Psych Flashcards
What can Advanced Practice Nurses do that RNs cannot?
Prescribe meds and do psychotherapy
When is it most important that a psych nurse advocate for her client?
To improve care in hospitals with legislations
What are the signs and symptoms of depression?
Anhedonia, fatigue, sleep disturbances, appetite changes, hopelessness, thoughts of death or suicide, inability to concentrate, change in physical activity, and psychomotor retardation
What is psychomotor retardation
An extreme slowing of movement not associated with normal aging
Who uses the DSM 5?
Medical professionals diagnosing a patient
Who uses the ICD 9 CM?
Insurances companies like Medicare
What stage would Freud consider a 26 month old?
Anal; ability to delay gratification and control over impulse
What stage would Freud consider a 4 year old?
Phallic; obsessed with genitals and parent of the same sex
How does Maslow’s Hierarchy of Needs work?
Have to fulfill the basic bottom ones in order to find self happiness
What are the basic needs according to Maslow?
Food, oxygen, water, sleep, sex and body temperature
What is aversion therapy?
A form of punishment when all else fails that causes adverse affects to stimuli
Name an example of aversion therapy?
Antabuse for alcoholics
The source of all drives, reflexes, needs, instincts, genetic inheritance, and capacity to respond as well as all the wishes that motivate us
Id
What is transference?
Feelings a patient has towards healthcare workers that were initially meant for another person in their life
What is counter transference?
The unconscious feelings a healthcare worker has towards their patient
How are phobias treated?
Systematic desensitization
What is cognitive distortion?
Rapid, unthinking responses based on schemas
An extreme form of magnification in which the very worst of is assumed to be a probable outcome
Catastrophizing
Using a bad outcome as evidence that nothing will ever go right again
Overgeneralization
Maintaining a negative view by rejecting information that supports the positive view as being irrelevant, inaccurate, or accidental
Disqualifying the positive
Assuming responsibility for an external event or situation that was likely outside personal control
Personalization
Problem solver and reality tester
Ego
The moral component of personality
Super Ego
What are neurotransmitters?
Chemicals releases across neural synapses that deliver messages throughout the nervous system
What are the functions of neurotransmitters?
They either stimulate or inhibit impulses
What can the Id not tolerate?
Frustration or delayed satisfaction
What is the difference between a CT and PET scan?
CT shows structure while PET scans should activity
What does the Id lack?
The ability to problem solve
What medication promotes GABA receptors in the brain?
Benzodiazapam
What does Benzodiazapam do?
Calms and sedates in high doses
What changes occurs in a schizophrenic’s frontal lobe?
Reduced volume, increased thickness
What changes occur in a schizophrenic’s hippocampus?
Reduced volume
What changes occurs in a schizophrenic’s cerebellum?
Enlargement of the lateral cerebral ventricles
What are the pharmacological interventions for anxiety?
Anti-anxiety meds, anti-depressants, and others
What are the main SSRIs?
Prozac, citalopram (celexa), zoloft, paxil, luvox, and lexapro
What do SSRIs do?
Block the reuptake and degradation of serotonin, thus increasing serotonin levels
What medication is used for bipolar disorder?
Lithium
What are the therapeutic levels of lithium?
0.8-1.4 mEq/L
What does lithium do?
Mood stabilizer
What are the toxic levels of lithium?
Anything above 1.5 mEq/L
What happens to patients with lithium toxicity?
Possible kidney damage and dialysis
According to Freud, what are the three parts of personality?
Id, Ego, and Super Ego
What are anti-cholenergic side effects caused by?
First generation anti-psychotics
What are anti-cholenergic side effects?
Dry mouth, constipation, and urinary retention
What do patients on SSRIs need to avoid?
Sunlight
What are the side effects of clozapine?
Metabolic syndrome, suppresses bone marrow, convulsions
Life threatening response to antipsychotics with temperature over 103, muscle rigidity, urinary retention, increased blood pressure and flushed appearance
Neuroleptic Malignant Syndrome
How do you treat Neuroleptic Malignant Syndrome?
Parlodel and stop giving med
A decrease in white blood cell count caused by antipsychotics
Agranulocytosis
What foods need to be avoided for patients on MAOIs?
Aged, cured, fermented, pickled, tyramine, alcohol
What medication given for Bipolar disorder causes fluid and electrolyte imbalance?
Lithium
What are the symptoms of schizophrenia?
Auditory and tactile hallucinations, positive and negative symptoms
What are nursing interventions for schizophrenic voices?
Assess for safety, redirect and distract, talk, maintain eye contact, present reality, do not challenge
What is the number one nursing intervention for schizophrenia?
Safety
In order to be diagnosed with depression, how many symptoms need to be demonstrated?
5
What are the major side effects of first generation antipsychotics?
Tardive dyskinesia, dystonia, occulogyric crisis, akathisia, and pseudoparkinsonianism
Head and neck muscles in constant, painful contraction
Dystonia
What is akathisia?
Restlessness
Eyeballs locked into place
Occulogyric Crisis
When assessing a patient with schizophrenia, how do you respond to voices in their head?
Ask what voices are saying and react accordingly
What are the signs and symptoms of mania?
Manipulative, demanding, splitting, flight of ideas, clang associations, and grandiosity
What are the nursing diagnoses associated with mania?
Risk for injury, ineffective coping
What do anticonvulsants do?
Alter electrical conductivity of the membrane
Name the anticonvulsants.
Neurotin, depakote, carbamazepine, topamax
What are the theories on the development of bipolar?
Genetic, neurotransmitters, hypothyroidism, or psych/environmental factors
What are the principles of cognitive therapy?
Individuals and environment, thoughts come before feelings and actions, and our thoughts are our own unique perspective of the the world and our place in it
What would you do for an out of control schizophrenic?
Verbal intervention
What teaching needs to accompany SSRIs?
Take with food
Who can’t have anti-convulsants?
Pregnant women
What are the side effects of SSRIs?
Sexual dysfunction and brown spots in the sun
What are the defense mechanisms?
Displacement, regression, denial and projection
Why are defense mechanisms used?
Used to keep anxiety at manageable levels
Escaping the unpleasant, anxiety-cauing thoughts, feelings, wishes or needs by ignoring their existence
Denial
The transference of emotions associated with a particular person, object or situation to another nonthreatening person, object or situation
Displacement
The unconscious rejection of emotionally unacceptable features and attributing them to others
Projection
Reverting to an earlier, more primitive and childlike pattern of behavior that may or may not have been previously exhibited?
Regression
What disease are defense mechanisms associated with?
Anxiety
Who says defense mechanisms are used to reduce anxiety?
Freud
What are the severe anxiety medications?
Percocet or prozac, valium, Ativan
If a patient has anxiety before surgery, how do you teach them?
Reduce their anxiety, calm, quiet environment, clear, simple directions, low/slow talk, and remove source if possible
Justifying illogical/unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy teller as well as listener
Rationalization
What is the highest priority with opium overdose?
Airway clearance
What are the most important substance abuse medications?
Thiamin, folate, Ativan, maltrexone, valium, benzo, methadone
What would a heroin or opioid overdose look like?
Bradycardia, hypotension, hypothermia, sedation, constricted pupils, hypokinesis, slurred speech, head nodding, euphoria, analgesia, calmness
Patient can’t find words
Aphasia
Loss of purposeful movement
Apraxia
Can’t recognize objects
Agnosia
Can’t feel pleasure
Anhedonia
What are the nursing interventions for patients with dementia?
General assessment, personal centered care approach, speak in soft tones, self care, teach and promote, safety, treat symptoms with low doses of antipsychotics
How is borderline personality disorder treated?
Set limits and treat symptoms
What can result from drug interaction, especially in the elderly?
Delirium
What are the interventions for borderline personality disorder?
Maintain safety, set realistic goals and options, set limits, conduct therapy
What are the signs of antisocial personality disorder?
Deceitful, manipulaiton, callousness, aggression, splitting, exploitation, threats to staff
What are the interventions for antisocial personality disorder?
Teamwork, maintain safety
Evidence based therapy developed to successfully treat chronically suicidal persons with borderline personality disorder by focusing on impulse control
Dialectical Behavioral Therapy
If a patient is receiving dialectical behavioral therapy and threatening suicide, what would you do?
Commit the client, call the police, and work with the client to bring about the situation they want
A person has a high level of resilience. Which other characteristic would the nurse expect this person to have?
Optimism
Which mental health problem has the highest annual prevalence in the US?
Major Depressive Disorder
According to Freud, which aspect of the personality motivates an individual to seek perfection?
Super Ego
Which theorist most influenced the professional practice of psychiatric nursing?
Hildegard Peplau
Schemata, anatomic thoughts and cognitive distortion are terms that relate to…
Cognitive Behavioral Therapy
A patient with schizophrenia says, “There are worms under my skin eating the hair follicles.” How would you classify this assessment finding?
Positive Symptom
What do loose association in a person with schizophrenia indicate?
Poorly organized thinking
Which assessment finding represents a negative symptom of schizophrenia?
Apathy
Which anticonvulsant medication might be prescribed for a patient with bipolar disorder?
Depakote
Which question would be a priority when assessing for symptoms of major depression?
You look really sad. Have you ever thought of harming yourself?
A patient with major depression walks and moves slowly. Which term should the nurse use to document this finding?
Psychomotor retardation
Which assessment fining is a patient with major depression represents a vegetative sign?
Hypersomnia
A parent is shopping with a 5-year-old child in a large, busy mall. The parent suddenly realizes the child is missing. Which level of anxiety would likely result?
Panic
An adolescent female is brought to the school nurse after fainting during gym class. She is grossly underweight, wears baggy clothes, and has dry skin. She complains of feeling cold despite wearing two sweaters. To further assess for an eating disorder, what should the nurse ask?
When was your last menstrual period?
Hypoalbuminemia in a patient with an eating disorder would produce which assessment finding?
Peripheral Edema
A nurse is assigned the care of four patients who are detoxing from alcohol. The patient with which symptoms would be the nurse’s highest priority?
Hallucinations and delusions
The spouse of an alcoholic pours all the alcohol in the home down the sink. What type of behavior is evident?
Codependence
A person has recently abused morphine. The person’s pupils would most likely be….
Constricted
Acute onset of disordered thinking is most associated with….
Delirium
A patient with dementia attempts to brush his teeth with a spoon. Which problem is evident?
Apraxia
Which behavior indicates that a patient diagnosed with borderline personality disorder is improving?
The patient informs a staff member that she feels unsafe and is having thoughts of harming herself
Use of splitting is most associated with which personality disorder?
Borderline
Perfectionism is a trait likely to be evident in a person with personality disorder?
Obsessive compulsive
Antisocial, obsessive compulsive, and schizotypal personality disorders occur most frequently in who?
Men
A patient is hospitalize with major depression and suicidal ideation. He has a history of several suicide attempts. For the first two days of hospitalization, the patient eats 20% of meal and stays in his room between groups. By the fourth day, the nurse observes that the patient is more sociable, is eating meals, and has a bright affect. Which factor should the nurse consider?
The patient may have decided to commit suicide; the nurse should reassess suicidality
A person with which psychiatric problem is most likely to complete suicide?
Major Depression
Which method of suicide has the highest lethality?
Self-inflicted gunshot wound
If a person has decreased circulating levels of GABA, which health problem would be expected?
Anxiety disorders
Which neuroimaging technique would reveal problems in the anatomical structure of the brain but not problems in function?
CT
Which age group is at the highest priority for suicide?
Anyone 10-64 (4th for 10-14, 3rd for 15-24, 4th for25-44, 8th for 45-64)
What statements would make you think a patient is a danger to himself or others?
Overt statements with intent and a plausible plan
What biochemical chemical changes occur in clients who are suicidal?
Changes in serotonin, norepinephrine and dopamine levels
What symptoms would a narcissistic patient display?
Need for constant admiration, lack of empathy, antagonism, grandiosity and attention seeking behaviors, exploitations of others, and feelings of intense shame and fears of abandonment
How is narcissistic personality disorder treated?
Family group therapy, no drugs
What are the nursing diagnoses for a patient with borderline personality disorder who has been self mutilating?
Set limits, treat symptoms, maintain safety, stay consistent
When a suicide threat is made, what needs to be assessed?
Assess how lethal the threat and if the patient has the means to carry out the plan
What are the nursing diagnoses for personality disorders?
Risk for injury, risk for violence, disturbed self image and inability to cope
What are the interventions for personality disorders?
Create a structured and safe environment in which to control and limit client’s behaviors, therapy, possible meds to treat symptoms
What are the positive symptoms of schizophrenia?
Alterations in thinking, alterations in speech, alterations in thought, alterations in perception, and alterations in behavior
What are the negative symptoms of schizophrenia?
Changes in affect and difficulty with attention, memory and information processing
What does opioid withdrawal look like?
Tachycardia, hypertension, insomnia, diaphoretic, goosebumps, yawning, runny nose, cramps, nausea, vomiting, diarrhea, anxiety and increased respiratory rate
What does alcohol withdrawal look like?
Restlessness, irritability, anorexia, tremors, insomnia, impaired cognitive functions, sweating, increased pulse and blood pressure, nausea, hypersensitivity, hallucinations, fever and grand mal seizures
In order for anorexics to be on a SSRI, what percentage of body weight must they be at?
90%
Why are anorexics and bulimics likely to have cardiac arrhythmias?
They have imbalanced fluids and electrolytes
Restore electrolyte imbalances, correct dysrhythmias and observe bathroom privileges and eating for patients with eating disorders
Re-feeding Syndrome
According to the DSM-5, there is evidence that symptoms and causes of mental illness are influenced by……
Cultural and ethnic factors
One characteristic of mental health that allows people to adapt to tragedies, trauma and loss is…
Resilience
One characteristic of mental health that allows people to adapt to tragedies, trauma and loss is…
Resilience
You are caring for Kiley, a 29-year-old female patient who is being admitted following a suicide attempt. Saying what illustrates the concept of patient advocacy?
Dr. Raye, I notice you ordered Prozac for Kiley. She has stated to me that she does not want to take Prozac because she had adverse effects when it was previously prescribed.
You have graduated with your BSN degree and have taken your first job on a psychiatric unit after becoming a RN. You are providing teaching to Mason, a newly admitted patient on the psych unit, regarding his daily schedule. What is an inappropriate teaching statement?
You will attend a psychotherapy group that I lead
Lucas states, “I will always be alone because nobody could love me.” This is most likely an example of:
Schema
You are caring for Vanessa, a 38-year-old patient with major depression. She states to you, “my provider said something about the medicine she is ordering working on my neurotransmitters. What exactly are neurotransmitters?” Your best response is?
Neurotransmitters are chemical messengers in the brain that help regulate specific functions.
Vanessa’s provider writes orders including medication to treat her depression. Based on current understanding of brain physiology, which of the following neurotransmitters would you expect to see targeted with the medication ordered?
Serotonin/Norepinephrine
Which neurotransmitter is messed up in patients with anxiety disorders?
GABA
The term pharmacodynamics refers to the effect for eh drug on the body, while pharmacokinetics refers to:
The effect of the person on the drug
A nurse who is active in local consumer mental health groups and in local state mental health associations and who keeps aware of state and national legislation affecting mental illness treatment may positively affect the climate for treatment by:
Reducing the stigma of mental illness and advocating for equality in treatments
You are caring for Alyssa, a 28-year-old patient with bipolar disorder who was admitted in a manic state. According to Maslow’s Hierarchy of Needs theory, which of the following symptoms needs to be the first priority in caring for this patient?
Lack of sleep
You and Jack are two of the nurses working on the psych unit. Jack mentions to you that the biological model for mental illness is the one he embraces and states, “it’s the only one I really believe.” Which of the following statements is true regarding believing in only the biological model?
In believing only the biological model, other incidences on mental health including cultural, environmental, social, and spiritual influences are not taken into account
Sullivan’s term “security operations” and Freud’s term “defense mechanisms” both reflect actions that serve to:
Reduce anxiety
The term pharmacodynamics refers to the effect for eh drug on the body, while pharmacokinetics refers to:
The effect of the person on the drug
Which of the following patients would need monitoring for potential development of the side effect of hypothyroidism?
Shelly, who is taking lithium
Julie, a 49-year-old patient diagnosed with schizophrenia at 22 years old, is taking risperidone. Which of the following nursing assessments is the priority assessment with Julie?
Monitoring for abnormal involuntary movements
Which statement best describes the DSM-5?
It is a medical psychiatric assessment system
Current information suggests that the most disabling mental disorders are the result of:
Biological influences
A nurse’s identification badge includes the term “Psychiatric Mental Health Nurse.” A client with a history of paranoia asks, “What does that title mean?” The nurse responds best by answering:
“We have the specialized skills needed to care for those with mental illnesses.”
The quantitative study of the distribution of mental disorders in human populations is called…
Epidemiology
A nurse’s identification badge includes the term “Psychiatric Mental Health Nurse.” A client with a history of paranoia asks, “What does that title mean?” The nurse responds best by answering:
“We have the specialized skills needed to care for those with mental illnesses.”
Which statement about diagnosis of a mental disorder is true?
Culture may cause variations in symptoms for each clinical disorder
These severe mental illness are recognized across cultures:
Schizophrenia and bipolar disorder
Which branch of epidemiology is the nurse involved in when seeking outcomes for patients whose depression was treated with ECT?
Clinical
A client tells the mental health nurse “I am terribly frightened! I hear whispering that someone is going to kill me.” Which criterion of mental health can the nurse assess as lacking?
Appraisal of reality
A 14-year-old belongs to a neighborhood gang, engages in sexually promiscuous behaviors, and has a history of school truancy but reports that her parents are just old-fashioned and don’t understand her. The assessment data supports that the client…
Is displaying deviant behavior
The nurse planning care for a mentally ill client bases interventions on the concept that the client…
Has areas of strength on which to build
In order to best differentiate whether an Asian client is demonstrating a mental illness when attempting suicide is to…
Identify his culture’s view regarding suicide
An individual is found to consistently wear only a bathrobe and neglect the cleanliness of his apartment. When neighbors ask him to stop his frequent outbursts of operatic arias, he acts outraged and tells them he must sing daily and will not promise to be quieter. This behavior supports that he is….
No demonstrating any definitive signs of mental illness
A nursing diagnosis for a client with a psychiatric disorder serves the purpose of…
Providing a framework for selecting appropriate interventions
Which of the following best demonstrates parity related to mental health care?
A client’s mental health coverage is equal to his medical/surgical coverage
The mental health status of a particular client can best be assessed by considering…
Placement on a continuum for health to illness
Which statement about mental illness is true?
Mental illness changes with culture, time in history, political systems, and the groups defining it
Epidemiological studies contribute to improvements in care for individuals with mental disorders by:
Identifying who in the general population will develop a specific disorder
Which statement best describes a major difference between a DSM-5 diagnosis and a nursing diagnosis?
The DSM-5 is associated with present symptoms, whereas a nursing diagnosis considers past, present, and potential responses to actual mental health problems
The intervention that can be practice by an advanced practice RN in psych by cannot be practiced by a basic level RN is:
Psychotherapy
An important difference between the developmental theories of Freud and Erikson is…
Erikson viewed individual growth in terms of social setting
Maslow’s theory of humanistic psychology has provided nursing with a framework for…
Holistic assessment
The premise underlying behavioral therapy is…
Behavior is learned and can be modified
The prevalence rate over a 12-month period for major depressive disorder is…
Greater than the prevalence rate fro generalized anxiety
A nursing student new to psych mental health nursing asks a peer what resources he can use to figure out which symptoms are present in a specific disorder. The best answer would be…
DSM-5
The premise underlying behavioral therapy is…
Behavior is learned and can be modified
Sullivan viewed anxiety as…
Any painful feeling or emotion arising from social insecurity
Which statement best clarifies the difference between the art and the science of nursing?
The art is the care, compassion, and advocacy component, and the science is the applied knowledge base
Which client problem would be most suited to the use of interpersonal therapy?
Dysfunctional grieving
A cognitive therapist would help a client restructure the thought “I am stupid!” to…
“What I did was stupid.”
The nurse providing anticipatory guidance to the mother of a toddler should advise that childhood temper tantrums are best handled by…
Ignoring the tantrum and giving attention when the child acts appropriately
Freud believed that individuals cope with anxiety by using…
Defense mechanisms
Which contribution to modern psychiatric mental health nursing practice was made by Freud?
The theory of personality struct and levels of awareness
The theory of interpersonal relationships developed by Hildegard Peplau is based on the foundation provided by which early theorist?
Sullivan
The concepts at the heart of Sullivan’s theory of personality are:
Needs and anxiety
The premise that an individual’s behavior and affect are largely determined by his or her attitudes and assumptions about the world underlies:
Cognitive-behavioral therapy
One implication of Freud’s theory of the unconscious on psychotic mental health nursing is related to the consideration that conscious and unconscious influences can help nurses better understand…
The root causes of client suffering
According to Freud, the nurse recognizes that a client experiencing dysfunction of the conscious as part of the mind with have problems with…
All material that the person is aware of at any one time
A suspicious client who smokes several packs of cigarettes daily and drinks large quantities of coffee and soda as he is able to afford reacts to every nursing intervention wit sarcasm. When asking for advice, the nurse manager’s most helpful response is…
Remember that sarcasm represents the oral-stage fixation of development
The nurse planning care for a 14-year-old needs to take into account that the developmental task of adolescent is to….
Achieve identity
Providing a safe environment for patients with impaired cognition, planning unit actives to stimulate thinking, and including patients and staff in unit meet ins are all part of:
Milieu Therapy
When asked, the nurse explains that a client’s id is…
The source of his instincts to save himself from hurting himself
As a result of Harry Stack Sullivan’s work, the mental health nurse is involved in providing clients with…
A psychotherapeutic environment
The nurse is working with a client experiencing both a postpartum depression and a very low self-esteem. The client is distrustful of unit staff and “just wants to go home.” Initially the nurse’s priority is to…
Establish trust with the client
Using Maslow’s model of needs, the nurse providing care for an anxious client identifies the priority intervention to be…
Assessing the client for her strengths upon which a nurse-client relationship can be based
A suspicious client who smokes several packs of cigarettes daily and drinks large quantities of coffee and soda as he is able to afford reacts to every nursing intervention wit sarcasm. When asking for advice, the nurse manager’s most helpful response is…
Remember that sarcasm represents the oral-stage fixation of development
A client with a history of three failed engagements is concerned about being “too possessive.” This concern supports a need for which type of therapy?
Interpersonal
The basic functional unit of the nervous system is called a…
Neuron
