Exam 6 Psychiatric Mental Health NP Flashcards
What nursing skill did the Technology Informatics Guiding Education Reform (TIGER) initiative seek to improve?
Computer and information literacy
The Technology Informatics Guiding Education Reform (TIGER) initiative developed
a 10-year plan for nursing’s path toward computer and information literacy. It involved more than 1,100 nursing content experts, and it took three years to complete. This initiative successfully defined the basic technology competencies and required curriculum for nurse practitioner education.
The TIGER initiative declared that it is a nurse practitioner’s responsibility to
understand and shape the landscape of health care technology in order to improve access, quality, and the patient experience.
Core symptoms of major depressive disorders in children are
irritability, somatic complaints, and social withdrawal.
Less common symptoms of major depressive disorders in children include
psychosis, motor retardation, hypersomnia, and increased appetite
To assess a patient’s potential to harm others in addition to themselves, nurse practitioners should ask the following questions:
Are there others who you think may be responsible for what you are experiencing?
Are you having thoughts of harming others? Who?
Are there other people you want to die with you?
Are there others who you think would be unable to go on without you?
For patients who present with thoughts about wanting to harm themselves, nurse practitioners could consider asking:
How close have you come to acting on those thoughts?
How likely do you think it is that you will act on them in the future?
What do you envision happening if you actually killed yourself?
Have you made a specific plan to harm yourself?
Are guns or other weapons available to you?
Have you made particular preparations for your death?
When clients are involuntarily admitted to an inpatient psychiatric facility,
they are admitted against their will, they are unable to come and go as they please, and the amount of time they can be kept against their wishes varies by state. These are examples of civil liberties that are withdrawn during the involuntary admission process.
If a client is voluntarily admitted to an inpatient psychiatric facility, they desire and agree to treatment and confinement within the structure of a hospital setting. The client maintains
all civil liberties, and they are able to leave as they please as long as they are not a danger to themselves or others or gravely disabled.
Clients are able to make phone calls, have visitors, and refuse medication. These civil liberties are maintained
even when admitted to an inpatient psychiatric unit involuntarily.
Prozac (fluoxetine) is an SSRI antidepressant and can produce a false positive for
methamphetamine.
Zoloft (sertraline) can produce a false positive for
benzodiazepines
Motrin can produce a false positive for
cocaine
Poppy seeds can produce a false positive
for heroin or morphine
Pharmacokinetics refers to
what the body does to a drug when it’s ingested.
Pharmacodynamics is the term that describes
what a drug does to the body when ingested and paired with the individual’s pharmacodynamic gene profile.
Norepinephrine:
alertness, focused attention, learning, and memory
Dopamine
_thinking, fine muscle action, and reward-seeking behavior
GABA_
reduces arousal, aggression, and anxiety
Serotonin
regulates sleep, pain, mood states, and temperature
Nurse practitioner core competencies include the following:
Scientific foundations Leadership Quality Practice inquiry Technology and information literacy Policy Health delivery systems Ethics Independent practice
What court case determined that the presence of a mental illness alone cannot justify involuntary hospitalization?
O’Connor vs. Donaldson
The 1976 case O’Connor vs. Donaldson ruled that
harmless mentally ill patients cannot be confined against their will if they can survive outside. This case determined that the presence of a mental illness alone cannot justify involuntary hospitalization.
In 1979, Rennie vs. Klein determined that
patients have the right to refuse any treatment and use an appeal process.
In 1981, Roger vs. Oken determined that
patients have an absolute right to refuse treatment but that a guardian may authorize their treatment.
Durham vs. United States
determined that an individual is not criminally responsible if the unlawful act was the product of mental illness. This case is known for originating the insanity defense.
Patients with obsessive-compulsive personality disorder are
perfectionistic and rigid. They are often workaholics who are indecisive, excessively scrupulous, and preoccupied with detail.
Patients with paranoid personality disorder are
suspicious, have few friends, and read hidden meaning into innocent remarks
Patients with narcissistic personality disorder
act self-important. They are preoccupied with envy, fantasies of success, and ruminations about the uniqueness of their own problems. They reject criticism and need constant admiration from others.
A nurse practitioner has the duty to protect identified victims from imminent danger. When a patient threatens to harm someone, your course of action should follow these steps:
Contact the party at risk
Notify the police
Take appropriate action to protect the party at risk
There are three phases of a therapeutic relationship between a nurse practitioner and his or her patient:
Introduction
Working
Termination
During the introduction phase, the following actions usually take place:
Creating a trusting environment
Establishing professional boundaries
Establishing the length of anticipated interaction
Providing diagnostic evaluation
Setting mutually agreed-upon treatment objectives
Mind-body interventions under the umbrella of complementary and alternative therapies (CATS) include the following:
Guided imagery
Meditation
Yoga
Biofeedback
Massage therapy and acupressure are
manipulative body-based therapies.
Vitamins and supplements are a
biological-based therapy.
From a systems perspective, the goal is to optimize rather than maximize what?
the goal is to optimize the quality recommendations from the Institute of Medicine (safe, effective, patient-centered, timely, efficient, and equitable) rather than maximize them.
From a systems perspective, the goal is to optimize rather than maximize the performance of each of its components in order to bolster the system’s overall production.
When involuntarily admitted to an inpatient psychiatric facility,
the client is not able to come and go as they please, which is a civil liberty.
Preventative factors are factors that protect a person from
developing a psychiatric condition.
Preventative factors fall into three categories:
biological, psychological, and social.
Biological preventative factors:
Without a history of mental illness in the family
Healthy nutritional status
Good general health
Psychological preventative factors:
Good self-esteem
Good self-concept
Internal locus of control
Healthy ego defenses
Social preventative factors:
Low-stress occupation
Higher socioeconomic status
Higher level of education
Both serotonin and norepinephrine are removed from the synaptic cleft and returned to storage
via an active reuptake process.
Dopamine, on the other hand, is removed from the synaptic cleft by
monoamine oxidase enzymatic action.
The Institutional Review Board
protects the rights and welfare of human research participants. They have the authority to approve, require modifications, or disapprove of any research activities.
The Institutional Review Board ensures that
Risks to participants are minimized
Participant selection is equitable
Adverse events are reported
Risks and benefits are evaluated
Informed consent is obtained and documented
Data safety monitoring plans are implemented when indicated
In a medical malpractice suit, the plaintiff must establish all of the following
The nurse practitioner owed the plaintiff a duty
The nurse practitioner’s conduct fell below the standard of care
The nurse practitioner’s conduct caused the plaintiff injury
Proof beyond reasonable doubt applies to
criminal cases.
Medical malpractice suits are
civil cases.
To establish a medical malpractice suit, the plaintiff must establish that a
dereliction of duty directly caused damage (also known as the four Ds of medical malpractice).
The burden of proof in medical malpractice suits is by
a preponderance of evidence (greater than 50%).
Specifiers used to describe mood disorders include the following:
With atypical features:
These patients eat a lot and gain weight, sleep excessively, and have a feeling of being sluggish or paralyzed. They are also sensitive to rejection.
With melancholic features:
These patients feel worse in the morning than in the afternoon, and they experience decreased appetite, weight loss, and agitation. They also tend to feel excessively guilty and have trouble making decisions.
With anxious distress:
These patients have high levels of tension, restlessness, worry, and fear.
With catatonic features:
These patients exhibit either motor hyperactivity or inactivity.
With mixed features:
These patients are experiencing a mixture of both manic and depressive symptoms.
With peripartum onset:
These patients develop a mood episode during pregnancy or within a month of having their baby.
With psychotic features:
These patients develop delusions or hallucinations along with their mood symptoms.
With rapid cycling:
These patients have experienced at least four mood episodes in the past year.
With seasonal pattern:
These patients regularly become ill at a certain time of the year.
Patients with obsessive-compulsive personality disorder are
perfectionistic and rigid. They are often workaholics who are indecisive, excessively scrupulous, and preoccupied with detail.
Patients with paranoid personality disorder are
suspicious, have few friends, and read hidden meaning into innocent remarks.
Patients with narcissistic personality disorder act self-important. They are preoccupied with
envy, fantasies of success, and ruminations about the uniqueness of their own problems. They reject criticism and need constant admiration from others.
Patients with dependent personality disorder
fear abandonment, feel helpless when they are alone, and are miserable when relationships end. They desperately desire the approval of others, and they often volunteer for unpleasant tasks to gain the favor of others.
An atypical presentation is characterized by the following:
Mood reactivity Weight gain Increased appetite Hypersomnia Leaden paralysis Long-standing pattern of interpersonal rejection sensitivity
Anhedonia is
the inability to feel pleasure, and it occurs in both typical and atypical presentations of major depressive disorder.
Vietnamese describe panic attacks
“Hit by the wind”
Latin Americans:
Attack of the nerves”
C
“Cambodians
“Soul loss”
What term most accurately describes a group of members of Congress or a political party created to support a defined political ideology?
caucus. A caucus is a group of members of Congress or a political party created to support a defined political ideology
Common herbals with psychoactive effects used to treat insomnia:
Valerian
Catnip
Chamomile, which also helps with anxiety
Ginkgo,
which helps with delirium, dementia, and sexual dysfunction
Black cohosh,
which is used to treat menopausal symptoms, premenstrual syndrome, and dysmenorrhea
Belladonna,
which is used to treat anxiety
Ginseng,
which helps with depression and fatigue
Most psychotropic medications are hepatic
cytochrome P450 inhibitors. Furthermore, most psychotropic medications are both lipophilic and highly protein-bound
Because many older adults have more body fat and less protein,It takes approximately five half-lives to completely eliminate most psychotropics from the body.
they are at increased risk for toxicity.
It takes approximately______________________ to completely eliminate most psychotropics from the body.
five half-lives
Bulimia does not usually affect
thyroid function;
laboratory findings in patients with bulimia might include the following:
Hypokalemia
Hypochloremia
High serum amylase
Hypomagnesemia
Preventative factors are those that They fall into three categories: biological, psychological, and social.
protect a person from developing a psychiatric condition.
Preventative factors fall into three categories:
biological, psychological, and social.
Biological preventative factors:
Without a history of mental illness in the family
Healthy nutritional status
Good general health
Psychological preventative factors:
Good self-esteem
Good self-concept
Internal locus of control
Healthy ego defenses
Social preventative factors:
Low-stress occupation
Higher socioeconomic status
Higher level of education
According to Freud, during what psychosexual stage of development are sexual concerns largely unimportant?
Latency stage. The latency stage is characterized by a time in which sexual concerns are largely unimportant. During this phase, children establish decisive patterns of adaptive functioning. They develop a sense of industry and a capacity for mastery of objects. This is the phase in which children develop a foundation for mature adult life satisfaction.
Freud’s stages of psychosexual development:
birth to 12-18 monthsAnal 12-18 months to 3 yearsPhallic_ 3 to 5-6 yearsLatency_ 5-6 years to adolescenceGenital_ adolescence to adulthood
According to Erik Erikson, during which psychosocial stage would you expect a person to develop a sense of unity in life’s accomplishments?
Ego Integrity vs. Despair.
Ego Integrity vs. Despair is the final stage of psychosocial development. Successful resolution of this stage is characterized by a sense of unity in life’s accomplishments. Failure to resolve this stage leads to regret over lost opportunities of life.
What is the most commonly used clinician-administered anxiety rating scale?
The Hamilton Anxiety Scale (HAM-A) is the most commonly used clinician-administered anxiety rating scale. It is best used in the evaluation of anxiety severity and tracking the efficacy of anxiety treatments over time.
The HAM-A is based on various domains of anxiety including
anxious mood, fears, sleep disturbance, somatic complaints, tension, and observed behavior.
The severity of each domain in HAM A is ranked from
0 (not present) to 4 (severe).
HAM A scoring
Score of 14-17: Mild anxiety
Score of 18-24: Moderate anxiety
Score of 25-30: Severe anxiety
Calcium values can be decreased during treatment with
anticonvulsants, aspirin, corticosteroids, heparin and oral contraceptives.
is a common non-psychoactive supplement used to cure symptoms of illness and maintain health.
Fish oil
Common non-psychoactive dietary supplements with physiological (not psychological) effects used to cure illnesses and maintain health are as follows:
Omega-3 fatty acids Tryptophan Vitamin E Melatonin SAM-e
What 1960 legal precedent approved a test of competence that determines if a criminal defendant is competent to stand trial?
Dusky vs United States
The 1960 case of Dusky vs. United States approved a test of competence that seeks to ascertain whether a criminal defendant has the ability to consult with a lawyer and to rationally understand the proceedings against him or her. This case established competence to stand trial.
Durham vs. United States
determined that an individual is not criminally responsible if the unlawful act was the product of mental illness. This case is known for originating the insanity defense.
O’Connor vs. Donaldson
The 1976 case ruled that harmless mentally ill patients cannot be confined against their will if they can survive outside. This case determined that the presence of a mental illness alone cannot justify involuntary hospitalization.
In 1979, ____________ determined that patients have the right to refuse any treatment and use an appeal process.
Rennie vs. Klein case
Altitude sickness might be included in the differential diagnosis of
panic disorder.
Mitral valve prolapse might be included in the differential diagnosis of
mania and severe anxiety.
Myasthenia gravis might be included in the differential diagnosis of
anxiety.
Oppositional defiant disorder (ODD) is an enduring pattern of angry or irritable mood and argumentative, defiant, or vindictive behavior lasting at least
six months with at least four of the following associated symptoms:
Loses temper Touchy or easily annoyed Angry or resentful Argues with authority Actively defies or refuses to comply with requests or rules from authority figures Blames others Deliberately annoys others Spiteful or vindictive
Physical exam findings and associated features of Rett syndrome are as follows:
Seizures Irregular respirations Scoliosis Loss of purposeful hand skills Stereotypic hand movements
Rett syndrome’s etiology is unknown. However, it is believed that children suffering from Rett syndrome have
- A known, progressive, and deteriorating course of illness after an initial period without apparent disability
- A potential metabolic disorder
- Genetic mutation(s)
A client taking clozapine is presenting with elevated body temperature. You recognize this potential serious side effect as:
Agranulocytosis
Agranulocytosis is a
serious acute condition involving severe and dangerous leukopenia (lowered white blood cell count), most commonly of neutrophils, thus causing neutropenia in the circulating blood.
Hyperprolactinemia is a
condition in which a person has higher-than-normal levels of the hormone prolactin in the blood, potentially causing the stimulation of breast milk.
Anemia is a condition in which
a person lacks enough healthy red blood cells to carry adequate oxygen to the body’s organs and tissues.
Hemophilia is a condition
where the body’s ability to form blood clots is reduced.
Physical exam findings in posttraumatic stress disorder (PTSD) are
nonspecific in nature.
Primary prevention is aimed at
decreasing the number of new cases of mental disorders.
An example of primary prevention is Drug Abuse Resistance Education (D.A.R.E.) programs in elementary and middle schools.
Secondary prevention is aimed
at decreasing the number of existing cases of mental disorder. Examples of secondary prevention include telephone hotlines, crisis intervention, and disaster response.
Tertiary prevention is aimed at r.
decreasing the disability and severity of a mental health disorder. Providing social skills education for a group of intellectually disabled teenagers is an example of tertiary prevention.
The deductible is
the amount that people spend before their health insurance pays for the cost of health care services.
The insurance premium is
the amount charged for insurance coverage, usually paid on a monthly basis by both the employer and the employee.
The loading charge is .
the amount charged by the health insurance company on a person’s renewal premium when they make claims on their policy
The latency stage is characterized by a time
in which sexual concerns are largely unimportant. During this phase, children establish decisive patterns of adaptive functioning. They develop a sense of industry and a capacity for mastery of objects. This is the phase in which children develop a foundation for mature adult life satisfaction.
Freud’s stages of psychosexual development:
birth to 12-18 monthsAnal 12-18 months to 3 yearsPhallic_ 3 to 5-6 yearsLatency_ 5-6 years to adolescenceGenital_ adolescence to adulthood
Enuresis refers to the repeated voiding of urine (either voluntarily or involuntarily) into bedding or clothing when
five years old or older.
Which piece of legislation established the prescription drug coverage (Part D) option under Medicare?
The Medicare Prescription Drug Improvement and Modernization Act of 2003 established the prescription drug coverage (Part D) option under Medicare. This legislation replaced Medicare + Choice with Medicare Advantage.
The Technology Informatics Guiding Education Reform (TIGER) initiative developed
a 10-year plan for nursing’s path toward computer and information literacy.
In February 2009, President Barack Obama signed into law the American Recovery and Reinvestment Act (ARRA) (Pub. L. 111-5). The ARRA includes
the Health Information Technology for Economic and Clinical Health (HITECH) Act, which attempts to update the American infrastructure, including the use of electronic health records.
Patients with obsessive-compulsive personality disorder are
perfectionistic and rigid. They are often workaholics who are indecisive, excessively scrupulous, and preoccupied with detail.
Minipress (prazosin) is
FDA-approved for the treatment of nightmares associated with PTSD.
SSRIs FDA approved for the treatment of PTSD
Zoloft and Paxil
The benefits of group therapy include the following:
Increases insight about oneself
Increases one’s social skills
Is cost-effective
Develops sense of community
Screening for developmental delays is a critical component of assessing for ASD. Checklists for this include the following:
Modified Checklist for Autism in Toddlers (Age-Specific)
Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Ages and Stages Questionnaires
Parents may also report the following symptoms in child with ASD:
No cooing by age one year, no single words by age 16 months, no two-word phrases by age 24 months
Loss of language skills
No imaginary play
Little interest in playing with other children
Extremely short attention span
No response when called by name
Little or no eye contact
Intense tantrums
Fixations on single objects
Unusually strong resistance to changes in routines
Oversensitivity to certain sounds, textures, or smells
Appetite or sleep-rest disturbance, or both
Self-injurious behavior
For an act to be considered criminal, it must have two components:
actus reus and mens rea.
Actus reus refers to
voluntary conduct. Voluntary conduct is deemed impossible if the offender’s mental status is deficient, abnormal, or diseased in a way that inhibits rational intent.
Mens rea refers
to evil intent. Evil intent is defined as the resolve to do harm.
Neither behavior nor intent alone is enough to convict a person of a crime.
is the only state where nurse practitioners bill at 100% of the allowable physician rate.
Iowa
Circadian rhythm sleep-wake disorders are characterized by
a mismatch between a person’s biological clock and the environment.
There are five subtypes of circadian rhythm mismatch:
Delayed sleep phase type
Advanced sleep phase type
Irregular sleep-wake type
Non-24-hour sleep-wake type
Shift work type
Delayed sleep phase type:
falling asleep and waking later than desired
Advanced sleep phase type:
falling asleep and waking earlier than desired
Irregular sleep-wake type:
falling asleep and waking at random times
Non-24-hour sleep-wake type:
falling asleep and usually waking progressively later than desired
Shift work type:
sleepiness associated with changes in work schedule
Jet lag refers to
feeling sleepy or “hungover” after crossing time zones. It is no longer considered a sleep disorder.
Which anxiety disorder is characterized by brief episodes of intense dread accompanied by physical symptoms like chest pain, chills, shortness of breath, and an irregular heartbeat?
Panic d/o
Privilege refers to
the patient’s right to prevent disclosure of confidential information in judicial hearings.
Nonmaleficence refers to the principle of .
bioethics that asserts an obligation not to inflict harm intentionally.
Beneficence refers to
an action done for the benefit of others.
Confidentiality refers to
the nurse practitioner’s responsibility to not release patient information learned in the course of treatment to third parties
The National Institutes of Health (NIH) created the National Center for Complementary and Alternative Medicine (NCCAM) in ____with mission to ___________
in 1998. The mission of NCCAM is to study therapies outside of traditional medicine.
Decreased levels of sodium (Na) can cause
Diuresis
Increased, levels of sodium (Na) can cause
dehydration, diabetes insipidus, and gastroenteritis.
laboratory findings in patients with bulimia might include the following:
Hypokalemia
Hypochloremia
High serum amylase
Hypomagnesemia
Forensic risk assessments are specifically for those with a
violent, dangerous, and/or criminal record and often take place in a judicial arena such as jail, prison, or court.
Failure to resolve the Generativity vs. Stagnation stage is associated with the
development of a mid-life crisis.
Failure to resolve the Industry vs. Inferiority stage is associated with
creative inhibition.
Failure to resolve the Initiative vs. Guilt stage is associated with
conversion disorder, phobias, and psychosomatic disorders.
during the DNA sequencing process single nucleotide polymorphisms detect
Single nucleotide polymorphisms detect single based changes
The FDA has approved both ______ for the treatment of ADHD in children.
stimulants and non-stimulants
