exam 3 (ch 15, 16, 22, 23, 29, 31, 35, 36)

Question 1

personality (31)

Answer 1

the totality of emotional and behavioral characteristics that are particular to a specific person and that remain somewhat stable and predictable over time

Question 2

when does personality become a personality disorder? (31)

Answer 2

when these traits become rigid and inflexible and contribute to maladaptive patterns of behavior or impairment in functioning

Question 3

types of personality disorders (31)

Answer 3

10 types of personality disorders are identified in the DSM-5.

classified into 3 clusters:
Cluster A: behaviors described as odd or eccentric
Cluster B: behaviors described as dramatic, emotional, or erratic
Cluster C: behaviors described as anxious or fearful

Question 4

cluster A: paranoid personality disorder (31)

Answer 4

• characterized by a pervasive, persistent, and inappropriate mistrust of others
• suspicious of others’ motives and assume that others intend to exploit, harm, or deceive them
• more common in men
• predisposing factors include being subjected to early parental antagonism and harassment
• clinical picture: on guard, tense, irritable, trust no one, tests honesty of others, insensitive to others feeling, oversensitive, magnifies and distorts cues in the environment, does not accept responsibility for his or her own behavior

Question 5

cluster A: schizoid personality disorder (31)

Answer 5

• characterized primarily by a profound defect in the ability to form personal relationships
• failure to respond to others in a meaningful way
• more common in men
• predisposing factor: childhood characterized as bleak, cold, unempathetic, notably lacking in nurturing
• clinical picture: aloof and indifferent to others, emotionally cold, no close friends, appears shy, anxious, or uneasy in the presence of others, inappropriately serious about everything, and displays a lifelong pattern of social withdrawal and discomfort with human interaction

Question 6

cluster A: schizotypal personality disorder (31)

Answer 6

• behavior is odd and eccentric but does not decompensate to the level of schizophrenia; a graver form of the pathologically less severe schizoid personality pattern
• predisposing factors: possible physiological influence, such as anatomic deficits or neurochemical dysfunctions within certain areas of the brain
• early family dynamics characterized: indifference, impassivity, formality, leading to a pattern of discomfort with personal affection and closeness
• clinical picture: behave in a bland and apathetic manner, magical thinking, ideas of reference, illusions, superstitious, belief in clairvoyance, telepathy, and sixth-sense
• exhibits bizarre speech pattern, when under stress may decompensate and demonstrate psychotic symptoms

Question 7

cluster B: antisocial personality disorder (31)

Answer 7

• characterized by a pattern of socially irresponsible, exploitative, and guiltless behavior that reflects a general disregard for the rights of others
• most frequently seen in jails, prisons, and rehabilitation services, usually seen to avoid legal consequences
• clinical picture: fails to sustain consistent employment, unable to delay gratification, fails to conform to the law and societal norms, exploits and manipulates others for personal gain, belligerent and argumentative, lacks remorse, blames others, low frustration tolerance
• predisposing factors: parent with ASPD or alcoholism, having a disruptive behavior disorder as a child, history of severe physical abuse and neglect, unstable, violent, or chaotic childhood
• patient problems: risk for other-directed violence; defensive coping; impaired social interaction
• do not try to convince the pt to do the “right thing” or use the words “you should” or “you shouldn’t”. instead say “you will be expected to…”

Question 8

psychopathy (31)

Answer 8

personality traits that include low fear, low empathy, domination, callous cruelty, and emotional insensitivity

DSM-5 continues to identify antisocial personality disorder as synonymous with psychopathy, but evidence is beginning to distinguish the difference

Question 9

cluster B: borderline personality disorder (31)

Answer 9

• characterized by a pattern of intense and chaotic relationships with affective instability
• designated as “borderline” because of the tendency of these clients to fall on the border between neuroses and psychoses
• fluctuating and extreme attitudes regarding other people
• highly impulsive, fear of abandonment, more common in women
• clinical picture: emotionally unstable, directly and indirectly self-destructive, lacks a clear sense of identity, unstable self-image, uses splitting manipulation and clinging/distancing behaviors, chronic depression
• predisposing factors: childhood trauma and abuse/parental loss
• problems: risk for self-mutilation, risk for suicide, disturbed personal identity, anxiety, low self-esteem

Question 10

cluster B: histrionic personality disorder (31)

Answer 10

• characterized by colorful, dramatic, and extroverted behavior in excitable, emotional people
• maintaining long-lasting relationships is difficult, engages in seductive, flirtatious behavior
• more common in women
• predisposing factors: learned behavior patterns, possible hereditary factor, biogenetically determined temperament
• clinical picture: tend to be self-dramatizing, attention-seeking, overly gregarious, and seductive; use manipulative and exhibitionistic behaviors in their demands to be the center of attention; require constant affirmation, approval, and acceptance from others; highly distractable and flighty by nature; provocative or sexually inappropriate interactions with others

Question 11

cluster B: narcissistic personality disorder (31)

Answer 11

• characterized by an exaggerated sense of self-worth, lack of empathy, belief in an inalienable right to receive special consideration
• more common in men
• predisposing factors: as children, fears, failures, or dependency needs were responded to with criticism, disdain, or neglect; parents are narcissistic; parents overindulged child and did not set limits
• clinical picture: overly self-centered; lack of humility; exploits others in an effort to fulfill own desires; mood, which is often grounded in grandiosity, is usually optimistic, relaxed, cheerful, and care-free; because of fragile self-esteem, mood can easily change if clients do not meet self-expectations or receive positive feedback that they expect

Question 12

cluster C: avoidant personality disorder (31)

Answer 12

• characterized by extreme sensitivity to rejection and social withdrawal
• predisposing factors: no clear cause is known; primary psychosocial influence is parental rejection and censure, which are often reinforced by peers
• clinical picture: awkward and uncomfortable in social situations; desire close relationships but avoid them because of fear of being rejected; perceived as timid, withdrawn, or cold and strange; often lonely and feel unwanted; pattern of relying on others for emotional support; depression and anxiety are common

Question 13

cluster C: dependent personality disorder (31)

Answer 13

• characterized by a lack of self-confidence and extreme reliance on others to take responsibility for them
• predisposing factors: possible hereditary influence; stimulation and nurturance are experienced exclusively from one source; a singular attachment is made by the infant to the exclusion of all others
• clinical picture: lets others make important decisions; intense discomfort being alone even for short periods of time; have a notable lack of self-confidence apparent in posture, voice and mannerisms; overly generous and thoughtful, while underplaying own attractiveness and achievements; avoid positions of responsibility

Question 14

cluster C: obsessive-compulsive personality disorder (31)

Answer 14

• characterized by inflexibility about the way in which things must be done
• devotion to productivity at the exclusion of personal pleasure
• relatively common, occurs more in men than in women
• most common in oldest children
• predisposing factors: overcontrol by parents; notable parental lack of positive reinforcement for acceptable behavior; frequent punishment for undesirable behavior
• clinical picture: especially concerned with matters of organization and efficiency; tend to be rigid and unbending; socially polite and formal; seek approval from authority; on the surface appear to be very calm and controlled but on the inside filled with ambivalence, conflict, and hostility

Question 15

treatment modalities for personality disorders (31)

Answer 15

interpersonal psychotherapy, milieu or group therapy, cognitive/behavioral therapy, dialectical behavior therapy, psychopharmacology

Question 16

primary prevention (35)

Answer 16

interventions designed to prevent the onset or future incidence of a specific problem; targets both individuals and the environment and its emphasis is 1) assisting individuals to increase their ability to cope effectively with stress and 2) targeting and diminishing harmful forces (stressors) within the environment

ex: stress reduction seminars

Question 17

secondary prevention (35)

Answer 17

an early intervention that decreases the prevalence of a specific problem; accomplished through early identification of problems and prompt initiation of effective treatment; nursing focuses on recognition of symptoms and provision of, or referral for, treatment

Question 18

tertiary prevention (35)

Answer 18

treatment designed to improve quality of life and reduce the symptoms after a disease or disorder has developed; does not reduce incidence or prevalence; accomplished in two ways: preventing complications of the illness and promoting rehabilitation directed toward achievement of each individual’s maximum level of functioning

Question 19

treatment alternatives (35)

Answer 19

program of assertive community treatment (PACT): follows people with severe mental illnesses

Question 20

types of mental illness among the homeless (35)

Answer 20

schizophrenia is most common, bipolar disorder, substance addiction, depression, personality disorders, neurocognitive disorders

Question 21

contributing factors to homelessness among the mentally ill (35)

Answer 21

deinstitutionalization, poverty, a scarcity of affordable housing, lack of affordable health care, domestic violence, addiction disorders

Question 22

interfering factor (35)

Answer 22

frequent relocation, health issues, alcoholism is common, thermoregulation, tuberculosis, dietary deficiencies, sexually transmitted diseases, special health needs of homeless children

Question 23

anger (15)

Answer 23

it is not a primary emotion; it is learned; it is physiological arousal; anger and aggression are significantly different; anger expression is learned.

Question 24

aggression (15)

Answer 24

one way that individuals express anger; a behavior that is intended to threaten or injure the victim’s security of self-esteem; can cause damage with words, fists, or weapons, but it is virtually always designed to punish

Question 25

predisposing factors to anger and aggression (15)

Answer 25

modeling: can be positive or negative, earliest role models are the primary caregivers, television and video violence can also lead to later aggressive behavior

operant conditioning: occurs when a specific behavior is positively or negatively reinforced

neurophysiological disorders: severe brain disorders and conditions have been implicated in episodic aggression and violent behavior (loss of function in the cortex, brain tumors, brain trauma, encephalitis)

Question 26

nursing process assessing for anger (15)

Answer 26

assessment: be aware of the risk factors and symptoms associated with anger and aggression in order to make an accurate assessment; the best intervention is prevention

identifiers: frowning, clenched fists, low-pitched words forced through clenched teeth, yelling and shouting, intense or no eye contact, hypersensitivity, easily offended, defensive, passive-aggressive, lack of control or overcontrolled emotions, flushed face

Question 27

the nursing process assessing for aggression (15)

Answer 27

identifiers: pacing, restlessness, tense face and body, verbal or physical threats, threats of homicide or suicide, loud voice, shouting, cussing, argumentative, increased agitation, overreaction to environmental stimuli, panic anxiety leading to misinterpretation of the environment, disturbed thought processes, destruction of property, acts of physical harm towards others

Question 28

the nursing process assessing risk factors (15)

Answer 28

three factors in identifying extent of risks
1. past history of violence
2. client diagnosis: including schizophrenia, major depression, bipolar disorder, and substance use disorders
3. current behavior
- prodromal syndrome

Question 29

prodromal syndrome (15)

Answer 29

characterized by anxiety and tension, verbal abuse and profanity, and increasing hyperactivity

behaviors associated: rigid posture, clenched fists and jaws, grim, defiant affect; talking in a rapid raised voice; arguing and demanding; cussing and threatening verbalizations; agitation and pacing; pounding and slamming

Question 30

somatic symptom disorders in general (29)

Answer 30

characterized by physical symptoms suggesting medical disease but without demonstrable organic pathology

Question 31

somatic symptom disorders: predisposing factors (29)

Answer 31

genetic: possible hereditary

biochemical: decreased levels of serotonin and endorphins may play a role

neuroanatomical: brain dysfunction has been implicated

family dynamics: in dysfunctional families, a child’s sickness shifts the focus from open conflict to the child. somatization brings some stability to the family and positive reinforcement to the child (called tertiary gain)

learning theory: somatic complaints are often reinforced when the sick person learns that they can 1) avoid stressful obligations (primary gain), 2) may become the prominent focus of attention (secondary gain), or 3) may relieve conflict within the family as concern is shifted to the ill person and away from the real issue (tertiary gain)

Question 32

somatic symptom disorder (29)

Answer 32

a syndrome of multiple somatic symptoms that cannot be explained medically and are associated with psychosocial distress and frequent visits to health care professionals to seek assistance; chronic disorder with symptoms beginning before age 30; anxiety, depression, drug abuse/dependence, and suicide attempts are common complications; personality characteristics: heightened emotionally, strong dependency needs, and a preoccupation with symptoms and oneself

Question 33

illness anxiety disorder (29)

Answer 33

unrealistic or inaccurate interpretation of physical symptoms or sensations, leading to a preoccupation with and fear of having a serious disease; extremely conscious of bodily sensations and changes; some have history of doctor shopping while others avoid medical assistance; anxiety and depression are common, and ocd traits frequently accompany the disorder

Question 34

conversion disorder (29)

Answer 34

a loss of or change in body motor or sensory function that cannot be explained by any known medical disorder or pathophysiological mechanism; conversion symptoms affect voluntary motor or sensory functioning suggestive of neurological disease; some instances of conversion disorder may be precipitated by psychological stress

Question 35

factitious disorder (29)

Answer 35

conscious, intentional feigning of physical and/or psychological symptoms; individual pretends to be ill to receive emotional care and support

may also be identified as munchausen syndrome

may be imposed on another person under the care of the perpetrator (formerly called munchausen syndrome by proxy)

Question 36

interventions for somatic system disorders

Answer 36

nursing care of the individual with a somatic symptom disorder aimed at relief of discomfort from the physical symptoms

assistance is provided to the client in an effort to determine strategies for coping with stress by means other than preoccupation with physical symptoms

Question 37

medical treatment modalities for somatic symptom disorders

Answer 37

individual psychotherapy, group psychotherapy, cognitive behavior therapy (CBT) and psychoeducation, psychopharmacology

Question 38

dissociative disorders (29)

Answer 38

defined by a disruption in the usually integrated functions of consciousness, memory, and identity, perception, behavior, emotion, body representation, and motor control

dissociative responses occur when anxiety becomes overwhelming, and the personality becomes disorganized

Question 39

dissociative amnesia (29)

Answer 39

defined as an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness, and which is not due to the direct effects of substance use or a neurological or other medical condition; onset usually follows severe psychosocial stress

localized amnesia: unable to recall all incidents associated with a stressful period

selective amnesia: can only recall certain incidents associated with a stressful event for a specific period after the event

generalized: amnesia for his or her identity and total life history

Question 40

dissociative identity disorder (29)

Answer 40

(DID) formerly called multiple personality disorder; characterized by the existence of two or more personality states in a single individual; transition from one personality state to another may be sudden or gradual and is sometimes quite dramatic

Question 41

depersonalization-derealization disorder (29)

Answer 41

characterized by a temporary change in the quality of self-awareness, which often takes the form of feelings of unreality, changes in body image, feelings of detachment from the environment, and a sense of observing oneself from outside the body

depersonalization- a disturbance in the perception of oneself

derealization- an alteration in the perception of the external environment

Question 42

suicide (16)

Answer 42

the second leading cause of death among americans ages 10-34

Question 43

risk factors for suicide (16)

Answer 43

women attempt suicide more often, but men succeed more; women tend to overdose while men tend to use more lethal methods such as firearms

risk of suicide increases with age, particularly among men

affiliation with religion decreases risk of suicide

whites are the highest risk for suicide, then american indian and alaska natives

Question 44

substance related disorders are divided into two groups (23)

Answer 44

1. substance-use disorders (addiction, long term independence)
2. substance-induced disorders (intoxication, withdrawal, delirium, such as never drank before, drank a 6 pack, and now youre drunk)

Question 45

substance addiction (23)

Answer 45

physical dependence (tolerance and withdrawal) with a psychological dependence (risky use, unable to control behavior), overwhelming desire to repeat the use of a particular drug to produce pleasure or avoid discomfort

Question 46

substance use disorder (23)

Answer 46

use of the substance interferes with ability to fulfill role obligations, attempts to cut down or control use fail; tolerance and withdrawal alone do not qualify a use disorder–> need 2 psychological symptoms as well

Question 47

substance induced disorders (23)

Answer 47

no one set of symptoms; it depends on the substance involved. whatever the symptoms of intoxication of a certain substance are, the withdrawal will be the opposite

Question 48

caffeine (23)

Answer 48

there is no use disorder with caffeine, only substance induced

Question 49

alcohol use disorder (23)

Answer 49

more than half of all homicide, suicide, and traffic accidents involve alcohol

phase 1: prealcoholic phase - used to relieve everyday stress and tensions of life
phase 2: early alcoholic phase- begins with blackouts, periods of amnesia occur, alcohol is now required
phase 3: the crucial phase - lost control
phase 4: the chronic phase - intoxicated more than sober

Question 50

wernicke’s encephalopathy (23)

Answer 50

most serious form of thiamine (vitamin B1) deficiency in alcohol patients

ataxia and ocular abnormalities “wet brain”, need thiamine or death will ensue

Question 51

fetal alcohol syndrome (23)

Answer 51

(FAS) problems with learning, memory, attention span, communication, vision, and hearing; abnormal facial features (small eye opening, small head, short nose, low nasal bridge, thin upper lip), short stature, underweight

Question 52

alcohol intoxication (23)

Answer 52

occurs at blood alcohol levels between 100 and 200 mg/dL (TN legal limit .08%)

Question 53

alcohol withdrawal (23)

Answer 53

can occur within 4-6 hours of not drinking or reduction after prolonged alcohol use; delirium tremens usually start 2-5 days after the last drink and can be fatal (hallucinations, tremors, seizures)

treat withdrawal with long-acting benzodiazepines during DETOX

Question 54

sedative/hypnotic/anxiolytic disorder (23)

Answer 54

use of CNS depressants: barbiturates, non-barbiturate hypnotics, antianxiety agents, “club drugs”

effects on sleep and dreaming, respiratory depression, cardiovascular effects, renal function, hepatic effects, body temp, sexual functioning, pupil constriction

slow taper from CNS depressants, severe withdrawal from CNS depressants can be life threatening

Question 55

stimulant use disorder (23)

Answer 55

psychomotor agitation- amphetamines, synthetic stimulants, cocaine, caffeine, nicotine

high abuse potential

Question 56

stimulant induced disorders (23)

Answer 56

intoxication: amphetamine and cocaine (euphoria, dilated pupils, impaired judgement, confusion, changes in VS); caffeine (excess of 250 mg, restlessness, insomnia)

withdrawal: amphetamine and cocaine (dysphoria, fatigue, sleep disturbances, increased appetite); caffeine (h/a, fatigue, irritability, n/v); nicotine (dysphoria, anxiety, difficulty concentrating, irritability, increased appetite)