SP22 Final Exam Flashcards
What is the most important therapeutic factor when providing in providing nursing care to clients with mental illness?
Positive, unconditional regard; nonjudgmental attitude
What should a nurse do if a patient asks about personal information (e.g., dating interests)?
Set limits and maintain boundaries
Token economy
Environments where there are clear rewards (and the removal of rewards) for desired behavior
What is the ego defense mechanism (e.g., rationalization, denial, suppression, displacement, etc.)? Can you recognize them?
Ego is the balancing or mediating force between ID and superego
Ego defense mechanism: Rationalization
Excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-respect
Ego defense mechanism: Denial
Failure to acknowledge an unbearable condition; failure to admit the reality of a situation
Ego defense mechanism: Suppression
Conscious exclusion of unacceptable thoughts and feelings from conscious awareness
Ego defense mechanism: Displacement
Ventilation of intense feelings toward persons less threatening than the one who aroused those feelings
What is milieu therapy?
Clients interaction with one another, including practicing interpersonal relationship skills, giving one another feedback about behavior, and working cooperatively as a group to solve day-to-day problems
What is the purpose/benefit of partial hospitalization programs?
Build communication and social skills, problem solving, monitoring medications, learning coping strategies and skills for daily living
Why are multidisciplinary teams important in mental healthcare?
Different members of the team have expertise in specific areas; by collaborating, they can meet patients needs more effectively
What are examples of advocating for a patient?
- ensuring privacy and dignity
- promoting informed consent
- preventing unnecessary exams and procedures
- accessing needed services and benefits
- ensuring safety from abuse and exploitation
What is boundary blurring? Examples?
Losing the nurse-patient relationship; crossing boundaries
-Ex. forming an intimate relationship with a patient
What is the first priority in the “orientation” phase of the nurse-patient relationship?
Form good rapport
What is assertiveness training? Examples?
The ability to express positive and negative ideas and feelings in an open, honest, and direct way
-Ex: “No I can not work for you”
“I do not like when you do that”
What is the best way to communicate with a patient during severe anxiety?
Use concrete messages-use words that are as clear as possible, need no interpretations
What is resilience?
having healthy responses to stressful circumstances or risky situations
What is culturally competent care?
Being sensitive to issues related to culture, race, gender, sexual orientation, social class, economic situation, etc
What should a nurse do when attempting to provide culturally competent care to a patient from a different racial or cultural group?
Learn about other cultures and become skilled at providing care to people with cultural backgrounds that are different from their own. Ask patient how nurse can promote spiritual, religious and health practices, recognize own feelings and possible prejudices
Affect
Outward expression of patients emotional state
Blunted affect
Showing little or slow-to-respond facial expressions
Flight of ideas
Excessive amount and rate of speech composed of fragmented or unrelated ideas
Judgment
Ability to interpret one’s environment and situation correctly and to adapt to one’s behaviors and decisions accordingly
Insight
Ability to understand the true nature of one’s situation and accept some personal responsibility for that situation
Suppose a nurse learns a client hasn’t been taking their medications. What should be the nurse’s initial response?
Inquire about the why
What might be a sign that a patient is hallucinating?
They say they hear voices, see things that are not there
If a client makes a credible threat to harm another person, can a nurse breach confidentiality?
Yes-safety to others and self is the first priority. Duty to warn
Suppose a client is involuntarily hospitalized because they are a danger to others. What rights (if any) does the client lose?
Right to freedom (the ability to leave the hospital when he or she wishes)
What is the ethical principle called autonomy? What is an example of a nurse advocating for it?
Refers to a person’s right to self-determination and independence.
-Ex: Encourage patients to make choices about his or her own health
What are the Kübler-Ross’s stages of grieving?
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
What is disenfranchised grief? How might a nurse experience it?
Grief over a loss that is not or cannot be acknowledged openly, mourned publicly or supported socially
-A nurse might experience it if she works in organ donation or is involved intimately with the death of patients who may donate organs to another person
What are behavior limits and when are they needed?
Limits placed on behavior, they are needed when patients are crossing boundaries, becoming physically aggressive, etc
What should a nurse do if a verbally aggressive client refuses to take a time out? What’s the next step?
Ensure a show of strength- gather more staff
What are examples of therapeutic statements to a rape victim?
- “You have a right to be safe and respected”
- “The rape is not your fault”
What should a nurse do if child abuse is suspected?
The nurse is mandated to report it; thorough documentation of assessment data
When might a nurse recommend a women’s shelter?
When her abuser violates an OP and they feel unsafe
What are the key symptoms of PTSD?
reexperiencing trauma through dreams or recurrent and intrusive thoughts; showing emotional numbing such as feeling detached from others; and being on guard, irritable, or experiencing hyperarousal
-experiences dreams, flashbacks, reactions to external cues about events
What childhood experiences sometimes are present in clients who have dissociative identity disorder?
Sexual and physical abuse
What is the priority when caring for a client recently sexually abused?
Continually assess the patient’s potential for self-harm or suicide and take action accordingly
Who can develop PTSD?
Anyone who has experienced a traumatic event
If a client is experiencing panic, what are your priority interventions?
Lower the patient’s anxiety to moderate or mild before proceeding with anything else. Also essential to remain with the patient bc the panic is likely to worsen if they are left alone
What are activities and therapies a nurse could recommend to help relieve stress?
Deep breathing, progressive muscle relaxation, meditation, imagining being in a quiet and peaceful place, talk in a calm manner, take patient to a quiet room
What are the different levels of anxiety? Can you recognize them (e.g., panic)?
Mild, moderate, severe (panic)
Mild anxiety
sensation something is different. Sensory stimulation increases and helps person focus attention to learn, solve problems, think, act, feel, and protect themselves (ex. helps students study for an exam)
Moderate anxiety
person can still process new info, solve problems, learn new things w/ assistance from others, difficulty concentrating independently but can be redirected (ex. you are talking to a patient about a surgery and they are anxious-you can redirect them to the topic)
Severe anxiety (panic)
primitive survival skills take over, defensive responses ensue, cognitive skills decrease, trouble w/ thinking and reasoning, muscles tighten, vital signs increase, person paces, restless, irritable, angry, fight-flight-or freeze
What is positive reframing? Can you recognize examples of this?
Turning negative messages into positive messages. Ex. “My heart is pounding-I am going to die!” to “I can stand this. This is just anxiety. It will go away”
Why is it important not to combine alcohol and benzodiazepines (e.g., alprazolam)?
You cannot combine CNS depressants
-can cause respiratory depression
What are the main symptoms of OCD?
Checking rituals, counting rituals, touching, rubbing, tapping, ordering, exhibiting rigid performance.
-ONLY DIAGNOSED WHEN THESE THOUGHTS, IMAGES AND IMPULSES CONSUME THE PERSON AND THEY ARE COMPELLED TO ACT OUT THE BEHAVIORS AT WHICH THEY INTERFERE WITH PERSONAL, SOCIAL, AND OCCUPATIONAL FUNCTIONS
What is thought blocking?
patients may suddenly stop talking in the middle of a sentence for several seconds to 1 minute
What is thought insertion?
belief that others are placing thoughts in their mind against their will
What is thought broadcasting?
Believe others can hear their thoughts
How should you respond to a person with delusions who attempts to get you to agree with them?
Do not support or challenge them, ask patient what they mean “Please explain that to me”
What are delusions? Can you recognize them if described?
Fixed, false beliefs with no basis in reality
What are the symptoms of neuroleptic malignant syndrome?
- Fever (may exceed 41ºC) , -Elevated WBC & CPK levels,
- Vital signs instability
- Encephalopathy
- Rigidity (“lead pipe”)
What is akathisia?
restless movement
What is tardive dyskinesia? Can you recognize it?
late-appearing side effect of antipsychotic medications. characterized by abnormal, involuntary movements such as lip smacking, tongue protrusion, chewing, blinking, grimacing
What lab should you check if a client is taking clozapine?
WBC and Absolute neutrophils
What medications can be given to a client who is psychotic (hallucinating) and anxious/agitated?
First gen antipsychotics-Haldol, Chlorpromazine
What would you teach a client newly prescribed antipsychotic medication? (Hint: think about dry mouth, orthostatic hypotension, and the importance of not abruptly stopping them.)
Increase fluids, slow position changes, don’t operate heavy machinery (i.e driving)
What are the key symptoms of depression?
insomnia, loss of interest in daily activities, poor appetite, decreased energym, withdrawn, low self-esteem
What is pressured speech? What mental disorder is it associated with?
Unrelenting, rapid, often loud talking without pauses; Bipolar Disorder
What is the goal of cognitive-behavioral therapy when treating depressed clients?
Increase patients positively reinforcing interactions w/ environment and to decrease negative interactions
What would be the most therapeutic way to respond to a client experiencing hair loss after taking valproic acid (Depakote)?
Ensure social support and offer information on wigs
Why are TCAs dangerous to give to suicidal patients?
They increase suicidal ideation
How should a nurse deal with negative feeling/emotions he/she develop when working with clients with a personality disorder?
Examine own thoughts and biases, set realistic goals, don’t take flattery/criticism personally
What are key features of conduct disorder and what personality disorder is associated with it?
physically and verbally aggressive, have little regard for laws or the rights and feelings of others, destruction of other people’s property, lying, and theft, get into serious trouble at school and usually have encounters with the justice system. Antisocial personality disorder is associated w/ it.
What are key symptoms of histrionic disorder? How would a nurse help a client prepare for a job interview?
colorful and theatrical speech w/ superlative adjectives, overdressing, overly concerned w impressing others, exaggerate emotions inappropiately. Give patient feedback on social interactions w/ others, teach social skills, be specific
What are the key symptoms of narcissistic personality disorder?
intact thought processing, insight is limited/poor, fragile self-esteem, hypersensitive to criticism, need constant attention and admiration
Why is maintaining boundaries so important when working with clients with borderline personality disorder?
They may cling and ask for help one minute and be angry the other, may attempt to manipulate staff
What happens if a client taking disulfiram (Antabuse) drinks alcohol?
flushing, throbbing headache, sweating, nausea, vomiting
What is a “tolerance break”?
when a very small amount of alcohol intoxicates a person
Why is methadone prescribed to clients addicted to opioids (e.g., heroin)? What is the purpose of it?
meets the physical need for opiates but does not produce cravings for more. Does not produce high associated w/ heroin
What are the key features of anorexia nervosa and bulimia? Can you differentiate the two?
MAIN DIFF IS TO BE DX W/ AN YOU MUST BE SEVERELY UNDERWEIGHT!!!
Anorexia nervosa
BMI <17, amenorrhea, dry and brittle hair, skin and nails, lanugo, preoccupation w/ food and counting calories
Bulimia nervosa
binge and then purge through laxatives, vomiting, diuretics, scarred knuckles
What is the top priority when caring for a client hospitalized for anorexia nervosa? (Hint: think about cardiovascular status and electrolytes
Bradycardia, hypotension, hypokalemia, hypomagnesemia
What treatment works best for bulimia nervosa?
Cognitive behavioral therapy
Why should a nurse observe a client with anorexia nervosa after meals?
To ensure they do not purge
Suppose a client has conversion disorder. How might they feel about their symptoms?
not very upset; indifferent
What are key nursing interventions for a client with conversion disorder?
Create therapeutic alliance, give unconditional positive regard, do not argue w/ patients or deny experiences, gradually decrease attention to patients physical symptoms
What is Munchausen syndrome?
Pretending to have physical or psychological illness to gain attention/sympathy
How should a nurse respond to a client with a history of somatic symptom disorder if they present with a new complaint?
Matter of factly tell them that you will inform the provider
What is malingering?
The intentional act of exaggerating or faking an illness for personal gain
What are key symptoms of autism?
Difficulty interacting w/ others and forming relationships, “cut off” from others, little interest in others, rarely make eye contact, dislike being touched
What are some key nursing interventions for a client with ADHD experiencing too much weight loss?
Provide high calorie snacks, eat good breakfast w/ morning dose
When might be the best time of day for a client to take methylphenidate (Ritalin)?
During daytime hours, preferably AM
Why should ADHD medication be kept in a safe place?
High risk for addiction and overdose
What evidence-based therapy works well for Tourette’s disorder?
Habit reversal therapy
What are the key features of ODD
demonstrate unusually high levels of anger and opposition to rules and authority figures. They seem to be in a persistent state of annoyance. They are spiteful and argumentative. Every mistake they make is someone else’s fault
What are key features of conduct disorder?
physically and verbally aggressive . They have little regard for laws or the rights and feelings of others. Misbehaviors include destruction of other people’s property, lying, and theft. They get into serious trouble at school and usually have encounters with the justice system
What is an example of a “time out”?
Going to a quiet room alone when feelings of agitation are increasing
What is behavior contracting and why is it essential when working with clients with conduct disorder?
an intervention technique in which a client signs an agreement to make certain behaviour changes within a specified time, usually with explicitly defined rewards for adherence or success; sets limits and boundaries
What is an illusion? How is it different from a delusion or hallucination?
Illusion is thinking something is something that it is not
How should you communicate with clients with dementia?
Introduce self each time, talk about one thing at a time, use short and clear sentences/words/phrases, approach from the front
Should a nurse disagree and reorient clients with advanced dementia?
No
What is the treatment and prognosis for delirium?
Tx: diagnose and treat the underlying medical disorder; Prognosis: reversible
What is usually the most therapeutic response when a patient or family member cries?
Sit quietly w/ them
What should a nurse do if a client’s mental status declines during their hospitalization?
Notify the provider (MD, NP, etc)
What is the best psychotherapy for clients w/ substance abuse disorder?
Self-help groups (AA, NA, etc)
What should a nurse do if a verbally aggressive client refuses to take a time out? What’s the next step?
Show sign of strength and ensure help of other staff members
