____ health care delivery: ● Providers' attitudes, insights, and knowledge ○ Reflect on our feelings ○ EX: CAC, we have to look at communities' concern for them to be invested in it. Must be a priority to the community ● Designing community health programs that mesh with client's belief system

rural

The following is nursing care in _____ environments: --Community oriented nursing needs to vary by community ****There is prevailing need in most rural areas especially for the following:**** ○ School nurses ○ Family planning services ○ Prenatal care ○ Care for individuals with AIDS and their families ○ Emergency care services ○ Children with special needs ○ Mental health services ○ Services for older adults ***Case Management and community health primary health care (COPHC)**** ○ Define and characterize the community ○ Identify the community's health problems ○ Develop or modify health care services in response to the community's identified needs ○ Monitor and evaluate program process and client outcomes

rural

the following are _____ characteristics: Most common health problems: o Pesticide exposure o Heat/sun exposure o Hazardous tools/machinery accidents o Respiratory illness o Skin disorders o Eye injuries (don't wear eye protection) o Infectious disease o Accessibility, affordability, and availability are struggles

rural

the following are _____ characteristics: Poor perception of overall health o Less likely to partake in preventative measures o Increase in chronic conditions (ex: COPD, HTN, DM, CA) o Less likely to seek healthcare interventions until problem is interfering with daily life § Travel time, distance Death rates are higher for working middle-aged in rural areas o Highest death rates due to unintentional injuries (ex: MVA) o Homicide rates are lower and suicide rates are higher q

rural

What thought disorder is described below: Phases ● Prodromal ○ symptoms appear 1 month to more than 1 year before 1st full-blown episode; speech & thought may be odd/eccentric ● Acute ○ symptoms appear & vary - few>many; mild>disabling; hospitalization may be needed ● Stabilization ○ symptoms diminishing & movement toward previous level of functioning; follow-up care varies ● Maintenance/ Residual ○ stabilized & new baseline established

schizophrenia

When using the nursing process for a patient with ______ we use implementation which includes: ● Patient with hallucinations >> Box 12.3 p. 209 ● Patient with delusions>> Box 12.4 pg. 209 ● Associative looseness - ○ Do not pretend to understand when you do not - ○ Place difficulty in understanding on yourself - "I'm having trouble following what you are saying." Not - "You're not making sense." ○ Look for themes in the patient's communication if possible

schizophrenia

the following are _____ characteristics: o 16% of country live in rural areas o Fastest growing areas o "Doughnut effect" o More affordable housing Rural: o Higher portion of Caucasians o Higher number younger and older residents o More married & widowed than divorced o Less formal education than urban Lower income o ¼ of all rural live at or near poverty levels o 40% of children are impoverished o Higher risk for being underinsured or uninsured Healthcare insurance issues o "Working uninsured" § Self-employed § Seasonal workers § Small companies may not offer insurance o Preexisting health conditions Poor perception of overall health o Less likely to partake in preventative measures o Increase in chronic conditions (ex: COPD, HTN, DM, CA) o Less likely to seek healthcare interventions until problem is interfering with daily life § Travel time, distance Death rates are higher for working middle-aged in rural areas o Highest death rates due to unintentional injuries (ex: MVA) o Homicide rates are lower and suicide rates are higher o Fewest dental visits o HIV rates increasing due to cultural unacceptance or lifestyle o Typically use only one healthcare provider o Increase in mental health issues (depression), less likely to seek care Most common health problems: o Pesticide exposure o Heat/sun exposure o Hazardous tools/machinery accidents o Respiratory illness o Skin disorders o Eye injuries (don't wear eye protection) o Infectious disease o Accessibility, affordability, and availability are struggles

rural

the following are _____ characteristics: o 16% of country live in rural areas o Fastest growing areas o "Doughnut effect" o More affordable housing ______: o Higher portion of Caucasians o Higher number younger and older residents o More married & widowed than divorced o Less formal education than urban

rural

the following are _____ characteristics: o Fewest dental visits o HIV rates increasing due to cultural unacceptance or lifestyle o Typically use only one healthcare provider o Increase in mental health issues (depression), less likely to seek care

rural

the following are characteristics of nursing practice in ______ areas: --variety and diversity in clinical experiences --broader and expanding scope of practice --generalist skills with specialty knowledge of crises assessment and management across disciplines and specialties --flexibility and creativity in delivering care --sparse resources (ex: materials, profressionals, equipment, fiscal) --professional or personal isolation --greater independence and autonomy --role overlap with other disciplines --slower pace --lack of anonymity --increased opportunity for informal interactions with clients and co-workers --opportunity for client follow-up on discharge in informal community settings --discharge planning allowing for integration of formal and informal resources --care for clients across the life span --exposure to clients with a full range of conditions and diagnoses --status in the community --viewed as a profressional role model --opportunity for community involvement and informal health education

rural

What consideration for inpatient care is described below: ○ 1) 2 identifiers 2) medicine safely 3) prevent infection 4)identify patient safety risk - determine which patients are most likely to attempt suicide -how?? ○ Perform suicide assessment tool ○ Should be a place on daily assessment ○ All belongings are inspected ○ Tracking patients - q 15 min checks ○ Monitoring visitation ○ Intimate relationships between patients are prohibited

safety

What thought disorder is described below: Assessment - 4 main categories ● Positive - something that is present but should not be (hallucinations, delusions, paranoia, disorganized thought/ speech) ● Negative - absence of something that should be present ● Cognitive - subtle/obvious impairment in memory, attention, thoughts ● Affective - expression of emotions/ symptoms involving emotions> hopelessness

schizophrenia

What thought disorder is described below: DSM-5 (193) ● Two (or more) criterion A symptoms required for any diagnosis of ________ ● Individual must have at least one of these symptoms: delusions, hallucinations, or disorganized speech ● Note - previous categories of _______, such as paranoid, disorganized, etc. have been eliminated - may still see in clinical setting such as chronic paranoid schizophrenia

schizophrenia

What thought disorder is described below: Risk Factors ● Diathesis-Stress model: explanation for this disorder (pg. 6) ● Genetic - inherited - about 80% of risk from genetic factors; concordance rates (percentage of shared disorder in twins) - 50% in identical twins ● Neurobiological— Dopamine theory (overactivity of dopamine) > 1st generation meds - block dopamine - 2 receptors and reduce hallucinations and delusions ● Other neurochemical - 2nd generation - block both serotonin and dopamine - reduce symptoms ● Brain structure abnormalities ● Prenatal - infection in pregnancy increases risk of mental illness in child ● Psychosocial stressors - __________ manifests at times of developmental and family stress ● Environmental—toxins ● What do you NOT see?? Family dynamics do not cause __________ ○ Cannot blame a mother or father for the way they raised boom a child

schizophrenia

What thought disorder is described below: Risk Factors ● Genetic - inherited - about 80% of risk from genetic factors; concordance rates (percentage of shared disorder in twins) - 50% in identical twins ● Neurobiological— Dopamine theory (overactivity of dopamine) > 1st generation meds - block dopamine - 2 receptors and reduce hallucinations and delusions

schizophrenia

What thought disorder is described below: Risk Factors ● Other neurochemical - 2nd generation - block both serotonin and dopamine - reduce symptoms ● Brain structure abnormalities ● Prenatal - infection in pregnancy increases risk of mental illness in child

schizophrenia

What thought disorder is described below: Risk Factors ● Psychosocial stressors - __________ manifests at times of developmental and family stress ● Environmental—toxins ● What do you NOT see?? Family dynamics do not cause __________ ○ Cannot blame a mother or father for the way they raised boom a child

schizophrenia

When using the nursing process for a patient with ______ we use implementation which includes: ● Clubhouse models - place where those with mental illness diagnosis go for socialization, activities, etc. Extra Mile - in lafayette ● Encourage participation in activities & groups ● Therapeutic communication - aim >>build trust & reduce anxiety

schizophrenia

When using the nursing process for a patient with ______ we use implementation which includes: ● Acute phase - Hospitalization - monitor for suicide risk ○ Medication ○ Psychoeducation -help patient recognize & self-manage symptoms ● Stabilization & Maintenance phases = 4 prong approach ○ 1) Medication ○ 2) Treatment adherence ○ 3) Relationship with trusted care providers & support people ○ 4) Community-based therapeutic services ● Postdischarge care - read this on page 203 carefully ● NAMI - National Alliance on Mental Illness ● Clubhouse models - place where those with mental illness diagnosis go for socialization, activities, etc. Extra Mile - in lafayette ● Encourage participation in activities & groups ● Therapeutic communication - aim >>build trust & reduce anxiety ● Patient with hallucinations >> Box 12.3 p. 209 ● Patient with delusions>> Box 12.4 pg. 209 ● Associative looseness - ○ Do not pretend to understand when you do not - ○ Place difficulty in understanding on yourself - "I'm having trouble following what you are saying." Not - "You're not making sense." ○ Look for themes in the patient's communication if possible

schizophrenia

When using the nursing process for a patient with ______ we use implementation which includes: ● Associative looseness - ○ Do not pretend to understand when you do not - ○ Place difficulty in understanding on yourself - "I'm having trouble following what you are saying." Not - "You're not making sense." ● Look for themes in the patient's communication if possible ● Focus on underlying feeling - not content of hallucinations/delusions - that is real! ● Not "why" ● Avoid arguing about false beliefs; ● Express that you do not see, hear or otherwise experience the hallucination/delusion - encourages patient to question the reality of his experience

schizophrenia

When using the nursing process for a patient with _______, planning includes: ○ Recognition of EARLY SIGNS OF RELAPSE >> reduced sleep, social withdrawal, worsening concentration ■ From A - Other Early signs of relapse - sleep disturbances, troubling thoughts, being unsure of what is real, hearing voices, becoming more uncomfortable around others ■ From B, let the TREATMENT TEAM KNOW RIGHT AWAY! Should have a list of whom to call, what to do, where to go

schizophrenia

When using the nursing process for a patient with _______, planning includes: ● Acute phase - Hospitalization if patient a danger to self or others ● Stabilization & Maintenance Phase - ○ Provide patient & family education, support, skills ○ Shelter ○ Educational & vocational strengths ○ Recognition of EARLY SIGNS OF RELAPSE >> reduced sleep, social withdrawal, worsening concentration ■ From A - Other Early signs of relapse - sleep disturbances, troubling thoughts, being unsure of what is real, hearing voices, becoming more uncomfortable around others ■ From B, let the TREATMENT TEAM KNOW RIGHT AWAY! Should have a list of whom to call, what to do, where to go

schizophrenia

the following are outcomes for patients with ______: ● Acute phase - patient safety & stabilization ○ Example - Patient refrains from self-injury ● Stabilization Phase - patient stabilization - patient understanding, optimal medication & psychosocial treatment ● Maintenance Phase - Maintaining & increasing symptom control and insight ○ Example - patient will demonstrate an increase in reality-based thinking with fewer hallucinations and delusions ○ If problem is adherence - patient will take prescribed medications ○ Example—patient will report decrase in voices. ■ If problem is adherence—patient will adhere to prescribed medication regimen

schizophrenia

We ALWAYS refer _____ afterwards: ● A key component of many secondary prevention interventions ● Involves the testing of groups of individuals who are at risk for specific condition, but do not have symptoms ● Goal ○ To determine the likelihood that these individuals will develop the disease ● NOT a diagnostic test ● Effective _______ programs must include referrals for diagnostic evaluation for those who screen positive, to determine if they actually have the disease and need treatment ● Box 9.2 in book ○ 5 things we look at is if the testing is valid and reliable, capable of large group administration, if there is a high yield on it

screening

When reviewing a _______ test: 1. Reliable - get SAME result each time you perform test 2. Validity - get the CORRECT result ● Sensitive - correctly classify cases - true positives ● Specificity - correctly classify non cases- true negatives 3. ________ and diagnosis are not identical

screening

When talking about natural history disease what level of prevention is described below: ● Symptom Development ● Clinical Stage: ○ Symptoms present

secondary

what level of prevention is described below: · Interventions which increase the probability the disease is diagnosed early and treatment will cure it -Ultrasound -DWI checkpoints in the sense that you are screening them knowing they are drunk and preventing accidents · Occurs to reduce the progress of disease (early detection so that treatment can begin early) · The disease already exists in the person -Cancer screening - cancer already present -The GOAL IS TO DETECT the cancer before clinical symptoms arise in order to improve prognosis

secondary

what level of prevention is described below: · Occurs to reduce the progress of disease (early detection so that treatment can begin early) · The disease already exists in the person -Cancer screening - cancer already present -The GOAL IS TO DETECT the cancer before clinical symptoms arise in order to improve prognosis

secondary

What level of prevention in outpatient care is described below: aimed at reducing the prevalence; early identification of problems, screening; delay or avert progression

secondary prevention

When talking about descriptive epidemiology we have concepts of time. Which concept of time is described below: --Long term patterns of morbidity or mortality- over years or decades --Short term patterns --Outbursts of disease or conditions for a given period of time

secular trends

The following are characteristics of ____-_____ persons: --people who are ____-_____ do not take life for granted --mystical or peak experiences. a peak experience is a moment of intense ecstasy, similiar to a religious or mystical experience, during which the self is transcended. --_____-______ people may become so involved in what they are doing that they lose all sense of time and awareness of self

self-actualized

The following are characteristics of ____-_____ persons: --accurate perception of reality. Not defensive in their perceptions of the world --acceptance of themselves, others, and nature --spontaneity, simplicity, and naturalness. _____-____ individuals do NOT live programmed lives. --problem-centered rather than self-centered orientation. Possibly the most IMPORTANT CHARACTERISTIC is a sense of mission to which they dedicate their lives **** --pleasure in being alone and in ability to reflect on events --active social interest --people who are ____-_____ do not take life for granted --mystical or peak experiences. a peak experience is a moment of intense ecstasy, similiar to a religious or mystical experience, during which the self is transcended. --_____-______ people may become so involved in what they are doing that they lose all sense of time and awareness of self --lightheartedness sense of humor that indicates "we are in it together" and lacks sarcasm of hostility --fairness and respect for people of different races, ethnicities, religions, and political views --creativity, especially in managing their lives --resistance to conformity (enculturation). It results in autonomous, independent, and self-sufficient individuals.

self-actualized 21

● Nurse can become triangulated into a patient' family system. You may notice patient not speaking to family member directly, but through you.

self-assessment

Support groups or self-help groups? --12 step groups that use a common model for recovery: Alcoholics Anonymous (AA)--the prototype for other 12 step groups: +Gamblers Anonymous (GA) +Overeaters Anonymous (OA) +Narcotics Anonymous (NA) +Co-Dependents Anonymous +Adult Children of Alcoholics (ACDA) and Al-Alon (friends and families of alocholics) --recovery international for people who have had a mental illness; groups use prescribed model for manaing illness and recovery --National Mental Health Consumers ____-_____ Clearinghous, an info clearinghouse to guide consumers to the nearly 500 diverse types of ___-____ groups in operation.

self-help

What is the primary goal of family psychoeducation? ○ Help family better understand the family member's illness, prodromal symptoms, medications ○ Share feelings and strategies for dealing with these feelings>>painful issues of anger, loss, stigma, sadness, helplessness ○ Other families support families coping with member who has severe psychiatric disorder ○ Parent management>>example - teaching parent to work with child who has conduct disorder

sharing of mental healthcare information

What challenging behavior in group therapy is described below: may be observing until they feel group is safe; may feel incompetent. ○ Address - person does not give feedback & group is deprived of their input. May need to give time to think about answers- "I'll give you a moment to think about that."

silent

What learning theory is described below: ● A perspective that states that people learn within a social context ● Facilitated through concepts such as modeling and observational learning. People especially children. Learn from the environment and seek acceptance from society by learning through influential models ● Also influenced by being rewarded and/ or punished for these actions

social learning theory

What learning theory is described below: ● Facilitated through concepts such as modeling and observational learning. People especially children. Learn from the environment and seek acceptance from society by learning through influential models ● Also influenced by being rewarded and/ or punished for these actions

social learning theory

families that people first learn how to negotiate for personal needs, how to plan, behavioral reinforcement. Learn from parents role modeling ○ Parents are role models, whether positive or negative; children watch parents and will grow up doing what they were taught/what their parents did ○ Or, sometimes they want to do the opposite of what their parents did

socialization

somatic

What basic method in epidemiology is described below: o Routinely collected data (census data, vital records, and surveillance data) o Data collected for other purposes (medical records) o Epidemiological data: original data collected

sources of data

The following are vulnerable population groups of ___ ______ to nurses: --poor and homeless persons --veterans --pregnant adolescents --migrant workers and immigrants --severely mentally ill individuals --substance abusers --abused individuals and victims of violence --persons with communicable disease and those at risk --persons who are human immunodeficiency virus-positive, have hepatitis B virus, or have a sexually transmitted disease

special concern

the following are ____ settings: ● Pediatric - they move to an adult unit at 18 ● Geriatric ● Veteran's ● Forensic ● Alcohol & Drug Use Disorder ● Self-Help options >>National Alliance on Mental Illness (NAMI)

specialty

○ true - (looks at correctly classifying your none- cases or true negatives.) **validity of reviewing a screening tool

specificity

With schizophrenia, we have outcomes in the different assessment phases. (prodromal, acute, stabilization, and maintenance). which one of these is described below: ● patient understanding, optimal medication & psychosocial treatment

stabilization

With schizophrenia, we have implementation in the different assessment phases. (prodromal, acute, stabilization, and maintenance). which one of these is described below: ● 4 prong approach ○ 1) Medication ○ 2) Treatment adherence ○ 3) Relationship with trusted care providers & support people ○ 4) Community-based therapeutic services ● Postdischarge care - read this on page 203 carefully

stabilization and maintenance

With schizophrenia, we have planning in the different assessment phases. (prodromal, acute, stabilization, and maintenance). which one of these is described below: ○ Provide patient & family education, support, skills ○ Shelter ○ Educational & vocational strengths ○ Recognition of early signs of relapse >> reduced sleep, social withdrawal, worsening concentration ■ From A in box 12.2 - Other Early signs of relapse - sleep disturbances, troubling thoughts, being unsure of what is real, hearing voices, becoming more uncomfortable around others ■ From B, let the TREATMENT TEAM KNOW RIGHT AWAY! Should have a list of whom to call, what to do, where to go

stabilization and maintenance

What term describing membership is described below: an individual or a small group that is isolated within a larger group and functions separetely. Members of a _____ may have greater loyalty, more similar goals, or more percieved similarities to one another than they do to the larger group.

subgroup

With major depressive disorder we use the nursing process. Under assessment, one assessment we do is a suicide assessment which includes assessing for ____ _____ which is the preoccupation with death; own funeral; dreams about death; thoughts about wanting to die ○ Emergency requiring immediate intervention!

suicidal ideation

The following are _____ warnings factors (immediate risk for _____): 1. often talking or writing about death, dying, or _____ 2. Making comments about being hopeless or worthless 3. Expressions of having no reason for living; no sense of purpose in life; saying things like "it would be better if I was not here" 4. Increased alcohol and/or drug misuse 5. Withdrawal from friends, family, and community 6. Reckless behavior or more risky activities seemingly without thinking 7. Dramatic mood changes 8. Talking about feeling trapped or being a burden to others

suicide

The following are protective factors for ____ (characteristics that make it LESS likely that individuals will consider, attempt, or die by _____): 1. effective mental healthcare; easy access to a variety of clinical interventions 2. strong connections to individuals, family, community, and social instituitions 3. problem solving and conflict resolution skills 4. contact with providers (ex: follow up phone call from healthcare professionals)

suicide

The following are risk factors for ____ (characteristics that make it more likely that an individual will consider, attempt, or die by ____): 1. previous ___ attempt 2. a history of ___ in the family 3. substance use 4. mood disorders (depression, bipolar disorder) 5. Access to lethal means (ex: keeping firearms in the house) 6. Losses and other events (Ex: the breakup of a relationship or a death, academic failures, legal difficulties, financial difficulties, bullying) 7. history of trauma or abuse 8. chronic physical illness including chronic pain 9. exposure to the suicidal behavior of others

suicide

The following are risk factors for ________: ● Biological - twin studies suggest genetic; postmortem exams—low levels of serotonin in parts of the brain ● Psychological- central emotional factor- hopelessness ● Environmental (copycat _______s) ● Cultural—highest among whites; protective factors (religion and extended family) ● Societal - society becoming more isolated ● *** History of _______ attempt puts a person at high probability of completing suicide in the future***

suicide

The following increase _____ risk in a patient: ● Expression of current thoughts or plans ● Active mental illness ● History of suicidal attempts ● Formulation of a plan ● Availability of means to carry out ● Disruption of important relationships Failure at personal endeavors

suicide

The following are skills of the effective educator: ● GAIN the attention, send clear message ● _____ the objectives of instruction and ensured ● ASK learners to recall knowledge related to the topic ● PRESENT the essential material ● HELP in application of new knowledge and guidance ● ENCOURAGE demonstration and participation ● PROVIDE feedback, assessment of performance, evaluation of transfer of knowledge

tell

The following is the epidemiology of ______: ● According to the CDC 10th leading cause of death overall ○ Age 10-34 : 2nd leading cause of death ○ Age 35-54 : 4th leading cause of death ○ Age 55-64 : 8th leading cause of death ● (2014) - 470,000 visits to ER - attempted suicide or suicidal ideation ● Some undetermined accidents, homicides, deaths - actually suicides ● Military rates of suicide - since 2008, _______ rates among active duty service members surpassed rate for civilians ● Veterans also - higher rates among US population

suicide

The following is the nursing process for _______: Diagnosis ● Highest priority - risk for ________ ● Other diagnoses may pertain (Table 25. 2) ○ Ineffective coping ○ Hopelessness ○ Chronic low self- esteem

suicide

The following is the nursing process for _______: Evaluation ● Ongoing ● Observe if patient engaged in problem solving—positve sign ● May benefit from outpatient attendance- partial hospitalization program (PHP) or intensive outpatient program (IOP) ● (Note - risk for _______ increases within 1st 2-3 weeks after starting medication - client's mood has not lifted as fast as energy has returned- HAS ENERGY TO CARRY OUT A PLAN ● **SUICIDAL BEHAVIOR IS RESULT OF INTERPERSONAL TURMOIL**

suicide

The following is the nursing process for _______: Nursing Process—Intervention · Somatic - ECT · Health Teaching - psychiatric diagnoses, medication, community resources, coping skills, stress management, communication skills; safety plan · Case management -aftercare referrals, support systems · Milieu Therapy - monitoring, safe milieu

suicide

The following is the nursing process for _______: Nursing Process—Intervention · Prevention - education in community arenas; high school · Psychosocial - Therapeutic alliance - promote problem solving · Psychobiological - Pharmacological >>help alleviate symptoms o Note - Lethal overdose is nearly impossible with newer antidepressants such as SSRIs. · Somatic - ECT · Health Teaching - psychiatric diagnoses, medication, community resources, coping skills, stress management, communication skills; safety plan · Case management -aftercare referrals, support systems · Milieu Therapy - monitoring, safe milieu

suicide

The following is the nursing process for _______: Outcome Criteria and Planning ○ Patient remains free from injury ○ Expresses will to live ○ Disclose plan to staff if present ○ Identifies coping strategies ○ Identifies social support ○ Expresses willingness to call on other for help --- Create Safety Plan ○ Identifies 1 support system within community ● Pharmacological ● Somatic ● Health teaching ● Case management ● Milieu therapy

suicide

The following is the nursing process for _______: Postvention - Those left behind ● May experience guilt, shame compounded by difficulty of discussing the subject of ________. ○ Nurses can offer support to survivors ● 6 survivors per suicide completion ● Speak of the deceased person ● If _______ happens in the hospital - staff may experience guilt, shock, anger, shame

suicide

The following is the nursing process for _______: ● Asking directly is the best approach ○ Have you ever felt that life was not worth living? ○ Have you been thinking about death recently? ○ Do you ever think about suicide? ○ Have you ever attempted suicide? ○ Do you have a plan for completing _______? ○ If so, what is your plan for ________?"

suicide

The following is the nursing process for _______: ● Assessment - Assessment tools - facility has its own; ________ Assessment Five-step Evaluation and Triage >>SAFE-T ● Verbal & Nonverbal Cues—be able to recognize difference— ○ Overt statements: actually saying it ■ "I can't take it anymore." ■ "Life isn't worth living anymore." ■ "I wish I were dead." ■ "Everyone would be better off if I died." ○ Covert statements: Not directly said ■ "It's okay now. Soon everything will be fine." ■ "Things will never work out." ■ "I won't be a problem much longer." ■ "Nothing feels good to me anymore and probably never will." ■ "How can I give my body to medical science?"

suicide

The following is the nursing process for _______: ● Lethality of the plan—how quickly a person would die by that particular mode; how likely that the person would die this way ○ Alert - patient shows sudden brightening of mood & more energy -especially after being prescribed antidepressant ○ Now...have the energy to carry out the plan. ○ Risk of _________ is highest in the 1st year after a ________ attempt

suicide

With major depressive disorder we use the nursing process. Under assessment, one assessment we do is a ______ assessment. We have to use the facility's policy on how to proceed for pt. stating suicidal: ○ Continue q 15 checks - may state thoughts are passive ○ Q 5 minute checks ○ LOS - Line of sight (while awake or 24 hours) ○ 1:1 - while awake or 24 hours ■ Key findings:

suicide

● intentional (not accidental) act of killing oneself by any means ○ Men are more likely to succeed, women make more attempts

suicide

With schizophrenia we have positive symptoms, one being alterations in speech. These include loose associations, word salad, clanging, neoglisms, echolia, magical thinking, paranoia, circumstantiality, tangentiality, cognitive retardation, pressured speech, flight of ideas, symbolic speech, magical thinking, and paranoia. Which of these is described below: ○ using symbols instead of direct communication ■ Ex: demons are sticking needles in me, meaning feeling a sharp pain

symbolic speech

When performing a _______ review: ● DEVELOP - a method for organization ● SEARCH - for evidence based material ● EVALUATE - the quality of the information ● ASSESS - cost effectiveness of the intervention ● IDENTIFY- issues with applying and implementing the intervention ○ If the intervention is possible ● SUMMARIZE - both benefits and harm ● Identify and summarize - evidence ● Biggest issues are cost and acceptance of the community **step 2: 4 approaches to finding evidence

systematic

What key characteristic of Patient-centered medical homes is described below: ● Evaluation and quality improvement ● Give feedback to facility

systems approach

What groups concept and definition is described below: deliberate contribution of a group member

task function

What Yalom's curative factor is described below: ● others have similar problems ○ They realize they are not alone alone alone - spongebob ○ Teach one another from past experience

universality

What phase of group development is described below: ● leader ensures each member summarizes personal accomplishments, shares insights, identifies future goals ○ Feedback - information group members get from other members about how they affect one another ○ CLARIFICATION: ■ ________ - members summarize accomplishments, new insights; members may feel loss or anger over group ending

termination

What level of prevention is described below: ● Interventions aimed at limiting disability from disease and enhancing rehabilitation ● EX: physical and occupational therapy

tertiary

When talking about natural history disease what level of prevention is described below: ● Resolution Stage ○ Problem resolved. Returned to health or chronic state or death

tertiary

what level of prevention is described below: · To reduce the limitation of disability from disease · The disease has already occurred, want to maintain them and focus on not letting them deteriorate further --Physical therapy for stroke victims --Halfway houses for recovering alcoholics --Shelter homes for the developmentally disabled --Fitness programs for heart attack patients

tertiary

What level of prevention in outpatient care is described below: focus on preventing progression; aim to preserve/restore functional ability Has Dx., want to prevent progression - restore function of ability

tertiary prevention

What level of prevention is described below: ○ Comprehensive case management ○ Needle exchange programs (also secondary prevention) ○ Political - influencing policy development

tertiary prevention examples

What level of prevention is described below: ○ Attempt to restore and enhance function ○ Support of affordable housing ○ Promotion of psychological rehab programs ○ Involvement in advocacy groups ○ Comprehensive case management ○ Needle exchange programs (also secondary prevention) Political - influencing policy development

tertiary prevention examples

The intervention wheel contains 3 major levels of practice. what are they? **public health application of EBP

the community, the systems, and the individual and the family

What consideration for inpatient care is described below: ____ ____ is a word of French origin and refers to surroundings and physical environment. In a therapeutic context, it refers to the overall environment and interactions within that environment. Peplau referred to this as the ____ _____. It is an all-inclusive term that recognizes the people (patients and staff), the setting, the structure, and the emotional climate as important to healing. Regardless of whether the setting involves treatment of psychotic children, adult patients in a psychiatric hospital, substance users in a residential treatment center, or psychiatric patients in a day treatment program, a well-managed mileu offers patients a sense of security and promotes healing. Structured aspects of the milieu include activities, rules, reality orientation practices, and environment.

therapeutic milieu

Rural or Urban? ○ : at least 20,000 but <50,000 § Nonfarm residence

urban

With schizophrenia we have positive symptoms, one being alterations in speech. This also includes delusions such as thought blocking, thought insertion, thought deletion, and thought broadcasting. Which one of these is described below: reduction or stoppage of thought **Delusions can vary according to culture - in USA, worry about CIA or FBI

thought blocking

With schizophrenia we have positive symptoms, one being alterations in speech. This also includes delusions such as thought blocking, thought insertion, thought deletion, and thought broadcasting. Which one of these is described below: ○ believe others can perceive their thoughts **Delusions can vary according to culture - in USA, worry about CIA or FBI

thought broadcasting

With schizophrenia we have positive symptoms, one being alterations in speech. This also includes delusions such as thought blocking, thought insertion, thought deletion, and thought broadcasting. Which one of these is described below: - thoughts are being removed from their heads **Delusions can vary according to culture - in USA, worry about CIA or FBI

thought deletion

With schizophrenia we have positive symptoms, one being alterations in speech. This also includes delusions such as thought blocking, thought insertion, thought deletion, and thought broadcasting. Which one of these is described below: someone has inserted thoughts into their brain; their thoughts are not their own but rather the thoughts of others that have become implanted in their heads **Delusions can vary according to culture - in USA, worry about CIA or FBI

thought insertion

With major depressive disorder we use the nursing process. Under assessment, we have certain areas to assess which includes affect (glossary), thought processes, mood, feelings, or cognitive changes, physical behavior, and vegetative signs of depression. Which one of these ares are described below: ○ Poor judgement, leading to indecisiveness → difficulty in making simple decisions such as what to wear or what to eat ○ Poor memory and concentration ○ May complain of intrusive negative thoughts ○ Extreme depression → person may become mute ○ Severe depression → may have delusional thoughts ○ *Note: may see major depressive disorder with psychosis

thought processes

The following is a background on ______ settings: ● Psychiatric care in US - roots in asylums - good intentions with belief that states had responsibility to care for "insane" ● No effective treatments to offer ● By 1950s - 2 options only 1) private psychiatrist 2) mental hospital ● 1999 - Supreme Court - keeping people in psychiatric hospitals >> "unjustified isolation" ● Court opinion - mental illness is a disability. Institutionalization is in violation of the Americans with Disability Act. All people with disabilities have a right to live in the community. ● Medicare & Medicaid had effect on care ● Medicaid ○ Paid for short-term hospitalizations in general hospitals and long-term care in nursing homes ○ Did NOT cover care for most in psychiatric hospitals ○ These incentives>>1) development of psychiatric units within general hospitals 2) transfer of geriatric patients from 100% state-paid psychiatric hospitals to Medicaid-reimbursed nursing homes ○ Thus....decrease in number in state-managed psychiatric hospitals

treatment

The following are foods that can interact with MAOIs since they contain ______: 1. veggies: avocados, especially if overripe; femented bean curd; femented soybean; soybean paste 2. fruits: figs, especially if overripe; bananas in large amounts 3. meats: meats that are fermented, smoked, or otherwise ages; spoiled meats; liver, unless very fresh 4. Sausages: fermented varieties: bologna, pepperoni, salami, others 5. Fish: dried or cured fish that is fermented, smoked, or otherwise aged; spoiled fish 6. Milk, milk products: practically ALL CHEESES 7. Foods with yeast: yeast extract (ex: Marmite, Bovil) 8. Beer, wine: some imported beers, Chianti wines 9. Other foods: protein dietary supplements; soups (may contain protein extract); shrimp paste; soy sauce

tyramine

The following are safe foods for people taking MAOIs since they contain little or no ______: 1. most vegetables 2. most fruits 3. meats that are known to be fresh (exercise caution in restaurants; meats may NOT be fresh) 4. nonfermented varieties of sausages 5. Fish that is known to be fresh; vacuum-packed fish, if eaten promptly or refrigerated only briefly after opening 6. milk, yogurt, cottage cheese, cream cheese 7. baked goods that contain yeast 8. Major domestic brands of beer; most wines

tyramine

What National Patient Safety Goals in Behavioral Healthcare is described below: Process: maintain and communicate accurate medication information for the individual served Example: find out what medications the patient is taking and compare them to newly ordered medications

use medicines safely

● Connecting rural providers and consumers ○ Text messages ○ Telehealth ○ Telephone ○ Video conferencing ○ Rural Health care needs

use of technology

→ measured by sensitivity and specificity xxx ○ sensitivity : true + (crucial when treatment is needed rigth away because we want to ID every case) ○ specificity : true - (looks at correctly classifying your none- cases or true negatives.) ○ Positive predictive value: proportion of persons with positive test who actually have the disease ○ Negative predictive value: proportion of persons with a negative test who are actually disease free

validity

● get the correct result. It is measured by sensitivity and specificity. Is it measuring what it claims to measure? How accurate is the measure? → is the measurement really measuring what we think it is, and how exactly ? → measured by sensitivity and specificity xxx ○ sensitivity : true + (crucial when treatment is needed rigth away because we want to ID every case) ○ specificity : true - (looks at correctly classifying your none- cases or true negatives.) ○ Positive predictive value: proportion of persons with positive test who actually have the disease ○ Negative predictive value: proportion of persons with a negative test who are actually disease free → EX: how close are the results to other screening tools used to measure the same thing EX: blood glucose; venipuncture vs finger stick → In screening tools, how often can a tool identify those who do not have the trait and those who do have the trait **reviewing a screening test

validity

The following are interventions targeting the _____ _____ _____ ____: Elimination (Constipation): 1. Monitor intake and output especially bowel movements RATIONALE: --many depressed patients are constipated. If the condition is not addressed fecal impaction can occur. 2. Offer foods high in fiber and provide periods of exercise. RATIONALE: --roughage and exercise stimulate peristalsis 3. Encourage the intake of fluids. RATIONALE: --fluid help prevent constipation 4. Evaluate the need for laxatives and enemas RATIONALE: --these measures prevent constipation

vegetative signs of depression

The following are interventions targeting the _____ _____ _____ ____: Self-care Deficits 1. encourage the use of toothbrush, washcloth, soap, makeup, and shaving supplies RATIONALE: --being clean and well groomed can improve self esteem 2. When appropriate give step by step reminders, such as, "wash the right side of your face, now the left." RATIONALE: --slowed thinking and difficulty concentrating make organizing simple tasks difficult.

vegetative signs of depression

The following are interventions targeting the _____ _____ _____ ____: 1. Nutrition (anorexia): 1. offer small high calorie and high protein snacks frequently throughout the day and evening. RATIONALE: - low weight and poor nutrition render the pt susceptible to illness. small frequent snacks are more easily tolerated than large plates of food when patient is anorexic. 2. offer high protein and high calorie fluids frequently throughout the day and evening. When possible encourage family and friends to join the patient during meals. RATIONALE: -these fluid prevent dehydration and can minimize constipation. -Eating is a social event. This strategy reinforces the idea that someone cares, can raise the patient's self-esteem and can serve as an incentive to eat. 3. include the patient in choosing foods and drinks. Involve a dietician if necessary. Weight the patient weekly and observe the patient's eating patterns. RATIONALE: --the patient is more likely to eat the foods provided --monitoring the pt status gives the info needed for revision of the intervention

vegetative signs of depression

The following are interventions targeting the _____ _____ _____ ____: 2. Sleep (Insomnia) 1. Provide periods of rest after activities. Encourage the pt to get up and dress and to stay out of bed during the day. RATIONALE: --fatigue can intensify feelings of depression --minimizing sleep during the day increases the likelihood of sleep at night and the establishment of healthy routines. 2. Encourage the use of relaxation measures in the evening (ex: a warm bath, warm milk, soothing music or sounds) RATIONALE: --these measures induce relaxation and sleep 3. Provide decaffeinated coffee and soda. RATIONALE: --decreasing caffeine increases the possibility of sleep

vegetative signs of depression

______ issues are described below: o 9/11/01 - began War on Terror and continutes ○ 2014: 19.3 million ________s across all races and genders ○ Post-Traumatic Stress Disorder (PTSD) § Occurs from: à Killing others à Watching others die à Personal danger or danger to others à Need for constant vigilance for determining who and where the enemy is

veteran

With schizophrenia we have positive symptoms. These includes alterations in perception.These alterations include auditory and visual hallucinations. Which one of these is described below: ■ 2nd most common; distortion of visual stimuli or formed and realistic. Seeing individual and animals are most common. ● Illusions - misinterpretation of real ○ Ex: sees coat on coat rack and thinks it is a bear ● Depersonalization - feeling of being unreal or having lost identity. Body parts do not belong to the body or have changed. ○ Ex: sees fingers as being smaller or not there ● Derealization - feeling that the environment has changed ○ Ex: familiar somehow seems strange or unfamiliar

visual

The following are factors contributing to _________: · Human Capital o all strengths, knowledge, and skills to allow individuals to live prosperous and happy · Disenfranchisement o feeling separation from mainstream society · _________ outcomes can be negative (lower health status) or positive (effective interventions) o Cycle: When one problem is solved another one emerges; may cause hopelessness

vulnerability

The following are factors contributing to _________: o Education o Environmental factors (ex: access to care) o Nutrition o Stress o Prejudice o Health status § Age (Boom: a child[ren] and elderly) § Changes in normal physiology · Results from a combined effect of limited resources (physical, environmental, personal, bio-psychosocial)

vulnerability

The following are factors contributing to _________: · Social determinants of health o Economic status (ex: poverty) § Primary cause - Poverty § Higher rates of chronic illness & infant morbidity/mortality, shorter life expectancy, & complex health problems § Child poverty rates are twice as high as those in single parent homes compared to those living with both parents § Poverty level for a family of 4 is $23,550 o Education o Environmental factors (ex: access to care) o Nutrition o Stress o Prejudice o Health status § Age (Boom: a child[ren] and elderly) § Changes in normal physiology · Results from a combined effect of limited resources (physical, environmental, personal, bio-psychosocial) · Human Capital o all strengths, knowledge, and skills to allow individuals to live prosperous and happy · Disenfranchisement o feeling separation from mainstream society · _________ outcomes can be negative (lower health status) or positive (effective interventions) o Cycle: When one problem is solved another one emerges; may cause hopelessness

vulnerability

The following are attitudes, beliefs, and media communication about ____ groups: --Cultural attitudes: beliefs & perspectives that a society value ○ Perspectives about individual responsibility for health and well-being are influenced by prevailing cultural attitudes. --Media: communicate thoughts and attitudes through literature, film, art, television, and newspapers ○ Can be positive, negative, true or false --Consider your personal beliefs and attitudes, clients' perceptions of their condition, and the social, political, cultural, and environmental factors that influence the client's situation.

vulnerable

_______ populations are: · those who have an increased risk of developing adverse health outcomes · The health of the community depends on the health of all persons within the community · Lower income and education tend to have higher risk of health problems · What is the basis for a _____ _______? o Genetic compositions o Social and environmental resources o Support systems o Access to health care

vulnerable population

vulnerable populations

When implementing care to ____ _____: o Create a trusting environment o Ensure privacy o Sit at patient's eye level o Show respect and compassion o Do not make assumptions o Assist the client in coordinating services o Helping them set up and get to appointments o Advocate for access o Focus on prevention and health promotion o Assist in developing a support network o Know when to "walk beside" and let client "walk ahead" o Be aware of all community services and share information o Develop your own support network

vulnerable populations

When implementing care to ____ _____: o Focus on prevention and health promotion o Assist in developing a support network o Know when to "walk beside" and let client "walk ahead" o Be aware of all community services and share information o Develop your own support network

vulnerable populations

the following are nursing roles in ____ _____: --Case finder --Health educator --Counselor --Direct care provider --Population health advocate --Community assessor --Monitor and evaluator of care --Case manager --Advocate --Health program planner --Participant in developing health policies

vulnerable populations

Integrative health in the US includes: defines health as absence of disease

western medicine

The following are guidelines for communication with severely ____ persons: 1. When a patient is silent, use the technique of making observations: "There are many new pictures on the wall." "You are wearing your new shoes." RATIONALE: --when a pt is not ready to talk, direct questions can raise the patient's anxiety level and frustrate the nurse. Pointing to commonalities in the environment draws the pt into and reinforces reality 2. Use simple, concrete words. RATIONALE: --slowed thinking and difficulty concentrating impair comprehension 3. Allow time for the pt to respond. RATIONALE: --slowed thinking necessitates time to formulate a response 4. Listen for covert messages and ask about suicide plans RATIONALE: --people often experience relief and decrease in feelings of isolation when they share thoughts of suicide 5. Avoid platitudes such as "things will look up" or "everyone gets down once in a while" RATIONALE: --platitudes tend to minimize the patient's feelings and can increase feelings of guilt and worthlessness because the pt cannot "look up" or "snap out of it."

withdrawn

The following is ______ health including maternal and infant health: --Higher infant and maternal morbidity rates --High proportion of racial minorities and fewer specialist --Extreme variations in pregnancy outcomes Particularly at risk are women who: ○ Live on or near Indian reservations ○ Are migrant workers ○ Are of African American descent & live in rural counties of states in the deep South ○ Are victims of sexual assault (isolated; living in close proximity to perpetrator; don't want to go to doctor bc they live in areas where everyone knows everyone, and they don't want people to know what happened to them)

women's

The following is ______ health including maternal and infant health: Particularly at risk are women who: ○ Live on or near Indian reservations ○ Are migrant workers ○ Are of African American descent & live in rural counties of states in the deep South ○ Are victims of sexual assault (isolated; living in close proximity to perpetrator; don't want to go to doctor bc they live in areas where everyone knows everyone, and they don't want people to know what happened to them)

women's

word salad

What phase of group development is described below: ● leader facilitates communication, group process flow, group conduct ○ conflicts are opportunities for growth → leader guides conflict resolution → can lead to confidence in problem solving abilities ■ Storming - disagreements, attempts at dominance ■ Norming - clashes resolved >> spirit of cooperation emerges ■ Performing - establish norms and roles ○ CLARIFICATION: ■________ - Leader facilitates communication; group members feel safe & conflicts may arise; leader guides & supports conflict resolution

working

What communicable disease is described below: ○ Transmission: STD and blood borne ■ Remains alive outside the body longer and is more infectious than HIV ■ Can survive at room temp for a week ○ Prevention ■ Vaccination ■ Protection during sex ○ Treatment ■ NO ETOH or drugs ■ rest ○ Symptoms ■ Mild flu like ■ Jaundice ■ Extreme lethargy ■ Nausea ■ Fever ■ Joint pain

Hepatitis B

What vector/animal borne disease is described below: ■ Spread via tick bite ● Improper removal of tick - head is left ■ Symptoms (70-80% of infected persons): ● Fever ● Chills ● Fatigue ● muscle/joint ache ● Swollen lymph nodes ● Bullseye rash ■ Treatments ● Doxycycline ● Amoxicillin

Lyme's Disease

What communicable disease is described below: ● Contact spread ● Treatment ○ Test for sensitivity: culture ○ Combination of meds ■ Vancomycin ■ Rifampin ■ Linezolid (zyvox) ■ Sulfamethoxazole-trimethoprim (Bactrim) ● Complications: sepsis or death

MRSA: Methicillin Resistant

What communicable disease is described below: ■ Monitor for adverse drug reactions ● Anorexia ● Nausea/vomiting ● Paresthesia of hands or feet ● Persistent weakness, fatigue, or fever ● Easy bruising or bleeding ■ Multidrug resistant _______ ● Organism that is resistant to at least isoniazid and rifampin ● Caused by those who: ○ Do not take medicine regularly: noncompliant so becomes resistant→ DOT ○ Do not take all of _____ medicine ○ Develop _______ disease again ○ Come from areas where drug resistant ______ is common ○ Exposure to drug-resistant ______ disease

What communicable disease is described below: ● About 5% develop pulmonary ______; 95% becomes latent ○ Latent ■ In a person without the disease ■ Bacteria are inhaled ■ Treated to prevent progression to active TB ■ Can not spread the disease ○ Active ■ TB infection with progression to disease ■ Can be spread to others ■ Typically forms in the lungs ■ Spread via respiratory droplets

What communicable disease is described below: ● Mycobacterium tuberculosis ● Airborne droplet ○ Carried by coughing, sneezing, talking ○ Cover your mouth ● Incubation → 4-12 weeks ● Leading cause of death worldwide among infectious disease ● BCG vaccine

What communicable disease is described below: ● Nursing Responsibilities ○ Protect the public and self ○ Negative pressure room ○ Protective gown, mask, gloves ○ Hand hygiene ○ Communication ○ Lab results ○ Monitor ○ Education

What communicable disease is described below: ● Screening test ○ T-spot ○ PPD - Mantoux (TST) ■ If allergic, do a chest XRAY then the confirmation test is sputum ○ Chest xray ○ AFB sputum culture ○ Pg. 490 "How To" box

What communicable disease is described below: ● Symptoms ○ Cough ○ Fever ○ Hemoptysis ○ Chest pain ○ Fatigue ○ Weight loss

What vector/animal borne disease is described below: ● (zoonoses) ○ Rabies ○ Hanta virus (deadly to humans) ○ Cat scratch fever - Kristen had this :) ○ Avian influenza ○ Monkeypox

animal

_____ disease has to have 3 factors of transmission (the epidemiological triangle). These include: ● Agent Factor: bacteria, fungi, parasites, and viruses ● Host Factor: human or animal ● Environment Factor: facilitate the transmission of the disease

communicable

What type of immunity for communicable disease is described below: potential of the host to transmit

infectiousness

What thought disorder is described below: ● Delusions that have lasted 1 MONTH OF LONGER ● Not severe enough to impair occupational or daily functioning

delusional disorder

What part of disease development of communicable diseases is described below: possible outcome; physiological or pathological

disease

____ ____ of communicable diseases includes: ● Infection: entry and development of the infectious agent ● Disease: possible outcome; physiological or pathological ● Incubation period: time from invasion to first signs and symptoms ● Communicable period: interval the infected host can transmit infection

disease development

What infectious disease is described below: ● Can you be re-infected? ○ Evidence of recovery from ● What are the symptoms (Here we go)? ○ Fever ○ Severe headache ○ Muscle pain ○ Weakness ○ Diarrhea ○ Vomiting ○ Abdominal pain ○ Unexplained hemorrhage- becoming more commonly seen

ebola

What infectious disease is described below: ● How is it treated? ○ No FDA approved vaccine or medicine ■ Vaccine for compassionate care; vaccine is out there, but has not been approved by FDA ○ Treat the signs and symptoms ■ Providing IV fluids and balancing electrolytes ■ Maintaining oxygen status and blood pressure due to dehydration ■ Treating other infections ● How do we protect from ______? ○ Use PPE ○ Wash hands and use sanitizer ○ Double glove ○ Wear protective water resistant gown and facemask with shield

ebola

What infectious disease is described below: ● Virus ● 5 known types → ⅘ is human contractible ● First discovered in 1976 ● Research ● How do you contract it? ○ Direct contact ■ Mucous membrane, cough sneeze, broken skin ○ Blood or body fluids ■ Saliva, sweat, urine, feces ○ Contaminated needles ○ Infected animals ○ No evidence that mosquitoes or other insects can transmit: ● How long does it last? ○ Once recovered, you can no longer spread the virus ■ BUT, stays in semen for up to 3 months ● Abstain from sex for at least 3 months ○ Need to have 2 negatives in a row until declared no longer infected ● Condoms ○ Can be killed with hospital-grade disinfectants ○ On dry surfaces for several hours ○ in body fluids (such as blood)

ebola

elimination or eradication? ● : to remove a disease from a geographic area

elimination

What part of disease development of communicable diseases is described below: ● time from invasion to first signs and symptoms

incubation period

What vector/animal borne disease is described below: Bubonic plague

fleas

_____ diseases include: ● Consumption of toxins (poisons) PRODUCED IN FOOD BY BACTERIA GROWTH ● 48 million illnesses annually examples: salmonella, C. botulnum, e. coli, listeria

foodborne

● Infections acquired during hospitalization or developed within the hospital setting ● Universal precautions

healthcare acquired infections (HAIs)

The following is the _____ of communicable disease: ● 1900 → Communicable disease = leading cause of death in US ● Greatly decreased due to ○ Clean water ○ Improved nutrition ○ Methods of food storage ○ Improved air ventilation ○ Improved sewage systems ○ Vaccines ○ Early detection of disease

history

The following is the _____ of communicable disease: ● Present ○ Infectious diseases still prevalent (ex: drug resistant strains of bacteria) ○ Emerging: has actually increased in the past two decades or has the potential to increase ■ Emerging in the 20th century (will cover later): ● West Nile virus ● Bioterrorism ● HIV ● Ebola ● Legionnaire's ○ Type of bacteria/pneumonia ○ Breathe in water droplets ○ There was a 217% increase from 2000 to 2009 ○ Complex water systems ○ 2-10 days after exposure ● Severe Acute Respiratory Syndrome (SARS) ○ Emerged in 2003

history

The following are the different types of _____ for communicable disease: ● Natural ________: species specific ● Acquired __________: passive/active ● Herd __________: high proportion of the population is immune ● Infectiousness: potential of the host to transmit ● Resistance: bish didn't put a definition- "ability to resist disease RT immune system/ vaccinations"

immunity

what vaccine preventable disease is described below: ● Complications: ○ Bacterial pneumonia ○ Ear infections ○ Sinus infections ○ Dehydration ○ Worsening of chronic medical conditions ○ Death

influenza (Flu)

what vaccine preventable disease is described below: ● Predictors: ○ What flu virus is spreading ○ How much vaccine is available ○ When the vaccine is available ○ How many people get vaccinated ○ How well the flu vaccine is matched to the flu viruses that are causing illness ■ Determines outbreak in the area ● Season: ○ Begins in September lasts until May ○ Everyone 6 months and older should get a flu vaccine

influenza (Flu)

what vaccine preventable disease is described below: ● Treatment: ○ Hydration and rest ○ Some may be prescribed antivirals ■ Oseltamivir (Tamiflu) ■ Zanamivir (Relenza) - inhaled ■ Prescribed 24-48 hours after symptoms begin ● Decreases S&S, doesn't get rid of flu ● Cost is an issue

influenza (Flu)

what vaccine preventable disease is described below: ● Viral; most common A, B, and C virus ○ Most common subtypes are A H1N1 and H3N2 ● Transmission: Airborne or droplet

influenza (Flu)

The following is an _____ to Unit 14: ● Worldwide concern about infectious diseases ○ Due to traveling, migrants ● People move and bring

introduction

what vaccine preventable disease is described below: ● Infection: ○ Mucus of nose and throat ○ Droplet transmission ■ Droplets can infect others for up to two hours ○ Can cause serious health complications ○ 1 to 2 per 1000 will die ● Treatment: ○ No treatment ○ Fever reducers ○ Antibiotics for secondary infections ● Prevention: ○ Vaccination: MMR live (attenuated) Born before 1957 is assumed immune

measles, mumps, rubella

What communicable disease is described below: ● Causes: ○ haemophilus influenza (type B, most often) ○ Streprococcus pnumoniae ○ Listeria ○ Nesisseria meningitidis: most concerning

meningitis (bacterial)

What communicable disease is described below: ● Causes: ○ haemophilus influenza (type B, most often) ○ Streprococcus pnumoniae ○ Listeria ○ Nesisseria meningitidis: most concerning ● Transmission → exchange of respiratory secretions ○ Saliva ○ Mucosa ○ Kissing, drinking after people ● Signs and Symptoms ○ Nausea ○ Vomiting ○ Increased sensitivity to light ○ Confusion ● Prevention → vaccination ○ Menactra- most common ○ Menveo ○ Menomune ○ Bexsero ● Severe cases → meningococcal septicemia (meningococcemia) ○ Cause → bloodstream infection of Neisseria meningitidis ○ Community health on high alert when cases appear; this is a rare occurrence but very serious ○ Very dangerous; can be fatal (death can occur in as little as a few hours); non-fatal cases leave permanent disabilities (mostly limb amputations) ○ Symptoms ■ Sudden onset ■ Same as with meningitis ■ Cold hands and feet ■ Cold chills ■ Severe pain in muscles and joints or abdomen ■ Rapid breathing ■ In later stages, dark purple rash

meningitis (bacterial)

What communicable disease is described below: ● Severe cases → meningococcal septicemia (meningococcemia) ○ Cause → bloodstream infection of Neisseria meningitidis ○ Community health on high alert when cases appear; this is a rare occurrence but very serious ○ Very dangerous; can be fatal (death can occur in as little as a few hours); non-fatal cases leave permanent disabilities (mostly limb amputations) ○ Symptoms ■ Sudden onset ■ Same as with meningitis ■ Cold hands and feet ■ Cold chills ■ Severe pain in muscles and joints or abdomen ■ Rapid breathing ■ In later stages, dark purple rash

meningitis (bacterial)

What communicable disease is described below: ● Transmission → exchange of respiratory secretions ○ Saliva ○ Mucosa ○ Kissing, drinking after people ● Signs and Symptoms ○ Nausea ○ Vomiting ○ Increased sensitivity to light ○ Confusion ● Prevention → vaccination ○ Menactra- most common ○ Menveo ○ Menomune ○ Bexsero

meningitis (bacterial)

What vector/animal borne disease is described below: → yellow fever, West Nile virus, Zika

mosquitoes

What type of immunity for communicable disease is described below: species specific

natural immunity

● Initiatives and Preventions ○ Screening patients before being admitted to the hospital for surgical procedures ○ Once diagnosed with a particular contagious infection, chart should be flagged for future admissions ○ Medicare has enacted guidelines regarding contraction of such infections ○ Re-education of all health-care staff ■ Hand hygiene

nosocomial infections

What vector/animal borne disease is described below: ● either intestinal parasitic infections or parasitic opportunistic infections ○ Pinworms ○ Trichomonas ○ Toxoplasmosis

parasites

what vaccine preventable disease is described below: ● Respiratory infection ● Treatment ○ Prevention → vaccine ○ Antimicrobials ("thro" like throat, you cough from your throat) ■ Azithromycin ■ Clarithromycin ■ Erythromycin ○ In the worst cases and in cases of young children, hospitalization is necessary

pertussis (whooping cough)

- compulsive drinking of excess fluids → causes hyponatremia **comorbidty of schizophrenia

polydipsia

The nurses role in ______ or control of infectious disease includes: ● 3 levels of _________ ○ Primary → reduce the incidence ○ Secondary → prevent the spread Tertiary → reduce complications

prevention

What thought disorder is described below: ● Altered cognition ● Altered perception ● Impaired ability to determine what is or is not real ● A break/ "split" with reality

psychosis

What foodborne disease is described below: ■ Infection: ● (salmonellosis) Bacterial infection ○ "Sneaky germ" ● Develop diarrhea and abdominal cramps ■ Treatment: ● Fluid replacement ● Antidiarrheals ● Antibiotics (if blood stream infection) ■ Sources of infection: ● Raw meat ● Chicken ● Eggs ● Fruits and vegetables

salmonella

What foodborne disease is described below: ■ Sources of infection: ● Raw meat ● Chicken ● Eggs ● Fruits and vegetables

salmonella

schizophrenia

What thought disorder is described below: Comorbidity (193) ● Physical illnesses - risk of premature death - 3.5 times greater than general population ● Polydipsia - compulsive drinking of excess fluids → causes hyponatremia

schizophrenia

What thought disorder is described below: Comorbidity (193) ● Substance use - particularly alcohol and marijuana; about 60% use nicotine ● Anxiety, depression, suicide - 20% attempt suicide; 5-10% die by suicide → 5 TIMES THAT OF GENERAL POPULATION ● Physical illnesses - risk of premature death - 3.5 times greater than general population ● Polydipsia - compulsive drinking of excess fluids → causes hyponatremia

schizophrenia

What thought disorder is described below: Symptoms - from DSM-5 (193) A. Characteristic symptoms - 2 or more present for significant portion of time during 1 month period (or less if successfully treated). At least 1 must be 1, 2, or 3 1 delusions 2 hallucinations 3 disorganized speech 4 grossly disorganized or catatonic behavior 5 negative symptoms B. Dysfunction in work, interpersonal relations, or self-care C. Duration - continuous for 6 months; this includes 1 month of symptoms that meet criterion A D. Not schizoaffective D/O or depressive or bipolar D/O with psychotic features E. Substance / general medical condition ruled out F. Autism/ other childhood diagnosis—can have schizophrenia if meet criteria a. Relationship to developmental disorder

schizophrenia

What thought disorder is described below: Symptoms - from DSM-5 (193) B. Dysfunction in work, interpersonal relations, or self-care C. Duration - continuous for 6 MONTHS; THIS INCLUDES 1 MONTH OF SYMPTOMS THAT MEET CRITERION A D. Not schizoaffective D/O or depressive or bipolar D/O with psychotic features

schizophrenia

What thought disorder is described below: Symptoms - from DSM-5 (193) D. Not schizoaffective D/O or depressive or bipolar D/O with psychotic features E. Substance / general medical condition ruled out F. Autism/ other childhood diagnosis—can have schizophrenia if meet criteria a. Relationship to developmental disorder

schizophrenia

What thought disorder is described below: ● (Not split personality - more accurate is disconnected mind; lack of coherence in mental functioning) ● Usually presents between ages 15-25 in males; 25-35 in women ● All diagnosed have at least 1 psychotic symptom: hallucinations, delusions, and/or disorganized speech or thought ● (Stigma still an issue) ● Most expensive of all chronic illnesses - lifelong intervention needs; expensive inpatient treatment ● Strikes just as approaching earning years ● Chronic—needs expensive inpatient stays)

schizophrenia

What thought disorder is described below: ● (Stigma still an issue) ● Most expensive of all chronic illnesses - lifelong intervention needs; expensive inpatient treatment ● Strikes just as approaching earning years ● Chronic—needs expensive inpatient stays)

schizophrenia

What thought disorder is described below: ● Rule out if psychosis is caused by: ○ Drugs ○ Alcohol ○ Medication ○ Toxin exposure ○ Delirium ○ Neurological problem ○ Other disease processes

substance induce psychotic disorder/ psychotic disorder due to another medical condition

The following is the different ways of ______ of communicable diseases: ● Vertical ________ (parent to child) ● Horizontal ________ (person to person) ● Common vehicle (the transportation of the infectious agent to a susceptible host) ● Vectors (mosquitoes, ticks)

transmission

The following are _____ preventable diseases: ● 11 Routine Childhood Immunization Schedule ○ Measles (viral) ○ Rubella (viral) ○ Pertussis (bacterial) ○ Diphtheria (bacterial) ○ Influenza (viral) ○ Polio (viral) ○ Meningitis (viral form and bacterial form) christmas af ○ Hepatitis B ○ Mumps ○ Varicella (chicken pox) ○ Streptococcus pneumonia

vaccine

_____/______ ______ diseases occur when: (refers to illness for which the infectious agent is transmitted by a carrier (vector) ● Ticks → Rocky (Horror Picture Show) Mountain Spotted Fever ○ Lymes ■ Spread via tick bite ● Improper removal of tick - head is left ■ Symptoms (70-80% of infected persons): ● Fever ● Chills ● Fatigue ● muscle/joint ache ● Swollen lymph nodes ● Bullseye rash ■ Treatments ● Doxycycline ● Amoxicillin ● Mosquitoes → yellow fever, West Nile virus, Zika ● Fleas → Bubonic plague ● Animal (zoonoses) ○ Rabies ○ Hanta virus (deadly to humans) ○ Cat scratch fever - Kristen had this :) ○ Avian influenza ○ Monkeypox ● Parasites → either intestinal parasitic infections or parasitic opportunistic infections ○ Pinworms ○ Trichomonas ○ Toxoplasmosis

vector/animal borne

_____/______ ______ diseases occur when: ● Animal (zoonoses) ○ Rabies ○ Hanta virus (deadly to humans) ○ Cat scratch fever - Kristen had this :) ○ Avian influenza ○ Monkeypox ● Parasites → either intestinal parasitic infections or parasitic opportunistic infections ○ Pinworms ○ Trichomonas ○ Toxoplasmosis

vector/animal borne

_______ disease outbreaks occur when: ● Protozoans ○ Entamoeba histolytica (amoebic dysentery) ○ Giardia (US citizens have no immunity when travelling ○ I tried - insert bday meme here * ● Water purification systems ○ Protozoans do not respond to chlorine treatments ○ Boiling of water: prevention measure

waterborne

_______ disease outbreaks occur when: ● Usually enter water supplies through fecal contamination ● Viruses ○ Hepatitis A ● Bacteria ○ Cholera ○ Typhoid ○ Bacillary dysentery ○ Shigella ○ Vibrio- flesh eating bacteria ○ Campylobacter ● Protozoans ○ Entamoeba histolytica (amoebic dysentery) ○ Giardia (US citizens have no immunity when travelling ○ I tried - insert bday meme here * ● Water purification systems ○ Protozoans do not respond to chlorine treatments ○ Boiling of water: prevention measure

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