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NUR206 > Mock Exam > Flashcards

Mock Exam Flashcards

1
Q

Outline four therapeutic communication techniques:

A
  • Listening (being fully present, lets patient be heard, convey interest)
  • Silence (gather thoughts)
  • Open ended questions (decide on manner of response)
  • Restating (repeat main message)
  • Reflection (reflect and interpret back)
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2
Q

Name four therapeutic approaches used in mental health setting:

A
  • Psychotherapy
  • Pharmacotherapy
  • ECT
  • CBT
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3
Q

List four reasons for carrying out a risk assessment:

A
  • Part of an overall assessment upon admission to mental health facility
  • Major changes in client circumstances
  • When moving clients between services
  • Prior to granting leave/discharge
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4
Q

State four side effects of atypical antipsychotics:

A
  • Hypotension
  • Dizziness
  • Fainting
  • Sedation
  • Weight gain
  • Insomnia
  • Dry mouth
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5
Q

Define depression and state four signs and symptoms of depression

A

A mood disorder characterised by depressed mood, pessimism, anhedonia and apathy

Social and emotional withdrawal, Impaired attention and conversation, delusions of guilt and worthlessness, fatigue, weight gain/loss

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6
Q

Briefly describe the powers and responsibilities of a Senior Mental Health Practitioner (SMHP) under the 1996 Mental Health Act.

A

May detain a voluntary patient at risk in the absence of a doctor for 6 hours

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7
Q

Assessments with substance abuse:

A

Alcohol and other drug history, physical appearance (general appearance, nutrition, intoxication and withdrawal), breathalyse, drug screening, AUDIT test, mental state examination

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8
Q

Effects of substance abuse on families:

A

Stress, financial problems, manipulation, lying, distrust

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9
Q

6 nursing management principles:

A
  • Consultation of a GP, counselling service or mental health clinic
  • Pharmacotherapy
  • AA/NA
  • Change peer group
  • CBT
  • Rehab
  • Therapy
  • Detox
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10
Q

Nursing diagnosis with anorexia:

A

Imbalanced Nutrition: less than Body Requirements R/T insufficient intake of nutrients to meet metabolic needs

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11
Q

One expected outcome for diagnosis:

A

The client will:

increase nutritional intake and increase weight within two weeks

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12
Q

6 nursing interventions:

A

Establish behaviour modification protocol to provide consistency and decrease power struggle

Provide a structure to mealtimes and state limits. Tell client when it is time to eat and present the food

Do not bribe, coax, or threaten the client to eat food but encourage, withdraw your attention if the client refuses to eat. When the mealtime is over and remove food.

Supervise client during and after meals. Do not allow client to use the bathroom until at least 30 minutes after each meal

Monitor client’s intake and record food intake and food not eaten. Document non-compliant behaviour in the progress notes

Encourage client to seek out for a staff member to talk about feelings of anxiety or fear

Grant and restrict privileges based on weight gain or loss

Weigh client before breakfast and after voiding

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13
Q

Antidepressants:

A

Treat depression, inhibit neurotransmitter breakdown and release neurotransmitters, increase serotonin levels

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14
Q

Types of antidepressant:

A

Tricyclic antidepressants (clomipramine), Selective serotonin reuptake inhibitors (sertraline-Zoloft), serotonin noradrenaline reuptake inhibitors (reboxitine), monoamine oxidase inhibitors (phenelzine)

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15
Q

Mood stabiliser:

A

Lithium carbonate

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16
Q

What is MSE:

A

Process of obtaining information about specific aspects of individuals mental experience and behaviour

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17
Q

Why we do MSE:

A

Determine risk and severity, identify signs and symptoms, monitor change and improvement, generate hypothesis, documentation

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18
Q

What done with history:

A

Individual details, identify present problems, history of illness, personal history, previous medical/surgical history, family history, illicit drug use, MSE

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19
Q

MSE includes (9):

A
  1. Appearance and behaviour
  2. Speech
  3. Mood and affect
  4. Form of thought
  5. Content of thought
  6. Perceptual disturbances
  7. Sensorium and cognition
  8. Insight
  9. Formulation
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20
Q

Symptoms of alcohol withdrawal:

A

Sweating, tremors, anxiety, agitation, nausea and vomiting, hallucinations, orientation, headaches, seizure

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21
Q

Principles of nursing care alcohol abuse + substance:

A

Initial assessment, friendly and calm, seizure precautions, limit environmental stimuli, dim lights, food and nourishing fluids, medication management, assist ADL’s, obtain history, teach about HIV, non-judgemental

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22
Q

Psychosis:

A

Group of disorders characterised by hallucinations and thought disorder

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23
Q

Schizophrenia:

A

Most common type of psychosis characterised by psychotic features.

Disturbed thought, perception, volition, emotion with impairment of judgement and behaviour

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24
Q

Subtypes of schizophrenia:

A

Paranoid (delusions of grandeur)
Disorganised (immature emotionally)
Catatonic (immobility or excited agitation, unusual motor response)
Residual (one episode but no longer shows major symptoms)
Undifferentiated (various symptoms not in one category)

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25
Q

Positive schizophrenic conditions:

A

Delusions, hallucinations, disorganised thoughts, disturbance in language

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26
Q

Negative schizophrenic conditions:

A

Blunting effect, anhedonia, sociality, abolition, apathy, poverty of speech

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27
Q

Diagnosing schizophrenia:

A

At least 2 symptoms in a period of one month:

  • delusion
  • hallucination
  • disorganised speech pattern
  • behaviour disturbance
  • negative symptoms

Social, occupational, duration (6 months), exclusions (other disorders)

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28
Q

Assessment in schizophrenia:

A
  • Full psychiatric history
  • Physical examination
  • MSE
  • Risk assessment
  • Current medications and compliance
  • Family response and support
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29
Q

Phases of schizophrenia (4):

A
  1. Prodromal phase (initial symptoms identified)
  2. Acute phase (psychotic symptoms)
  3. Maintenance phase (less severe symptoms)
  4. Stabilisation phase (remission of symptoms)
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30
Q

Anxiety VS anxiety disorders:

A

Anxiety is a normal reaction of alertness and an adaptive response, anxiety disorder is when a client sows exaggerated or excessive anxiety with psychological changes

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31
Q

Types of anxiety disorders:

A

Panic attack, panic disorder, generalised anxiety disorder, obsessive compulsive disorder, acute stress disorder, PTSD

32
Q

Symptoms of anxiety disorders:

A

Panic, fear, stress, worry

33
Q

Management of anxiety:

A

Anti-anxiety medication, beta blockers, relaxation and controlled breathing, constructive thoughts, CBT, flooding, thought stopping

34
Q

Somatoform disorders:

A

Somatization disorder, conversion disorder, pain disorder, body dysmorphic, undifferentiated somatoform

35
Q

Dissociative disorders:

A

Amnesia, fugue, depersonalisation disorder, identity disorder, multiple personality

36
Q

Cluster A personality disorders:

A

Paranoid, schizoid, schizotypal

37
Q

Cluster B personality disorders:

A

Antisocial, borderline, histrionic, narcissistic

38
Q

Cluster C personality disorder:

A

Avoidant, dependent, OCD

39
Q

Kleptomania:

A

Theft of worthless objects, relieves tension

40
Q

Assessments with personality disorders:

A

Full psychiatric history, history of physical and sexual abuse, history of drug and alcohol use, physical examination, MSE, risk assessment

41
Q

Managing personality disorders:

A

Antipsychotics, mood stabilisers, antidepressants, anti-anxiety, CBT, family therapy

42
Q

Basic counselling skills:

A

Active listening, attending behaviour

43
Q

ECT:

A

Induction of a fit or seizure by passing controlled electric current through the brain via mental electrodes across the temples

44
Q

Indications of ECT:

A

Major depression, bi polar, catatonic seizure, puerperal psychosis

45
Q

Contraindications to ECT:

A

MI, pulmonary embolism, cerebral tumours, subdural hematoma

46
Q

Types of risks:

A

Risk to suicide, risk of deliberate self harm, risk of self neglect, accidental harm, absconding

OTHERS:
Violence, harm to child, deliberate fire setting, sexual abuse, risk of exploitation, elder abuse

47
Q

Antipsychotics:

A

Main treatment of psychotic disorders, schizophrenia associated with dopamine overactivity, antipsychotics assist brain to restore chemical balance, subdivided into typical and atypical

48
Q

TYPICAL:

A

Older and conventional antipsychotics and AKA as neuroleptics, effective against positive symptoms

49
Q

Typical drugs include:

A

Chlorpromazine, haloperidol, thioridazine, trifluoperazine, pericyazine

50
Q

Effect of typical drugs:

A

Dopamine antagonist, target positive symptoms, calming effect, less expensive than atypical, do NOT treat negative symptoms or EPSE

51
Q

EPSE:

A

Dystonia (stiffness/tonic contraction of muscles)
Oculogyric crisis (rotate eyeballs)
Akathisia (restlessness, agitation)
Parkinsonism (tremor, rigidity, mask-like face)
Tardive dyskinesia (involuntary face movements, tongue and lips)
Neuroleptic malignant syndrome (severe EPS, sweating, muscle rigidity)

52
Q

Atypical antipsychotics:

A

Newer antipsychotics, treat both positive and negative symptoms and have less side effects which include (risperidone, olanzapine, clozapine)

53
Q

Anxiolytics:

A

Diazepam, clonazepam, lorazepam, buspirone

54
Q

Sedatives and hypnotics:

A

Zopiclone, zolpidem, temazepam

55
Q

Nursing diagnosis of depression:

A

Risk of suicide, imbalanced nutrition, self care defecit, hopelessness, impaired social interaction, ineffective coping

56
Q

Nursing diagnosis of mania:

A

Risk of violence, disturbed sensory perception, disturbed thought processes, impaired verbal communication, ineffective coping, non compliance

57
Q

MHA:

A

Police have the power to apprehended any person they suspect has a mental illness. Either a medical practitioner or an authorised mental health practitioner must examine the patient who could be released or referred for further psychiatric examination

58
Q

MHA legal forms:

A

Form 1- Referral by MP or AMHP for examination by psychiatrist within 24 hrs
Form 2- Detention of voluntary patient at risk by SMHP in the absence of doctor for 6 hours
Form 3 - Transport Order
Form 4 - Detention for further assessment for 48 hrs
Form 5 - Order for receival into authorised hospital for further assessment for 72 hrs
Form 6 - Involuntary patient order. Patient is detained for 28 days
Form 7 - Transfer between authorised hospitals
Form 8 - No longer involuntary patient
Form 9 - Continuation of involuntary order for up 6 months
Form 10 - Community Treatment Order (CTO)
Form 11 – Revocation of a CTO
Form 12 - Extending or varying a CTO
Form 13 - Breach of CTO
Form 14 - Order to attend treatment

59
Q

Medication treatment of AWS:

A

Naltrexone, benzodiazepine, thiamine, acamprosate, methadone

60
Q

Anorexia nervosa:

A

Anorexia nervosa is a serious mental disorder characterised by significant weight loss resulting from excessive dieting
Anorexic clients consider themselves to be fat, no matter what their actual weight is
Usually strive for perfection
Set very high standards for themselves and feel they always have to prove their competence
They feel the only control they have in their lives is in the area of food and weight
If they cannot control what is happening around them, they can control their weight

61
Q

Complications of AN:

A

Cardiac irregularities due to protein-calorie malnutrition
Electrolyte abnormalities: low potassium and sodium levels
GIT effects: feeling bloated or full even after eating small amounts
Renal dysfunction: Reduced glomerular filtration rate
Neurological changes due to brain atrophy
Cognitive changes: impairment in attention & concentration
Skin changes due to protein-calorie malnutrition
Re-feeding syndrome due to imbalance in electrolytes and fluids

62
Q

Bulimia nervosa:

A

Bulimia is mental disorder characterised by a cycle of dieting, binge eating followed by purging to try and lose weight
A binge may range from 1,000 to 10,000 calories
Purging methods usually involve vomiting and laxative abuse Other forms of purging can involve use of diuretics, diet pills and enemas
People with bulimia usually do not feel secure about their own self- worth
They often strive for the approval of others
Food becomes their only source of comfort
Bulimia also serves as a function for blocking or letting out feelings
Unlike anorexia, people with bulimia do realise they have a problem & are more likely to seek help

63
Q

Potential nursing diagnosis of AN and BN:

A 
Anorexia nervosa 
Imbalanced Nutrition: Less than Body Requirement
Distorted Body Image
Ineffective Individual Coping
Chronic Low Self-Esteem

Bulimia nervosa and binge eating
Anxiety
Ineffective Individual Coping
Compromised Family Coping

64
Q

Assessments with ED:

A

Psychiatric evaluation/ mental state assessment
Body image assessment
Disordered eating behaviours & rituals assessment
Nutritional assessment
Family assessment
Physical examination
Routine laboratory investigations: TFT, FBC, LFT, RFT
Blood chemistry: Electrolytes
Cardiac assessment: ECG

65
Q

BMI calculation:

A

Height squared divided by weight

66
Q

Managing ED:

A

Psychopharmocotherapy
Antidepressants, anti-anxiety & antipsychotics such as olanzapine to reduce image distortions & severe obsessions
Other medications
Multivitamins, Phosphate Sandoz, Calcitrate Plus Vitamin D

Psychosocial therapy 
   Cognitive behaviour therapy - behaviour modification
   Motivational enhancement therapy 
   Psycho-education and goal setting
   Supportive therapy
   Family support and education 
   Interpersonal relationship therapy
   Individual & group psychotherapy
67
Q

Dementia:

A

Dementia denotes a group cognitive disorders characterised by:
Cognitive impairment
Deterioration of language and motor skills
Disturbance in perception
Mood changes
The distinguishing landmark in dementia is
the significant change in cognitive functions

68
Q

Causes of dementia:

A

Some of the causes include:
Infection to the brain (meningitis, encephalitis)
Head injury
Poisons and toxic sprays
Alcohol and drug abuse
Metabolic and endocrine disturbances: myxoedema
Degenerative diseases: parkinson’s disease
Vascular disorders: stroke/CVA
Hereditory

69
Q

Types of dementia:

A 
Alzheimer's disease AD
Huntington Chorea
Creutzfeldt-Jakob Disease
Dementia with Lewis Bodies
Frontal lobe dementia - Pick’s Disease
Vascular dementia
Wernicke-Korsakoff Syndrome
70
Q

Assessment with dementia:

A

Thorough Physical examination
Collateral history
Mini-Mental State Examination (MMSE)
Mental Status Examination (MSE)
Neurological examination
Beck Depression Inventory (R/O depression)
Routine blood checks - FBC TFT, B12, Folate
Blood chemistry - Renal function, metabolic, hepatitis, HIV, VDRL
CT scan- Computerised Tomography
MRI - Magnetic Resonance Imaging test

71
Q

Treatment of dementia:

A

Psychopharmacotherapy
Symptomatic treatment with: anti-anxiety, anti-psychotic, anti-depressants and sedatives
Cholinesterase inhibitors are used to treat mild to moderate dementia and include the following drugs: Aricept (donepezil), Galantamine and Rivastigmine - prevent cognitive deterioration
Memantine used to treat mild to moderate dementia to slow memory deterioration
Psychosocial therapies
Cognitive Behaviour Therapy (CBT)
Occupation therapy
Recreational therapy and music therapy
Validation therapy
Reminiscence, reviewing past events using photos albums – by looking at school days, wedding day photos

72
Q

Delirium:

A 
Delirium is an acute organic mental syndrome characterised by: 
Cognitive impairment 
Altered level of consciousness 
Poor concentration and attention 
Psychomotor activity 
Sleep-wake disturbances
73
Q

Delirium causes:

A

Any conditions affecting the brain
- Head injury, brain tumour, epilepsy, subdural, CVA
Drug toxicity, interaction or withdrawal
Hypoxia secondary to respiratory or circulatory disorder
Infections: meningitis, encephalitis, sepsis, HIV,
CCF: due to diminished cerebral blood flow
Biochemical disturbances: calcium, sodium, urea
Metabolic and endocrine disorders: thyroid, blood glucose abnormalities
Psychiatric disorders: depression or psychosis
Hyperthermia or hypothermia
Nutritional deficiencies especially B12 and iron

74
Q

Assessment of delirium:

A 
Routine BLOOD screening:  FBC, LFT, TFT, B12 
Blood chemistry: drug screening, renal
	function, hepatitis, HIV, VDRL 
Neuropsychological testing 
CT scan - Computerised Tomography 
MRI - Magnetic Resonance Imaging test
Thorough physical assessment
Assess medication effects or withdrawal
Mini-Mental State Examination (MMSE)
Mental Status Examination (MSE)
75
Q

Nursing care of patient with delirium:

A

Provide safe and familiar environment to prevent injury
Evaluate the need for one to one to protect patient
Provide non-stimulating environment to promote rest
Provide good nurse patient relationship
Offer continuity of care with familiar faces to alley fear
Communication should be simple, clear, call patient’s name, tell who you are, where she/he is, what time it is
Avoid sudden movement as patient is frightened
Obtain urine, blood and other specimen as ordered by the doctor
Assist with ADL’s: hygiene, bowels, bladder and ensure patients wear glasses or hearing aids if they wear them
Provide adequate light diet and fluids
Restore and maintain fluid and electrolyte balance
Give medication as ordered to treat cause or symptoms
Offer support and reassurance to patient and family

76
Q

Differentiating the 3 D’s:

A 
Differentiating 3 D’s (depression, delirium and dementia) needs comprehensive assessment including:
A complete medical/surgical/psychiatric and collateral history
Examine the presenting symptoms
A full physical examination
Neurological examination 
Mental State Examination
Blood checks and urine test 
ECG and EEG
CT scan and MRI
Check support offered to the patient

NUR206 (2 decks)

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