Psych final review tests!! Flashcards
Which is more detailed documentation?
Client refused to go to group, or client is pacing in has cursing. (In Chart the more specific the better, why did client not go to group? Sleeping??)
An involuntary admit has what rights?
The right to atty and right to refuse TX, until judicially committed
PET scan shows
Blood Flow and glucose metabolism, know that
Which disorder is related to depression?
Parkinsonism
Serotonin is linked to which illness?
Depression
Motor function and memory are found in which lobe?
Temporal
Which lobe is executive function?
Frontal
Where in the Temporal lobe is memory found?
? Hippocampus
A voluntary admit wants to leave, what must they do?
Sign and wait 3 business days
You have an Alzheimer’s patient, what medicine is best?
? One that increases acetylcholine or stops the decrease of acetylcholine.
What must happen for an involuntary admit?
Witness to behavior over 18= first cert. , doctor must be called within one hour and see patient within 24 hours, second cert, court notified w/I 3 bus. Days
Your patient is going for an MRI what should you as nurse tell doctor?
? Patient has knee replacement, has claustrophobia
A nurse talks to the charge nurse “why should I not feel sympathy for that family, they lost their child the same way I lost mine?”
reply is “get to a shrink, handle your shit.”
Client says “I was really hard on my kids growing up” nurse says “you were strict?”
what is this? Paraphrasing or restating.
What is done during orientation?
Explaining confidentiality and the working contract.
A woman brings a child into ER, has bite marks and x-ray shows a healing fracture, what do you do?
Talk to parent more, or call CPS…your guess.
Your client is suicidal what is their GAF score?
10
Basal ganglia =
motor function
I want, I can, I will
Establishing an internal locus of control
Talking to a new patient about their rights, what else should you do?
Give them the booklet about rights in writing.
GABA
anxiety
Know facilitators and blockers.
Resistance
Transference
Counter transference
Boundary violations
In a mental health assessment what do you assess?
mood & affect, judgment, appearance, attitude & speech.
What are the criteria for involuntary treatment?
Danger to self or others, and cannot provide for one’s basic needs.
CT=
= gross anatomy, one dimensional
MRI
layers and structures, 3D
PET
blood flow, oxygen and glucose metabolism
SPECT
vascular
If a nurse becomes close to a patient and they start discussing their mutual things in common why is this a problem?
? Boundary Violations. No longer a therapeutic relationship.
You have a client who is mute, and the family states she hasn’t bathed or eaten in 5 days, is she wholly, partially, or supportive compensatory?
Wholly
What is their GAF score? 10
A patient states when he is released he intends to kill his wife and her lover, what do you do?
? Document it and tell the doctor, call the wife and lover immediately, make a report with the police.
The definition of Mental Health Nursing is:
: prevention of mental disorders, the treatment of disorders and the restoration of health.
What make the DSM IV special?
it classifies and gives statistical info.
If your patient had a stroke on the left side what should you as a nurse expect to find?
Client struggles to hold spoon with right hand.
What is the job of the neurotransmitter?
The electric impulse
How would a nurse assess a client’s judgment?
Ask what they would do if their house was on fire.
What is necessary for a properly written nursing DX?
? The NANDA DX, The etiology, and the supportive info.
Which is a properly written outcome statement?
Client will attend one group session by end of day
Also
Client will report a reduction in anxiety from severe to moderate by end of day.
What type of therapeutic communication is this;
“Can you give me an example of that?”
CLARIFYING.
What determines how a person views stress?
Locus of control
Hans Selye- what is important about him?
GAD theory/and PTSD work.
What is the GAD theory?
General Anxiety Disorder
CBT or cognitive behavior therapy-
change the way you think about things changes your stress.
Signs and symptoms of anxiety
mild, moderate, severe, and panic
Name two types of drugs to treat insomnia?
Benzodiazepine and nonbenzodiazepines.
What is a no benzodiazepine?
? Antihistamines, such as Benadryl.
ECT- electric convulsive treatment
done under sedation, approximately 12 treatments. Side effect= memory loss.
Which type of drug is an anti-depressant?
SSRI
Know about the allergy to tyramine
you get this from taking lithium. Which means you cannot eat cheese, wine, and other items that have tyramine in them.
Lithium-
Know that the therapeutic level is very close to the toxic level, therefore blood levels must be monitored, so only clients who will come in for blood work are candidates ALSO, hypertension patients cannot take lithium, you must be able to maintain normal levels of sodium. If sodium levels decrease the lithium will not be excreted, and will build up to toxic levels. Patients must also avoid very salty foods, such as lunch meats because too much sodium will increase renal excretion
If a patient cannot take lithium what could they take?
Depakote.
Anticonvulsant drugs-
why are these used to treat mania? There is a therapeutic side effect that stabilizes mood.
Know that coming off anti-convulsant drugs
needs to be slow.
Central serotonin syndrome
know about the dangers- if client takes 2 drugs that increase serotonin, could =death. Remember, St. John’s Wart although herbal does increase serotonin.
Know about the plan to prevent suicide in clinical settings.
No belts, shoe laces, building should have no breakable glass, sharp objects, metal silverware.. etc.
What is the daily schedule of the clinical setting called?
Milieu
Know what an anti-cholinergic effect is-
dry mouth, urinary retention, constipation, blurred vision. Slide #25 in Mood Disorders.
The main problem with MAOIs
is that they interact dangerously
with foods containing tyramine (an amino acid). The
combination can lead to acute hypertension (high blood
pressure). This can be very dangerous and cause stroke,
heart attack, or death, though such a severe reaction is rare.
Symptoms of a hypertensive attack are severe headache in the back
of the head, nausea, weakness, sudden collapse.
A partial list of foods to be avoided is
: cheese, yogurt, soy
sauce, avocado, ripe bananas or figs, smoked salmon, cured
ham, salami, pickled herring, broad beans.
Caffeine and chocolate should be used with caution
as they are diacritics and will make levels in blood stream
What is important when taking Lithium?
Need to have normal sodium range.
Your patient is on an MAOI which diet is best?
The one that doesn’t have processed meat, avocados, bananas, wine, or cheese- no old or mold.
You have a bi-polar patient, who is very manic, which food is best?
Finger food, so sandwich, apple,ect
Chronic depression over two years
= dysthymic disorder
You have a very anxious patient, which drug is a good drug for PRN?
? You want a benzo- quick acting, not Busbar, 4 weeks. Think Xanax.
Cognitive therapy-
but keep in mind any Cognitive question involves client to change THINKING!
Patient recently had knee surgery, feels as though will never recover, is depressed. Which should be the nursing DX?
Risk for hoplessness. (doesn’t think suicide was listed)
There is an adolescent patient that has suicidal ideations, which is the priority?
I have a neck tie and will hang myself tonight. (Has plan, plan is lethal, and has means to carry out plan)
When assessing for suicide what is the best question to ask client?
? One of these: do you have any firearms in your house, or are you having suicidal thoughts..If not suicidal who cares if they are a hunter.
If your patient has frontal lobe injury, what would you teach patient?
Don’t remember the choices, but know that frontal lobe is where judgment and decision making happens, they may need to get an opinion about choices from a family member.
Your patient is on lithium and an anti- psychotic med, why would they be on both?
Agitation relief. (a small dose will slow down mania)
Central Serotonin syndrome=
cardiac collapse
What is important for a nurse to do with a patient with mania?
set limits
Know these three things about suicide
specifics of detail, lethality of proposed method, availability of means to carry out.
repression
The unconscious exclusion of painful impulses, desires, or fears from the conscious mind.
suppresion
Conscious exclusion of unacceptable desires, thoughts, or memories from the mind.
Know the symptoms of the different levels of anxiety.
(patients can’t think straight if severe panic, they think they are dying- this is when you would give advise- or even directions, they need guidance,
A patient leaves his home and winds up in another state and can’t remember how they got there, what is their problem?
Dissociative Fugue.
PTSD
flashbacks
Insomnia is a
dysomnia
Nurse is yelled at by doctor, then she yells as a family member
Diplacement
Stop divert and reframe, which are these?
I need to stop thinking I am going to do poorly, I can do it and I will
Think about someplace nice, like the beach.
I will read the question,find the key word,and select the correct answer.
This is just a test, if I flunk I will do better next time.
Which neurotransmetters are involved with SSRI’s?
Serotonin
My patient states he falls asleep 6-10 times per day for 20 mins. At a time. Which nursing intervention is appropriate?
Suggest a sleep study consult
Give an amphedimine
Tell client not to nap during day
A patient tells the nurse they are feeling better and no longer need to be on suicide watch, what does nurse ask patient?
(this is when you would watch patient closely…just enough energy to harm themselves. Do you feel like hurting yourself
What is a good tool to assess potential for mental issues?
Holmes and Rahe Life Stress inventory
Which meds would RN assess that may affect quality of sleep?
Opiates, amphetamines, anti-depressants, alcohol select all.
What would an RN advise a patient taking a benzo to avoid?
Grapefruit juice, alcohol, herbals antidepressants
Patient starting a MAOI what would you assess first?
Their cognitive ability to avoid tyramine.
Which is the correct nursing outcome for PTSD with sleep disturbance?
not intervention)
Client states he had a good night rest without nightmares.
Which is the correct nursing DX for a client that states they are worthless?
Suicide prevention
Student is taking a test and everything goes blank, can’t remember anything, what is the student’s anxiety level?
? Severe. (Moderate is when you are in a good test taking place)
What is the best way to approach a client in a manic state, for the RN
calm using a steady tone of voice.
Patient comes in to ER wearing a green bathing suit singing loudly, what is the nurse’s primary concern?
Setting strict boundaries, finding out patient’s needs for food water and rest (Maslow’s first priority)
A patient was in a bad car accident, he saw his friend die, now he cannot see at all and isn’t concerned about it, what is the diagnosis?
Conversion Disorder with La Belle Indifferance
A client has hypochondriasis what would you expect them to say?
? I am sure my headache is a brain tumor.
What would you expect to hear from a patient whose cognitive therapy is working?
My depression is due to chemicals in my brain
Cognitive therapy is working when a patient states
; I can control my reaction to anxiety
Which of the following exhibits Internal locus of control;
I need to manage my money to stay out of debt
If your patient can’t take lithium, what is a good replacement?
Tegretol
Which diet is good for a MAOI patient?
Pork chop with green beans
If your patient is in the beginning stages of Serotonin Syndrome what symptoms would you expect to see?
Nausea, diarrhea, raised Blood pressure, brachycardia, confusion, orthostatic hypotension???
Your patient states they take melonine and herbal teas to help sleep at home,they ask does this help me? what is an acceptable answer?
There are no guidelines for herbals, therefore the preparations are all different, so I cannot answer that.
After 3 weeks of taking Zoloft, client has increased energy, what is nursing intervention?
? Suicide-prevention.
What are early signs of Serotonin Syndrome?
Confusion and agitation
A bi-polar patient is action out in hall pacing, what is going on?
Psychomotor agitation
The prodromal phase of schizophrenia – symptoms start with?
Slowly becoming isolative and withdrawn.
Name the drug that is associated with problems that involve high fevers?
Clozeral(clozapine)-agranulocytosis drop in white blood cells can get infection = fever.
When using inhalants (huffing) what is the negative side- affects to worry about?
Cardio- vascular problems.
Nurses risk of substance abuse? Select all
Addiction more than average population-NO!! Actually the same as gen. population,p.332.
Due to stress of job. YES
Access to substances- YES
Knowledge of drug use makes them think they are immune- YES
Which patient in ER gets treated first?
Cocaine user who has chest pain.
Client with a history of alcohol abuse is diagnoised with Wernicke-Korsakoff syndrome- what should a nurse expect to see?
? Loss of memory, and confusion
Know that Artane and Cogentin, and Benadryl treat EPS-
all except Tardive Dyskinesia- (that requires a med change.)
Methadone treats
Opiates. (not amphetamines
Person with mental illness repeatedly gets readmitted because he goes off meds, what is the best intervention upon release from the hospital.
. A program like ACT- a community outreach program.
Your patient has been taking Haldol po and is back at hospital for non-compliance, what is the best plan?
Haldol IM
What drug is the known to give metabolic syndrome??
Zyprexa
Histrionic Patient what would you expect to observe?
Seductive Behavior
Know the signs and symptoms of drugs, which causes weight gain
Zyprexa, metabolic syndrome.
Which causes drop in White blood cells
Colzapine (clozoril). Agranulocytosis
When teaching a schizo patient what is the best method?
Brief to the point statements and hand-outs with visual aids.
Know that Schizoid -Affective is
depression with psychotic behavior also later onset, like 40 years old.
Know the difference between the three types of mood disorder, and their symptoms, questions will say “client is doing this..and that..which disorder?
So you need to have handle on those 3 types.
There is a question that states a client is readmitted and claims he was taking his meds, what is going on?
Symptoms have returned, don’t assume they stopped taking meds.
Patient comes into ER with alcohol withdrawal, what is first thing RN should do?
Check vitals
A pregnant woman is an alcoholic, what can we expect of her baby?
small facial features, learning disabilities, etc.
You have a drug addict come to hospital and has surgery, how do you treat their pain
- with opioids, may even need extra because of tolerance.
Know the signs and symptoms of meds
Especially; akathisia, psudo-parkinsons (shuffeling gait, hand tremors, pill rolling), tardive dyskinesia (facial twitching, numbness), and neuroleptic Malignant syndrome (high fever)
Know that the importance of DBT therapy (journaling)
is to give patients an alternative to suicide. Especially important to Borderline.
Know that the AIMS scale measures
for Tardive Dyskinesia
Know which withdraws give you cramps
CNS depressants
How long it the “high” from crack?
<45 minutes for inter-nasal, 10-20 minutes if interveinous
If a person with paranoid Schiz. Is on your unit, which of the following would you expect…?
Patient to believe someone may have poisoned his food.
Paranoid Patient comes on unit, which nursing intervention is best-
- try to assign same staff to build trusting relationship
Patient comes to ER vomiting, sweating and is red in face, after drinking a glass of wine- what is wrong?
Reaction to alcohol while on antabuse.
RN is teaching a group of adolescents about marijuana- what should she tell them-
over time it will affect their memory and the will not test well, perform poorly in school
Two days after an abdominal surgery your patient is becoming agitated and has tremors what should a nurse consider?
Alcohol withdrawal
Elderly patients taking any meds, should be taught this no matter what
risk for falls.
Patient is coming off addiction to cocaine- what is a high risk?
Suicide (powerlessness)
What is primary Diagnosis for a client experiencing cocaine intoxication?
Cardiac –risk for profusion.
A nurse is teaching a family about the etiology of schizophrenia- what statement indicates the correct understanding of content?
There are a lot of potential causes for the disease, it is a very controversial topic.
During intake nurse makes sure the patient is in a quiet room with little distractions because??
Schizophrenic patients can become guarded and will not talk
High school aged kid is annoyed and throws a chair- what’s his problem?
He takes anabolic steroids
Patient’s neck is stiff and eyes are rolling back in head- what to do with next psych med dose?
Hold and call doctor.
Your patient is an alcoholic and has had a relapse, what teaching should you do as his nurse?
Tell him that recovery is a process not an event, one day at a time.
This question has an answer that isn’t the same as our Hesi**
Patient is sitting in room, not wanting to interact
encourage them to come out and play cards. (don’t just go sit in there)
Patient is experiencing anxiety, what can you give them without calling the doctor?
BENZO, they are usually PRN
You have a catatonic patient, what is the number one nursing priority?
Passive ROM, or physiologic needs think physiologic needs based on Maslow’s- food and water first.
You have a 40 year old patient suffering from mood swing and is experiencing mania, what is the DX?
Schizo-affective.
Patient in hospital claims she saw a man standing at the foot of her bed in the middle of the night, what is the cause?
Delirium
Alzheimer’s patient wanders out of her room in the middle of the night and is trying to open the patio door, what is an appropriate response from RN-
“Mrs. Smith, are you looking for the bathroom?”
When explaining Alzheimer’s disease to the family members what is an appropriate explanation?
It is chronic, and progressive.
Patient comes to a crisis center after losing his home and his car in a tornado- what is the FIRST priority?
Food and shelter.
A client DX with an eating disorder has a nursing DX of low self -esteem, which nursing intervention will address this clients issues?
Give client decision making opportunities.
How do you interview your patient when you think they are being abused?
Ask least invasive questions and work up to the tougher questions as you go.
A patient comes into the ED with delirium due to an infection, what is an appropriate nursing DX?
Disturbed thought process related to fever.
The school nurse suspects a student is being abused at home, what is the proper action to take?
Follow school protocol to start the process of investigation.
Child comes into the ED and nurse suspects sexual abuse, what is the priority that nurse must first address?
Comfort and safety for the child.
Patient with bulimia comes into your unit, as her RN what is the primary concern?
Imbalanced fluid
Child comes into the hospital with bruises and staff suspects abuse how do you handle it?
? (no, you do not separate the kid from parents) be open and honest and show concern.
What is the difference between bereavement and depression? With bereavement you would expect?
Suicide / remit and exacerbation/ guilt/ psychomotor retardation
An anorexia patient is 5’10” and weighs 100 lbs, what would you expect from her?
Wanting to see her weight on scale/ not wanting to see her weight on scale/ her stating when she is ready to be weighed/ her wearing several layers of clothing
In a group therapy an anorexic patient is asked to draw a picture of herself what would you expect it to look like?
? A fat person.
There is a train that derails, many people are injured. What can you expect to hear from the people who were not harmed in accident?
They are shocked, numb and doesn’t seem real.
Alzheimer’s in the 3rd stage, what must staff be concerned about?
Choking
Your anorexia patient has been eating all her meals and snacks but isn’t gaining any weight, what should your intervention be?
Teaching in the community about stress and alternatives to deal with.
Your anorexia patient has a fit and yells that you “can’t make her eat, and she will do what she wants!” what is the best intervention?
1:1 monitoring.
Bulimic comes in to hospital, what is the priority labs to do?
Urinalysis/ EKG/ bone density/serum potassium
Abused woman whose husband died three years ago, only talks about what a wonderful man he was, and states he was wonderful. What is an outcome that you should strive for?
be able to list both positive and negative aspects of marriage.
A binge eater tells her therapist??
I know bingeing isn’t good for me, but it makes me feel good for a little while.
Alzheimer’s patient most likely to be abused pick one
the elderly parent whose alcoholic adult daughter moves in to help provide care.
1st stage Alzheimer’s patient, appropriate outcome is:
“Patient will maintain highest level of functioning possible”
Adult daughter brings her father into ED stating he has a change in behavior, which statement makes you think delirium?
? “It came on so fast! I didn’t know what was happening”
Stage 2 Alzheimer’s – what is a good intervention to keep cognitive functions at current level?
Spend time doing things you both enjoy.
Which of the following has a better understanding of crisis intervention?
Pick “personal growth or disorganization” (handling crisis positively or negatively)
Person comes to ED after family member has died, they are complaining of GI disturbances what do you explain?
? This is a normal response to grief (physical symptoms).
Elderly patient appears abused but denies it, why would they not want to admit the truth?
Fear of being removed from family
Patient is DX with low self-esteem, what is a primary outcome?
Client will make decisions where applicable.
What is the MOST important assessment in a crisis?
? How the client perceives the event
