Final Exam Flashcards
Which cognitive disorder includes: • Progressive cognitive impairment/deterioration • NO change in LOC • Primarily memory impairment • Aphasia • Apraxia • Agnosia • Echolalia • Palilalia
Dementia
deterioration of language
aphasia
inability to execute motor function
apraxia
inability to recognize or name objects
agnosia
echoing what is heard
echolalia
repeating words or sounds over and over
palilalia
Mild, moderate, or severe clinical course of dementia?
Forgetfulness; difficulty finding words, loses things, may avoid social settings due to anxiety over forgetfulness.
Mild
Mild, moderate, or severe clinical course of dementia?
Confusion; progressive memory loss, cannot perform complex tasks, recognizes familiar faces, unable to live independently, loses info like phone # and address.
Moderate
Mild, moderate, or severe clinical course of dementia?
Personality/emotional changes; forget names of loved ones, needs assistance w/ ADLs.
Severe
What are 4 medications used with dementia patients? What is their purpose?
Dr. Good Memory
donepezil (Aricept), rivastigmine (Exelon), galantamine (Reminyl), memantine (Namenda)
Purpose: Slow progression of dementia
Dementia medication administered 5-10 mg PO/daily and requiring the following nursing interventions:
- Monitor for nausea, diarrhea, insomnia
- Test stool for occult bleeding
donepezil (Aricept)
Dementia medication administered 3-12 mg PO/daily and requiring the following nursing interventions:
-Monitor for GI upset, including loss of appetite
rivastigmine (Exelon)
Dementia medication administered 16-32 mg PO/daily and requiring the following nursing interventions:
-Monitor for GI upset, dizziness, syncope
galantamine (Reminyl)
Dementia medication administered 10-20 mg/daily and requiring the following nursing interventions:
-Monitor for HTN, pain, H/A, vomiting, constipation, and fatigue
memantine (Namenda)
When promoting client safety r/t dementia offer _______ assistance w/ supervision while they cook or perform ADLs.
unobtrusive
What are some ways the nurse can promote adequate sleep for the dementia patient?
Encourage physical activity throughout the day
What are some ways the nurse can promote proper nutrition for the dementia patient?
Ask their favorite foods and provide them with a focus on foods easier to self-feed.
What are some ways the nurse can promote hygiene for the dementia patient?
- Aid bowel patterns by encouraging fluids and fiber.
- Remind client to urinate; provide pads/diapers prn and change them frequently.
What are some ways the nurse can structure environment and routine for the dementia patient?
- Encourage following regular routine; bathing, dressing
- Monitor environmental stimulation and adjust prn
What are some ways the nurse can provide emotional support for the dementia patient?
Through calm, reassuring kindness and respect and supportive touch when appropriate
What are some ways the nurse can promote interaction and involvement for the dementia patient?
- Plan activities the client enjoys
- Reminisce w/ the client
- Use techniques like distraction, time away, going along, or reframing to calm them.
What intervention offers alternative points of view to explain events?
reframing
What thought process does the dementia patient use to make up answers to fill in memory gaps?
confabulation
Which cognitive disorder is characterized by…
- gradual onset
- increasing decline in function
- loss of speech
- loss of motor function
- profound personality and behavioral changes including paranoia, delusions, hallucinations, inattention to hygiene, and belligerence
- Caused by ↓cerebral neurons, ↑ senile plaque, and enlarged 3rd & 4th ventricles
- Linked to genetic component (chromosomes 21, 14, 19)
Alzheimer’s disease
Which cognitive disorder is characterized by…
- rapid onset
- brief duration
- impaired LOC
- short-term memory impairment
- slurred, rambling, pressured, and/or irrelevant speech
- temporarily disorganized thought process
- visual or tactile hallucinations, delusions
- anxious, fearful, weeping, and/or irritable mood
Delirium
Which cognitive disorder is characterized by…
- extensive neuropsychiatric symptoms
- motor symptoms
- delusions and visual hallucinations
- can occur in families
Lewy body dementia
Which cognitive disorder is characterized by…
- ABRUPT onset
- rapid change in functioning
- plateau> more changes >plateau effect
- imaging reveals vascular lesions of cerebral cortex
- ↓ blood supply to brain
vascular dementia
Which cognitive disorder is characterized by…
- degenerative brain disease
- affects frontal and temporal lobes
- similar to Alzheimer’s symptoms
- strong genetic component
- onset at 50-60 years
- death within 2-5 years
frontotemporal lobar degeneration
Which cognitive disorder is characterized by…
- inherited dominant gene
- primarily involves cerebral atrophy, demyelination, and enlargement of brain ventricles
- choreiform movements during waking hours
- facial contortions, twisting turning, tongue movements
- personality changes
- then memory loss, ↓ intellect
- onset 30’s or early 40’s
Huntington’s disease
Which dementia is a result of long-term use of alcohol?
Korsakoff’s syndrome (previously known as amnestic disorder)
What neurodevelopmental disorder is characterized by…
- inattentiveness, overactivity, and impulsiveness
- persistent pattern of inattention and/or hyperactivity and impulsivity
- affects 5-8% school-aged children
- risk factor: male
- as infants; fussy, temperamental, poor sleeping patterns
- as toddlers; “always on the go”
- poor academic performance
- fidgety
ADHD
What is the two most common medications used to treat ADHD?
methylphenidate (Ritalin) and amphetamine (Adderall)
Which SNRI antidepressant is used to treat ADHD?
atomoxetine (Strattera)
Which two antihypertensives are used to treat ADHD?
clonidine (Kapvay) ER
guanfacine (Intuniv) ER
What are the nursing considerations for methylphenidate (Ritalin)?
Monitor for appetite suppression and growth delays
What are the nursing considerations for amphetamine (Adderall)?
Monitor for insomnia.
What are the nursing considerations for clonidine (Kapvay) ER and guanfacine (Intuniv) ER?
- Monitor for hypOtension, dizziness, syncope, and somnolence
- Use calorie-free beverages to relieve dry mouth
What are the nursing considerations for the SNRI atomoxetine (Strattera)?
- Give with food.
- Monitor for appetite suppression
- Use calorie-free beverages to relieve dry mouth
- Monitor for ↑LFTs
When can you use restraints and seclusion?
Only when the client is imminently aggressive and dangerous to themself or to others and all other means of calming them were unsuccessful.
For adults, restraint and seclusion requires a face-to-face evaluation by a licensed practitioner within ____ hours of restraint or seclusion and every ____ hours thereafter.
Must have physician’s order every ____ hours.
1 hour
8 hours thereafter
Physician: 4 hours
The nurse must assess and document restraints and seclusion every _____ to ____ hours.
1-2 hours
For children, restraint and seclusion requires a face-to-face evaluation with physician every ____ hours.
Must have physician’s order every ____ hours.
4 hours
renewed 2 hours
What is the first question in the suicide (lethality) assessment?
Do you have a plan? If so, what is it? (Is the plan specific?)
What is the second question in the suicide (lethality) assessment?
Are the means available to carry out the plan? (ie. access to a gun, pills)
What is the third question in the suicide (lethality) assessment?
Ask yourself as the nurse… will this plan be lethal?
What is the fourth question in the suicide (lethality) assessment?
Ask the client if they have made death preparations like giving things away, writing suicide note, or talking to someone for the last time.
What is the fifth question in the suicide (lethality) assessment?
Ask the client where and when they plan to carry out the suicide.
What is the sixth question in the suicide (lethality) assessment?
Ask the client if the intended time is a special date or has some special meaning.
A history of suicide increases risk for suicide in the next __ years, especially the next __ months.
2 years
3 months
What mood disorder is characterized by…
- extreme mood swings
- episodes of mania and depression
Bipolar disorder
What are the symptoms of a manic phase in a bipolar disorder?
- euphoric, grandiose, energetic, sleepless
- poor judgment with rapid thoughts, actions and speech
What are the symptoms of a depressive phase in a bipolar disorder?
-mood, behavior and thoughts like someone with depression
The diagnosis of a manic episode or mania requires at last 1 week of what symptoms?
incessantly heightened, grandiose, or agitated mood PLUS 3 or more of the following:
- exaggerated self-esteem
- sleeplessness
- pressured speech
- flight of ideas
- reduced ability to filter extraneous stimuli
- distractibility
- increased activities w/ increased energy
- multiple grandiose, high-risk activities involving poor judgment and severe consequences (ie. spending spree, sex w/ strangers, impulsive investments)
What are the symptoms of the antipsychotic medication side effect extrapyramidal (EPS)?
dystonic reactions, akathisia, and Parkinsonism
What characterizes dystonic reactions?
muscle spasms in the neck (torticollis) or eyes (oculogyric crisis), protrusion of tongue, dysphagia (leading to compromised airway)
What treatment is given for dystonic reactions?
- diphenhydramine IM or IV
- Cogentin IM
What characterizes pseudoparkinsonism?
shuffling gait, masklike facies, muscle stiffness, cog-wheeling rigidity, drooling, akinesia (slow movements)
What characterizes akathisia?
restless movement, pacing, inability to remain still, client report of inner restlessness
What treatment is given for akathisia?
propranolol
What is a tool used to assess for EPS?
Simpson-Angus scale (Score can be 0-40; the higher the number the more severe the EPS)
What are the symptoms of the antipsychotic medication side effect tardive dyskinesia?
abnormal, involuntary movements like lip smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform movements of limbs and feet.
T/F? Tardive dyskinesia is reversible.
False
What medication can arrest progression of tardive dyskinesia?
clozapine (Clozaril)
What scale is commonly used to screen for symptoms of movement disorders?
The abnormal involuntary movement scale. (AIMS)
Photosensitivity is a common side effect of antipsychotic medications, especially which one?
Thorazine
Seizures are a common side effect of _______ medications.
antipsychotic
What are the symptoms of the antipsychotic medication side effect neuroleptic malignant syndrome (NMS)?
muscle rigidity, ↑ muscle enzymes (Cr, phosphokinase), high fever, and ↑ leukocytes (leukocytosis)
What is treatment for NMS?
STOP meds and contact doctor
Which antipsychotic medication has the side effect of agranulocytosis?
clozapine (Clozaril)
What are the symptoms of agranulocytosis (failure of bone marrow to produce adequate WBCs)?
fever, malaise, ulcerative sore throat, and leukopenia
When prescribed clozapine (Clozaril), how often must client get WBC count tested?
Weekly the first 6 months, then q2weeks thereafter.
What is the lowest WBC count acceptable to get more clozapine (Clozaril)?
3500 cells/mm3
What is the treatment for agranulocytosis crisis?
STOP meds, give liquids and expect to give platelets.
What less threatening side effect of antipsychotics requires the nurse to teach balanced diet with controlled portions and regular exercise?
weight gain
Which level anxiety is characterized by…
- sharpened senses
- increased motivation
- alert
- enlarged perceptual field
- can solve problems
- learning is effective
- restless
- GI butterflies
- sleepless
- irritable
- hypersensitive to noise
Mild
Which level anxiety is characterized by…
- perceptual field reduced to one detail or scattered details
- cannot complete tasks
- cannot problem solve or learn
- behavior focused on anxiety relief
- feels awe, dread, or horror
- doesn’t respond to redirection
- severe H/A
- N/V/D
- trembling
- rigid stance
- vertigo
- pale
- tachycardia
- chest pain
- crying
- ritualistic behavior
Severe
Which level anxiety is characterized by…
- selectively attentive
- perceptual field limited to the immediate task
- can be redirected
- cannot connect thoughts or events independently
- muscle tension
- diaphoresis
- pounding pulse
- H/A
- dry mouth
- higher voice pitch
- increased rate of speech
- GI upset
- frequent urination
- increased automatisms
moderate
Which level anxiety is characterized by…
- perceptual field reduced to focus on self
- cannot process environmental stimuli
- distorted perceptions
- loss of rational thoughts
- personality disorganized
- doesn’t recognize danger
- possibly suicidal
- delusions or hallucinations possible
- can’t communicate verbally
- either cannot sit or totally mute and immobile
panic
Refers to client’s pervasive and enduring emotional state.
Mood
Refers to the outward expression of the client’s emotional state.
Affect
Affect:
Showing little or a slow-to-respond facial expression.
Blunted affect
Affect:
Displaying a full range of emotional expressions.
Broad affect
Affect:
Showing no facial expression.
Flat affect
Affect:
Displaying a facial expression that is incongruent with mood or situation; often silly or giddy regardless of circumstances.
Inappropriate affect
Affect:
Displaying one type of expression, usually serious or somber.
Restricted affect
What the client actually says in regards to their thoughts.
Thought content
How the client thinks.
Thought process
Thought content and process:
Client eventually answers a question, but only after giving excessive unnecessary detail.
circumstantial thinking
Thought content and process:
A fixed, false belief not based in reality.
Delusion
Thought content and process:
Excessive amount and rate of speech composed of fragmented or unrelated ideas.
Flight of ideas
Thought content and process:
Client’s inaccurate interpretation that general events are personally directed to them, such as hearing a speech on the news and believing the message had personal meaning.
Ideas of reference
Thought content and process:
Disorganized thinking that jumps from one idea to another with little or no evident relation between the thoughts.
Loose associations
Thought content and process:
Wandering off topic and never providing the information requested.
Tangential thinking
Thought content and process:
Stopping abruptly in the middle of the sentence or train of thought; sometimes unable to continue the idea.
Thought blocking
Thought content and process:
A delusional belief that others can hear or know what the client is thinking.
Thought broadcasting
Thought content and process:
A delusional belief that others are putting ideas or thoughts into the client’s head.
Thought insertion
Thought content and process:
A delusional belief that others are taking the client’s thoughts away and the client is powerless to stop it.
Thought withdrawal
Thought content and process:
Flow of unconnected words that convey no meaning to the listener.
Word salad
What are the seven questions in a suicide assessment?
Ideation: Are you thinking of killing yourself
Plan: Do you have a plan?
Method: How will you do it?
Access: Do you have what you need to do it?
Where: Where will are you planning to do it?
When: When are you planning to do it?
Timing: What day/time will you do it?
Admission based on the client willing to seek treatment and agree to be hospitalized is done on a ________ basis.
voluntary
Admission based on a client unwilling to seek treatment, but has become either a danger to themselves or others is hospitalized on an ____________ basis.
involuntary
T/F? A client that voluntarily admits to hospitalization can leave whenever they wish.
False.
Both civil commitments and involuntary hospitalizations curtail a client’s right of freedom to leave the hospital when they wish. However, all other rights remain the same.
A person can be detained in a psychiatric facility for ____ to ____ hours on an emergency basis until a hearing can be conducted to determine whether or not they should be committed to the facility for treatment for a specified time period.
48-72 hours
Lithium is not metabolized, but is reabsorbed by the _____ ______ and excreted in the _____.
proximal tubule
urine
Treatment levels of Lithium should be between ___ and ___ mEq/L.
0.8 - 1.5
Increased salt in the diet leads to ____ of lithium levels.
decrease
Too much water or hypervolemia can lead to ____ of lithium levels.
decrease
Too little water or hypovolemia can lead to _____ of lithium levels which is _____ ______.
increase
VERY dangerous
Nursing considerations with Lithium therapy include…
- daily weights
- I&Os
- monitor for dependent edema
- contact MD if diarrhea, fever, flu or any dehydrating illness occurs
- q6months thyroid levels checked (d/t ↑TSH leading to anxiety, labile emotions, sleeping difficulties)
- bc excreted via urine; renal status should be evaluated
Lithium therapy is contraindicated in people with any of these 4 conditions.
renal impairment, urinary retention, brain, or CV damage
Side effects for benzodiazepines like alprazolam (Xanax) include…
dizziness, sedation, H/A, sexual dysfunction, blurred vision, dry mouth, constipation, high potential for abuse
Nursing considerations for benzodiazepines like alprazolam (Xanax) include…
- Avoid using with other CNS depressants (ie. Benadryl or alcohol)
- Avoid caffeine
- Caution w/ hazardous activities (ie driving)
- Rise slowly from lying/sitting (ortho-hypotension)
- Use sugar-free beverages/hard candies
- drink fluids
- never d/c abruptly
What is benztropine (Cogentin) and what does it treat?
(Central muscarinic antagonist) anti-tremor medication used in Parkinson’s and to treat pseudoparkinsonism and dystonia.
Nursing considerations for benztropine (Cogentin) include…
- increase fluids and fiber to avoid constipation
- use ice chips or hard candy for dry mouth
- assess for memory impairment
Risperidone (Risperdal) is what type of medication used to treat what disorders?
antipsychotic
schizophrenia and bipolar
Sometimes called social crises and includes natural disasters like floods, earthquakes, or hurricanes; war; terrorist attacks, riots; and violent crimes such as rape or murder.
Adventitious crises
Used to help people with phobias overcome their fears.
systematic desensitization
This occurs when the client displaces onto the therapist attitudes and feelings that the client originally experienced in other relationships. (ie. therapist similar age to parents and reacting to therapist like they would their parent)
Transference
Separation of the emotions of a painful event or situation from the facts involved; acknowledging the facts but not the emotions. (ie. person shows no emotional expression when discussing serious car accident)
Intellectualization
The nurse who appreciates her client as a unique worthwhile human being can respect the client regardless of his or her behavior, background, or lifestyle. This unconditional, nonjudgmental attitude is known as ____ ____.
positive regard
The theory that bases decisions on the greatest good for the greatest number.
Utilitarianism
A situation in which either ethical principles conflict or when there is no one clear course of action to take.
Ethical dilemma
What phase of the aggression cycle is defined as an event or circumstance in the environment that initiates the aggressive response; usually anger or hostility and appears as restlessness, anxiety, irritability, pacing, rapid breathing, sweating, loud voice?
triggering
What phase of the aggression cycle is defined as the client responses represent escalating behaviors that indicate movement toward a loss of control and appear as pale or flushed face, yelling, swearing, agitation, threatening, demanding, clenched fists, inability to think?
escalation
What phase of the aggression cycle is defined as being during an emotional and physical crisis where the client loses control and appears as emotional, physical outburst, screaming, inability to communicate clearly?
crisis
What phase of the aggression cycle is defined as client regains control and appears as lowering of voice, decreased muscle tension, clearer more rational communication?
recovery
What phase of the aggression cycle is defined as client attempts reconciliation with others and returns to baseline functioning and appears as remorse, apologies, crying, quiet and withdrawn?
postcrisis
______ (1978) identified four “patterns of knowing” in nursing as empirical knowing, personal knowing, ethical knowing, and aesthetic knowing.
Carper
Which “pattern of knowing” is defined as obtained from the science of nursing (ie. Client in panic disorder begins to have an attack. Panic attack will raise pulse rate.)?
empirical knowing
Which “pattern of knowing” is defined as obtained from life experience (ie. Client’s face shows panic.)?
personal knowing
Which “pattern of knowing” is defined as obtained from the moral knowledge of nursing (ie. Although the nurse’s shift has ended, she remains with the client.)?
ethical knowing
Which “pattern of knowing” is defined as obtained from the art of nursing. (ie. Although the client shows outward signals now, the nurse has sensed previously the client’s jumpiness and subtle differences in the client’s demeanor and behavior.)?
aesthetic knowing
What medication is sometimes used with Lithium to treat bipolar disorder?
clonazepam (Klonopin); anticonvulsant and a benzodiazepine
What are the basic nursing considerations with SSRI antidepressants? (-tine, -line, -pram) Name them… “a PARrot FLU EaSily to SERTA CITy”
- Give in evening if causes drowsiness
- Monitor for hyponatremia
- Encourage SF hard candies if dry mouth
- Give w/ food
- fluoxetine (Prozac)
- sertraline (Zoloft)
- paroxetine (Paxil)
- citalopram (Celexa)
- escitalopram (Lexapro)
What are the basic nursing considerations with tricyclic antidepressants? (-pine, -line, -mine) Name them… “I Am A”
- orthostatic hypotension
- @ HS
- Encourage SF hard candies if dry mouth
- Encourage exercise
- monitor CV
- amitriptyline (Elavil)
- amoxapine (Asendin)
- Imipramine (Tofranil)
What are the basic nursing considerations with atypical antidepressants? (-xine, -tine, -pion) Name them… “BVD”
- Give w/ food
- Fluids
- @ HS
- orthostatic hypotension
- venlafaxine (Effexor)
- duloxetine (Cymbalta)
- bupropion (Wellbutrin)
What are the basic nursing considerations with MAOI antidepressants? (-zine, -zid, -mine) Name them… “PIT”
- low-tyramine diet, give w/ food
- Fluids
- @ AM
- orthostatic hypotension
- isocarboxazid (Marplan)
- phenelzine (Nardil)
- tranylcypromine (Parnate)
Signs and symptoms of hypertensive crisis? Seen with what medications?
- occipital H/A 🤕, HTN, N/V, chills, sweating 😰, restlessness, nuchal rigidity, dilated pupils 😳, fever, motor agitation
- When taking MAOIs and ingesting foods with tyramine
Haldol depot injection is in _____ oil and lasts ___ to ___ weeks. Dosing range is ___.
sesame
2-4 weeks
2-20 mg
Risperidone (Risperdal) depot injection dosing range is ____.
5-20 mg
Paliperidone (Invega) depot injection dosing is ____.
6 mg
Lorazepam (Ativan) is used for ___ ___.
alcohol withdrawal
Nursing considerations with use of lorazepam (Ativan) include…
-monitor VS, dizziness, drowsiness
Clonazepam (Klonopin) is used to treat acute ____.
mania
What foods contain tyramine?
- mature/aged cheese
- aged meats
- fava beans, tofu,
- banana peel, overripe fruit
- avocado
- All tap beers
- limit can or bottle beers to 2/day
- limit wine to 4 oz/day
- sauerkraut, soy sauce
- yogurt, sour cream
- peanuts
- brewer’s yeast
- MSGs
What mental health resource offers…
• Taxonomy describing all mental disorders based on clinical research and experience
• Provides standardized nomenclature and language
• Present defining characteristics to differentiate specific diagnoses
• Assist in identifying underlying causes of disorders.
• Nursing – More utilized in advanced practice.
DSM-5
What kind of therapy involves
- talking about trauma, (helpful in rape survivors)
- structured sessions that focus on examining beliefs that are erroneous or interfere with daily life, such as guilt and self-blame.
Cognitive therapy
Theory that states decisions should be based on whether action is morally right or wrong, with no regard for consequences.
Deontological
Ethical right to self-determination, independence.
Autonomy
Ethical duty to benefit others or promote good.
Beneficence
Ethical requirement to do no harm
Nonmaleficence
Ethical fairness
Justice
Ethical honesty, truthfulness
Veracity
Ethical obligation to honor commitments, contracts
Fidelity
T/F? Domestic violence spans families of all ages and from all ethnic, racial, religious, socioeconomic, sexual orientation backgrounds.
true
Which women are at greater risk to be battered?
immigrant and pregnant
The phases of the client-nurse relationship were built upon ____ interpersonal theories.
Sullivan’s
Which phase of the therapeutic Nurse-Client relationship is defined as “engaging the client in treatment”?
Begins when the nurse and client meet and ends with the client beings to identify the problem to examine.
orientation phase
Which phase of the therapeutic Nurse-Client relationship is defined as “begins with patient working interdependently with the nurse”?
identification phase
Which phase of the therapeutic Nurse-Client relationship is defined as “client makes full use of services offered”?
exploitation phase
Which phase of the therapeutic Nurse-Client relationship is defined as “client no longer needs services and gives up dependent behavior”?
resolution phase
What type of communication focuses on the needs, experiences, feelings, and ideas of the client ONLY. Parameters are clear and focus is NOT on the nurse?
Therapeutic communication
What develops when the client believes the nurse will be consistent?
Trust
What mental health term defines when words and actions match?
Congruence
The ability of the nurse to perceive the meanings and feelings of the client and to communicate understanding.
Empathy
Not to be confused with Sympathy (feelings of concern or compassion one shows for another); this often shifts the emphasis to the nurse’s feelings.
By not becoming upset or responding negatively to a client’s outbursts, anger, or acting out shows ____.
acceptance
In the orientation phase the nurse establishes what and builds what?
roles, purpose of the meeting, parameters of subsequent meetings, clarifies expectations (contract), and identifies the client’s problems. Builds TRUST.
Note: Before the meeting gather any information (meds, background, and find a quiet, private, comfortable, and SAFE setting).
Client may be distrustful and exaggerate, act out, or ramble. A positive start likely to succeed in establishing goals.
What orientation tool outlines responsibilities of both nurse and client?
Nurse Client Contract
Note: If the nurse fails to follow through, trust is lost.
Tarasoff vs. Regents of the University of California (1976) – releases professionals from privileged communication with their clients if clients make a homicidal threat. The nurse must report this threat so both police and identified victim can be notified. What is this called?
Duty to Warn
What is it called when we reveal personal information about ourself to the client?
Self-Disclosure
Self-Disclosure is used to convey…
support, educate clients, and demonstrate a client’s anxiety is normal
What part of the Working Phase involves client identifying issues or concerns causing distress?
Phase 1 – Problem Identification
What part of the Working Phase involves the nurse guiding the client to examine feelings and responses and to develop better coping skills and a more positive self-image to encourage independence?
Phase 2 – Exploitation
When client begins to feel uncomfortable because he/she is getting too close to the truth; he/she will use ____ ____ to avoid the subject.
testing behaviors
T/F? The nurse should give advice when using therapeutic communication.
False.
Refrain from giving advice
Which phase is the final stage and begins when the problems are resolved and ends with the relationship ending?
Termination Phase
In the Termination Phase clients may feel this as a loss and act ____ or as if the problem has ____ ____ ____.
angry
not been resolved
____ is diagnosed once thoughts or behaviors consume the person to the point where the thoughts or actions interfere with personal, social, and/or occupational functioning.
OCD
In clients w/ OCD the person realizes that the thoughts/behaviors are _____, but he/she cannot stop/control them.
unreasonable
First line medications to treat OCD include:
SSRIs (fluvoxamine, sertraline)
Second line medication to treat OCD include:
SNRI (venlafaxine)
Treatment-resistant OCD is treated with what 3 second-generation antipsychotics? “ROQ”
risperidone, quetiapine, olanzapine
What 3 critical components are included in normal grieving?
- Adequate perception regarding loss
- Adequate support while grieving for loss
- Adequate coping behaviors during the process.
What type of grief is one that cannot be openly acknowledged, mourned publicly, or supported socially: ie. A relationship has no legitimacy. The loss itself is not recognized. The griever is not recognized.
Disenfranchised Grief
The following are examples of what type of grief?
- Person devoid of emotion
- Grieving for prolonged periods
- Expressions of grief seem disproportionate to event
Complicated Grief
How do you deal with an escalating angry person?
Aggression management:
Take control; provide directions in firm, calm voice
Direct patient to room or quiet area for time-out
Offer medication again
Let patient know aggression is unacceptable; nurse or staff will help maintain/regain control
If ineffective, obtain help from other staff (show of force)
What are the patterns of behavior for someone with PTSD?
- Intense memories of the trauma
- Dreams/nightmares
- Flashbacks
- Intense, recurrent, intrusive thoughts
- Emotional numbing
- Increased irritability
- Hyperarousal; being on guard, irritable
What are the risk factors for developing PTSD?
- Directly involved in the traumatic event
- Experiences of physical injury
- Loss of loved one(s)
- Lack of social supports
- Pervious psychiatric history or personality factors.
Nursing considerations for client with PTSD include:
- Help them to refocus their view of themselves from being a victim to being a survivor
- Psychotherapy (individual or group)
- Medications (antidepressants, anxiolytics, sleep aids)
- Self-help groups
- Exposure therapy
- Relaxation techniques
- Adaptive disclosure
- Cognitive processing therapy
What type of therapy for PTSD allows the client to regain a measure of control over their thoughts and feelings?
Exposure therapy
What type of therapy for PTSD was developed by the military to offer an intense, specific, short term therapy for active-duty personnel with PTSD?
Adaptive disclosure
What type of therapy for PTSD allows the client to talk about trauma (helpful in rape survivors), are structured sessions that focus on examining beliefs that are erroneous or interfere with daily life, such as guilt and self-blame?
Cognitive processing therapy
What are the five stages of grieving according to Kubler-Ross’ theory?
DAB-DA
Denial Anger Bargaining Depression Acceptance
Name that ego defense mechanism:
Person who cheats on a spouse brings the spouse a bouquet of roses.
Undoing
Exhibiting acceptable behavior to make up for or negate unacceptable behavior
Name that ego defense mechanism:
Student decides not to think about a parent’s illness to study for a test.
Woman tells a friend she cannot think about her son’s death right now.
Suppression
Conscious exclusion of unacceptable thoughts and feelings from conscious awareness
Name that ego defense mechanism:
Nurse is too busy with tasks to spend time talking to a dying patient.
Person attends court-ordered treatment for alcoholism but refuses to participate
Resistance
Overt or covert antagonism toward remembering or processing anxiety-producing information
Name that ego defense mechanism:
Woman has no memory of the mugging she suffered yesterday.
Woman has no memory before age 7, when she was removed from abusive parents.
Repression
Excluding emotionally painful or anxiety-provoking thoughts and feelings from conscious awareness
Name that ego defense mechanism:
Woman who never wanted to have children becomes a supermom.
Reaction formation
Acting the opposite of what one thinks or feels
Name that ego defense mechanism:
Nurse with low self-esteem working double shifts so her supervisor will like her
Compensation
Overachievement in one area to offset real or perceived deficiencies in another area
Name that ego defense mechanism:
Teenager forbidden to see X-rated movies is tempted to do so by friends and develops blindness, and the teenager is unconcerned about the loss of sight.
Conversion
Expression of an emotional conflict through the development of a physical symptom, usually sensorimotor in nature
Name that ego defense mechanism:
Waiting 3 days to seek help for severe abdominal pain
denial
Failure to acknowledge an unbearable condition; failure to admit the reality of a situation or how one enables the problem to continue
Name that ego defense mechanism:
Child who is harassed by a bully at school mistreats a younger sibling
displacement
Ventilation of intense feelings toward persons less threatening than the one who aroused those feelings
Name that ego defense mechanism:
Never learning to delay gratification
Fixation
Immobilization of a portion of the personality resulting from unsuccessful completion of tasks in a developmental stage
Name that ego defense mechanism:
Adult remembers nothing of childhood sexual abuse.
Dissociation
Dealing with emotional conflict by a temporary alteration in consciousness or identity
Name that ego defense mechanism:
Nursing student becoming a critical care nurse because this is the specialty of an instructor she admires
Identification
Modeling actions and opinions of influential others while searching for identity, or aspiring to reach a personal, social, or occupational goal
Name that ego defense mechanism:
Person shows no emotional expression when discussing serious car accident.
Intellectualization
Separation of the emotions of a painful event or situation from the facts involved; acknowledging the facts but not the emotions
Name that ego defense mechanism:
Person who dislikes guns becomes an avid hunter, just like a best friend.
Introjection
Accepting another person’s
attitudes, beliefs, and values as one’s own
Name that ego defense mechanism:
Man who has thought about same-gender sexual relationship, but never had one, beats a man who is gay.
Projection
Unconscious blaming of unacceptable inclinations or thoughts on an external object
Name that ego defense mechanism:
Student blames failure on teacher being mean.
Man says he beats his wife because she doesn’t listen to him.
Rationalization
Excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-respect
Name that ego defense mechanism:
A 5-year-old asks for a bottle when new baby brother is being fed.
Man pouts like a 4-year-old if he is not the center of his girlfriend’s attention.
Regression
Moving back to a previous developmental stage to feel safe or have needs met
Name that ego defense mechanism:
Person who has quit smoking sucks on hard candy when the urge to smoke arises.
Person goes for a 15-minute walk when tempted to eat junk food.
Sublimation
Substituting a socially acceptable activity for an impulse that is unacceptable
Name that ego defense mechanism:
Woman who would like to have her own children opens a day care center.
Substitution
Replacing the desired gratification with one that is more readily available
Name that ego defense mechanism:
Exhibiting acceptable behavior to make up for or negate unacceptable behavior
Undoing
Name that ego defense mechanism:
Conscious exclusion of unacceptable thoughts and feelings from conscious awareness
Suppression
Name that ego defense mechanism:
Overt or covert antagonism toward remembering or processing anxiety-producing information
Resistance
Name that ego defense mechanism:
Excluding emotionally painful or anxiety-provoking thoughts and feelings from conscious awareness
Repression
Name that ego defense mechanism:
Acting the opposite of what one thinks or feels
Reaction formation
Name that ego defense mechanism:
Overachievement in one area to offset real or perceived deficiencies in another area
Compensation
Name that ego defense mechanism:
Expression of an emotional conflict through the development of a physical symptom, usually sensorimotor in nature
Conversion
Name that ego defense mechanism:
Failure to acknowledge an unbearable condition; failure to admit the reality of a situation or how one enables the problem to continue
Denial
Name that ego defense mechanism:
Ventilation of intense feelings toward persons less threatening than the one who aroused those feelings
Displacement
Name that ego defense mechanism:
Immobilization of a portion of the personality resulting from unsuccessful completion of tasks in a developmental stage
Fixation
Name that ego defense mechanism:
Dealing with emotional conflict by a temporary alteration in consciousness or identity
Dissociation
Name that ego defense mechanism:
Modeling actions and opinions of influential others while searching for identity, or aspiring to reach a personal, social, or occupational goal
Identification
Name that ego defense mechanism:
Separation of the emotions of a painful event or situation from the facts involved; acknowledging the facts but not the emotions
Intellectualization
Name that ego defense mechanism:
Accepting another person’s attitudes, beliefs, and values as one’s own
Introjection
Name that ego defense mechanism:
Unconscious blaming of unacceptable inclinations or thoughts on an external object
Projection
Name that ego defense mechanism:
Excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-respect
Rationalization
Name that ego defense mechanism:
Moving back to a previous developmental stage to feel safe or have needs met
Regression
Name that ego defense mechanism:
Substituting a socially acceptable activity for an impulse that is unacceptable
Sublimation
Name that ego defense mechanism:
Replacing the desired gratification with one that is more readily available
Substitution
