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Health And Healing > MIDTERM REVIEW > Flashcards

MIDTERM REVIEW Flashcards

1
Q

Define Resiliency

A

The ability to cope and re-emerge from life events of a traumatic or difficult nature

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2
Q

What are some roles of a psychiatric nurse?

A
  • Socializing agent
  • Teacher
  • Model
  • Advocate
  • Counsellor
  • Nurturer
  • Guide -> promote understanding
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3
Q

The nurse is experiencing negative feelings toward the client and is unable to identify any cause for these feelings. Which of these interpretations of the nurse’s behavior is most justifiable?

  1. Transference may be occurring.
  2. Certain developmental tasks may be incomplete.
  3. The nurse’s feelings are unprofessional.
  4. Countertransference may be occurring.
A

Countertransference is the nurse’s emotional reaction to the client based on significant relationships in the nurse’s past… affecting the nurse-patient relationship.

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4
Q

What are the 3 different types of civil committals for mental-health patients? (VII)

A
  1. Voluntary - Physician admits, through ER, psychiatrist. Patient agrees to treatment
  2. Involuntary - Physical exam, police action, JP action, in-which the patient goes against their will
  3. Informal - Substitute decision-maker admits the patient because they unable to do so themselves
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5
Q 
Explain the following:
Form 1
Form 2
Form 3
Form 4
A

Form 1 - Completed by physician, valid for 72 hours; used for recommendation that client seek psychiatric care. Cannot be contested.

Form 2 - Completed by Judge after family/friend brings attention forth. States patient could be dangerous to self or others and refuses hospital treatment. ONLY for ER admission, once there form invalid.

Form 3 - 2 weeks duration from the date of issue by another Dr.

Form 4 - If patient still meets one of criteria after form 3 is done, they are issued form 4 for 1 month admission x3

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6
Q

In order for a patient to be admitted to the hospital for psychiatric assessment, they must meet one or more of the following criteria:

A
  1. Danger to self or others
  2. Risk of serious impairment of the person
  3. Context of mental illness (Addiction included)
  4. Extra criteria -
    Previous treatment has been helpful
    Likely to harm or substantial deterioration of health is possible if untreated,
    person is incapable SDM consents
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7
Q

True or false, All treatment requires consent unless patient is a significant danger to others, or criminally charged.

A

False. No matter what, all treatment at the hospital requires consent.

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8
Q

Differentiate between Mood and Affect

A

Mood - The internal state of a person (emotions, perceptions)

Affect - The emotional state of a person seen from outsiders (visible affect)

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9
Q

What is the Mental Status Exam (MSE)?

A

Standardized tool to evaluate client’s mental and emotional health. Involves observation of client.

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10
Q

List some risk factors for depression.

A
  1. Previous history (person/family)
  2. Prior suicide attempt
  3. Female
  4. Post partum
  5. Medical co-morbidity/chronic issues
  6. poor social support
  7. Low S.E.S.
  8. Workplace stress
  9. Stressful life events
  10. Hist. or sexual abuse
  11. Current substance abuse
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11
Q

What defines Major Depressive disorder (MDD)?

A

One or more major depressive episodes in the course lasting more than two weeks or a loss of interest accompanied by 4 additional symptoms of depression

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12
Q

This is characterized by a chronically low mood and moderate symptoms of depression that are usually manageable.

A

Dysthymia

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13
Q

This mood disorder is characterized by the reverse symptoms typically seen in depression; including increased sleep, appetite and weight, Marked by fatigue, weakness and sometimes a decreased libido.

A

Atypical depression

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14
Q

What is Seasonal Affective Disorder (SAD)?

A

Onset of depressive symptoms that correlate with the weather/seasons and typically occurs in Northern climates. Treatment includes light therapy.

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15
Q

This is the most commonly diagnosed mood disorder in which almost every aspect of life is affected.

A

MDD (Major Depressive disorder)

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16
Q

The hyper-secretion of cortisol, dysregulation of serotonin, and diminished number of cells in hypothalamus can contribute to this…

A

Major Depression Disorder

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17
Q

Why would Electroconvulsive therapy (ECT) be used to treat depression?

A

Most effective treatment for severe acute depression, especially when medications did not help.

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18
Q

WHat is the typical side effect to ECT?

A

Short-term memory loss

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19
Q

What questions might you ask while assessing for suicidal risk?

A
  1. Previous thoughts of ending their life? if yes, ask about circumstances
  2. If they have an active plan and the means to complete it
  3. Anything that is stopping them for doing it
  4. Can they commit to a future event? (Wedding, family event, etc.)
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20
Q

A client demonstrates poor judgement, is being aggressive, is hyperactive and demonstrates an exaggerated self-esteem. What is their diagnosis?

A

Mania

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21
Q

A client demonstrates poor personal care, insomnia, apathy, agitation, and hallucinations. What is their diagnosis?

A

Depression with Psychosis

Hallucinations

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22
Q

A client is incredibly tired, is sensitive to rejection, and has been gaining weight for the past month. What is their prognosis?

A

Atypical depression

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23
Q

Günter is typically is happy fellow, but every winter his mood deteriorates, and he feels depressed and an increased need for sleep. What is wrong with Günter?

A

Seasonal Affective Disorder (SAD)

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24
Q

Björn states that he has been feeling “down” for a few years now and finds himself apathetic and unable to enjoy life. What the hell is wrong with Björn?

A

Dysthymia

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25
Q

Magnus often finds himself fluctuating between feelings of normalcy and sadness. What SPECIFIC disorder does Magnus have?

A

Bipolar (type II)

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26
Q

Differentiate between the 4 types of Bipolar affective disorder

A
  1. Cycles of mania and depression
  2. Cycles of hypomania and depression
  3. Antidepressant induced
  4. Rapid cycling of at least 4+ episodes per year of depression or mania/hypomania
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27
Q

What are some alternative therapies for Bipolar disorders?

A

Psychoeducation
Psychotherapy
Vocational counselling
Case management/community mental health workers

28
Q

Freya has a severe fear of flying and cannot function when she knows she needs to fly. What mood disorder does Freya suffer from?

A

She doesn’t, she has a fear/phobia.

Anxiety is fear or tension without an identifiable cause

29
Q

When does anxiety become harmful?

A

When it impedes our ability to function.

30
Q

When does Anxiety become a disorder?

A

Causes distress in a person’s life

Affects ability to work, study, socialize, manage life

When a person avoids stressors

irrational or excessive fear

Difficulty managing daily tasks or stress about daily tasks

31
Q

Lars is experiencing severe diaphoresis, dizziness, pounding heart palpitations, fear of losing control, and a shortness of breath. What is Lars’ problem?

A

He’s having a panic attack

32
Q

Brigitta cannot leave her house without first locking her door and unlocking her door 87 times. She also has a house full of porcelain dolls (159 to be exact). What is wrong with Brigitta?

A

Obsessive compulsive disorder (OCD)

33
Q

Bjørk sometimes gets the sense of impending doom, associated with heart palpitations, diaphoresis, nausea, and shortness of breath without cause. What disorder does she have?

A

Generalized Anxiety disorder (GAD)

34
Q

Hålvor tends to avoids driving because it reminds him of his car accident from last year. It is significant enough to impede his everyday functioning, and every time he hears a car, he runs and hides under his couch for 3 days. What is Hålvor’s problem?

A

Post Traumatic Stress Disorder (PTSD)

35
Q

What are some health teaching/promotion exercises for anxiety disorders?

A
  1. Coping mechanisms
  2. Yoga/relaxation
  3. Insight into anxiety
  4. health teaching
  5. Provision of safety
  6. Environmental management
  7. Physical activity
36
Q

Jonas cannot remember specific details, has difficulty with recognizing people and objects, and cannot plan out his day. What is Jonas’ problem?

A

DEMENTIA.

37
Q

What are some risk factors for dementia?

A
  1. Lower education
  2. Advanced age
  3. Family history
  4. Alcohol abuse
  5. Previous head injury
  6. Genetic disposition
  7. Exposure to toxic levels of aluminum
  8. stroke or vascular disorders
  9. Metabolic conditions
  10. Neurologic conditions (Parkinson’s)
38
Q

Ragnar suddenly lost his memory, has difficulty moving, and is having difficulty speaking. It happened very quickly, seems to plateau then worsen. What is Ragnar’s problem?

A

Vascular dementia

39
Q

Åstrid had been deteriorating for some time now, slowly losing her ability to speak, and her motor skills. Åstrid is dead, and the physician found amyloid plaque on her brain… which means….

A

Åstrid had Alzheimer’s disease

40
Q

Greta has been fainting and losing consciousness randomly over the past few years, and experiencing visible and audible hallucinations. What is Greta’s issue?

A

Lewy Body Dementia

41
Q

Nicolaj makes questionable decisions that appear to be fairly impulsive; such as wearing bikini bottoms to his nephew’s bar mitzvah. He also smells horrible, and repeats a lot of his actions. Aside from beings a terrible uncle, what is Nicolaj’s problem?

A

Frontotemporal dementia

42
Q

In this type of dementia, you typically see a decline in functioning, followed by stability, then another decline.

A

Vascular dementia

43
Q 
This type of dementia typically affects your behaviour first.
A/ Alzheimer's
B/ Lewy Body
C/ Vascular
D/ Frontotemporal
A

D. Frontotemporal

44
Q

What are some side effects of the pharmaceutical treatment of ADD/ADHD in children?

A 
Nervousness
Insomnia
Hypertension
Anorexia
Weight loss
Growth supression
45
Q

What is an example of an educational treatment for a child with ADD/ADHD?

A

Modification of the classroom to reduce stimulation and improve learning

46
Q

Olaf responds to information differently than his peers, prefers to be alone, is ritualistic, rarely makes eye contact, but has no language delays. What is Olaf’s issue?

A

Asperger’s syndrome

47
Q

Helga is having trouble communicating with her family, is resisting change, makes no eye contact, and laughs often without reason. What is wrong with Helga?

A

Autism

48
Q 
\_\_\_\_\_\_ can cause the following issues:
Bowel problems
Early Menarche
Seizures
Fertility dysfunction
Fibromyalgia
Depression
Personality disorders
Anorexia/bulemia
Manic depression
dissociation
A

Child abuse

49
Q

what does ABCD-ER mean when screening women for domestic abuse?

A 
A - attitudes and approachability
B - Belief
C - Confidentiality
D - Documentation
E - Education
R - Respect and Recognition
50
Q

What are some safety planning tools for domestic abuse victims?

A
  • Emergency escape plans
  • Photocopies of relevant and important documents
  • Keep list of numbers for friends, shelters and helplines
  • Make arrangements to stay with fam/friend if possible
  • create a code word for children/friends to know when to call for help
51
Q

A patient with a diagnosis of major depression who has attempted suicide says to the nurse, “I should have died. I’ve always been a failure. Nothing ever goes right for me.” Which response demonstrates therapeutic communication?

a. “You have everything to live for”
b. “Why do you see yourself as a failiure?”
c. “Feeling like this is all part of being depressed.”
d. “You’ve been feeling like a failure for a while?”

A

(D) “You’ve been feeling like a failure for a while?”
RATIONALE: Responding to the feelings expressed by a patient is an effective therapeutic communication technique. The correct option is an example of the use of restating. The remaining options block communication because they minimize the patient’s experience and do not facilitate exploration of the patient’s expressed feelings. In additions, use of the word “why” is nontherapeutic.

52
Q

When the community health nurse visits a patient at home, the patient states, “I haven’t slept at all the last couple of nights. Which response by the nurse illustrates a therapeutic communication response to this patient.”

a. “I see.”
b. “Really?”
c. “You’re having difficulty sleeping?”
d. “Sometimes, I have trouble sleeping too.”

A

(C) “You’re having difficulty sleeping?”
RATIONALE: The correct option uses the therapeutic communication technique of restatement. Although restatement is a technique that has a prompting component to it, it repeats the patients major theme, which assists the nurse to obtain a more specific perception of the problem from the patient. The remaining options are not therapeutic responses since none encourage the patient to expand on the problem. Offering personal experiences moves the focus away from the patient and onto the nurse.

53
Q

A patient experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the use to encourage the patient to eat?

a. Using open-ended questions and silence
b. Sharing personal prefernce regarding food choices
c. Documenting reasons why the patient does not wat to eat
d. Offering opinions about the necessity of adequate nutrition

A

(A) Using open-ended questions and silence
RATIONALE: Open-ended questions and silence are strategies use to encourage patients to discuss their problems. Sharing personal food preferences is not a patient-centered intervention. The remaining options are not helpful to the patient because they do not encourage the patient to express feelings. The nurse should not offer opinions and should encourage the patient to identify the reasons for the behavior.

54
Q 
A patient admitted to a nental health unit for treatment of psychotic behavior spends hours at teh locked exit door shouting. "Let me out. Ther's nothing wrong with me. I don't belong here." What defense mechanism is the patient implementing?
a. Denial
b. Projection
c Regression
d. Rationalization
A

(A) Denial
RATIONALE: Denial is refusal to admit to a painful reality, which is treated as if it does not exist. In projection, a person unconsciously rejects emotionally unacceptable features and attributes them to other persons, objects, or situations. Regression allows the patient to return to an earlier, more comforting, although less mature, way of behaving. Rationalization is justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller and the listener.

55
Q

A patient diagnosed with terminal cancer says to the nurse “I’m going to die, and I wish my family would stop hoping for a cure! I get so angry when they carry on like this. After all, I’m the one who’s dying.” Which response by the nurse is therapeutic?

a. “Have you shared your feelings with your family?”
b. “I think we should talk more about your anger with your family.”
c. “You’re feeling angry that your family continues to hope for you to be cured?”
d. “You are probably very depressed, which is understandable with such a diagnosis”

A

(C) “You’re feeling angry that your family continues to hope for you to be cured?”
RATIONALE: Restating is a therapeutic communication technique in which the nurse repeats what the patient says to show understanding and to review what was said. While it is appropriate for the nurse to attempt to assess the patient’s ability to discuss feelings openly with family members, it does not help the patient discuss the feelings causing the anger. The nurse’s attempt to focus on the central issue of anger is premature. The nurse would never make a judgment regarding the reason for the patient’s feeling, this is non-therapeutic in the one-to-one relationship.

56
Q

On review of the patients record, the nurse notes the admission was voluntary. Based on this information, the nurse anticipates which patient behavior?

a. Fearfulness regarding treatment measures.
b. Anger and agressiveness directed toward others.
c. An understanding of the pathology and syptoms of the diagnosis
d. A willingness to participte in the planning of the care and treatment plan

A

(D) A willingness to participate in the planning of the care and treatment plan
RATIONALE: In general, patients seek voluntary admission. If a patient seeks voluntary admission, the most likely expectations is the patient will participate in the treatment program since they are actively seeking help. The remaining options are not characteristics of this type of admission. Fearfulness, anger, and aggressiveness are more characteristic of an involuntary admission. Voluntary admission does not guarantee a patient’s understanding of their illness, only of their desire for help.

57
Q

A patient admitted voluntarily for treatment of an anxiety disorder demands to be released from the hospital. Which action shoul dthe nurse take INITIALLY?

a. Contact the patients health care provider (HCP)
b. Call the patients family to arrange for transportations.
c. Attempt to persuade the pationt to stay “for only a few more days”
d. Tell the patient tha tleaving would likely result in an involuntary commitment

A

(A) Contact the patients health care provider (HCP)
RATIONALE: In general, patients seek, voluntary admission. Voluntary patients have the right to demand and obtain release. The nurse needs to be familiar with the state and facility policies and procedures. The best nursing action is to contact the HCP, who has the authority to discuss discharge with the patient. While arranging for safe transportation is appropriate it is premature in this situation and should be done only with the patient’s’ permission. While it is appropriate to discuss why the patient feels the need to leave and the possible outcomes of leaving against medical advice, attempting to get the patient to agree to staying “a few more days” has little value and will not likely be successful. Many states require that the patient submit a written release notice to the facility staff members, who reevaluate the patient’s condition for possible conversion to involuntary status if necessary, according to criteria established by law. While this is a possibility, it should not be used as a threat to the patient.

58
Q

When reviewing the admission assessment, the nurse notes that a patient was admitted to the mental health unity involuntarily. Based on this type of admission, the nurse should provide which intervention for this patient?

a. Monitor closely for harm to self or others
b. Assist in completing an applicaiont for admission
c. Supply the patient with written information about their mental illness
d. Provide an opprotunity fo the family to discuss why they felt the admission was needed

A

(A) Monitor closely for harm to self or others
RATIONALE: Involuntary admission is necessary when a person is a danger to self or others or is in need of psychiatric treatment regardless of the patient’s willingness to consent to the hospitalization. A written request is a component of a voluntary admission. Providing written information regarding the illness is likely premature initially. The family may have had no role to play in the patient’s’ admission.

59
Q

The nurse is preparing a patient for the termination phase of the nurse-patient relationship. The nurse prepares to implement which nursing task that is MOST APPROPRIATE for this phase?

a. Planning short-term goals
b. Making appropriate referrals
c. Developing realistic solutions
d. Identifying expected outcomes

A

(B) Making appropriate referrals
RATIONALE: Tasks of the termination phase include evaluating patient performance, evaluating achievement of expected outcomes, evaluating future needs, making appropriate referrals and dealing with the common behaviors associated with termination. The remaining options identify tasks appropriate for the working phase of the relationship.

60
Q

The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbors says to the nurse, “How is Carol doing? She is my best friend and is seen at your clinic every week.” Which is the MOST APPROPRIATE nursing response?

a. “I can not discuss any patient situation with you.”
b. “If you want to know about Carol, you need t ask her yourself.”
c. “Only because you’re worried about a friend, I’ll tell you that she is improving.”
d. “Being her friend, you know she is having a difficult time and deserves her privacy.”

A

(A) “I cannot discuss any patient situation with you.”
RATIONALE: The nurse is required to maintain confidentiality regarding the patient and the patient’s care. Confidentiality is basic to the therapeutic relationship and is a patient’s right. The most appropriate response to the neighbor is the statement of that responsibility in a direct, but polite manner. A blunt statement that does not acknowledge why the nurse cannot reveal patient information may be taken as disrespectful and uncaring. The remaining options identify statements that do not maintain patient confidentiality.

61
Q

The nurse in the mental health unit recognizes ___ as being therapeutic communication techniques? SELECT ALL THAT APPLY

a. Restating
b. Listening
c. Asking the patient “Why?”
d. Maintaing neutral responses
e. Providing acknowledgment and feedback
f. Giving advice and approval or disapproval

A

(A, B, D, E) Restating, Listening, Maintaining neutral responses, Providing acknowledgment and feedback
RATIONALE: Therapeutic communication techniques include listening, maintaining silence, maintaining neutral responses, using broad openings and open-ended questions, focusing nd refocusing, restating, clarifying and validating, sharing perceptions, reflecting, providing acknowledgment and feedback, giving information, presenting reality, encouraging formulation of a plan of action, providing nonverbal encouragement, and summarizing Asking why is often interpreted as being accusatory by the patient and should also be avoided. Providing advice or giving approval or disapproval are barriers to communication.

62
Q

What is the purpose of a community treatment order?

A

An order that establishes extensive and comprehensive plan of care in the community that is less restrictive than institutional care… intended for “revolving door” patients

63
Q

When might anxiety become a disorder?

A
  • Cause of distress in a person’s life
  • Affects ability to work, study, socialize, manage daily tasks
  • Cognitive – anxious thoughts
  • Physical – excessive physical reactions relative to the context
  • Behavioural – avoidance of feared situations or activities
  • Irrational and excessive fear
  • Apprehensive and tense feelings
  • Difficulty managing daily tasks and/or distress related to these tasks
64
Q

WHat are some health deficits of Child Abuse?

A

Physical system - puberty & Sexualization
Brain Development - Limbic irritability, differentiation between left and right hemispheres, child focus tends to fixate on survival
Belief system - abuse teaches that others come first, and submission to others is important. Decreased self-esteem

65
Q

What are some long-term physical effects of child abuse?

A 
Seizures
Early Menarche
Idiopathic bladder
Bowel issues
Fibromyalgia
Fertility and sexual dysfunction
Dental damage
66
Q

What are some long term mental effects of child abuse?

A 
Depression
Anxiety disorder
Personality disorders
Eating disorders
PTSD
Self-mutilation
Phobias
Manic Depressive
Dissociation

Health And Healing (7 decks)

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