Mental Final Flashcards
What is the most important factor when providing therapeutic communication to pts with a mental illness?
Using open therapeutic technique and meeting them where they are at in a nonjudgmental regard
What should a a nurse do if a pt asks about personal information?
Redirect the patient back to the line of questioning
What is a token economy?
Using “tokens” to reward positive behavior by trading them for privileges, especially in the hospital setting.
Compensation
Overachievement in one area to offset real or perceived deficiencies in another area.
Conversion:
Expression of an emotional conflict through the development of a physical sx, usually sensorimotor
Denial:
Failure to acknowledge an unbearable condition; failure to admit the reality of a situation or how one enables the problem to continue
Displacement:
Ventilation of intense feelings toward persons less threatening than the one who aroused those feelings
Dissociation:
Dealing with emotional conflict by a temporary alteration in consciousness or identity
Fixation:
Immobilization of a portion of the personality resulting from unsuccessful completion of tasks in a developmental stage
Identification:
Modeling actions and opinions of influential others while searching for identity, or aspiring to reach a personal, social, or occupational goal
Intellectualization:
Separation of the emotions of a painful event or situation from the facts involved; acknowledging the facts but not the emotions
Introjection:
Accepting another person’s attitudes, beliefs, and values as one’s own
Projection:
Unconscious blaming of unacceptable inclinations or thoughts on an external object
Rationalization:
Excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-respect
Reaction Formation:
Acting the opposite of what one thinks or feels
Regression:
Moving back to a previous developmental stage to feel safe or have needs met
Repression:
Excluding emotionally painful or anxiety-provoking thoughts and feelings from conscious awareness
What is milieu therapy?
“the total environment and its effect on the patient’s treatment”
What is the purpose/benefit of partial hospitalization programs?
Programs are designed to help client’s in a gradual transition from being inpatient to living more independently and to prevent readmission
Why are multidisciplinary teams important in mental healthcare?
Multidisciplinary approach = multifaceted level of care and meeting the patient’s needs more effectively
What are examples of advocating for a client?
Ensuring privacy and dignity. The process of acting on the client’s behalf. Informed consent.
What is boundary blurring?
When the nurse-patient relationship becomes blurred as the nurse did not maintain the boundaries set in the orientation phase.
What is the first priority of the orientation phase?
Building a rapport and opening lines of communication to establish a trusting relationship
What is assertiveness training?
“I” statements. Communicating both negative and positive emotions in an open and direct manner
What is the best way to communicate to a client during severe anxiety?
Patient’s in a severe anxiety attack cannot respond to external stimuli. The nurse can sit with the patient and wait for their anxiety to decrease to a more manageable level.
What is resilience?
Having healthy responses to stressful circumstances or risky situations
What is culturally competent care?
Being sensitive to issues related to race, ethnicity, culture, sexual identity and orientation, as well as socioeconomic situation
What should a nurse do when attempting to provide culturally competent care to a client from a different racial or cultural group?
A nurse should always check their own bias while striving to give equitable and culturally competent care to all patients.
What do affect, blunted affect, flight of ideas, judgement, and insight mean?
Affect: the outward expression of the patient’s emotional state
Blunted Affect: showing little or a slow-to-respond facial expression
Flight of Ideas: excessive amount and rate of speech composed of fragmented or unrelated ideas
Judgement: the ability to interpret one’s environment and situation correctly and to adapt one’s behavior and decisions accordingly
Insight: the ability to understand the true nature of one’s situation and accept some personal responsibility for that situation
Suppose a nurse learns a client hasn’t been taking their medication. What should their initial response be?
Ask the client why they’ve stopped their medication and educate them on the importance of medication compliance.
What might be a sign that a client is hallucinating?
The client cannot focus on their surroundings or external conversations, they admit to hearing or seeing things, they’re having one sided conversations.
Suppose a client is involuntarily hospitalized because they are a danger to others. What rights does the patient lose?
The patient loses the right to autonomy/free will/right to refuse care
What is autonomy? What is an example of a nurse advocating for it?
A patient’s right to self-determination.
Making the client a part of their own care team/the patient reserves the right to refuse meds/treatment.
What are Kubler-Ross’s stages of greiving?
Denial, Anger, Bargaining, Depression, and Acceptance
What is disenfranchised grief?
When a person experiences nonconventional loss or is grieving an unconventional loss. Like a nurse that loses a number of patients, but is expected to be fine.
What are behavior limits and when are they needed?
Behavior limits are boundaries of what is acceptable behavior in the nurse-patient relationship
- State the behavioral Limit
- Identify consequences for exceeded limit
- Identify expected or desired behavior
What should a nurse do if a verbally aggressive client refuses to take a time out? What’s the next step?
Call for backup (show of force) and ensure safety of other patients
Examples of therapeutic responses to a rape victim
“You have the right to be safe and respected.”
“This is not your fault.”
What should the nurse do if they suspect a child is being abused?
Nurses are mandated reporters. They must report suspected abuse immediately.
When might a nurse recommend a women’s shelter?
In instances of suspected or evidenced domestic abuse.
What are the s/sx of PTSD?
Flashbacks, deteriorated memory, nightmares, and intrusive thoughts.
What childhood experiences sometimes present in client’s with DID?
Childhood sexual and/or physical abuse
What is the priority when caring for a client who was recently sexually abused?
Assist the patient in finding a safe space and work at their pace. Give back as much control as possible
Who can develop PTSD?
Anyone who has experienced a traumatic event can develop PTSD but it is most common in soldiers and adults that suffered childhood abuse.
If a client is experiencing panic, what is the nurse’s priority intervention?
The client has no capacity for rational thought or ability to perceive harm. The nurse can try to calm them to a more manageable state of anxiety or wait it out.
If inpatient, they might have PRN antianxiety meds
What are activities and therapies that a nurse can recommend to help relieve stress?
Positive reframing, assertiveness training, and decatastrophizing.
What are the different levels of anxiety?
Mild, moderate, severe, and panic.
What are the main sx of OCD?
Repetitive thoughts and behaviors (reward seeking and self soothing)
Sx of psychosis such as Thought Blocking, Thought Insertion, and Thought Broadcasting?
Thought blocking: when the patient suddenly stops talking for several seconds.
Thought insertion: the patient states that others are placing thoughts in their head against their will.
Thought broadcasting: the patient believes that others can hear the thoughts in their head.
What are the sx of NMS?
It is characterized by muscle rigidity, high fever, increased CPK, and increased WBCs.
What is akathisia?
Restless movement such as pacing. Patient is restless inside and out. A side effect of antipsychotics or antianxiety medication
What is tardive dyskinesia?
A late appearing side effect of antipsychotic medication. Characterized by abnormal involuntary movements (lip smacking, chewing, blinking, grimacing etc). It is irreversible but sx can be decreased.
What labs do you check if your client is taking clozapine?
Clozapine is an atypical 2ng gen antipsychotic. Check WBC and absolute neutrophil count (ask about fever, sore throat, or infection looking out for agranulocytosis).
What medications can be given to a client who is psychotic (hallucinating) and anxious/agitated?
Haldol and Lorazepam
What is pressured speech? What mental disorder is it associated with?
Pressured speech = unrelenting, rapid, often loud talking without pauses. It is often associated with bipolar disorder 1.
What is the goal of cognitive behavioral therapy when treating depressed clients?
CBT aims to help you identify and challenge unhelpful thoughts and to learn practical self-help strategies.
Why are TCAs (e.g., imipramine) dangers to give to suicidal patients?
TCAs are more toxic in overdoses that SSRIs and can worsen suicidal ideation.
What are the key fts of conduct disorder and what personality disorder is associated with it?
Characterized by persistent behavior that violates societal norms, rules, laws, and the rights of others. The associated personality disorder is antisocial disorder (in adults).
What are key symptoms of histrionic disorder? How would a nurse help a client prepare for a job interview?
Characterized by a pervasive pattern of excessive emotionality and attention-seeking. Found in 1-3% of the general population. Speech is usually colorful and theatrical and full of superlative adjectives. Role play the interview experience to better prepare the patient.
What are the key symptoms of narcissistic personality disorder?
Pervasive patterns of grandiosity, need for attention, and lack of empathy. Patients may be arrogant or haughty. Insight is limited or poor.
Why is maintaining boundaries so important when working with clients with borderline personality disorder?
It is important to set realistic expectations in the nurse-patient relationship and to be consistent in limiting negative behavior.
What is the best psychotherapy for clients with substance abuse disorder? (Hint: think about AA).
12 step programs and other anonymous support groups are best psychotherapy for substance abuse patients
What happens if a client taking disulfiram (Antabuse) drinks alcohol?
Patients taking disulfiram will be ill and vomit when drinking alcohol.
Why is methadone prescribed to clients addicted to opioids (e.g., heroin)? What is the purpose of it?
Methadone is a synthetic opiate use to keep heroin users from detox without the high.
What are the key features of anorexia nervosa and bulimia? Can you differentiate the two?
Russel’s signs with normal BMI are indicative of bulimia nervosa while low BMI is anorexia nervosa.
What is the top priority when caring for a client hospitalized for anorexia nervosa? (Hint: think about cardiovascular status and electrolytes).
Anorexia nervosa patients have bradycardia and depressed electrolytes.
What treatment works best for bulimia nervosa?
The best treatment for bulimia nervosa is CBT.
Why should a nurse observe a client with anorexia nervosa after meals?
Anorexia nervosa patients must be observed so that they do not purge after meals.
Suppose a client has conversion disorder. How might they feel about their symptoms? (Answer: not very upset; indifferent).
Patients have unexplained sudden deficits in sensory or motor fx and don’t care about it.
What are key nursing interventions for a client with conversion disorder?
Involve patient in activities, focus on work or home situations and relationships, and evaluate medication.
What is Munchausen syndrome?
Factitious Disorder. When a person inflicts illness or injury on themselves to gain attention of emergency personnel.
What is Munchausen by proxy?
AKA Factitious Disorder by proxy. In 95% of cases, mothers inflict illness or injury on their children
How should a nurse respond to a client with a history of somatic symptom disorder if they present with a new complaint?
Always take patient’s concerns seriously but redirect and inform providers.
What is malingering?
The intentional production of false or grossly exaggerated physical or psychological sxs motivated by external incentive such as avoiding work or criminal prosecution, obtaining financial compensation or getting drugs.
What are key symptoms of autism?
Stereotyped motor disorders such as delayed speech, not making eye contact, obsessive interests, and lack of interest in other things.
What are some key nursing interventions for a client with ADHD experiencing too much weight loss?
High calorie portable snacks and giving medication at mealtimes.
Why should ADHD medication be kept in a safe place?
It is a controlled substance with a high street value.
What evidence-based therapy works well for Tourette’s disorder
Risperidone and CBT to work opposite the tics.
What are the key features of oppositional defiant disorder and conduct disorder? Can you recognize them?
Uncooperative, defiant, disobedient, and hostile behavior towards authority figures without major social violations.
How should you communicate with clients with dementia?
Communicate clearly and give simple directions. Use hand gestures, speak slowly, and approach from the front.
Resistance:
Overt or covert antagonism toward remembering or processing anxiety-producing information
Sublimation:
Substituting a socially acceptable activity for an impulse that in unacceptable
Substitution:
Replacing the desired gratification with one that is more readily available
Suppression:
Conscious exclusion of unacceptable thoughts and feelings from conscious awareness
Undoing:
Exhibiting acceptable behavior to make up for or negate unacceptable behavior
