Mental health final examination Flashcards

1
Q

(Maslow’s hierarchy of needs): Basic fundamental needs include food, water, air, sleep, exercise, elimination, shelter, and sexual expression.

A

Physiological needs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

(Maslow’s hierarchy of needs): The individual possesses a feeling of self fulfillment and the realization of their highest potential.

A

Self actualization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

(Maslow’s hierarchy of needs): Needs at this level are for avoiding harm, maintaining comfort, order, structure, physical safety, freedom from fear and protection.

A

Safety and security

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

(Maslow’s hierarchy of needs): The individual seeks self respect and respect from others, works to achieve success and recognition in work, and desires prestige from accomplishments.

A

Self esteem

esteem of others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

(Maslow’s hierarchy of needs): Needs are for giving and receiving of affection, companionship, satisfactory interpersonal relationships, and identification with a group.

A

Love and belonging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

During this stage, the responses of the fight or flight syndrome are initiated.

A

Alarm reaction stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

This stage occurs when there is a prolonged exposure to the stressor to which the body has become adjusted. The adaptive energy is depleted, and the individual can no longer draw from the resources for adaptation. without intervention for reversal death can occur.

A

Stage of exhaustion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The individual uses the physiological response of the first stage as a defense in the attempt to adapt to the stressor. if adaptation occurs, the third stage is prevented or delayed.

A

Stage of resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

This level of anxiety prepares people for action. it sharpens the senses, increases motivation for productivity, increases the perceptual field, and results in a heightened awareness of the environment. The individual is able to function at their optimal level.

A

Mild anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Anxious individual is less alert to events occurring within the environment. The individual’s attention span and ability to concentrate decrease. assistance with problem solving may be required. increased muscular tension and restlessness are evident.

A

Moderate anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Anxious individual is so greatly diminished that concentration centers on one particular detail only or on many extraneous detail. attention span is extremely limited, and the individual has difficulty completing the simplest task. physical symptoms (e.g., HA, palpitations, insomnia). and emotional symptoms (e.g., confusion, dread, horror) may be evident.

A

Severe anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Individual is unable to focus on even one detail. misperceptions are common, and a loss of contact with reality may occur. The individual experience hallucinations or delusions. behavior is characterized as wild and desperate actions or extreme withdrawal. feeling of terror, and individuals may be convinced that they have a life threatening illness or fear that they are going crazy, are losing control, or are emotionally weak.

A

Panic anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Sleeping, eating, physical exercise, smoking, crying, yawning, drinking, daydreaming, laughing, cursing, pacing, foot swinging, fidgeting, nail biting, finger tapping and talking to someone with whom one feels comfortable.

A

Mild anxiety coping behaviors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Covering up a real or perceived weakness by emphasizing a trait one considers more desirable.

A

Compensation

EX: a physically handicapped boy is unable to participate in football, so he compensates by becoming a great scholar.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Refusing to acknowledge the existence of a real situation or the feelings associated with it.

A

Denial

EX: a woman drinks alcohol every day and cannot stop, failing to acknowledge that she has a problem.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The transfer of feelings from one target to another that is considered less threatening or that is neutral.

A

Displacement

EX: a client is angry at his doctor, does not express it, but becomes verbally abusive with the nurse.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Attempting to make excuses or formulate logical reasons to justify unacceptable feelings or behaviors.

A

Rationalization

EX: john tells the rehab nurse i drink because its the only way i can deal with my bad marriage and my worse job.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Preventing unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors.

A

Reaction formation
EX: jane hates nursing. she attended nursing school to please her parents. during career fay she speaks to prospective students about the excellence of nursing as a career.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Responding to stress by retreating to an earlier level of development and the comfort measures associated with that level of functioning.

A

Regression
EX: when 2 year old jay is hospitalized for tonsillitis he will drink only from a bottle although his mother states he has been drinking from a cup for 6 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

An attempt to increase self worth by acquiring certain attributes and characteristics of an individual one admires.

A

identification
EX: a teenaged boy who required lengthy rehabilitation after an accident decides to become a physical therapist as a result of his experience.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

An attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual processes of logic, reasoning and analysis.

A

Intellectualization
EX: susans husband is being transferred with his job to a city far away from her parents. she hides anxiety by explaining to her parents the advantages associated with the move.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Integrating the beliefs and values of another individual into one’s own ego struture.

A

Introjection
EX: children integrate their parents’ value system not the process of conscience formulation. a child says to friend don’t cheat its wrong.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Separating a thought or memory from the feeling tone or emotion associated with it

A

Isolation

EX: without showing any emotion, a young woman describes being attacked and raped.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Attributing feelings or impulses unacceptable to one’s self to another person.

A

Projection

EX: sue feels a strong sexual attraction to her track coach and tells her friend he’s coming on to me.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Involuntarily blocking unpleasant feelings and experiences from one’s awareness.

A

Regression

EX: an accident victim can remember nothing about the accident

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive.

A

Sublimation
EX: a mother whose son was killed by a drunk driver channels her anger and energy into being the president of the local chapter of mothers against drunk drivers.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

The voluntary blocking of unpleasant feelings and experiences form one’s awareness.

A

Suppression

EX: Scarlett O’hara says i don’t want to think about that now ill think about that tomorrow.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Symbolically negating or canceling out an experience that one finds intolerable.

A

Undoing

EX: joe is nervous about his new job and yells at his wife. on his way home he stops and buys her some flowers.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Psychiatric disturbances characterized by excessive anxiety that is expressed directly or altered through defense mechanisms. it appears as a symptom such as an obsession, a compulsion, a phobia or a sexual dysfunction.

A

Neuroses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

defined as a severe mental disorder characterized by gross impairment in reality testing, typically manifested by delusion, hallucinations, disorganized speech, or disorganized or catatonic behavior.

A

psychosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q
  • Exhibit minimal distress
  • unaware that their behavior is maladaptive
  • unaware of any psychological problems
  • exhibiting a flight from reality into a less stressful world or into one in which they are attempting to adapt.
A

common characteristics of people with psychoses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q
  • Aware that they are experiencing distress
  • aware that their behaviors are maladaptive
  • unaware of any possible psychological cause of the distress.
  • feel helpless to change their situation
  • experience no loss of contact with reality.
A

Common characteristics of people with neuroses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

A subjective state of emotional, physical and social responses to the loss of a valued entity.

A

Grief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

the loss, or anticipated loss, of anything of value to an individual can trigger the grief response. this period of characteristics emotions and behaviors is known as?

A

Mourning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

This is a stage of shock and disbelief. the response may be one of No! it can’t be true. protective mechanism that allows the individual to cope within an immediate time frame while organizing more effective defense strategies.

A

Denial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Why me? and its not fair! envy and resentment toward individual not affected by the loss are common. may be directed at the self or displaced on loved ones, caregivers and even God.

A

Anger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

If God will help me through this I promise I will go to church every Sunday and volunteer my time to help others. sometimes the promise is associated with feelings of guilt for not having performed satisfactorily, appropriately or sufficiently.

A

Bargaining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

During this stage the full impact of the loss is experienced. this is a time of quiet desperation and disengagement form all associations with the lost entity. it represents advancement toward resolution rather than the fixation in an earlier stage of the grief process.

A

Depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

The final stage brings a feeling of peace regarding the loss that has occurred. the focus is on the reality of the loss and its meaning for the individuals.

A

Acceptance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Individuals often begin the work of grieving before the actual loss occurs.

A

Anticipatory grief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Resolution fact

A

Length of the grieving process is also affected by the number of recent losses experienced by an individual and whether they are able to complete one grieving process before another loss occurs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

is characterized by an intense preoccupation with memories of the lost entity for many years after the loss has occurred. behaviors associated with the stages of denial or anger are manifested, and disorganization of functioning and intense emotional pain related to the lost entity are evidenced.

A

the prolonged response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

The individual becomes fixed in the denial stage of the grieving process. the emotional pain associated with the loss is not experienced, but anxiety disorders (e.g., phobias, somatic symptom disorders) or sleeping and eating disorders (e.g., insomnia, anorexia) may be evident. may remain in denial for many years until the grief response is triggered by a reminder of the loss.

A

Delayed or inhibited response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Fixed in the anger stage of grieving. All the normal behaviors associated with driving such as helplessness, hopelessness, sadness, anger and guilt are exaggerated out of proportion to the situation. the individual turns the anger inward on the self, is consumed with overwhelming despair and is unable to function in normal activities of daily living.

A

Distorted response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

The combination of character, behavioral, temperamental, emotional and mental traits that are unique to each specific individual

A

personality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Meeting basic needs. locus of instinctual drives-the pleasure principle. Present at birth, it endows the infant with instinctual drives that seek to satisfy needs and achieve immediate gratification. behaviors are impulsive and may be irrational.

A

ID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

also called the rational self or the reality principle begins to develop between the ages of 4 to 6 months. a primary function is one of mediator that is to maintain harmony among the external world.

A

EGO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Referred to as the perfection principle. develops between ages 3 and 6 years, internalizes the values and morals set forth by primary caregivers. composed of two major components the ego ideal and the conscience

A

superego

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Includes all memories that remain within an individuals awareness. events and experiences that are easily remembered or retrieved are considered to be within one’s conscious awareness. EX: telephone numbers, birthdays of self and significant others, dates of special holidays, and what one had for lunch today.

A

Conscious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

includes all memories that may have been forgotten or are not in present awareness but, with attention, can readily be recalled into consciousness. examples: telephone numbers or addresses once known but little used and feelings associated with significant life events that may have occurred at some time in the past. helps to suppress unpleasant or nonessential memories from consciousness. under control of the superego which helps to suppress unacceptable thought and behaviors.

A

preconscious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

includes all memories that one is unable to bring to conscious awareness. it is the largest of the three topographical level. consists of unpleasant or nonessential memories that have been repressed and can be retrieved only through therapy, hypnosis, and with certain substances that later the awareness, and have the capacity to restructure repressed memories. may emerge in dreams.

A

preconscious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

psychic energy (or the drive to fulfill basic physiological needs such as hunger, thirst, and sex).

A

libido

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

the process by which the id invests energy into an object in an attempt to achieve gratification. EX: instinctively turns to alcohol to relieve stress.

A

Cathexis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

the use of psychic energy by the ego and the superego to control id impulses. EX: i already have ulcers from drinking too much. i will call my AA sponsor for support. i will not drink

A

Anticathexis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Freud’s stages

relief from anxiety through oral gratification of needs

A

Oral ages birth-18months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Freud’s stages

Learning independence and control, with focus on the excretory function.

A

Anal ages 18 months-3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Freud’s stages

Identification with parent of same gender; development of sexual identity; focus on genital organs

A

Phallic ages 3-6 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Freud’s stages

Sexuality repressed; focus on relationships with same gender peers

A

Latency ages 6-12 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Freud’s stages

Libido reawakened as genital organs mature; focus on relationships with members of the opposite gender.

A

Genital ages 13- 20 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

is a feeling of emotional discomfort, toward the relief or prevention of which all behavior is aimed. is the chief disruptive force in interpersonal relations and the main factor in the development of serious difficulties in living. it arises out of one’s inability to satisfy needs or achieve interpersonal security.

A

Anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

the fulfillment of all requirements associated with an individual’s physiochemical environment. ex: oxygen, food, water, warmth, tenderness, rest, activity, sexual expression

A

satisfaction of needs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

the feeling associated with relief from anxiety. when all needs have been met, one experiences a sense of total well being.

A

interpersonal security

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

is a collection of experiences or security measures, adopted by the individual to protect against anxiety.

A

self system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Components of the self system:

the ____ ____ is the part of the personality that develops in response to positive feedback from the primary caregiver. feelings of pleasure, contentment, and gratification. the child learns which behaviors elicit this positive response as ti becomes incorporated into the self system.

A

the good me

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Components of the self system:

the ___ ___ is the part of the personality that develops in response to negative feedback from the primary caregiver. anxiety is experienced, eliciting feelings of discomfort, displeasure, and distress. the child learns to avoid these negative feelings by altering certain behaviors.

A

the bad me

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Components of the self system:

The __ ___ is the part of the personality that develops in response to situations that produce intense anxiety in the child. feelings of horror, awe, dread and loathing are experience in response to these situations, leading the child to deny these feelings in an effort to relieve anxiety. these feelings have been denied becoming __ __ but someone else. this withdrawal from emotions has serious implications for mental disorders in adult life.

A

The not me

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

To develop a basic trust in the mothering figure and learn to generalize it to others.

A

Erikson
Trust vs mistrust
infancy (birth-18months)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

To gain some self control an independence within the environment

A
Erikson 
Autonomy vs shame and doubt
early childhood (18months-3 years)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

to develop a sense of purpose and the ability to initiate and direct own activities

A

Erikson
initiative vs guilt
late childhood 3-6 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

to achieve a sense of self confidence by learning, competing, performing successfully, and receiving recognition from significant others, peers and acquaintances.

A

Erikson
industry vs inferiority
school age 6-12 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

to integrate the tasks mastered in the previous stages into a secure sense of self

A

Erikson
identity vs role confusion
adolescence 12-20 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

to form an intense, lasting relationship or a commitment to another person, cause, institution or creative effort

A

Erikson
intimacy vs isolation
young adulthood 20-30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

to achieve the life goals established for oneself while also considering the welfare of future generations.

A

Erikson
generatively vs stagnation
adulthood 30-65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

to review one’s life and derive meaning from both positive and negative events while achieving a positive sense of self worth

A

Erikson
ego integrity vs despair
old age 65-death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

being able to understand ones own behavior to help others identify felt difficulties and to apply principles of human relations to the problems that arise at all levels of experience

A

psychodynamic nursing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

one who provides specific needed information that helps the client understand their problem and the new situation

A

resource person

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

one who listens as the client reviews feelings related to difficulties their experiencing in any aspect of life. interpersonal techniques have been identified to facilitate the nurse’s interaction in the process of helping the client solve problems and make decisions concerning these difficulties

A

a counselor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

one who identifies learning needs and provides information to the client that may aid in improvement of the life situation

A

a teacher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

one who directs the nurse-cleint interaction and ensures that appropriate actions are undertaken to facilitate achievement of the designated goals.

A

a leader

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

one who understands various professional devices and possesses the clinical skill necessary to perform the interventions that are in the best interest of the client

A

A technical expert

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

one who serves as a substitute figure for another

A

A surrogate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

is the phase during which the client, nurse, and family work together to recognize, clarify and define the existing problem

A

orientation phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

is the phase after which the client’s initial impression has been clarified and during which they begin to respond selectively to persons who seem to offer the help that is needed.
The client can response in 3 ways:
1) on the basis of participation or interdependent relations with the nurse.
2) on the basis of independence or isolation from the nurse.
3) on the basis of helplessness or dependence on the nurse.

A

identification phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

is the phase during which the client proceeds to take full advantage of the services offered to them. Having learned which services are available, feeling comfortable within the setting, and serving as an active participant in their own health care, the client exploits the services available and explores all possibilities of the changing situation.

A

Exploitation phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

When the client is freed from identification with helping persons and gathers strength to assume independence. ____ is the direct result of successful completion of the other three phases.

A

Resolution phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

learning to communicate in various ways with the primary caregiver to have comfort needs fulfilled.
**clients with unmet dependency needs regress during illness and demonstrate behaviors that relate to this stage of development. other clients regress to this level because of physical disabilities associated with their illness.

A

Peplau’s interpersonal theory
age: infancy
Stage: learning to count on others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Learning the satisfaction of pleasing others by delaying self gratification in small ways
** First step in the development of interdependent social relations. the child feels powerless and fails to learn the satisfaction of pleasing others by delaying self gratification in small ways. they may also exhibit rebellious behavior by failing to comply with demands of the mothering figure in an effort to counter the feelings of powerlessness.

A

Peplau’s interpersonal theory

age: toddlerhood
stage: learning to delay satisfaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

learning appropriate roles and behaviors by acquiring the ability to perceive the expectations of others.
** a concept of self develops as a product of interaction with adults. a child learns to structure self concept by observing how others interact with them.

A

Peplau’s interpersonal theory

age: early childhood
stage: learning to identifying oneself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

learning the skills of compromise, competition, and cooperation with others; establishing a more realistic view of the world and a feeling of one’s place in it.
If a child tries to use the skill of an earlier level of development (crying, whining, or demanding), they may be rejected by peers of this juvenile stage. as this stage progresses, children begin to view themselves through the eyes of their peers.
preadolescents take on a more realistic view of the world and a feeling of their place in it. the capacity to love others develops at this time and is expressed in relation to one’s self acceptance. failure to develop appropriate skills at any point along the developmental progression results in an individual;s difficulty in confronting the recurring problems of life.

A

Peplau’s interpersonal theory

age: late childhood
stage: developing skills in participation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Peplau’s interpersonal theory fact:

A

potenital behaviors of individuals who have failed to complete the task of the second stage of development (learning to delay satisfaction):

  • exploitation and manipulation of others to satisfy their own desires because they are unable to do so independently.
  • suspiciousness and envy of others, directing hostility toward others in an effort to enhance their own self image.
  • hoarding and withholding possessions form others; miserliness.
  • inordinate neatness and punctuality.
  • inability to relate to others through sharing of feelings, ideas or experiences.
  • ability to vary the personality characteristics to those required to satisfy personal desires at any given time.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Theoretical perspectives:
is the greatest happiness principal. this principal holds that actions are right to the degree that they tend to promote happiness and wrong as they tend to produce the reverse of happiness. the doctrine that actions are right if they are useful or for the benefit of a majority.
action is taken based on the end results that produced the most good for the most people.

A

Utilitarianism theory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

it is not the consequences or end results that make an action right or wrong; rather it is the principle or motivation on which the action is based that is the morally decisive factor.
this theory is also called deontology
this theory is made out of respect for moral law.
EX: i make this choice because it is morally right and my duty to do so.

A

Kantianism theory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

this approach to ethical decision making is focused on the way of life and teachings of jesus christ. focus on the importance of virtues such as love, forgiveness, and honesty. the decisions about right and wrong should be centered in love for God and in treating others with the same respect and dignity with which we would expect to be treated.

A

the christian ethics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

this theory advances the idea that decisions about right versus wrong are self evident and determined by human nature.

A

natural law theory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

what is right and good is what is best for the individual making the decision. an individuals actions are determined by what is to their own advantage. the action may not be best for anyone else involved, but consideration is only for the individual making the decision.

A

ethical egoism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

a situation that requires an individual to make a choice between two equally unfavorable alternatives.

A

ethical dilemma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

this viewpoint emphasizes the status of persons as moral agents whose right to determine their destinies should always be respected. individuals are always capable of making independent choices.

A

autonomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

refers to one’s duty to benefit or promote the good of others.

A

beneficence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

the requirement that healthcare providers do no harm to their clients

A

nonmaleficence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

“fairness”. the right of individuals to be treated equally regardless of race, sex, marital status ect.

A

justice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

refers to one’s duty to always be truthful. there are time when limitations much be placed on this principal, such aw when this principal will knowingly produce harm or interfere with recovery process

A

veracity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

this act requires that healthcare facilities provide clear written information for every patient concerning their legal rights to make healthcare decisions, including the right to accept or refuse treatment.

A

the patient self determination act

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

this law has been enacted by a legislative body, such as a county or city council, state legislature, or the U.S congress.

A

statutory law

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

these law are derived from decisions made in previous cases. these laws apply to a body of principles that evolve from court decisions resolving various controversies. EX: might be how different states deal with a nurse’s refusal to provide care for a specific event.

A

common law

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

this law protects the private and property rights of individuals and businesses.

A

civil law

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

a ____ is a violation of a civil law in which an individual has been wronged. in a ___ action, one party asserts that wrongful conduct on the part of the other has caused harm and seeks compensation for hair suffered.

A

torts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

malpractice and negligence actions is an example of an _____ tort

A

unintentional tort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

touching of another person without that person’s consent. EX: medical treatment without the client’s consent can result in a charge of battery.

A

intentional tort.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

True or false:
if a client confides in the nurse the potential for harm to an intended victim, is it the duty of the nurse to report this information?

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

the doctrine is the preservation and protection of individual autonomy in determining what will and will not happen to the person’s body.

A

informed consent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

informed consent fact:

A

the client should receive information such as what treatment alternatives are available; why the physician believes this treatment is most appropriate; the possible outcome should the client select another treatment alternative; and the possible outcome should the chose to have no treatment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

there are some conditions under which treatment may be performed without obtaining informed consent. what 5 conditions are they?

A

1) . when a client is mentally incompetent to make a decision and treatment is necessary to preserve life or avoid serious harm.
2) . when refusing treatment endangers the life or health of another.
3) . during an emergency, in which a client is in no condition to exercise judgement.
4) . when a client is a child (consent is obtained form parent or surrogate).
5) . in a case of therapeutic privilege: information about a treatment may be withheld if the physician can show that full disclosure would: hinger or complicate treatment, cause severe psychological harm, or be so upsetting as to render a rational decision by the client impossible.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

True or false:
if a psychiatric/mental health client in a health facility have severe psychiatric illness they are competent and capable of giving informed consent.

A

false

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

true or false:

if an individual has been legally determined to be mentally incompetent, consent is obtained from the legal guardian.

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

what is the nurse’s role in obtaining informed consent?

A

the nurse’s role in obtaining informed consent is that they act as the clients advocate to ensure that the following three major elements of informed consent have been addressed: knowledge (adequate information), competency (the individuals cognition is not impaired to an extent that would interfere with decision making), and free will (given consent voluntarily).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

an individual makes direct application to the institution for services and may stay as long as treatment is deemed necessary

A

voluntary admissions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

in which circumstances can involuntary commitments be made?

A
  • in an emergency situation (client who is dangerous to self or others)
  • for observation and treatment of mentally ill persons.
  • when an individual is unable to take care of basic personal needs (the gravely disabled).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

what are the 5 criteria to involuntary outpatient commitment?

A

1) a history of repeated decompensation requiring involuntary hospitalization.
2) the likelihood that without treatment the individual will deteriorate to the point of requiring inpatient commitment.
3) the presence of severe and persistent mental illness and limited awareness of the illness or need for treatment.
4) the presence of severe and persistent mental illness contributing to a risk of becoming homeless, incarcerated or violent, or of committing suicide.
5) the existence of an individual treatment plan likely to be effective and a service provider who has agreed to provide the treatment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

the failure to exercise the standard of care that a reasonably prudent person would have exercised in a similar situation; any conduct that falls below the legal standard established to protect others against unreasonable risk of harm, except for conduct that is intentionally, or willfully disregardful of others’ rights.

A

negligence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

these are examples of what type of lawsuit:

  • a duty to the patient existed, based on the recognized standard of care.
  • a breach of duty occurred, meaning that the care rendered was not consistent with the recognized standard of care.
  • the client was injured
  • the injury was directly caused by the breach of a standard of care.
A

malpractice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

when shared information is detrimental to the clients reputation, the person sharing the information may be liable for ______ of _____

A

defamation of character

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

when the information that is detrimental to the clients reputation is in writing…

A

libel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

when the information that is detrimental to the clients reputation is oral defamation ….

A

slander

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

an act that results in a persons genuine fear that they will be touched without consent

A

assault

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

unconsented touching of another person.

A

battery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

a therapeutic manner requires that the nurse have a great deal of self awareness and self understanding, having arrived at a philosophical belief about life, death and the overall human condition.

A

use of the self

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

what are some examples of nursing interventions that would promote trust in an individual who is thinking concretely (focuses their thought processes on specifics rather than generalities and immediate issues rather than eventual outcomes).

A
  • providing a blanket when cold
  • providing food when hungry
  • being honest
  • simply and clearly providing reasons for certain policies, procedures and rules.
  • providing written, structured schedule of activities.
  • attending activités with the client if they are reluctant to go alone.
  • being consistent in adhering to unit guidelines
  • taking the client’s preferences, request, and opinions into consideration.
  • ensuring confidentiality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

what is the difference between empathy and sympathy?

A

empathy means that you remain emotionally separate from the other person, even though you can see the patient’s viewpoint clearly. sympathy implies taking on the others needs and problems as if they were your own and becoming emotionally involved to the point of losing your objectivity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

this phase of a therapeutic nurse-client relatioship involves preparation for the first encounter with the client. tasks include: obtaining information about the client from chart, significant others, or health team members. also examining feelings, fears, and anxieties about working with a particular client.
the goal in this phase involves exploring self perceptions.

A

preinteraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

during this phase of a therapeutic nurse-client relationship, the nurse and client become acquainted. tasks include: creating an environment for trust and rapport. establishing a contract for interventions. gathering assessment information. identifying the clients strengths and limitations. setting goals, developing a plan of action and exploring feelings.
the goal in this phase is establishing trust and formulating a contract for intervention

A

orientation (introductory) phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

the therapeutic work of the relationship is accomplished during this phase of a therapeutic nurse-client relationship. tasks include: maintaining the trust and rapport, promoting the clients insight and perception of reality, problem solving, overcoming resistance behaviors, and continuously evaluating progress.
the goal in this phase is to promote client change.

A

the working phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

occurs when the client unconsciously displaces to the nurse feelings formed toward a person from their past.

A

transference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

what are some interventions for transference?

A

the relationship does not need to be terminated, except when the transference posses a serious barrier to therapy or safety. the nurse should assist the patient into identifying the transference and reassign a new and more appropriate meaning to the current nurse patient relationship.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

refers to the nurse’s behavioral and emotional response to the client.

A

countertransference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

what are some examples of a nurse’s behavior in countertransference ?

A

the nurse over identifies with the client’s feelings, the nurse and client develop a social or personal relationship, gives advice or attempts to rescue the client, encourages and promotes the clients dependence, feels anxious and uneasy in the presence of the client, the nurse is bored and apathetic in sessions with the client, the nurse has difficulty setting limits on the clients behavior, or the nurse defends the clients behavior to other staff members.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

what are some interventions for countertransference?

A

the relationship should not be terminated. the nurse should be supportively assisted by other staff members to identify their feelings and behaviors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

the main task for this phase of a therapeutic nurse-client relationship involves bringing a therapeutic conclusion to the relationship.

A

the termination phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

intimate distance is how many inches

A

0-18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

person distance is how many inches

A

18-40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

social distance is how many feet away

A

4-12 feet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

public distance is how many feet away

A

one that exceeds 12 feet.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

this type of touch is impersonal and businesslike. it is used to accomplish a task.

A

functional-professional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

a tailor measuring a customer for a suit or a physician examining a client.

A

social polite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

a handshake. this type of touch at this level indicates a strong liking for the other person-a feeling that they are a friend

A

friendship-warmth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

laying one’s hand on the shoulder of another. this type of touch conveys an emotional attachment or attraction for another person.

A

love-intamcy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

engaging in a strong, mutual embrace. touching another in the genital region. this type of touch at this level is an expression of physical attraction only.

A

sexual arousal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

this is the gestural component of the spoken word. it consists of pitch, tone, and loudness of spoken messages, the rate of speaking, expressively places pauses, and emphasis assigned to certain words.

A

paralanguage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

what therapeutic communication technique is used when it gives the client the opportunity to collect and organize thoughts, and to think through a point.

A

using silence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

what therapeutic communication technique is used when it conveys an attitude of reception and regard
Give an example.

A

accepting
EX: yes i understand what you said.
eye contact and nodding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

what therapeutic communication technique is used when acknowledging and indicating awareness; better than complimenting, which reflects the nurse’s judgement
Give an example

A

giving recognition

EX: i see you made your bed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

what therapeutic communication technique is used when making oneself available on an unconditional basis, increasing client’s feelings and self worth
Give an example

A

offering self

EX: ill stay with you awhile

152
Q

what therapeutic communication technique is used when it allows the client to take the initiative in introducing the topic; emphasizes the importance of the client’s role in the interaction.
Give an example

A

giving broad openings

EX: tell me what your are thinking

153
Q

what therapeutic communication technique is used when it offered the client encouragement to continue
Give an example

A

offering general leads
EX: yes, i see.
Go on

154
Q

what therapeutic communication technique is used when it clarifies the relationship of events in time so that the nurse and client can view them in perspective.
Give an example.

A

placing the event in time or sequence
EX: what seemed to lead up to…
was this before or after….
when did this happen…

155
Q

what therapeutic communication technique is used when verbalizing what is observed or perceived. this encourages the client to recognize specific behaviors and compare perceptions with the nurse.
Give an example

A

making observations
EX: you seem tense
i notice that you are pacing a lot

156
Q

what therapeutic communication technique is used when asking the client to verbalize what is being perceived; often used with clients experiencing hallucinations.
Give an example

A

encouraging description of perceptions.
EX: tell me what is happening now?
are you hearing the voices again?

157
Q

what therapeutic communication technique is used when asking the client to compare similarities and differences in ideas, experiences, or interpersonal relationships.
Give an example

A

encouraging comparison
EX: what was your response the last time this occurred?
was this something like…?

158
Q

what therapeutic communication technique is used when repeating the main idea of what the client has said. this lets the client know whether or not an expressed statement has been understood and gives them the chance to continue.
Give an example

A

restating
EX: Client: i can’t study. my mind wanders.
Nurse: you have trouble concentrating.

159
Q

what therapeutic communication technique is used when questions and feelings are referred back to the client so that they may be recognized and accepted.
Give an example

A

reflecting
EX: C: what do you think i should do about my wife’s drinking problem?
N: what do you think you should do

160
Q

what therapeutic communication technique is used when taking notice of a single idea or even a single word
Give example

A

focusing

EX: this point seems worth looking at more closely. perhaps we can discuss it together.

161
Q

what therapeutic communication technique is used when delving further into a subject, idea, experience or relationship.
Give example

A

exploring

EX: please explain that situation in more detail.

162
Q

what therapeutic communication technique is used when you strive to explain which is vague or incomprehensible and searching for mutual understanding.
Give example

A

seeking clarification and validation

EX: im not sure what i understand. would you please explain?

163
Q

what therapeutic communication technique is used when the client has a misperception of the environment, the nurse indicated the clients perception of the situation.
Give example

A

presenting reality

EX: i understand that the voices seem real to you, but i do not hear any voices.

164
Q

what therapeutic communication technique is used when expressing uncertainty as to the reality of the client’s perception.
Give example

A

voicing doubt

EX: i understand that you believe that to be true, but i see the situation differently.

165
Q

what therapeutic communication technique is used when putting into words what the client has only implied or said indirectly.
Give example

A

Verbalizing the implied
EX: C: its a waste of time to be here. i can’t talk to you or anyone.
N: are you feeling like no one understands?

166
Q

what therapeutic communication technique is used when feelings are expressed indirectly, and the nurse tries to desymbolize what has been said and to find clue to the underlying true feelings.
Give example

A

Attempting to translate words into feelings
EX: C: I’m way out in the ocean.
N: you must be feeling very lonely right now

167
Q

what therapeutic communication technique is used when a client has a plan in mind for dealing with what is considered to be a stressful situation.
Give example

A

formulating a plan of action

EX: what could you do to let your anger out harmlessly?

168
Q

what Non-therapeutic communication technique is used when you persistently question the client; pushing for answers.

A

Probing

EX: tell me how your mother abused you

169
Q

what Non-therapeutic communication technique is used when you attempt to protect someone from verbal attack

A

defended

EX: you have a very capable physician

170
Q

what Non-therapeutic communication technique is used when you ask the client to provide the reasons for thoughts, feelings, behaviors, or feelings

A

requesting an explanation

EX: why do you think that?

171
Q

what Non-therapeutic communication technique is used when attributing the source of thoughts, feelings and behaviors to outside influences.

A

indicating the existence of an external source of power.
EX:what makes you say that?
what made you do that?

172
Q

what Non-therapeutic communication technique is used when the nurse misjudges the degree of the clients discomfort, a lack of empathy and understanding may be conveyed.

A

belittling feelings expressed.
EX: C: i have nothing to live for.
N: everyone gets down in the dumps at times.

173
Q

what Non-therapeutic communication technique is used when the nurse makes empty conversations.

A

making stereotyped comments
EX: hang in there its for your own good.
I’m fine, and how are you?
keep your chin up.

174
Q

What does the S in soler stand for

A

sit squarely facing the client

175
Q

what does the O in soler stand for

A

observe an open posture

176
Q

what does the L in soler stand for

A

lean forward toward the client

177
Q

what does the E in soler stand for

A

Establish eye contact

178
Q

what does the R in soler stand for

A

relax

179
Q

who is responsible for negotiating with multiple health care providers to obtain a variety of services for the client?

A

case manager

180
Q

what can be used as the tools for provision of care in a case management system?
this is a plan of care that provides outcome based guidelines for goal achievement within a designated length of stay.

A

critical pathways of care

181
Q

what is the goal in milieu therapy?

A

the goal is to manipulate the environment so that all aspects of the clients hospital experience are considered therapeutic.

182
Q

What are the 7 basic assumptions on which a therapeutic community is based?

A

1) the health in each individual is to be realized and encouraged to grow.
2) every interaction is an opportunity for therapeutic intervention.
3) the client owns their own environment
4) each client owns their own behavior
5) peer pressure is a useful and powerful tool
6) inappropriate behavior are dealt with as they occur.
7) restrictions and punishment are to be avoided

183
Q

Under what 6 conditions is a hospital environment considered therapeutic?

A

1) . Basic physiological needs are fulfilled.
2) . the physical facilities are conductive to achievement of the goals of therapy (space is provided for therapeutic interaction. furnishings are arranged to present a homelike atmosphere).
3) . a democratic form of self government exists (clients participate in decision making and problem solving that effect the management of the treatment setting.
4) . Responsibilities are assigned according to client capabilities.
5) . a structured program of social and work related activities is scheduled as part of the treatment program.
6) . community and family are included in the program of therapy in an effort to facility discharge from treatment.

184
Q

what is the role of a nurse in a milieu therapy?

A
  • the nurses are generally the only members of the interdisciplinary treatment team who spend time with the clients on a 24 hours basis.
  • they assume responsibility for management of the therapeutic milieu.
  • they provide ongoing assessment of client condition, both mentally and physically. *administers medications.
  • assists clients with all therapeutic activities as required.
  • focus is on one to one relationship development.
  • a nurse is responsible for setting limits on unacceptable behavior.
185
Q

within a group, members are able to express both positive and negative feelings. this open expression of feelings, is beneficial for the individuals within the group. what is this term?

A

catharsis

186
Q

During phase 1: initial or orientation phase, what are the group activities?
what are the expectations of the leader, and what are the member behaviors?

A

Group activities: leader and members work together to establish the rules that will govern the group.

187
Q

During phase 2: middle or working phase,
what are the group activities?
what are the expectations of the leader, and what are the member behaviors?

A

Group activities: cohesiveness has been established. this is when the productive work toward completion of the task is undertaken. problem solving and decision making occur within the group. cooperation prevails, and differences and disagreements are confronted and resolved.

Leader expectations: diminishes and becomes more one of facilitator. leadership functions are shared by certain members of the group as they progress toward resolution. the leader helps to resolve conflict and continues to foster cohesiveness among the members while ensuring that they do not deviate from the intended task or purpose.

member behaviors: trust has been established. they turn more often to each other and less often to the leader for guidance. they accept criticism from each other. subgroups will form in which two or more members conspire with each other to the exclusion of the rest of the group.

188
Q

During phase 3: final or termination phase,what are the group activities?
what are the expectations of the leader, and what are the member behaviors?

A

Group activities: termination should be mentioned from the outset of group formation. it should be discussed in depth for several meetings prior to the final session. a sense of loss that precipitates the grief process may be in evidence.

Leader expectations: encourages the group members to reminisce about what has occurred within the group, to review the goals and discuss the actual outcomes, and to encourage members to provide feedback to each other about individual process. encourages members to discuss feelings of loss associated with termination.

member behavior: may express surprise over the actual materialization of the end. this represents the grief response of denial, which may then progress to anger. anger toward group or leader may reflect abandonment. this feelings may lead to members discussing pervious losses for which similar emotions were experienced. successful termination of the group may help members develop the skills needed when losses occur in other dimensions of their lives.

189
Q

____ leaders have personal goals for the group. they withhold information from group members, particularly issues that may interfere with achievement of their own objectives.
EX: we will do it my way or my way is best.
the focus in this style of leadership is on the leader. members are dependent on the leader. this type of leader is one of persuasion, striving to persuade others in the group that their ideas and methods are superior. productivity is high with this type of leadership, but moral within the group is low because the lack of member input and creativity.

A

autocratic leader

190
Q

____ leadership style focuses on the members of the group. information is shared with members in an effort to allow them to make decisions regarding achieving the goals for the group. members are encouraged to participate fully in problem solving.
EX: decide what must be done, consider the alternatives, make a selection, and proceed with the actions required to complete the task.

the leader provides guidance and expertise. productivity is lower, but morale is higher because of the extent of input allowed

A

democratic leadership

191
Q

_____ leadership style allows people to do as they please. there is no direction from the leader. this leader’s approach is noninvolvement. goals for the group are undefined. no decisions are made, no problems are solved, and no action is taken. members become frustrated and confused, and productivity and morale are low.

A

laissez-faire leadership

192
Q

what method employs a dramatic approach in which clients become actors in life situation scenarios.

A

psychodrama

193
Q

An acute response to an external situational stressor

A

dispositional crisis

194
Q

Normal life cycle transitions that may be anticipated but over which the individual may feel a lack of control.

A

crises of anticipated life transitions.

195
Q

crises precipitated by unexpected external stressor over which the individual has little or no control and from which they feel emotionally overwhelmed and defeated.

A

crises resulting from traumatic stress

196
Q

crises that occur in response to situations that trigger emotions related to unresolved conflict in ones life. these crises are of internal origin and reflect underlying developmental issues that involve dependency, value conflicts, sexual identity, control, and capacity for emotional intimacy.

A

maturational/ developmental crises

197
Q

emotional crises in which preexisting psychopathology has been instrumental in precipitating the crisis or in which psychopathology significantly impairs or complicates adaptive resolution.
EX: borderline personality disorder, severe neuroses, and schizophrenia.

A

crises reflecting psychopathology

198
Q

crisis situations in which general functioning has been severely impaired and the individual rendered in competent or unable to assume personal responsibility.
EX: acutely suicidal individuals, drug overdoses, reaction to hallucinogenic drugs, acute psychoses, uncontrollable anger, and alcohol intoxication.

A

psychiatric emergencies

199
Q

SAMHSA suggests that a life in recovery is supported by four major dimensions… what are they?

A

1) health
2) home
3) purpose
4) community

200
Q

What are the guiding principles of recovery?

A
  • recovery emerges from hope
  • recovery is person driven
  • recovery occurs via many pathways
  • recovery is holistic
  • recovery is supported by peers and allies
  • recovery is supported through relationship and social networks.
  • recovery is culturally based and influenced
  • recovery is supported by addressing trauma
  • recovery involves individual, family, and community strengths and responsibility
  • recovery is based on respect
201
Q

what recovery model uses a person centered approach to help people deal with their problems of human living. focus is on the individuals personal story, which is where their problems first appeared and where any growth, benefit or recovery will be found.

A

the tidal model

202
Q

what are the 10 tidal commitments

A

1) value the voice: actively listen to the persons story and to help the person record the story in their own words.
2) respect the language: individuals are encouraged to speak their own words. help these individuals express in their own language their understanding of personal experiences through use of stories, antidotes and metaphors.
3) develop genuine curiosity: express genuine curiosity in their story so that they can better understand the storyteller and the story. this reflects an interest in the person and the persons experience. ask for clarification of certain points, and assisting the person to unfold the story at their own rate.
4) become the apprentice: develop a plan of care for the individual, based on their expressed needs or wishes, and helping the individual identify specific problems and ways to address them.
5) use the available toolkit: concentration is given to the individuals strengths, which are the major tools in the recovery process. help individuals identify what efforts may be successful in relation to solving identified problems and which persons in the individuals life may be able to provide assistance.
6) craft the step beyond: decide together what needs to be done immediately. help them determine what kind of change would represent a step toward recovery and what they need to do to take that first step in the progress toward that goal.
7) give the gift of time: acknowledging (and helping the individual understand) the importance of time dedicated to addressing the needs of the individual and the planning and implementing of care.
8) reveal personal wisdom: help them to identify personal strengths and weaknesses and to develop self confidence in their ability to help themselves.
9) know that change is constant: help them develop awareness of the changes that are occurring and how they have influenced these changes. develop awareness of how change is happening and to support the person in making decisions regarding the course of the recovery.
10) be transparent: ensure that the individual is aware of the significance of all interventions and that they receive copies of all documents related to the plan of care.

203
Q

what are the 6 steps in the wellness recovery action plan?

A

step 1: developing a wellness toolbox

204
Q

what model focuses on the persons self determination in the course of their recovery process.

A

psychological recovery model

205
Q

define psychological recovery as the establishment of a fulfilling, meaningful life and a positive sense of identity founded on hopefulness and self determination.

A

psychological recovery model

206
Q

what are the four components that were consistently evident in the recovery process?

A

hope
responsibility
self and identify
meaning and purpose

207
Q

five stage model of recovery:
describe stage 1: moratorium and list what the meaning is for hope, responsibility, self and identify, meaning and purpose.

A

this stage is identified by dark despair and confusion. it is called moratorium because it seems life is on hold.
HOPE: hopelessness prevails
RESPONSIBILITY: the individual feels out of control and powerless to change.
SELF IDENTITY: individuals feel as though they no longer know who they are as a person. their sense of identity as a valuable and functional member of society can be lost with a diagnosis of mental illness.
MEANING AND PURPOSE: the diagnosis of mental illness is a traumatic event that can challenge an individuals fundamental beliefs, creating a loss of meaning and purpose in life.

208
Q

Five stage model of recovery: describe stage 2: awareness and list what the meaning is for hope, responsibility, self and identify, meaning and purpose.

A

the individual comes to a realization that a possibility for recovery exists. it involves an awareness of a possible self.
HOPE: there is a dawn of hope that indeed life is not over.
RESPONSIBLITY: individual develops an awareness of the need to take control of their life. which can lead to a sense of personal empowerment.
SELF AND IDENTITY: individual comes to realize that they are a person independent of the illness. the person realizes that there still exists an intact self capable of taking action on ones own behalf.
MEANING AND PURPOSE: individual strives for a personal comprehension of the illness, why it occurred, and what the implications of the illness are for their future.

209
Q

Five stage model of recovery: describe stage 3: preparation and list what the meaning is for hope, responsibility, self and identify, meaning and purpose.

A

this stage begins with the individuals resolve to begin the work of recovery.
HOPE: manifested in the mobilization of personal and external resources to foster self care and find pathways to goals.
RESPONSIBILITY: involves learning about the effects of the illness and how to recognize, monitor, and manage symptoms. ability to be independent and take care of basic needs.
SELF AND IDENTITY: the person takes stock of their skills and strengths in order to build on them to rediscover a positive sense of identity. the person is willing to take risks and try new activities to re-establish a sense of self.
MEANING AND PURPOSE: the basis for a meaningful life lies in solid core values. each individual must live by certain tenets that make life personally valuable and enriching.

210
Q

Five stage model of recovery: describe stage 4: rebuilding and list what the meaning is for hope, responsibility, self and identify, meaning and purpose.

A

the hard work of recovery takes place in this stage. the individual takes the necessary steps to work towards their goals in rebuilding a meaningful life.
HOPE: has hope for and looks forward to a more fulfilling life. realistic goals are set, and the individual is encouraged to pursue the recovery process at their own pace.
RESPONSIBILITY: the person begins to actively take control of their own life; not only management of symptoms but also enlisting social support, improvement of self image, handling social pressures and building social competence.
SELF AND IDENTITY: elaborates and enhances their sense of identity by having succeeded in previous stages in developing a positive self identity separate from the illness and a new sense of self confidence by succeeding at new activities.
MEANING AND PURPOSE: having realistic goals and a positive sense of identity provides a sense of purpose in life.

211
Q

Five stage model of recovery: describe stage 5 and list what the meaning is for hope, responsibility, self and identify, meaning and purpose.

A

the outcome of the psychological recovery process is growth. the personal growth is a continuing life process.
HOPE: the individual feels a sense of optimism and hope of a rewarding future. skills from previous stages are applied with confidence, and they strive for higher levels of well being.
RESPONSIBILITY: exhibit confidence in managing their illnesses and are resilient when relapses occur. they are empowered by personal input and decision making regarding their treatment.
SELF AND IDENTITY: developed a strong, positive sense of self and identity. people have reporting feeling that they are a better person as a result of their struggle with the illness. reported developing personal qualities, including strength and courage, more confidence in the self, resourcefulness and responsibility.

212
Q

interventions that differ from the traditional or conventional biomedical treatment of disease.

A

alternative medicine

213
Q

an intervention that is different from, but used in conjunction with, traditional or conventional medical treatment.

A

complementary medicine.

214
Q

what are some examples of alternative medicine?

A
acupuncture
herbal formulas
massage and manipulation
diet 
tai chi
qi gong
215
Q

what are some examples of mind body interventions?

A
yoga
tai chi
internal qi gone
hypnosis
meditation 
biofeedback
humor 
journaling
art, music, and dancing therapies
216
Q

what are some examples of manipulative and body based methods?

A
cranial sacral 
swedish massage
reflexology
pilates
body psychotherapy
217
Q

what are some examples of energy therapies?

A
external qi gong
healing science
healing touch
natural healing 
therapeutic touch
218
Q

in what therapy is the client allowed to say whatever comes to mind in response to a word that is given by the therapist.

A

free association

219
Q

defined as the healthful release of ideas through talking out conscious material, accompanied by an appropriate emotional reaction; the release into awareness of repressed material from the unconscious.

A

catharsis

220
Q

maladaptive symptoms to catharsis may be resolved by bringing unconscious thoughts and feelings into consciousness. sometime the individual not only may recall the painful experience, but also may relive it.

A

abreaction

221
Q

what therapy is a time limited therapy that was developed for the treatment of major depression. this therapy has a specific focus, identified goals, and a limited number of sessions.

A

interpersonal psychotherapy aka brief psychotherapy.

222
Q

what therapy is based on control theory and suggests that all individuals are responsible for what they choose to do. it involves power, belonging, freedom, fun and survival.
emphasis is on the present. this therapy promotes the conviction that although an individual is a product of the past, they need not continue as its victim.

A

Reality therapy

223
Q

True or false
assertive behavior helps individuals feel better about themselves by encouraging them to stand up for their own basic human rights, which have equal representation for all individuals.

A

true

224
Q

individuals seek to please others at the expense of denying their own basic human rights

A

nonassertive

225
Q

individuals stand up for their own rights while protecting the rights of others

A

assertive

226
Q

those who respond ____ defend their own rights by violating the basic rights of others.

A

aggressively

227
Q

those who respond in a ______ ______ manner defend their own rights by expressing resistance to social and occupational demands.

A

passive aggressive

228
Q

in what therapy is the individual taught to control thought distortions that are considered to be a factor in the development and maintenance of mood disorders?

A

cognitive therapy

229
Q

defined as a mental state characterized by a disturbance of cognition, which is manifested by confusion, excitement, disorientation and a clouding of consciousness. hallucinations and illusions are common.

A

delirium

230
Q
systemic infections
febrile illness
metabolic disorders
hepatic encephalopathy
head trauma
seizures
migraine HA
brain abscess
stroke 
postoperative states
and electrolyte imbalances
are conditions that have been know to precipitate what?
A

delirium

231
Q

a term that is used to describe cognitive functions closely linked to particular areas of the brain that have to do with thinking, reasoning, memory, learning and speaking.

A

neurocognitive

232
Q

the term used when a person can not speak

A

aphasia

233
Q

the term used to define a person who has an inability to carry out motor activities despite intact motor function.

A

apraxia

234
Q

this stage of AD illness, there is no apparent decline in memory

A

stage 1: no apparent symptoms

235
Q

in this stage of AD illness the individual begins to lose things or forget names of people. losses in short term memory are common. they are aware of the intellectual decline and may feel ashamed, becoming anxious and depressed.

A

stage 2: forgetfulness.

236
Q

in this stage of AD illness there is interference with work performance. the person may get lost when driving. concentration is interrupted. there is difficulty recalling names or words. a decline occurs in the ability to plan or organize

A

stage 3: mild cognitive decline

237
Q

in this stage of AD illness they may forget major events in personal history, such as their own child’s birthday; experience declining ability to perform tasks, or unable to understand current news events. they may deny that a problem exists by covering up memory loss with confabulation (creating imaginary events to fill in memory gaps). depression and social withdrawal are common.

A

stage 4: mild to moderate cognitive decline

238
Q

in this stage of AD illness they lose the ability to perform some ADL’s and require assistance to manage these. they may forget addresses, phone numbers and names of close relatives. disoriented about place and time, but maintain knowledge about self.

A

stage 5: moderate cognitive decline

239
Q

in this stage of AD illness they may be unable to recall recent major life events or the name of their spouse. may not be able to recall the day, season or year. unable to manage ADLs without assistance. urinary and fecal incontinence are common. sleeping becomes a problem. wandering, obsessiveness, agitation, and aggression are common. symptoms worsen in the late afternoon and evening

A

stage 6: moderate to severe cognitive decline

240
Q

in this stage of AD illness the person is unable to recognize family members. they are bedfast and aphasic. become chair bound or bed bound. muscle are rigid, contractors develop. appetite decreases and dysphasia is present; aspiration is common. the person may no longer recognize family members.

A

stage 7: severe cognition decline

241
Q

Pathophysiology of AD

A

AD is characterized by the syndrome of symptoms identified as mild or major NCD. the onset of symptoms is slow and insidious, and the course of the disorder is progressive and deteriorating. memory impairment is an early feature.

examination by CT or MRI reveal degenerative pathology of the brain that includes atrophy, widened cortical sulci, and enlarged cerebral ventricles.

242
Q

causes of AD?

A
  • Acetylcholine alterations: the enzyme that produces this is greatly reduced.
  • plaques and tangles: which contribute to the destruction and death of neurons, leading to memory failure, personality changes, inability to carry out ADLs.
  • head trauma

**genetic factors: the apolipoprotein E epsilon.

243
Q

what is the most common mental illness in older adults?

A

depression

244
Q

what medications are used for a person with delirium.

A

they prefer not to prescribe medications reasoning that additional agents may only coupnund the syndrome of brain dysfunction.
choice of drugs: low dose antipsychotics. a benzodiazepine (lorazepam) is commonly used when the etiology is substance withdrawal

245
Q

what medications are used for a person with AD?

A
  • the cholinesterase inhibitor physostigmine (antilirium) has been shown to enhance cognitive functioning in mild to moderate AD. *also higher doses of donepezil for moderate to severe AD.
  • Donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne) act by inhibitign acetylcholinesterase, which slows the degradation of acetylcholine.
246
Q

what are some anticholinergic side effects?

A
confusion
blurred vision
constipation
dry mouth
dizziness
and difficulty urinating
247
Q

what are some predisposing factors to substance related disorders?

A
  • biological factors (genetics and biochemical)
  • psychological factors (developmental influences and personality factors).
  • sociocultural factors (social learning, conditioning, cultural and ethnic influences)
248
Q

in this phase through which the alcoholic’s pattern of drinking progresses is characterized by the use of alcohol to relieve the everyday stress and tensions of life. as a child the individual may have observed parents drinking and enjoying the effect. the child learns that use of alcohol is an acceptable method of coping with stress.

A

phase 1 the pre-alcoholic phase

249
Q

in this phase through which the alcoholic’s pattern of drinking progresses begins with blackouts following a period of drinking. the alcohol is no longer a source of pleasure but a drug that is required. common behavior include sneaking drinks or secret drinking, preoccupation with drinking and maintaining the supply of alcohol, rapid gulping and further blackouts. the person feels guild and becomes defensive about their drinking. denial and rationalization is evident.

A

phase 2: the early alcoholic phase

250
Q

in this phase through which the alcoholic’s pattern of drinking progresses the person has lost control, and addiction is clear. inability to choose whether or not to drink. binge drinking lasting from a few hours to several weeks. anger and aggression are common. drinking is the total focus, they are willing to risk losing everything in order to maintain their addiction. loss of job, marriage, family, friends and self respect.

A

phase 3: the crucial phase

251
Q

in this phase through which the alcoholic’s pattern of drinking progresses is characterized by emotional and physical disintegration. intoxicated more than they are sober. profound helplessness and self pity. may result in psychosis. abstention from alcohol results in a terrifying syndrome of hallucinations, tremor, convulsion, severe agitation and panic. depression and suicide are common.

A

stage 4: the chronic phase

252
Q

this represents the most serious form of thiamine deficiency in alcoholics. symptoms include paralysis, diplopia, ataxia, and stupor.

A

wernicke’s encephalopathy

253
Q

identified by a syndrome of confusion, loss of recent memory, and confabulation in alcoholics.
treatment is with parenteral or oral thiamine replacement

A

korsakoff’s psychosis

254
Q

what are some symptoms of alcohol intoxication

A
disinhibition of sexual or aggressive impulses
mood lability 
impaired judgement 
impaired social or occupational functioning
slurred speech
incoordination 
unsteady gail
nystagmus 
and flushed face
255
Q

intoxication usually occurs at blood alcohol levels between ?

A

100 and 200 mg/dL.

death has been reported from 400-700

256
Q

what are some alcohol withdrawal symptoms?

A
begins within 4-6 hours after last drink. may process to delirium on 2nd or 3rd day. use librium or serax. 
coarse tremor of hands, tongue or eyelids.
nausea or vomiting 
malaise or weakness
tachycardia
sweating 
elevated BP
anxiety 
depressed mood or irritability 
transient hallucinations or illusions
HA
and insomnia
257
Q

this is a result when one drug results in a lessened response to another drug. one drug can prevent withdrawal symptoms

A

cross tolerance

258
Q

True or false

the nurse must examine their own feelings about working with a client who abuses substances?

A

true

259
Q

this tool is used by many hospitals to assess risk and severity of withdrawal from alcohol

A

the clinical institute withdrawal assessment of alcohol scale (CIWA-Ar)

260
Q

these two tools are used for the diagnosis of alcoholism …

A

Michigan alcoholism screening test and the CAGE questionnaire

261
Q

Care during detoxification in a person with alcoholism.

A

provide a safe and supportive environment for the process.

262
Q

intermediate care with a person who has alcoholism.

A

provide explanations of physical symptoms.

  • promote understanding and identify the causes of substance addition.
  • provide education and assistance in course of treatment to client.
263
Q

care during rehabilitation with a person who has alcoholism

A

encourage continued participation in long term treatment

  • promote participation in outpatient support
  • assist client to identify alternative sources of satisfaction.
  • provide support for health promotion and maintenance.
264
Q

what are some signs that a nurse is chemically impaired?

A
  • poor concentration
  • difficulty meeting deadlines
  • inappropriate responses
  • poor memory or recall are usually late in the disease process.
  • problems with relationships
  • irritability, mood swings, tendency to isolate, elaborate excuses for behaviors, unkempt appearance, impaired motor coordination, slurred speech, flushed face, inconsistent job performance, and frequent use of the restroom.
265
Q

what will a state board do if a nurse is chemically impaired?

A

deny, suspend, or revoke a license. some allow the nurse to avoid disciplinary action by agreeing to seek treatment.

266
Q

program for nurses who are impaired by substances or psychiatric illness. the individuals who administer these efforts are nurse members of the state associations, as well as nurses who are in recovery themselves. for this reason they are called ?

A

peer assistance program.

267
Q

this drug is used as a deterrent to drinking to individuals who abuse alcohol. ingestion of alcohol while this drug is in the body results in a syndrome of symptoms that can produce a great deal of discomfort.

A

disulfiram (Antabuse)

268
Q

how does disulfiram (Antabuse) work?

A

by inhibiting the enzyme aldehyde dehydrogenase, thereby blocking the oxidation of alcohol at the stage when acetaldehyde is converted to acetate. this results in an accumulation of acetaldehyde in the blood, which produces the symptoms associated with the disulfiram alcohol reaction.

269
Q

symptoms of disulfiram alcohol reaction can occur within how many minutes of ingestion of alcohol?

A

5-10 minutes

270
Q

mild reactions of disulfiram alcohol reaction can occur at blood alcohol levels as low as?

A

5-10 mg/dL

271
Q

what are the symptoms in disulfiram alcohol reaction ?

A

flushed skin, throbbing head and neck, respiratory difficulty, dizziness, N/V, sweating, hyperventilation, tachycardia, hypotension, weakness, blurred vision and confusion.

272
Q

disulfiram should not be given until it has be ascertained that the client has abstained from alcohol for at least ___ hours?

A

12 hours

273
Q

other facts about disulfiram…

A

client should not drink for 2 weeks after stopping drug. should be aware of the alcohol containing substances. a thorough medical screening is performed before therapy, and written informed consent is required.

274
Q

what drugs are used for substitution therapy in alcohol withdrawal?

A

benzodiazepines : chloriasepoxide (Librium), oxazepam (Serax), lorazepam (Ativan) and diazepam (Valium).

275
Q

what are the four phases in the pattern of development of schizophrenia?

A

Phase 1: the premorbid phase: social maladjustment, social withdrawal, irritability and antagonist thoughts and behavior (being very shy and withdrawn, poor peer relationships, doing poorly in school and demonstrating antisocial behavior).

Phase 2: the prodromal phase: onset of frank psychotic symptoms. this phase can be brief as a few weeks or months. sleep disturbances, anxiety, irritability, fatigue.

Phase 3: schizophrenia: active phase. delusion, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms. continuous signs of the disturbance persist for at least 6 months. this 6 month period must include 1 month of symptoms. schizoaffective disorder and depressive or bipolar have been ruled out. the disturbance is not due from the effects of a substance. if history of autism spectrum schizophrenia is made only if delusions or hallucinations are present for at least 1 month.

Phase 4: residual phase: usually follows an active phase of the illness. symptoms of the acute stage are absent or no longer prominent. flat affect and impairment in role functioning are common.

276
Q

with this type of delusion the individual believes that someone, usually higher status is in love with them.

A

erotomanic type

277
Q

people with this delusion have irrational idea regarding their own worth, talent, knowledge or power.
EX: believe that someone famous is in love with them or they are a famous person.

A

grandiose type

278
Q

the content of this type of delusion centers on the idea that the person’s sexual partner is unfaithful.

A

jealous type

279
Q

this type of delusion is the most common type, people believe they are being persecuted or malevolently treated in some way.

A

persecutory type

280
Q

people with this type of delusion believe they have some type of general medical condition

A

somatic type

281
Q

a false idea that the self, a part of the self, others, or the world is nonexistent. is an example of what type of delusion?

A

Nihilistic delusion

282
Q

excessive demonstration of or obsession with religious ideas and behavior

A

religiosity

283
Q

the person believes that their thoughts or behaviors have control over specific situations or people.

A

magical thinking

284
Q

thinking is characterized by speech in which ideas shift from one unrelated subject to another.
EX: we wanted to take the bus, but the airport tool all the traffic.

A

associative looseness

285
Q

here the psychotic person invents new words that are meaningless to others but have symbolic meaning to the person

A

neologisms

286
Q

represents a regression to an earlier level of cognitive development. abstract thinking is very difficult.

A

concrete thinking

287
Q

takes the form of rhyming.

EX: it is very cold. i am cold and bold

A

clang associations

288
Q

a group of words that are put together randomly.

EX: most forward action grows life double plays circle uniform.

A

word salad

289
Q

the person delays in reaching the point of a communication because of unnecessary and tedious details

A

circumstantiality

290
Q

this term differs from circumstantiality in that the person never really gets to the point of the communication.

A

tangentiality

291
Q

is an individual’s inability or refusal to speak

A

mutism

292
Q

persistently repeats the same word or idea in response to different questions.

A

perseveration

293
Q

the client with schizophrenia may repeat words that they hear. this term is called…

A

echolalia

294
Q

purposelessly imitating movements made by others

A

echopraxia

295
Q

inability to experience pleasure is termed

A

anhedonia

296
Q

outcome goal for a patient with schizophrenia

A

the client will:

  • demonstrate an ability to relate satisfactorily with others.
  • recognize distortions of reality
  • has not harmed self or others
  • perceives self realistically
  • demonstrates the ability to perceive the environment correctly.
  • maintains anxiety at a manageable level.
  • relinquishes the need for delusions and hallucinations.
  • demonstrates the ability to trust others
  • uses appropriate verbal communication in interactions with others.
  • performs self care activities independently
297
Q

symptoms in tardive dyskinesia

A

bizarre facial and tongue movements, stiff neck and difficulty swallowing.

298
Q

this is a rare but fatal complication of treatment with antipsychotic drugs

A

neuroleptic malignant syndrome
symptoms include: severe parkinsonian muscle rigidity, high fever, tachycardia, tachypnea, fluctuations in BP, diaphoresis and rapid deterioration of mental status to stupor and coma. discontinue drug immediately. dantrium may be given to counteract the effects.

299
Q

depression facts:

A

depression is higher in women that men. depression is found more in low socioeconomic status. being single was a significant predictor of depression.

300
Q

characterized by depressed mood or loss of interest or pleasure in usual activities. impaired social and occupational functioning that has existed for at least 2 weeks, no history of manic behavior.

A

major depressive disorder

301
Q

individuals with this mood disturbance describe their mood as sad or down in the dumps. no evidence of psychotic symptoms. chronically depressed mood for most of the day, for at least 2 years.

A

persistent depressive disorder (Dysthymia).

302
Q

when can mild depressive episodes occur?

A

when the grief process is triggered in response to the loss of a valued object. loss of loved one, pet, friend, home. symptoms will subside within a few weeks.

303
Q

when can moderate depressive episodes occur?

A

when grief is prolonged or exaggerated. they become fixed in the anger stage of the grief response. the person is unable to function without assistance. dysthymia is an example of moderate depression.

304
Q

when can severe depression occur?

A

may demonstrate a loss of contact with reality. complete lack of pleasure and rumination about suicide are common. major depressive disorder is an example of severe depression.

305
Q

what scale is most commonly used to test depression?

A

Hamilton depression rating scale

306
Q

symptoms at this level of depression are not dysfunctional. may include: sadness, dejection, feeling down, having the blues, crying, difficulty getting mind off of ones disappointment, feeling tired and listless.

A

transient depression

307
Q

symptoms at this level of depression include denial of feelings, anger, anxiety, guilt, helplessness, hopelessness, sadness, regression, restlessness, agitation, withdrawal, self blame, anorexia or overeating, insomnia, HA, backache, and chest pain

A

mild depression

308
Q

symptoms at this level of depression include sadness, powerlessness, gloomy and pessimistic outlook, low self esteem, difficulty experiencing pleasure, slowed physical movements, slumped posture, rumination about life’s failures, social isolation, decreased interest in hygiene and grooming.

A

moderate depression

309
Q

outcome goals for depression

A

client will….
experience no physical harm to self
discusses the lose with staff and family
no longer idealizes or obsesses about lost entity.
sets realistic goals
no longer afraid to attempt new activities
able to identify aspects of self control
expresses personal satisfaction from spiritual practices.
interacts willingly with others
able to maintain reality orientation
able to concentrate, reason and solve problems.
eats a well balanced diet to prevent weight loss
sleep 6 to 8 hours and feels rested
bathes, washed and combs hair, and dresses in clean clothing without assistance.

310
Q

what are the 3 phases in individual psychotherapy for depression.

A

phase 1: in this phase the client is assessed to determine the extent of illness.
Phase 2: treatment at this phase focuses on helping the client resolve complicated grief reactions.
phase 3: final phase of interpersonal psychotherapy, the therapeutic alliance is terminated. with emphasis on reassurance, clarification of emotional states, improvement of interpersonal communication, testing of perceptions and performance in interpersonal settings.

311
Q

treatments for depression ….

A

electroconvulsive therapy
transcranial magnetic stimulation
light therapy

312
Q

drugs to treat depression…

A

*tricyclics (amitriptyline, amoxapine. ine endings).
*SSRI’s (celexa, lexapro, prozac, luvox, paxil, zoloft).
*MAOIs (marplan, nardil, parnate, emsam).
*Heterocyclics (wellbutrin, maprotiline, remeron, nefazodone).
SNRIs (pristiq, cymbalta, effexor).

313
Q

a hypertensive crisis may occur with ingestion of foods or other products containing high concentrations of…

A

tyramine

314
Q

fact about suicide:

A

suicide is highest in people older than 50. adolescent are also at high risk. males are at higher risk than females.
caucasians are at higher risk

315
Q

what bipolar disorder is the diagnosis given to an individual who is experiencing a manic episode or has a history of one or more manic episodes.

A

bipolar I

316
Q

what bipolar disorder is characterized by recurrent bouts of MDD with episodic occurrence of hypomania. the client has never experienced a full manic episode. if the current syndrome is a major depressive episode psychotic or catatonic may be noted

A

bipolar II

317
Q

treatment strategies for bipolar disorders

A

monotherapy: with mood stabilizers (lithium, divalproex, carbamazepine) or atypical antipsychotics (olanzapine, quetiapine, risperidone, aripiprazole).

Family interventions

318
Q

facts about stage 1 hypomania

A

disturbance is not sufficiently severe. the mood is cheerful and expansive. the nature of this person is very volatile and fluctuating. thinking is flightly with a rapid flow of ideas. perception of environment is heightened. they are very extroverted and sociable. they talk and laugh usually very loud. increased libido is common. engages in inappropriate behaviors like phoning the president.

319
Q

facts about stage 2 acute mania

A

characterized by euphoria and elation. easily changing to irritability and anger. rapid thinking, pressured speech with abrupt changes from topic to topic. speech is disorganized and incoherent. attention span is short. hallucinations and delusion are common. sexual interest is increased. poor impulse control. excessive spending is common. have the ability to manipulate others. energy seems inexhaustible and the need to for sleep is diminished. grooming is neglected. dress may be disorganized, flamboyant or bizarre. excessive make up or jewelry is common.

320
Q

facts about stage 3 delirious mania

A

severe clouding of consciousness. the mood is very labile. may exhibit feelings of despair, panic anxiety may be evident. other symptoms include religiosity, delusions of grandeur or persecution, and auditory or visual hallucinations. extremely distractible and incoherent. exhaustion can lead to death.

321
Q

outcome goals for bipolar disorder

A

client will…
exhibits no evidence of physical injury
has not harmed self or others
no longer exhibiting signs of physical agitation
eats a well balanced diet
verbalizes an accurate interpretation of the environment
verbalizes that hallucinatory activity has ceased
accepts responsibility for own behaviors
does not manipulate others for gratification of own needs
interacts appropriately with others
is able to fall asleep within 30 mins
is able to sleep 6 to 8 hours per night

322
Q

lithium therapeutic serum concentration for acute mania

A

1.0 to 1.5

323
Q

lithium therapeutic serum concentration for maintenance

A

0.6 to 1.2

324
Q

symptoms of lithium toxicity begin to appear at blood levels greater than?

A

1.5

325
Q

at lithium serum level of 1.5 to 2.0 symptoms include…

A

blurred vision, ataxia, tinnitus, persistent N/V, severe diarrhea.

326
Q

at lithium serum level of 2.0 to 3.5 symptoms include…

A

excessive output of dilute urine, increasing tremors, muscular irritability, psychomotor retardation, mental confusion and giddiness.

327
Q

at lithium serum level of 3.5 and above symptoms include…

A

impaired consciousness, nystagmus, seizures, coma, oliguria/anuria, arrhythmias, myocardial infarction and cardiovascular collapse.

328
Q

lithium fact:

A

lithium dosage should be withheld if the level reaches 1.5.

not skimp on dietary sodium intake.

329
Q

this disorder is characterized by resurrect attacks, the onset of which is unpredictable and manifested by intense apprehension, fear, or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort. symptoms include: palpitations, pounding heart or increased heart rate, sweating, trembling or shaking, SOB, feelings of choking, chest pain, nausea or abdominal pain, dizzy, instead, lightheaded or faint, chills or heat sensations, paresthesia (numbness or tingling), derealization or depersonalization (detached from oneself), fear of losing control or going crazy, fear of dying.

A

panic attacks

330
Q

fact about panic attacks:

A

usually last minutes or more rarely hours. the average age of onset of panic disorder is the late 20’s. may or may not be accompanied by agoraphobia (fear of places).

331
Q

this disorder is persistent, unrealistic, and excessive anxiety and worry, which have occurred more days than not for at least 6 months. the anxiety and worry are associated with muscle tension, restlessness or feeling keyed up or on edge. person avoids activities that may result in negative outcomes, or spend a lot of time and effort preparing for such activities. anxiety and worry result in procrastination, and they seek reassurance from others. the disorder may begin in childhood or adolescence. tends to be chronic, with frequent stress.

A

generalized anxiety disorder

332
Q

this disorder includes the presence of obsessions, compulsions, or both. the person recognizes that the behavior is excessive but because of the feeling of relief from discomfort that it promotes, is compelled to continue the act. equally common in men and women. more often begins in childhood but more in adolescent or early adulthood. the course is chronic. single people are affected by this disorder more than married

A

obsessive compulsive disorder

333
Q

what is the most used scale to test anxiety

A

Hamilton anxiety rating scale

334
Q

outcome goals for anxiety disorders

A

the client :
can recognize signs of escalating anxiety and intervene before reaching panic level.
can maintain anxiety at manageable level and make independent decisions about life situations.
can maintain anxiety at a manageable level without resorting to the use of ritualistic behaviors.
demonstrates more adaptive coping strategies for dealing with anxiety than ritualistic behaviors.

335
Q

interventions for panic anxiety

A

stay with client and offer reassurance of safety and security. do not leave them alone.
maintain a calm, nonthreatening matter of fact approach.
use simple words and brief messages
keep immediate surroundings low in stimuli
teach S&S of escalating anxiety, and ways to interrupt its progression.

336
Q

treatment modalities for anxiety

A

cognitive therapy: this is usually brief and time limited about 5- 20 sessions. this discourages the clients dependency on the therapist which is prevalent in anxiety disorders.
Behavior therapy:covert desensitization and habit reversal therapy. systematic desensitization and implosion therapy are used to treat OCD behaviors.

337
Q

the client is gradually exposed to the phobic stimulus. there are two steps. step 1: training is relaxation techniques
step 2: progressive exposure to a hierarchy of fear stimulus while in the relaxed state.

A

systematic desensitization

338
Q

this is a therapeutic process in which the client must imagine situations or participate in real life situation that they find externally frightening for a prolonged period of time. the therapist floods the patient with information concerning situations that trigger anxiety

A

implosion therapy (flooding)

339
Q

what drugs are used to treat generalized anxiety disorder

A

Anxiolytics: benzodiazepines. (alprazolam, lorazepam, and clonazepam).

340
Q

what drugs are used to treat OCD

A

antidepressants: SSRIs (fluoxetine, paroxetine, sertraline and fluvoxamine.

341
Q

reaction to an extreme trauma, which is likely to cause pervasive distress to almost anyone. these symptoms are not related to common experiences such as uncomplicated bereavement, marital conflict, or chronic illness, but are associated with events that would be markedly distressing to almost anyone. symptoms include: re-experiencing the traumatic event, sustained high level of anxiety or arousal, general numbing of responsiveness. intrusive recollections or nightmares of the event. symptoms of depression are common. survivors often describe painful guilt feelings about surviving when others did not. substance abuse and aggressive behavior and relationship problems are common. the full symptom must be present for more than 1 month, and may begin within the first 3 months after trauma.

A

post traumatic stress disorder.

342
Q

what psychoactive properties does opioids have on a person with PTSD?

A
tranquilizing action
reduction of rage/aggression
reduction of paranoia 
reduction of feelings of inadequacy
antidepressant action
343
Q

outcome goals for a client with trauma related disorder.

A

the client:
can acknowledge the traumatic event and the impact it has has on their life.
is experiencing fewer flashbacks, intrusive recollections, and nightmares than they were on admission.
can demonstrate adaptive coping strategies.
can concentrate and has made realist goals.
includes significant others in recovery and accepts support.
verbalizes no ideas of self harm.
has worked through feelings of survivors guilt.
gets enough sleep to avoid risk of injury.
verbalizes community resources
attends a support group
verbalizes desire to put the trauma in the past and progress with their life.

344
Q

interventions for post trauma

A

assign the same staff as often as possible
use nonthreatening approach
respect client’s wishes
be consistent; keep promises, convey acceptance and spend time with the client.
stay with client during periods of flashbacks.
encourage them to talk about trauma at own pace.
provide nonthreatening private environment
discuss coping strategies.

345
Q

this disorder is characterized by a maladaptive reaction to an identifiable stressor or stressors that result in the development of emotional or behavioral symptoms. the symptoms are expected to remit soon after the stressor is relieved.

A

adjustment disorder

346
Q

this is the most commonly diagnosed adjustment disorder. clinical presentation is one of predominant mood disturbance. depressed mood, tearfulness, and feelings of hopelessness.

A

adjustment disorder with depressed mood.

347
Q

outcome goals for adjustment disorder

A

the client:
verbalizes acceptable behaviors associated with each stage of the grief process.
demonstrates a reinvestment in the environment
accomplishes ADLs
demonstrates ability for adequate occupational and social functioning.
verbalizes awareness of change in health status and the effect it will have on lifestyle.
solves problems and sets realistic goals
demonstrates ability to cope effectively with change in lifestyle.

348
Q

during this phase the client gives attention to the negative beliefs and disturbing emotions associated with the traumatic event.

A

desensitization

349
Q

during this phase the client given attention to the positive belief that they have identified to replace the negative belief associated with the trauma.

A

installation phase

350
Q

during this phase the positive cognition has been strengthened, the client is asked to concentrate on any lingering physical sensations.

A

body scan phase

351
Q

true or false:

SSRIs are now considered first line treatment of choice for PTSD?

A

true

352
Q

goals of therapy for adjustment disorders

A

relieve symptoms associated with stressor.
enhance coping with stressors
establish support system

353
Q

what is the most common therapy for adjustment disorders?

A

individual psychotherapy

354
Q

how come adjustment disorders are not treated with medications?

A

their effect may be temporary and only mask the real problem.
psychoactive drugs carry the potential for physiological and psychological dependence.

355
Q

symptoms that cannot be explained medically and are associated with psychosocial distress and long term seeking of assistance from health care professional. symptoms may be vague, dramatized, and an excessive amount of time and energy is devoted to worry and concern about the symptoms.

A

somatic symptom disorder

356
Q

outcome goals for a client with somatic symptom disorder.

A

the client :
effectively uses adaptive coping strategies during stressful situations without resorting to physical symptoms.
verbalizes relief from pain and demonstrates adaptive coping strategies during stressful situations to prevent the onset of pain
verbalize understanding of correlation between physical symptoms and psychological problems.
verbalize that fears associated with bodily sensations are irrational.
verbalize emotional problems as a contributing factor to the allegation in physical functioning.

357
Q

this disorder is characterized by the existence of two or more personalities in a single individual. only one personally is evident at any given time, and one is more dominant. each is unique and composed of a complex set of memories, behavior patterns and social relationships.

A

dissociative identity disorder

358
Q

interventions for dissociative disorder

A
  • obtain as much information as possible about the client from family and significant others.
  • do not flood client with data regarding their past life.
  • expose client to stimuli that represent pleasant experiences from the past.
  • encourage client to discuss situations that have been stressful and to explore the feeling associated with those times.
  • identify conflicts that remain unresolved. provide instruction regarding more adaptive ways to respond to anxiety.
  • develop a trusting relationship with the original person and with each of the sub personalities.
  • help client understand the existence of the sub personalities and the need each serves in the personal identity of the individual.
  • help client identify stressful situations that precept transition form one personality to another.
  • help sub personalities understand that their “being” will not be destroyed but rather integrated into a unified identity.
  • provide support during disclosure of painful experiences and reassurance when client becomes discourage with lengthy treatment.
  • provide support and encouragement during time of depersonalization.
  • explain the depersonalization behaviors
  • explain the relationship between severe anxiety and depersonalization.
  • explore past experiences and possibly repressed painful situations.
  • discuss these painful experience and encourage them to deal with the feelings.
  • discuss more ways the client may adaptively respond to stress, and use role play.
359
Q

is when an individual has no memory of specific events that took place, usually traumatic. The memory loss is localized within a specific window of time (usually several hours or 1–2 days). For example: A car wreck survivor who has no memory of the experience until two days later.

A

localized amnesia

360
Q

is when a person can recall only small parts of events that took place in a defined period of time. For example: A veteran of a war may recall some details, such as taking prisoners, but not others, such as seeing a good friend get hit.

A

selective amnesia

361
Q

is when a person’s amnesia encompasses his or her entire life. These individuals are usually found by the police or taken by others to a hospital emergency room.

A

generalized amnesia

362
Q

this disorder is pervasive, persistent, and inappropriate mistrust of others. suspicious of others’ motives and assume that others intend to exploit, harm or deceive them. more commonly diagnosed in men.
constantly on guard, hyper vigilant, and ready for any real or imagined threat. appear tense and irritable. extremely oversensitive and tend to misinterpret even minute cues, magnifying and distorting them into thoughts of trickery and deception

A

paranoid personality disorder.

363
Q

this disorder is a pattern of socially irresponsible, exploitative and guiltless behavior that reflects a general disregard for the rights of others. they exploit and manipulate others for personal gain and unconcerned about obeying the law.

A

antisocial personality disorder

364
Q

this disorder is characterized by a pattern of intense and chaotic relationships, with affective instability and fluctuating attitudes. they are impulsive, directly and indirectly self destructive, and lack a clear sense of identity. more common in women.

A

borderline personality disorder

365
Q

this disorder is characterized by colorful, dramatic, and extroverted behavior in excitable, emotional people. difficultly maintaining long lasting relationships, although they require constant affirmation of approval and acceptance from others. more common in women. tend to be self dramatizing, attention seeking , overly gregarious and seductive.

A

histrionic personality disorder.

366
Q

interventions for borderline personality disorder

A

observe clients behavior frequently

  • secure a verbal contract from client that they will seek out staff member when urge for self mutilitation is felt.
  • remove all dangerous objects from room.
  • try to redirect violent behavior.
  • have sufficient staff
  • administer tranquilizing medications
  • if restraints are used: an in person evaluation by a physician be conducted within 1 hour of the invitation of the restraint or seclusion. they must reissue a new order for restraints every 4 hours for adults and every 1 to 2 hours for children and adolescents. restraints should be observed at least every 15 mins, assist the client with needs related to nutrition, hydration, and elimination; and to position the client so that comfort is facilities and aspiration is prevented. removed one restraint at a time
  • convey accepting attitude.
  • identify the function that anger and rage serve for the client.
  • explore true source of anger
  • help client understand appropriate ways to express anger.
  • set limits on acting out and explain consequences.
  • help client realize you will be available without reinforcing dependent behaviors.
  • rotate staff members to avoid dependence.
  • explore feelings that relate to abandonment
367
Q

the treatment of choice for people with histrionic personality disorder have been…

A

psychoanalytical psychotherapy

368
Q

this treatment is appropriate for individuals with antisocial personality disorder….

A

milieu or group therapy

369
Q

what type of therapy is useful for clients with OCD

A

cognitive/behavioral therapy

370
Q

contributing factors to development of ADHS

A

when one twin of an identical twin pair has the disorder, the other is likely to have it.

  • abnormal levels of these neurotransmitters (dopamine, norepinephrine and serotonin) may be associated with the symptoms of inattention, hyper activity, impulsive, mood and aggression.
  • maternal smoking during pregnancy has been linked to hyperkinetic impulsive behavior. intrauterine exposure to toxic substances, including alcohol can produce effects on behavior.
  • exposure to lead
  • link between food dyes and additives also sugar.
  • disorganized and chaotic environments or a disruption in family equilibrium may contribute to ADHD.
  • maternal mental disorder, paternal criminality, low socioeconomic status, living in poverty, growing up in an institution, and unstable foster care.
371
Q

seeks to prevent the onset of specific diseases via risk reduction: by altering behaviours or exposures that can lead to disease, or by enhancing resistance to the effects of exposure to a disease agent. Examples include smoking cessation and vaccination. Primary prevention reduces the incidence of disease by addressing disease risk factors or by enhancing resistance.

A

primary prevention

372
Q

includes procedures that detect and treat pre-clinical pathological changes and thereby control disease progression. Screening procedures (such as mammography to detect early stage breast cancer) are often the first step, leading to early interventions that are more cost effective than intervening once symptoms appear. Routine blood sugar testing for people over 40 would be an example relevant to detecting Catherine’s diabetes early. Screening is usually undertaken by health professionals, either at the level of individual doctor-patient encounters (e.g., routine blood pressure checks) or via public health screening programs (e.g., mammography screening).

A

secondary prevention

373
Q

seeks to soften the impact caused by the disease on the patient’s function, longevity, and quality of life. Examples include cardiac rehabilitation following a myocardial infarction, seeking to alter behaviours to reduce the likelihood of a reinfaction. Tertiary prevention can include modifying risk factors, such as assisting a cardiac patient to lose weight, or making environmental modifications to reduce an asthmatic patient’s exposure to allergens.

A

tertiary prevention

374
Q

ability to perform self care activities the levels of intellectual developmental disorder: what level?

capable of independent living, with assistance during times of stress.

A

mild 50-70

375
Q

ability to perform self care activities the levels of intellectual developmental disorder: what level?

can perform some activities independently. requires supervision.

A

moderate 35-49

376
Q

ability to perform self care activities the levels of intellectual developmental disorder: what level?

may be trained in elementary hygiene skills. requires complete supervision.

A

severe 20-34

377
Q

ability to perform self care activities the levels of intellectual developmental disorder: what level?

no capacity for independent functioning. requires constant aid and supervision.

A

profound below 20