Final

Question 1

ADOLESCENTS: intellectual development disorder [IDD]

Answer 1

causes: hereditary factors [e.g. Tay Sachs, Fragile X], alterations in early embryonic development [e.g. Downs’ syndrome], preg. and prenatal problems [fetal malnutrition, infection], others [e.g. trauma]
types: mild [have communication/social skills w/ minimal sensorimotor impairment], moderate [have communication/social skills but have difficulty following social conventions], severe [early {little or no speech}, late {basic self-care needs}], profound [ID’ed neuro disorder causing retardation]

Question 2

ADOLESCENTS: autism spectrum disorder

Answer 2

an abnormal self-absorption characterized by lack of response to people/actions w/ limited ability to communicate
developmental disabilities in social skills, communication, rigid repeated behaviors and routines [responds catastrophically to minor changes], other [e.g. aggression, unusual rx to sensorium]
interventions: parental involvement and support, rispridone and/or beta-blockers [for upset mood sx.’s], SSRI’s [OCD-like sx.’s]

Question 3

ADOLESCENTS: attention deficit- hyperactivity disorder [ADHD]

Answer 3

shows underdevelopment and inactivity in the cortex of frontal lobe [controls thoughts and actions]
core sx.’s: impulsiveness, impaired attention, lack of motivation
- -> low tolerance for frustration, low self-esteem, labile moods
- sx.’s must be present 6 mo. to be dx
interventions: parental involvement and support, behavioral modifications [rewarded behavior more likely to be repeated], CNS stimulants [e.g. ritalin, adderall] + clonidine [improved results], guanicine [for extreme CNS stimulation from tx]

Question 4

ADOLESCENTS: tourette’s disorder

Answer 4

involves verbal/motor tics -> impairment in social and occupational function; it is life-long but can have periods of remission
- tics: presents w/ sterotyped, rapid, involuntary, recurring motor movements that wax and wane over time and usually occurs in presence of stress, anxiety, fatigue…
– motor tics: corpoapraxia [sexually obscene gestures], echopraxia [imitation of movements], coprolalia [uttering obscenities]
s/s: obsessions, compulsions, hyperactivity, distractibility, impulsivity
interventions: clonidine and guanfacine

Question 5

ADOLESCENTS: oppositional defiant disorder [ODD]

Answer 5

a persistent pattern of negativity, disobedience, defiance, and hostility directed towards authority figures
- in addition, present w/ stubbornness, testing of limits, argumentativeness, unwillingness to negotiate, refusal to accept blame for misdeeds
- feel as if they are responding to unreasonable demands or situations
N.I.: assess child/parent relationship [can contribute to the development of disruptive behaviors], assess cognitive/psychosocial/moral development [immaturity -> disruptive behaviors
interventions: parental involvement and support, focus on correcting faulty beliefs about self ad strengthening ability to control impulses be developing coping mechanisms; anti-psychotics/convulsants/depressants, CBT fosters development of internal controls; bring family into tx

Question 6

ADOLESCENTS: conduct disorder

Answer 6

behavioral/emotional disorder characterized by a persistent pattern of behavior in which the rights of others and societal rules are violated
s/s: aggressive behavior towards others, destructive behavior, deceitfulness, serious rule violations
may coexist w/ ADHD, anxiety, mood/learning disorders
interventions: focus on correcting faulty beliefs about self ad strengthening ability to control impulses be developing coping mechanisms; anti-psychotics/convulsants/depressants, CBT fosters development of internal controls; parental involvement and support

Question 7

ADOLESCENTS: anxiety disorders

Answer 7

problematic when there’s an inability to move beyond the fears that interferes w/ normal development
causes: genetics, dysfunctional efforts to make sense of life’s events
s/s: same as anxiety in adults + more somatic complaints [e.g. stomachaches, H/A, N/V]
types: separation anxiety disorder
N.I.: assess parental’s response to child’s anxiety [increased attention reinforces behavior]
interventions: CBT [e.g. play therapy] focuses on underlying fears and reinforces self-control behaviors, SSRI’s [if CBT ineffective], parental involvement and support

Question 8

ADOLESCENTS: therapeutic modalities for children/adolescent disorders

Answer 8

parental involvement and support
group therapy
- challenging b/c there’s a contagious effect of disruptive
milieu therapy
behavior modification
- rewarded behavior is more likely to be repeated
- to extinguish behavior it is either ignored or [if too disruptive] limits that have specific consequences are set
point and level system
removal and restraint
seclusion
- affects superficial compliance but has little to do w/ real behavioral change
time-out
CBT [e.g. play therapy]

Question 9

ADOLESCENTS: The E.D. nurse usually assess adult pt.’s but tonight she is responsible for assessing the suicide potential of a 13 y.o. adolescent. Which topic must be explored in this assessment of an adol. that is diff. from such an assessment in an adult?

a. ID of feeling such as depression, anger, guilt, and rejection
b. circumstances at the time suicidal thoughts are experienced
c. the presence of ideas about hurting self seriously or causing death
d. the presence of distorted perceptions about suicide and death

Answer 9

d

Question 10

SOMATIC DISORDERS: somatic sx. disorder and related disorders

Answer 10

presents w/ increased health care use, functional impairment, provider dissatisfaction, psychiatric comorbidity, failure to respond to standard tx.
it is imp. to know that these sx. are not intentional or under the conscious control of the pt. w/ the exception of factitious disorders
causes: genetics; early experiences and learning -> somatic sensitivity and bodily preoccupations; unavailable, harsh, inconsistent parents -> unmet emotional/nurturing needs -> self-focus ensues
s/s: low pain threshold [-> low quality of life -> suicide], use of narcotics/sedatives, alexithymia [poor inability to express emotions], distractibility, impulsiveness
N.I.: dx. is imp. b/c original sx. may lead to development of an organic condition [by the same hand, presence of a medical condition does not exclude coexisting somatic sx. or related disorder], meet physiobiological needs altered by somatic sx.’s, recognize that somatic sx.’s may be the pt.’s chief means of communication of emotional needs; GOAL: MEET NEEDS W/O SOMATIZATION
interventions: antidepressants [e.g. SSRI’s], anxiolytics

Question 11

SOMATIC DISORDERS: factitious disorder

Answer 11

deliberate fabrication of sx.’s or self-injury w/ purpose of receiving nurturance, comfort and attention
s/s: exaggeration of, fabrication of, simulation of a sx.
types: factitious disorder by proxy [deliberate fabrication of sx.’s imposed on another person, usually child], munchausen syndrome. munchausen syndrome by proxy
N.I.: dx. is imp. b/c original sx. may lead to development of an organic condition [by the same hand, presence of a medical condition does not exclude coexisting somatic sx. or related disorder], meet physiobiological needs altered by somatic sx.’s, recognize that somatic sx.’s may be the pt.’s chief means of communication of emotional needs; GOAL: MEET NEEDS W/O SOMATIZATION
interventions: antidepressants [e.g. SSRI’s], anxiolytics

Question 12

SOMATIC DISORDERS: malingering

Answer 12

involves a conscious process of intentionally producing sx.’s for an obvious benefit [e.g. disability income]
mot considered a somatic sx. disorder

Question 13

SOMATIC DISORDERS: illness anxiety disorder

Answer 13

may or may not present w/ somatic sx.’s
- if they do the sx.’s are usually mild
do present w a total and excessive preoccupation w/ their belief that they have a devastating sickness or disease
N.I.: dx. is imp. b/c original sx. may lead to development of an organic condition [by the same hand, presence of a medical condition does not exclude coexisting somatic sx. or related disorder], meet physiobiological needs altered by somatic sx.’s, recognize that somatic sx.’s may be the pt.’s chief means of communication of emotional needs; GOAL: MEET NEEDS W/O SOMATIZATION
interventions: antidepressants [e.g. SSRI’s], anxiolytics

Question 14

SOMATIC DISORDERS: conversion disorders

Answer 14

most common of the somatic disorders where there’s dysfunction that does not correspond to current scientific understanding of known neurological and medical illnesses
common co-morbidities: depression, anxiety, personality disorders
often there is smaller hippocampal volume
s/s: sx.’s that affect voluntary motor/sensory fx.’s and suggest a medical condition, lack of emotional concern about sx.’s [la belle indifference], common sx.’s [involuntary movements, seizures, paralysis, abnormal gaits, anesthesia, blindness, deafness]
N.I.: dx. is imp. b/c original sx. may lead to development of an organic condition [by the same hand, presence of a medical condition does not exclude coexisting somatic sx. or related disorder], meet physiobiological needs altered by somatic sx.’s, recognize that somatic sx.’s may be the pt.’s chief means of communication of emotional needs; GOAL: MEET NEEDS W/O SOMATIZATION
interventions: antidepressants [e.g. SSRI’s], anxiolytics

Question 15

SOMATIC DISORDERS: body dysmorphic disorder

Answer 15

pt.’s usually have a normal appearance but there’s a preoccupation w/ an imagined “defective body part” results in obsessional thinking and compulsive behavior
- even when cosmetic surgery is sought there is NO relief of sx.’s
common co-morbidities: MD, substance use disorders, social phobia, OCD
s/s: suicidal ideations/attempts
interventions: SSRI’s, antidepressants, TCA’s [e.g. clomipramine]
N.I.: dx. is imp. b/c original sx. may lead to development of an organic condition [by the same hand, presence of a medical condition does not exclude coexisting somatic sx. or related disorder], meet physiobiological needs altered by somatic sx.’s, recognize that somatic sx.’s may be the pt.’s chief means of communication of emotional needs; GOAL: MEET NEEDS W/O SOMATIZATION
interventions: antidepressants [e.g. SSRI’s], anxiolytics

Question 16

SOMATIC DISORDERS: pseudocyesis

Answer 16

the false belief that one is preg. while at the same time the woman’s body may mimic the s/s of preg [e.g. abd. enlargement, sensations of fetal movement, breast engorgement, endocrine changes
N.I.: dx. is imp. b/c original sx. may lead to development of an organic condition [by the same hand, presence of a medical condition does not exclude coexisting somatic sx. or related disorder], meet physiobiological needs altered by somatic sx.’s, recognize that somatic sx.’s may be the pt.’s chief means of communication of emotional needs; GOAL: MEET NEEDS W/O SOMATIZATION
interventions: antidepressants [e.g. SSRI’s], anxiolytics

Question 17

DISSOCIATIVE DISORDERS

Answer 17

disturbances in the normally well-integrated continuum of consciousness, memory, identity, perception; it is an unconscious defense mechanism to protect the individual against overwhelming anxiety
they have intact reality, no delusions or hallucinations are present
everyone dissociates [.e.g. day-dreaming], but in this disorder the dissociation interferes w/ functioning and quality of life
causes: STRESS, traumatic events affect the limbic system and neurotransmitters, learned methods for avoiding stress and anxiety
co-morbidities: PTSD, BDD, borderline personality disorders, attention deficit
types: dissociative amnesia, dissociative fugue, depersonalization, consciousness may be altered

Question 18

DISSOCIATIVE DISORDERS: depersonalization/derealization disorder

Answer 18

depersonalization: the persistent alteration in the perception of self while reality testing remains intact
feelings of seeing self from a distance or outside the body
derealization: a persistent experience of unreality of surroundings while reality testing remains intact
s/s: not r/t any other medical/mental condition

Question 19

DISSOCIATIVE DISORDERS: dissociative amnesia

Answer 19

psychologically induced memory loss of an autobiographical nature, marked by the inability to recall imp. personal info.

Question 20

DISSOCIATIVE DISORDERS: dissociative fugue

Answer 20

characterized by sudden, unexpected travel away from the customary locale and inability to recall one’s identity and info. about some or all of the past
usually precipitated by traumatic event
during a fugue state, individuals tend to lead rather simple lives, rarely calling attention to themselves
- after some time, they remember former ID and become amnesic of the time spent in fugue state

Question 21

DISSOCIATIVE DISORDERS: dissociative identity disorder

Answer 21

formerly known as multiple personality disorder
characterized by presence of 2+ distinct personality states that recurrently take control of behavior
each alter-personality had its own pattern of perceiving, r/t, thinking about the self and the env’t., affect, cognition, behavior, and/or memories
primary personality usually unaware of subpersonalities, perplexed by lost time
- on the other hand, subper. are semi-aware of primary person
pt. usually seeks help when primary person is depressed
causes: severe sexual, physical, psychological trauma in childhood
s/s: cognitive distortions [personalities inhabit separate bodies and are unaffected by the actions of one another]
N.I.: assess feeling of hopelessness/helplessness in a sub-person, encourage pt.’s to keep a journal
interventions: PSYCHOTHERAPY, benzodiazepines [may increase memory retrieval]

Question 22

DISSOCIATIVE DISORDERS: Nurses working w/ pt,’s w/ somatization and dissociative disorders can expect that these pt.’s will fit on the continuum of psychobiological disorders at the:

a. they do not belong on the continuum, b/c anxiety has been reduced by ego defense mechanisms
b. mild level
c. moderate to severe level
d. severe to psychotic level

Answer 22

c

Question 23

PERSONALITY DISORDERS [P.D.]

Answer 23

there is an assumption that others think and fx. as they do -> in dysfunctional relationships they do not see themselves as the problem but that others do
these pt.’s most often have co-morbidities
s/s: inflexible and maladaptive responses to stress, disability in work and personal relationships, difficulty w/ accurately perceiving and interpreting the world and others, inappropriate emotional responses, difficulty w./ impulse control, affective instability [or lability]
interventions: dialectal behavioral therapy; pt.’s don’t see self as problem :. tx. may be deterred but it is imp. to treat b/c the condition may affect the course and tx. of another disorder; goals are met slowly and include trial and error; affect management in milieu; SSRI’s for co-morbid depression
- many have experienced interrupted therapeutic relationships -> set-up for failure in future tx.’s plans

Question 24

PERSONALITY DISORDERS: cluster A disorders

Answer 24

s/s: avoidance of interpersonal relationships, unusual beliefs, indifference to the rx.’s of others in their lives

types:
- schizotypal P.D.: closely resemble pt.’s w/ schizophrenia; genuinely unhappy about lack of relationships
- - antipsychotics [help anxiety and psychotic sx.’s
- schizoid P.D.: lack warmth, attention to power and rank, disdain weak and impaired, suspicious of intentions of others [ideas of reference]
- paranoid P.D.: content w/ avoiding even the most superficial relationships

Question 25

PERSONALITY DISORDERS: cluster B disorders

Answer 25

these disorders appear to share dramatic, erratic, flamboyant, or erratic behaviors as part of the sx.’s
s/s: manipulation
types:
- antisocial P.D.: presents w/ deceit, manipulation, harm to other w/ absence of remorse; sense of entitlement [right to hurt others, take what they want]; count on others to conform to social norms
- borderline P.D.: instability of affect marked by labile moods’ high emotional sensitivity, acute responsiveness, slow return to normal; may experience dissociativeness; use of splitting [inability to integrate + and - of others]
– can become psychotic under stress [atypical antipsychotic may help]; SSRI [co-morbid panic attacks]
- histrionic P.D.: manipulation via charming and sexually seductive behaviors; act out when they don’t receive attention; emotional lability; lack insight about their role in future relationships
- narcissistic P.D.: grandiose sense of personal achievements; arrogant; lack of empathy; blame others for their short-comings; attention seeking; fragile self-esteem; manipulation; use of splitting

Question 26

PERSONALITY DISORDERS: cluster C disorders

Answer 26

pt. ‘s experience of high levels of anxiety and outward signs of fear; they are inhibited and tend to internalize blame for the frustration in their lives even when they are not to blame
types:
- avoidant P.D.: high levels of anxiety and fear, low self-worth; hypersensitive to criticism; avoid socialization despite desire for affection; respond by withdrawing; anhedonia from their self-isolation
- dependent P.D.: feel they are incapable of surviving if left alone; inability to complete anything or make decision for themselves
- obsessive-compulsive P.D.: preoccupied w/ perfectionism and control; follow rules and details rigidly; inability to incorporate new idea; formal demeanor, lack sense of humor, limited interpersonal skills
- - SSRI [for obsessional thinking]

Question 27

PERSONALITY DISORDERS: passive-aggressive personality traits

Answer 27

pt.’s are chronically irritable and unjustifiably blame others; apt to express their negative/hostile feelings indirectly
s/s: aggression, hostility, manipulation, ambivalent/conflicted interpersonal relationships

Question 28

EATING DISORDERS: anorexia nervosa

Answer 28

presents w/ intense irrational beliefs about their shape and weight, and they engage in self-starvation, express intense fear of gaining weight, and have a disturbance in self-evaluation of weight and its importance
type: restriction of intake of food, binge-eating and/or purging
causes: disruption in serotonin levels [distortion of body image], overvalued ideas about weight, shape, and control
1/3 of deaths attributable to suicide
s/s: terror of gaining weight, preoccupation w/ thoughts of food, views self as fat, peculiar handling of food, rigorous exercise regimen
N.I.: acknowledge that the primary goal of tx. [weight gain] is the very outcome the client fears; observe for cachexia, lanugo, low B.P., low pulse [all are consistent w/ malnourishment]; assess for refeeding syndrome
interventions: CBT, dialectical behavioral therapy; weight restoration w/ normalization of eating habits that addresses psychological needs; antipsychotic [promotes weight gain and improve cognition about body image]

Question 29

EATING DISORDERS: bulimia nervosa

Answer 29

presents w/ repeated episodes of binge eating followed by inappropriate compensatory behaviors [e.g. vomiting, misuse of laxative, diuretics; fasting; excessive exercise
causes: disruption in serotonin levels [distortion of body image], overvalued ideas about weight, shape, and control
1/3 of deaths attributable to suicide
s/s: self-induced vomiting, etc.; hx of anorexia, s/s of depression, chemical dependency, impulsive stealing
N.I.: acknowledge that the primary goal of tx. [weight gain] is the very outcome the client fears; assess for prominent parotid glands [overstimulation from purging], assess for refeeding syndrome; labs [electrolyte, glucose, CBC, ECG]; interrupt binge/purge cycle and prevent disorganized eating behaviors
interventions: fluoxetine [decreases binge-purge behaviors]

Question 30

EATING DISORDERS: binge-eating disorder

Answer 30

when individuals engage in repeated episodes of excessive eating, consuming large amounts of calories, after which they feel significant distress
co-morbidities of depression, mood disorders, P.D.
causes: overvalued ideas about weight, shape, and control
1/3 of deaths attributable to suicide
N.I.: acknowledge that the primary goal of tx. [weight gain] is the very outcome the client fears; assess for refeeding syndrome

Question 31

EATING DISORDERS: cognitive distortions r/t E.D.

Answer 31

overgeneralization: a single event affects unrelated situations [e.g. he didn’t ask me out, I must be fat.”
all-or-nothing thinking: reasoning is absolute and extreme, either strictly good or bad
catastrophizing: the consequences of an event are magnified [e.g. if I gain weight, me weekend will be ruined]
personalization: events are overinterpreted as having personal significance [e.g. I know everybody is watching me eat]
emotional reasoning: subjective emotions determine reality [e.g. when I’m thin, I feel powerful]

Question 32

EATING DISORDERS: Which of the following is an example of all-or-nothing thinking, which is a frequent cognitive distortion of pt.’s w/ E.D.?
a If I allow myself to gain weight, I’ll become immense
b I’m unpopular b/c I’m fat
c when I’m thin, I’m powerful
d when people say I look better, they’re really thinking I look fat

Answer 32

A

Question 33

EATING DISORDERS: typical goals of inpatient hospitalization for an anorectic pt. do no include:
a stabilization of the pt.’s immediate condition
b limited weight restoration
c determination of the causes for the E.D.
d restoration of normal electrolyte balance

Answer 33

C

Question 34

EATING DISORDERS: Which pt. w/ an E.D. would be at greatest risk for hypokalemia? A pt. w/:
a anorexia who loses weight by restricting food intake
b anorexia or bulimia who purges to promote weight loss
c bulimia whose predominant pathological behavior is excessive nocturnal eating
d an eating disorder who exercises intensely more than 4 hr.’s/day but maintains a normal electrolyte balance

Answer 34

B

Question 35

SPECIAL GROUPS VIOLENCE: perpetrators

Answer 35

an abusive relationship is all about instilling fear and wanting to have power and control in that relationship
- violence is prevalent among all gender, ethnic, religious, social, and socioeconomic groups as well as among all age-groups
usually has a low sense of self, poor impulse control, limited tolerance for frustration, senses lack of control
a person [who is violent] who feels judged or accused of wrong-doing is most likely to become defensive, and any attempts at changing coping strategies in the family will be thwarted
- better for the nurse to ask about ways of solving disagreements or methods of disciplining children, rather than use the word abuse or violence
causes: exposed to abuse in childhood -> developed idea that violence is a behavioral norm, stress [-> frustration -> aggression], patriarchal theory

Question 36

SPECIAL GROUPS VIOLENCE: child abuse

Answer 36

when a child is harmed by someone else physically, psychologically, sexually, or by acts of neglect
- overindulgence of children can be considered neglectful b/c it may result in social impairment, emotional stunting, and physical problems caused by inactivity and obesity
often the abuser are parents or someone w/I the family and most often there is hx of substance abuse
s/s: physical [bruises/wounds in differing stages of healing, bald patches on scalp], neglect [malnourishment, poor hygiene, lapses in attendance of school], sexual [difficulty in walking or sitting, UTI’s, STI’s], emotional [speech disorders, lag in physical development]
N.I.: adopt a nonthreatening relationship w/ parents, understand children do not want to betray parents

Question 37

SPECIAL GROUPS VIOLENCE: intimate partner violence [IPV]

Answer 37

a pattern of assault and course of behaviors that may include physical injury, psychological abuse, sexual assault, progressive social isolation, stalking, deprivation, intimidation and threats b/w current/former partners, regardless of gender or marital status
more than half of battered woman are abused during preg.
- birth defects and infant deaths are frequent outcomes of abuse of a woman during preg.
violence may cause PTSD, anxiety disorders, suicidal ideation/attempts
children in homes where IPV occurs are vulnerable to feeling of responsibility, guilt, emotional distress, behavioral regression, somatic complaints, PTSD, substance abuse and may become a perpetrator later in life
s/s: denial and blame, emotional abuse, control through isolation/intimidation/economic abuse/power
N.I.: make assessments w/o her partner present, ask if children are being abused

Question 38

SPECIAL GROUPS VIOLENCE: elder abuse

Answer 38

has worsened in recent years b/c the health care system is w/o appropriate manpower to administer assessments and provide effective interventions to protect older Americans
types: domestic, institutional, self-neglect
intervention: adult protective services [APS], pt. has to be unable to care for self
age-related syndromes often result in frailty and functional decline, making an older adult even more at risk for abuse, neglect, and self-neglect
s/s: increased PCP visits, fear of being alone w/ caregiver, malnutrition. skin lesions, valuable missing
N.I.: SAFETY, reinforce social value of elders

Question 39

SEXUAL VIOLENCE: sexual assault

Answer 39

an act of violence, power, and hate-not sex-and most often results in devastating severe and long-term trauma; often committed in the contact of unequal power in order to demonstrate dominance and control
causes: alterations in the functioning of neurotransmitters, more prevalent in those w/ antisocial personality disorder, hx of sexual abuse
co-morbidities of depression, suicide, substance abuse
survivor is someone who has addressed many of the issues and is moving on e/ his or her life
victim is someone who can become a survivor w/ time, intervention/counseling
there is no mandated reporting for crimes of sexual assault unless they involve abuse of a minor of elder
- all forms of rape are underreported though
cultural and societal factors play a part in forming attitudes about women’s inferiority and support male superiority and sexual entitlement

Question 40

SEXUAL VIOLENCE: child sexual abuse

Answer 40

presents w/ disruptions of sense of worth, self-concept, place in the world, affective capabilities
those sexually assaulted as children have a greater chance of being assaulted at a later age
co-morbidities of depression, substance abuse, dissociative disorders, personality disorders, anxiety disorders, suicidal ideation
untreated victims have higher inclinations of being involved in crime and sexual abuse

Question 41

SEXUAL VIOLENCE: young adult victims of assault

Answer 41

people ages 16-19 have the highest rate of sexual victimization of any age group
alcohol and other drugs often play a part of sexual assault, whether taken by the victim, the perpetrator, or both
- most common is alcohol
many reasons why rape isn’t reported

Question 42

SEXUAL VIOLENCE: male victims of sexual assault

Answer 42

laws addressing male on male rape have been established, they are often not acknowledged or enforced, and the culture of blaming the victim still persists
beyond the physical trauma, such as risk of transmission of STI’s, HIV, or pregnancy, psychological consequences can cause long-term psychological trauma
co-morbidities of depression, anxiety, difficulties w/ daily functioning, low self-esteem, E.D., self-destructive behaviors, substance abuse disorders, suicidal ideation
male rape victims are more likely to commit suicide and to become infected w/ HIV via anal tears than are women

Question 43

SEXUAL VIOLENCE: post-sexual abuse

Answer 43

people who have been sexually assaulted often go to the ED to find emotional support, help in regaining a sense of control, and reassurance regarding their safety
facilities differ widely in the kind of care they provide, and the ideal is not always the case-care is not always compassionate, comprehensive, or competent
to collect evidence, a consent form must be signed to take photographs, perform a pelvic exam., and carry out any other procedures necessary to collect evidence and provide tx
intervention: benzodiazepine [for anxiety and agitation], SSRI’s [for PTSD, if present]

Question 44

SEXUAL VIOLENCE: rape-trauma syndrome

Answer 44

nursing dx that is a variant of PTSD
survivors of sexual assault may suffer from PTSD, depression, panic disorder, suicidal ideation and attempts, and substance abuse are more prevalent among survivors of sexual assault
phases:
- acute: experiences of shock, numbness, and disbelief
- long-term: experiences of re-living the trauma, social withdrawal, avoidance behaviors and actions [that recall event], increased psychological arousal characteristics, fears and phobias, nightmares and difficulty sleeping
goals: pt. should knows lists of common physical, social, and emotional rx.’s that may follow sexual assault, pt. should state results of physical exam, pt. should return to precrisis level of functioning w/ minimal sx.’s, have comfortable sex
N.I.: tx of physical injuries, STD prophylaxis, preg. prevention

Question 45

ANGER & VIOLENCE: anger vs. aggression vs. violence

Answer 45

anger
- is an unexplained rx to a stressor
- not everyone responds to anger w/ aggression or violence
- when it is managed in a constructive manner, anger can help keep people safe and meet needs
- the acting out of anger may meet immediate needs, but at the expense of causing emotional or physical harm to ourselves or others
aggression
- protects oneself, one’s family, or a person being bullied, OR can be destructive
- behaviors include rage, hostility, potential for physical assault or verbal destructiveness and can be directed at other or oneself - a hostile rx that occurs when control over anger is lost, used in an attempt to regain control over the stressor or flee the situation
violence
- does not always have anger as its origin
- e.g. bullying

Question 46

ANGER & VIOLENCE: bullying

Answer 46

bullying occurs b/w persons w/ diff. levels of authority
lateral bullying refers to bullying among those of equivalent status
all kinds of bullying behaviors create a toxic env’t.
those who are bullied are prone to negative feelings about self, humiliation, poor self-concept, great emotional pain
co-morbidities of depression, PTSD, anxiety disorders

Question 47

ANGER & VIOLENCE: aggressors

Answer 47

causes: alteration in brain structure [hippocampus, septum, cingulate, fornix, amygdala, temporal love, prefrontal cortex] can increase aggression/violence, some medical conditions, exposure of childhood exposure, substance abuse, low socioeconomic statuses, low serotonin, dopamine [only if violence is rewarded]
s/s: increased demands, irritability, changes in mood and behavior
N.I.: ENSURE SELF-SAFETY FIRST, ID self for personal triggers and responses likely to escalate pt. violence, assess personal negative feeling held towards pt., exercise psychopharmacological means and restraints w/ caution, help pt. recognize tendencies begin to escalate and employ at least one new tension-reducing behavior
interventiosn: CBT, behavioral interventions, atypical antipsychotics and typical neuroleptics [for acute aggression and psychosis-induced violence], benzodiazepines [for acute aggressive episodes, beta-blockers [for organic causes of violence], anticonvulsants [for impulsive rage rx.’s]

Question 48

ANGER & VIOLENCE: stages of the violence cycle

Answer 48

preassaultive stage: de-escalation approaches
- respect can be maintained if the nurse assumes that the pt.’s are doing their best, wants to improve, behaviors make sense w/I their worldview
assaultive stage: med., seclusion, restraint
- during an episode only the leader of the tem should communicate w/ pt.
- restraint measures should only be used for the management of violent or self-destructive behavior
- pt. is closely monitored to determine the pt.’s ability to reintegrate into unit
– if reintegration leads to increased agitation, the pt. is returned to a comfort room
postassaultive stage
- review of incident w/ pt. occurs to learn from situation, ID stressors, plan alternative ways to respond to stressors

Question 49

ANGER & VIOLENCE: restraints

Answer 49

the least restrictive means of restraint is always tried 1st and seclusion/restraint is used only pc alternative interventions have been attempted; use has gone down since the incorporation of med.’s into this pt. pop.
may be preferred when staff believe that continued verbal and calming strategies would allow the pt. to de-escalate and that restraints could be removed at the earliest possible time
mechanical restraints are avoided in individuals who have a hx of sexual abuse and trauma, and in those at risk for positional asphyxia or sudden cardiac collapse
there is no evidence that supports the therapeutic value of seclusion or restraints; many die each year as a result of these interventions, leaving other psyhchologically harmed or physically injured

Question 50

ANGER & VIOLENCE: critical incident debriefing

Answer 50

crucial b/c a review is necessary to ensure that quality care was provided to the pt. and b/c the profound effects of workplace violence do not disappear pc the incidence is over and harm is not only to the individual assaulted
some nurses internalize [depression, avoidance, withdrawal] and others will externalize [anger, outburst, lability] emotional and behavioral responses

Question 51

ANGER & VIOLENCE: interventions for pt.’s w. neurocognitive deficits

Answer 51

reality orientation consists of providing the correct info. to the pt. about place, date, and current life circumstances
sedation only further clouds a pt.’s sensorium, which makes disorientation worse and increases the risks of falls or injuries
pt. may experience severe agitation and aggression that it is referred to as a catastrophic rx
- rather than attempting to reorient the pt. the nurse asks the pt. to further describe the setting or situation referred by the pt.

Question 52

ANGER & VIOLENCE: After a few days on an inpatient unit, a pt. w/ a hx. of explosive outburst states to the nurse, "I am really feeling angry now."  the nurse determines that this represents:
a a clear threat
b anti-social behavior
c positive behavioral change
d continued negativity

Answer 52

c

Question 53

ANGER & VIOLENCE: To help prevent displays of anger and aggression, the nurse must understand that anger and aggression are preceded by feeling of:
a vulnerability 
b depression
c elation
d isolation

Answer 53

a

Question 54

CRISIS & MASS DISASTER: crisis

Answer 54

presents both a danger to personality organization and a potential opportunity for personality growth
crises are acute, time-limited occurrences experienced as overwhelming rx.’s to stressful situational event, developmental event, societal event, cultural event, perception of an event

Question 55

CRISIS & MASS DISASTER: individuals experiencing crises

Answer 55

many factors may limit a person’s ability to problem solve or cope w/ stressful life events
even though acute grief is a normal rx to a distressing situation, preventative interventions could eliminate or decrease serious personality disorganization and devastating psychological consequences from the sustained effects of severe anxiety
an understanding of phases of crises, types of crises, aspects of crisis that have relevance for nurses enables application of the nursing process

Question 56

CRISIS & MASS DISASTER: types of crises

Answer 56

maturational
- based off of erik Ericson’s 8 stages of growth and development
- each developmental stage can be referred to as a maturational crisis, each crisis requires new coping skills
– the way one crisis is resolved affects ability to pass through subsequent stages
situational
- e.g. loss of a job, death of a loved one, unwanted preg.
adventitious
- may result from a natural disaster, a national disaster, a crime of violence

Question 57

CRISIS & MASS DISASTER: disaster response

Answer 57

can cause cognitive [memory impairment, difficulty making decisions], behavioral [withdrawal], emotional [flood of emotions] difficulties; PTSD, depression
the need for psychobiological first aid [crisis intervention] and debriefing pc crisis situation for all is imp.
debriefing is an imp. step in coming to terms w/ overwhelming violent or otherwise disastrous situations once they are over
- helps staff place the crisis in perspective and begin healing themselves
- critical incident stress debriefing is an example of a tertiary intervention; 7 phases that ends in summarization of the debriefing experience and how it helped

Question 58

CRISIS & MASS DISASTER: self-care for nurses

Answer 58

nurses need to constantly monitor personal feelings and thoughts when dealing w/ people in crisis and be aware when they need self-help esp. when confronted w/ mass casualties and natural disasters
nurses may respond w/ anxiety to a pt.’s situation or anxiety level and try to repress to maintain personal comfort
- when unaware, may unconsciously prevent expression of painful feeling in the pt. that are precipitating the nurse’s own discomfort

Question 59

CRISIS & MASS DISASTER: application of the nursing process

Answer 59

individual may be affected by an unrealistic perception of the precipitating event, inadequate situational supports [tells us what resources they have available to them], and inadequate coping mechanisms [esp. suicidal ideation]
- presence of these factors are used to form goals
outcomes must be congruent w/ the pt.’s needs, values, and cultural expectations
goals: pt. safety, anxiety reduction to precrisis levels
- it is imp. to note that the pt. is in charge of their own life, able to make decisions, crisis counseling relationship is one b/w PARTNERS

Question 60

CRISIS & MASS DISASTER: Which statement about crisis theory provides a basic for nursing intervention?
a a crisis is an acute, time-limited phenomenon experienced as an overwhelming emotional rx to a problem perceived
b a person in crisis usually has had adjustment problems and has coped inadequately in his or her usual life situations
c crisis is precipitated by an event that enhances the person’s self-concept and self-esteem
d nursing intervention in crisis situations rarely has the effect of ameliorating the crisis

Answer 60

1

Question 61

CRISIS & MASS DISASTER: For a nurse working in crisis intervention, which belief would be least helpful?
a a person in crisis is incapable of making decisions
b the crisis counseling relationship is 1 b/w partners
c crises counseling helps the pt. refocus to gain new perspectives on the situation
d anxiety reduction techniques are used so the pt.’s inner resources can be assessed

Answer 61

1

Question 62

SETTINGS FOR PSYCH. CARE: outpatient settings

Answer 62

the stigma an combo. of mental + PHYSICAL sx.’s prevents pt.’s from seeking care of professionals in the field, instead they will go to their PCP
- disadvantages are time constraints to care and lack of expertise on psychiatric disorders
types:
- psychiatric rehabilitation: focus on the development of social skills, the ability to access resources and the acquisition of optimal env’t. that fosters recovery
- psychiatric home care: reduce need for costly and disruptive hospitalizations; provides a comfortable and safe alternative to the clinical setting
- intensive outpatient programs [IOP’s] and partial hospitalization programs [PHP’s]: bridge gap b/w outpatient and inpatient care
for community nursing, it i imp. to view the whole community as a pt.

Question 63

SETTINGS FOR PSYCH. CARE: inpatient settings

Answer 63

, length of hospital stays decreased b/c of intro. of psychopharmacology, managed care, alternatives to inpatient hospitalization

units are usually lock to promote privacy and prevent elopement
therapies:
- milieu: refers to the env’t. in which holistic tx. occurs and includes all members of the tx. team
pt.’s are active participants in their plan of care and can refuse tx. [if not declared incompetent]
assessments for inpatient settings begins by ruling out co-morbidities

Question 64

SETTINGS FOR PSYCH. CARE: state cute care system

Answer 64

primarily provide intermediate tx. for pt.’s unable to stabilized in short-term care hospitals OR there’s an emphasis on acute care that is reflective of gaps in the private sector

Question 65

SETTINGS FOR PSYCH CARE: A 24-year-old female is diagnosed with alcohol dependence and requires acute detoxification. The most appropriate setting is: 
a partial hospitalization
b residential setting
c rehab unit
d acute inpatient care.

Answer 65

d