Mental Health Final (Blueprint)

Question 1

What is stigmatization of mental illness?
How does it affect individuals with mental illness and their families?

Answer 1

• Stigmatization in mental health - is when someone with a mental illness is called ‘dangerous’, ‘crazy’ or ‘incompetent’ rather than unwell, it is an example of a stigma. It’s also stigma when a person with mental illness is mocked or called weak for seeking help. Stigma often involves inaccurate stereotypes.
• This causes the mentally ill patients to stay away from the public and even refuse ti take their medications because of the stigma.
• We should say “People who have Bipolar or Schizophrenia.”

Question 2

Define mental health and illness. How are they different from each other?

Answer 2

• Mental Healthy - is a dynamic state of internal equilibrium (balance) which enables individuals to use their abilities in harmony with universal values of society.
• Mental Illness - a syndrome characterized by clinically significant disturbance in an individuals cognition, emotion regulation or behavior that reflects a dysfunction in the psychological, biological, or developmental process underlying mental function.
• Mental Disorders - Are usually associated with significant distress in social, occupation or other important activities.

Question 3

What interventions are effective for managing aggressive clients in mental health settings?

Answer 3

• Avoid touching the client that are angry and anxious.
• Set clear boundaries, describe the consequences and always follow through.
• keep a safe distance (Anger distance x 2)
• Ensure no one is blocking the doorway.
• Ensure sufficient staff is present.
• Use the least restrictive means possible (PRN meds, time out, then Open seclusion).

Question 4

What is meant by the least restrictive means in mental health treatment?
How is it related to involuntary admission criteria?

Answer 4

• Least Restrictive measure - using less invasive ways before using Restraints and Seclusion.
• The least restrictive means possible such as :-
  * PRN meds
  * Verbal instructions
  * Warnings
  * Interventions
  * Diversions/Redirections
• Patient who are involuntarily admitted still retain all their rights such as:-
  * Use of least restrictive measures.

Question 5

What are the criteria for involuntary admission of a patient to a mental health facility?
When is involuntary admission considered?

Answer 5

• Criteria for involuntary admissions include:-
  * Presence of mental illness.
  * Pose a danger to self or others.
  * Requires treatment but is unable to seek it voluntarily.
  * Demonstrates severe disabilities or inability to meet basic needs E.g (Clothing, Food, Shelter).
• When a client is a danger to :-
  * Self
  * Other

Question 6

Explain the CBT approach to treating mental health disorders.
What are some of the most common CBT interventions?

Answer 6

• CBT (Cognitive Behavioral Therapy) - is a talking therapy that can help you manage Mental health problems by changing the way they think and behave. It’s most commonly used to treat anxiety and depression.
• Common CBT interventions include:-
  * Education - (The Therapists aims to teach the client to be his or her own therapist.)
  * Socratic questioning - (This is the technique of asking a series of focused but open ended questions that help clients discover unrecognized deeply held beliefs and values that are impacting the client.)
  * Assertiveness training - (Some clients need help standing up for themselves and creating healthy boundaries. Assertiveness training teaches client how to stick up for themselves without becoming overly aggressive.)

Question 7

What are the various ego defense mechanisms?
How do they impact an individual’s mental health and well-being?

Answer 7

1) Conversion
Converting strong emotional stress into a physical symptom.

2) Denial
Not acknowledging reality because it is too painful or difficult.

3) Dissociation
Temporarily losing your connection to the outside world to escape the pain.

4) Projection
Attributing your own unacceptable thoughts, feelings, or behaviors to someone else.

5) Rationalization
Justifying unacceptable feelings or behavior by giving excuses.

6) Regression
Returning to childlike, immature behaviors during a time of stress.

7) Repression
Unknowingly pushing an unpleasant thought or memory out of your consciousness.

8) Splitting
Seeing people, situations, or events as either completely good or completely evil.

9) Sublimation
Redirecting unacceptable drives or passions into socially acceptable forms.

Question 8

What are some effective treatments for phobias?
How do these treatments work?

Answer 8

• Systemic Desensitization (Exposure therapy).
• A technique in which therapists help clients extinguish phobias by experiencing increasingly anxiety-provoking situations. Typically relaxation techniques are practiced during these exposures.
• Relaxation techniques (reciprocal inhibition)
• Teaching clients proven techniques that decrease anxiety and stress (e.g., deep breathing, progressive muscle relaxation, meditation, etc.).

Question 9

What are the therapeutic factors described by Carl Rogers?
How can they be applied to mental health treatment?

Answer 9

• Carl Rogers - Talked about Therapeutic climate such as:-
  * Genuineness - need to be real and transparent with the client.
  * Unconditional positive regard - Have a genuine, caring, acceptance, prizing and love for the client.
  * Empathy - Change can occur if you understand the inner world of the client (see the world through the client’s eyes).

Question 10

Explain the concept of motivational interviewing.
How is it used in mental health treatment?

Answer 10

• Motivational interviewing (MI) - its an alternative to the 12-step framework (e.g., Alcoholics Anonymous).
• It’s based on the idea that the harder you push someone to change, the harder they will resist your efforts.
• Its highly effective in treating addictions and motivating people to make positive lifestyle changes (e.g., dieting, exercise).
• It has been used most extensively to treat substance use problems.

Question 11

How can therapeutic communication be used to support grieving clients?
What are some key principles of therapeutic communication in this context?

Answer 11

-Don’t speak; be present
- Listen
- Take action instead of giving false promise
- Express compassion and care

Question 12

What are the key components of the mental status exam?
How can these be used to assess a patient’s mental health?

Answer 12

• Major components of the mental status exam:-
  * Level of consciousness (Alert, lethargic, stuporous, comatose)
  * Physical appearance
  * Behavior (Mood and affect)
  * Cognitive and intellectual abilities
  - Cognitive is mostly used for dementia patients. (Place, time, person, date)

Question 13

What are the prodromal signs of aggression?

Answer 13

• Prodromal signs of aggression:-
  * Defiant affect
  * Rigid posture
  * Clenched fist and jaw
  * Agitation
  * Pacing
  * Slamming
  * Pounding
  * Talking loudly and rapidly
  * Using profanity
  * Making threats

Question 14

How can these prodromal signs of aggression be used to prevent aggressive behavior in mental health settings?

Answer 14

• Use a calm caring voice.
• Set limits and identify consequences
• Tell the client you are concerned and would like to listen (e.g., “You seem upset, can you tell me what’s going on?”).
• Seek to understanding what is behind the anger/aggression.
• Reduce stimulation and loud noise.
• Respect the client’s personal space. (“Anger = Distance x 2”)
• Give the client options (e.g., time out, PRN medication, walk outdoors).
• Attempt to redirect attention to a pleasurable activity (e.g., eating a snack, soft music, sports/leisure activity).

Question 15

Explain the concept of limit setting. How is it used in mental health treatment?

Answer 15

• Nurses set limits on unacceptable behavior. They do this by:-
  * Using a calm, matter-of-fact tone.
  * Using clear, understandable terminology.
  * Explaining what the consequence will be if the behavior is continued.
  * Ensuring consistency among staff in explaining and enforcing these limits.

Question 16

What are some nursing interventions that can be used to manage mania in mental health patients?

Answer 16

• Decrease environmental stimuli (e.g., low lighting, low noise, fewer people) when clients are manic. Do not, however, isolate a client.
• Assess for suicidal and homicidal thoughts.
• Remove all dangerous objects when clients are agitated, confused, or suicidal.
• Assess for illicit drug use. Substances can increase the risk of harm and make medication management more difficult.
• Maintain a calm demeanor and tone of speech. Remember that anxiety can be contagious.
• Set limits on dangerous and manipulative behaviors.
• Listen to and act on legitimate complaints.
• Avoid power struggles; don’t become emotional.
• Provide outlets for physical energy (e.g., exercise, punching bag).
• Clients experiencing mania have increased caloric needs and may have difficulty sitting down to eat meals. Monitor nutritional status. Provide frequent high-protein, high-calorie, portable foods and drinks. ⭐
• Promote good sleep hygiene and limit caffeine use during manic episodes. Remember to provide frequent rest periods during the day too. ⭐

Question 17

What are Kübler-Ross’s stages of grief?
How can they be applied to mental health treatment?

Answer 17

• Use the mnemonic “DABDA”
• Denial
• Anger
• Bargaining
• Depression
• Acceptance

Question 18

What are some effective suicide assessment strategies? What are covert statements? How should a nurse respond to them?

Answer 18

• Use the Mnemonic “IS PATH WARM”
• Ideation
• Substance abuse
• Purposelessness
• Anger
• Trapped
• Hopelessness
• Withdrawing
• Anxiety
• Recklessness
• Mood shifts
• History of previous attempts

Question 19

Nursing Interventions of suicide.

Answer 19

• Pay attention to indirect (also called “covert”) statements (e.g., “I don’t have anything worth living for anymore.” Or “I wish I could fall asleep and never wake up.”). Assess for suicidal ideation when you hear statements like these. ⭐
• A sudden improvement in a client’s mood can indicate the client intends to commit suicide in the near future. ⭐

Question 20

What interventions are effective for managing panic attacks in mental health patients?

Answer 20

• Stay with the client and offer reassurance. Don’t leave a client who is experiencing severe or panic anxiety alone.
• Anxiety is contagious; remain calm. Use a matter-of-fact approach.
• Use simple words and phrases. During intense anxiety, clients are unable to focus and are unable to comprehend complicated speech.
• Reduce environmental stimuli (e.g., decrease the number of people in the room, turn the TV off, dim the lighting).
• Hyperventilation can be treated by having the client breathe into a small paper bag. This helps the client retain more carbon dioxide (CO2), relieving many of the panic attack symptoms.
• Administer prescribed fast-acting PRN anxiolytic medication (e.g., a benzodiazepine).
• When the client is calm and receptive to learning, reinforce teaching on ways to halt anxiety attacks (e.g., relaxation techniques, deep breathing exercises, meditation, exercise).

Question 21

What interventions are effective for managing PTSD flashbacks in mental health patients?

Answer 21

• Stay with the client during flashbacks and nightmares.
• Be calm and matter-of-fact.
• Reassure the client that he or she is safe. ⭐

Question 22

What are some signs and symptoms of schizophrenia?

Answer 22

• Positive Symptoms of Schizophrenia:-
  * Hallucinations (Auditory, Command & visual)
  * Delusion (delusion of control, Grandeur, persecusion, Reference, Somatic.)
• Negative Symptoms of Schizophrenia:-
  * Affective flattening
  * Alogia
  * Anergy
  * Avolition
  *Anhedonia
• Cognitive Symptoms of Schizophrenia:-
  * Loose association
  * Word Salad
  * Decreased ability to think abstractly
  * Concrete thinking
  * Attention deficits
  * Memory loss

Question 23

What interventions are effective for managing clients who hear voices in their heads?

Answer 23

• Assess the hallucinations’ content (e.g., “What do you hear the voices saying?”). This can help you determine the client’s emotional reaction to the voices and may help prevent aggressive responses.
• Command hallucinations can easily lead to dangerous behaviors if the client has poor insight or believes the commands must be obeyed. In general, you should consider command hallucinations a potential psychiatric emergency.
• Show empathy, but do not reenforce the hallucinations. For example, you might say, “That must be frightening for you to hear that. I do not hear those voices.”
• Direct clients’ attention away from hallucinations by encouraging them to engage with other people and activities. Listening to music or watching TV may be helpful.
• Do not directly dispute a hallucination or delusion, but do not reinforce them either. Focus your attention on the client’s underlying emotion (e.g., anxiety, feelings of low self-worth), but politely indicate that you do not share the experience or belief.

Question 24

What are some signs and symptoms of antisocial personality disorder?

Answer 24

• Manipulation
• Lying
• Selfish
• Ruthless
• Cheating
• Violent behavior
• Stealing from others
• Destroying other peoples things
• Low tolerance for frustration
• The have an “every man for himself & survival of the fittest” worldview
• They prey on the weak, poor, elderly intellectually disable

Question 25

What interventions are effective for managing antisocial personality disorder?
What are some key principles of this approach?

Answer 25

• Clients with antisocial personality disorder can be difficult to care for. Don’t allow yourself to have personal “triggers.” Monitor your thoughts and emotions. Watch out for countertransference.
• Remember to convey unconditional positive regard. Maintain the attitude that it is not the person but his or her behavior that is unacceptable.
• Observe the client’s behavior frequently. Remove dangerous objects from the environment.
• Set clear limits on unacceptable and manipulative behavior. Remember to use a calm, matter-of-fact tone. Use clear, understandable terminology. Explain what the consequence will be if the limits are broken.
• Ensure consistency among staff in explaining and enforcing these limits.
• Give positive feedback when clients behave appropriately.
• Clients with antisocial personality disorder often misuse the ego defense mechanism of displacement. Help clients realize this and recognize the real source of their anger.
• Encourage clients to express their anger in healthy ways (e.g., assertive communication, punching bag, jogging, exercise bike).
• Ensure sufficient staff is available to present a “show of strength” if necessary. Remember to use the least restrictive means necessary.

Question 26

What are the characteristics of delirium?

Answer 26

• Characteristics of Delirium are:-
  * Disoriented to time and place.
  * Emotions are very labile (unstable).
  * Difficulty focusing and being attentive.
  * Easily destructed by environmental stimuli such as (Noise and movements).
  * Perceptual distortion (illusion or hallucinations).

Question 27

What nursing interventions are effective for managing delirium in mental health patients?

Answer 27

• Delirium is usually reversible if diagnosis and treatment are prompt.
• Risk for self-harm is high; safety is paramount.
  * Keep clients’ beds in a low position.
  * Assign them rooms near the nurse’s station.
  * Assist with ambulation and remove fall hazards.
• Closely monitor clients who wander. Make sure the exits are electronically controlled. If a client is wandering, walk with them a short distance and then gently redirect them.
  Ensure clients’ basic physiological needs are being met (i.e., sleep, nutrition, hydration).
• Ensure adequate lighting. Have clients wear their eyeglasses and hearing aids.
• Eliminate unnecessary environmental noise. Intensive care units are excessively noisy.
• Create a calm, quiet environment—especially at night.
• Remove or cover objects that startle or cause illusions (e.g., fabric with patterns, pictures of faces, mirrors).
• Speak with a calm, reassuring tone.Remember that anxiety is contagious.
• Introduce yourself each time you encounter clients. Refer to clients by their names. Explain what you are doing. Approach from the front.
• Assign consistent caregivers. This may help minimize confusion.
• Communicate clearly: use simple words, speak slowly, and use hand gestures. Ask only one question at a time.

Question 28

What nursing interventions are effective for managing dementia in mental health patients?

Answer 28

• The risk for self-harm is high; safety is paramount. Keep clients’ beds in a low position.
• Ensure a well-lit environment. Have clients wear their eyeglasses and hearing aids.
• Unlike other disorders, it’s not always therapeutic to re-orient clients with advanced dementia. If a client is looking for their deceased spouse, it’s best just to redirect them and engage them in conversation. For example, you might talk to the client about activities they enjoyed with their partner.
• Display large clocks and calendars. Place large signs on doors.
• Allow the client to have as many familiar objects as possible.
• Utilize reminiscence therapy (i.e., discussion of past events using tangible objects such as photographs).
• Provide frequent, regular bathroom trips.
• Provide diversion activities (e.g., familiar music, TV shows, simple games, low-impact exercise).

Question 29

How should controlled substances misuse be reported in the workplace?
What are some key principles of this process?

Answer 29

• Report concerns to the Supervisor.

Question 30

What are some physical signs and symptoms of anorexia and bulimia nervosa?
How can these be used to diagnose and treat these disorders?

Answer 30

• Signs and symptoms of Bulimia.
  * Dental erosion
  * Enlarged of the parotid gland
  * Scarring of the knuckles (Russell sign)
  * Metabolic Alkalosis
  * Tachycardia
• Signs and symptoms of Anorexia.
  * Amenorrhea
  * BMI < 17
  * Lanugo
  * Hypotension
  * Hypothermia
  * Bradycardia
  * Low bone density
  * Low growth & development
  * Yellow pigmentation
  * Peripheral Edema

Question 31

What are some signs and symptoms of conversion disorder?
How can these be used to diagnose and treat this disorder?

Answer 31

• Conversion disorder - Clients have neurological symptoms that can’t be explained medically. These symptoms cause significant distress or impairment.
• Signs and symptoms of Conversion disorder.
  * Seizures
  * Paralysis
  * Speech difficulty
  * Blindness
• Treatment options are:-
  * CBT
  * Anti-depressants

Question 32

What interventions are effective for managing intellectual disability in mental health patients?

Answer 32

• Maintain a safe environment. Watch out for sharp objects, choking hazards, and fall risks.
• Promote as much autonomy in self-care as possible.
• When teaching self-care tasks, use simple, concrete speech. Focus on one learning need at a time. Teach one step at a time. Give positive reinforcements.
• Clients with communication deficits may become agitated and aggressive when their needs are unmet. Try to learn the nonverbal signs that a client is becoming upset and respond early.
• Seek to learn the clients’ nonverbal and idiosyncratic communication patterns. Ask the primary caregiver(s) for guidance.

Question 33

What interventions are effective for managing ADHD in mental health patients?
What are some key principles of this approach?

Answer 33

• Convey unconditional positive regard toward clients. Emphasize that it is not the client but certain behaviors that are unacceptable.
• Set limits on unacceptable behaviors. Explain the consequences in a matter-of-fact manner. Ensure consistence among staff members enforcing these limits.
• Ensure that goals for the client are realistic. Ask clients to repeat instructions back to you.
• Break complicated tasks into individual steps. Provide positive reinforcements each time a step is completed. Gradually decrease the amount of assistance you provide.
• Try to reduce distractions while clients are completing tasks.
• Involve clients in group situations. Clients can learn appropriate social behaviors from others. Group members can also provide important positive and negative feedback.

Question 34

What are the toxicity risks associated with TCAs?

Answer 34

• Suicide ideation
• Cardio toxicity
• Orthostatic hypotension.
• Lethal overdose
• Anticholinergic effects (Can’t see, pee, spit, defecate)

Question 35

What is tardive dyskinesia?
How can it be managed in mental health patients?

Answer 35

• Tardive dyskinesia - A movement disorder that can occur as a side effect of long-term use of antipsychotic medications, such as haloperidol.
• Signs and symptoms of tardive dyskinesia include-
  * Involuntary movements of the tongue, lips, and jaw.
  * May progress to involve the limbs and trunk.
• Consider switching to a lower-potency antipsychotic medication or discontinuing the medication if tardive dyskinesia develops.

Question 36

What are the effects and side effects of benzodiazepines?
How can these be managed in mental health patients?

Answer 36

• Side effects of of Benzodiazepines are:-
  * Hepatotoxicity
  * Dependance
  * Withdrawal
  * Sedation
  * Drug interaction
• Monitor LFT before and after giving the medications.
• Advise patients to avoid Alcohol.

Question 37

What is the relationship between ADHD medication and growth suppression?
What are some key principles of managing this issue in mental health patients?

Answer 37

• We give ADHD patients CNS Stimulants (methy..) and they can reduce the appetite, causing weight loss and growth suppression.

Question 38

What is serotonin syndrome? What are the signs and symptoms of this syndrome, and how can it be managed in mental health patients?

Answer 38

• Serotonin Syndrome - A rare but potentially life-threatening condition that can be caused by several classes of psychotropic medications.
• Signs and symptoms of serotonin syndrome include :-
  * Agitation
  * Confusion
  * Tachycardia
  * Hyperthermia
  * Diaphoresis
  * Myoclonus
  * Shivering.
• Discontinue the medication when you start experiencing this syndrome.

Question 39

What are the signs and symptoms of neuroleptic malignant syndrome (NMS)? How can it be managed in mental health patients?

Answer 39

• Signs and symptoms of neuroleptic malignant syndrome (NMS) are:-
  * Fever
  * Elevated WBC, CPK
  * Vitals signs (Elevated)
  * Encephalopathy (Altered mental status)
  * Rigidity

Question 40

Why is monitoring necessary when using clozapine?
What are some key monitoring considerations?

Answer 40

• Agranulocytosis
  * Fever
  * Sore throat
  * Mouth sores
• The Interventions are :-
  * Monitor CBC with differential regularly.
  * Assess for signs of infection.
  * Discontinue the meds if the Neutrophil count is less than 1500/mm3

Question 41

What is mandatory reporting of abuse?
When is it necessary, and what are the key principles involved?

Answer 41

• Its mandatory law of mostly reported on Child abuse.
• Nurses have a legal and ethical duty to report suspicious cases.
• The key principles are:-
  * Document the injury.
  * Ask how the injury occurred.
  * Report any concerning findings to a nursing supervisor or physician

Question 42

What are the legal and ethical responsibilities of healthcare professionals in reporting child and elder abuse?

Answer 42

• Nurses have a legal and ethical duty to report suspicious cases.
• The key principles are:-
  * Document the injury/abuse.
  * Ask how the injury occurred.
  * Report any concerning findings to a nursing supervisor or physician