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781 Dipiazza > midterm > Flashcards

midterm Flashcards

1
Q

What’s the purpose of the American Nurses Association’s Psychiatric–Mental Health Nursing: Scope and Standards of Practice.

A

Defines the role and actions for the NP.

It tells us what is reasonable and prudent practice.

Professional nursing organizations will provide information on what is seen as acceptable educational preparation for practice.

However, the individual legislative regulations of each state determine what constitutes legal practice for each individual PMHNP.

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2
Q

The purpose of the ANA’s PMH Nsg: Scope and Standards of Practice is to (SHORT ANSWER):

A

Define the role and actions for the NP

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3
Q

What regulation, rule, or standard should Ms. Harris consult to determine if she is legally allowed to treat both children and adults

A

Ms. Harris should consult the Nurse Practice Act and related legislation of the state in which she practices, which will delineate the legal boundaries of her practice.

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4
Q

What regulation, rule, or standard should Ms. Harris consult to determine if she is legally allowed to treat both physical and psychiatric disorders?

A

Professional standards and scope-of-practice documents suggest what is reasonable and prudent practice. The individual legislative regulations of each state determine what constitutes legal practice for each individual PMHNP.

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5
Q

What is the role of professional psychiatric nursing organizations in assisting Ms.Harris to determine the scope of practice that is appropriate for her as a new graduate?

A

Professional nursing organizations provide information through a Scope and Standards document about what is seen as an acceptable practice role for PMHNPs, but the PMHNP’s practice is ultimately guided by the individual state’s Nurse Practice Act.

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6
Q

Primary prevention is aimed at

A

decreasing the incidence (number of new cases) of a disorder. Examples: Stress management classes for graduate students, smoking prevention classes, Drug Abuse Resistance Education (DARE),

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7
Q

Secondary prevention is aimed at

A

decreasing the prevalence (number of existing cases) of mental disorders, Early case finding, Screening, Prompt and effective treatment. Examples: Telephone hotlines, crisis intervention, disaster responses

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8
Q

Tertiary prevention: is aimed at

A

decreasing the disability and severity of a mental Disorder. Rehabilitative services. Avoidance or postponement of complications. Examples: Day treatment programs; case management for physical, housing, or vocational needs; social skills training

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9
Q

The NP is asked by a church organization to work with members within your health system to develop a substance abuse prevention program. According to public health principles, this is an example of what level of prevention?

A

A substance abuse prevention program is an example of primary prevention. Primary prevention is aimed a decreasing the incidence (number of new cases) of a disorder. Example: Stress management classes for graduate students, smoking prevention classes, Drug Abuse Resistance Education (DARE), Keepin’ It REAL elementary and middle school curriculum

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10
Q

beneficence

A

to do what benefits the patient. An example of beneficence is performing daily tasks for patients who are unable to carry them out alone.

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11
Q

maleficence

A

Non-maleficence is not inflicting harm, so maleficence would be inflicting harm.

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12
Q

Situations where an NP has a duty to report

A

Nurses have a right and duty to express their opposition and only compromise if such a decision preserves their moral integrity.
the individual nurse’s responsibility and accountability in nursing practice, as well as the promotion of safe, quality health care

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13
Q

During an initial assessment, the relevant features of communication are its ability to

A

Promote a therapeutic alliance and increase understanding

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14
Q

Open-ended questions

A

Are useful in the beginning of an interview

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15
Q

Validation is a communication strategy used to

A

Let the patient know that his or her feelings are reasonable

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16
Q

Characteristics of the Biopsychosocial Assessment

A

Biopsychosocial Case Formulation is an organizational model consisting of 3 areas: biologic, psychological, and social. Each domain has an independent knowledge and treatment focus but can interact and be mutually interdependent with the other dimensions.

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17
Q

the primary function of the bio-psychosocial case formulation is to

A

generate an understanding of the person as a whole.

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18
Q

The primary purpose of the bio-psychosocial case formulation is to

A

organize facts around a cause, the source of the problem.

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19
Q

Purpose of defense mechanisms.

A

Used to resolve conflict

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20
Q

Denial

A

Avoidance of unpleasant realities by unconsciously ignoring their existence

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21
Q

Projection

A

Unconscious rejection of emotionally unacceptable personal attributes, beliefs, or actions by attributing them to other people, situations, or events.

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22
Q

Repression

A

Unconscious exclusion of unwanted, disturbing emotions, thoughts, or impulses from conscious awareness

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23
Q

Reaction Formation

A

Often called overcompensation.

You feel bad about something, so you do the opposite to overcompensate

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24
Q

Rationalization

A

Justifying something illogical by making an acceptable explanation for it

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25
Q

Undoing

A

Behaviors that attempt to make up for or undo an acceptable action, feeling or impulse

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26
Q

Intellectualization

A

Attempts to master current stressor or conflict by expansion of knowledge, explanation or understanding

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27
Q

Suppression

A

Conscious analog of repression, conscious denial of a disturbing, situation, feeling or event

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28
Q

Sublimation

A

Unconscious process of substitution of socially acceptable constructive activity for something unacceptable

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29
Q

Altruism

A

Meeting the needs of others in order to discharge drives, conflicts, or stressor

30
Q

Suppression is the only defense mechanism in which

A

the client channels conflicting energies into growth-promoting activities.

31
Q

Agraphesthesia,

A

Inability to feel or identify writing on the skin

32
Q

Astereognosis,

A

Inability to identify objects by feeling them

33
Q

Choreiform,

A

Jerking or writhing movements, or what appears to be poor coordination.

They are absent during sleep.

They get progressively worse over the years.

34
Q

Dysdiadochokinesia

A

The inability to perform rapid, alternating muscle movements such as fast finger tapping or foot tapping.

35
Q

Stevens-Johnson Syndrome

A

A serious disorder of the skin and mucous membranes. It is a medical emergency usually requiring hospitalization. Flu like symptoms appear followed by a painful rash. Treatment involves stopping the medication, caring for wounds, and pain management.
Medications that can cause it (most of them are anticonvulsants): Armodafinil, Modafinil, Buproprion, Carbamazepine, Lamotrigine, Levetiracetam, Oxcarbazepine, Zonisamide

36
Q

Bipolar 1,

A

-Had at least one manic episode
Mania:
-Elevated or irritable mood, increased energy and goal directed activity, lasts at least 1 week
-grandiose, decreased sleep, talkative, flight of ideas, distractibility, more goal directed, risky behavior.
-Functioning is severely impaired or hospitalization is required.

37
Q

Bipolar 2,

A

Had at least one hypomanic episode, but cannot have had any manic episodes.
Had at least one major depressive episode.
Hypomania:
-Elevated or irritable mood, increased energy, lasts at least 4 days
-grandiose, decreased sleep, talkative, flight of ideas, distractibility, more goal directed, risky behavior.
-The level of function changes, but not as severely as mania and doesn’t required hospitalization.
-No psychotic symptoms (otherwise it’s mania)

38
Q

Major Depressive Disorder,

A

Depressed mood
Lack of interest in usual activities
Marked weight loss or gain
Sleep disturbances, agitation, fatigue or loss of energy
Feelings of worthlessness or inappropriate guilt
Difficulty concentrating or making decisions
Thoughts of death or suicide

39
Q

Narcissistic Personality Disorder,

A

Grandiose, needs admiration, no empathy, preoccupied with fantasies, exploits people, jealous

40
Q

Generalized Anxiety Disorder

A
  • Excessive anxiety about multiple things for at least 6 months.
  • Has difficulty coping
  • Restless, fatigue, poor concentration, irritable, muscle tension, sleep disturbances
  • Impaired functioning
41
Q

Post Traumatic Stress Disorder

A

For people age 6 and up:

  • It involves a death, death threat, serious injury, sexual assault in one of these ways: Direct experience, witnessing, hearing that it happened to someone close to you (for a death it has to be violent or accidental), repeated/extreme exposure to details of the event.
  • Distressing memories, distressing dreams, dissociations (flashbacks), being emotionally triggered by things, or having physical reactions.
  • Avoiding the stimulus
  • Unable to remember something about the trauma, having exaggerated negative beliefs, distorted beliefs about the event, negative emotional state, or decreased interest in activities and other people
  • Having outbursts, recklessness, hypervigilance, startles easily, poor concentration, sleep disturbances.
  • Lasts more than 1 month *
42
Q

Acute Stress Disorder,

A

-Same as PTSD except it last for 3 days to 1 month.

43
Q

Adjustment Disorder

A

Within 3 months of a stressor the person gets emotional/behavioral symptoms. The distress is out of proportion to the stressor and causes impairment. It can’t be normal bereavement. When the stressor is gone, the symptoms go away within 6 months.

44
Q

Panic Disorder

A
  • Has repeated panic attacks. Panic attacks are sudden and peak quickly
  • At least 1 attack is followed by a month of worrying about the next attack or a month of maladaptive behavior (like behaviors with the purpose of avoiding an attack).
45
Q

Panic Attack

A

It is not a mental disorder by itself, but it can be associated with disorders.

46
Q

Separation Anxiety

A
  • Excessive worry about separating
  • Thinking you’ll lose the loved one or something bad will happen to them
  • Refusing to separate
  • Nightmares about separating
  • Has somatic complaints when separating
  • The fear last at least 4 weeks in kids and 6 months in adolescents/adults
47
Q

Social Anxiety

A

-Fear of situations where one could be scrutinized by others. Lasts at least 6 months.

48
Q

Agoraphobia

A

Fear of 2 or more: Public transportation, open spaces, enclosed spaces, crowds, leaving the house alone. They’re afraid that help might be unavailable if they panic, could also be they’re afraid they’ll be embarrassed (like an old person afraid of being incontinent outside the home). Lasts longer than 6 months.

49
Q

Remember that derealization is common in

A

anxiety disorders, and it is characterized by the sense of one’s surrounding being strange or unfamiliar and not real.

50
Q

Primary prevention care practices are an essential aspect of the PMHNP role. Which of the following is the best example of a primary prevention care strategy for community behavioral health?

A

Parenting skills classes for pregnant adolescents

51
Q

The trend in legal rulings on cases involving mental illness over the past 25 years has been to

A

Protect the individual’s freedoms or rights when he or she is committed to a mental hospital

52
Q

Mr Smithers, an involuntarily hospitalized patient experiencing psychotic symptoms, refuses to take any of his ordered medication because he believes “Jesus Christ told me I am the prophet and must fast for a year.” Your actions should be based on your knowledge that:

A

Psych clients can refuse treatment

53
Q

A community has an unusually high incidence of depression and drug use among its teenage population. The public health nurses decide to address this problem, in part, by modifying the environment and strengthening the capacities of families to prevent the development of new cases of depression and drug use. This is an example of:

A

primary prevention

54
Q

Mrs Kemp is voluntarily admitted to the hospital. After 24 hours, she states she wants to leave because “this place can’t help me.” The best nursing action that reflects the legal right of the client is

A

explain that the client cannot leave until you can complete further assessment

55
Q

Mrs Kemp is voluntarily admitted to the hospital. After 24 hours, she states she wants to leave because “this place can’t help me.” The best nursing action that reflects the legal right of the client is

A

explain that the client cannot leave until you can complete further assessment

56
Q

In forming a therapeutic relationship with clients, the PMHNP must consider developing many characteristics that are known to be helpful in relationship-building. These characteristics include all of the following EXCEPT

A

accuracy in assessment

57
Q

Mr Johnson is a 54-year-old client you have been seeing for several weeks in therapy. While discussing his current concerns of marital stress, he lies on the floor and assumes the fetal position. This is most likely an example of

A

Immature regressive defense mechanism

58
Q

A man thinks to himself that his wife is really ugly as they sit at the breakfast table, but of course he does not verbalize his feelings. Later in the day he gets a sudden unexplainable urge to send her flowers. The best explanation for his unconscious action is

A

Undoing

59
Q

All Borderline Subjects Are Tough, Troubled Characters

A 
Appearance
Behavior
Speech
Affect
Thought process
Thought content
Cognitive examination
60
Q

Suicide: Age

A

Age falls into a bimodal distribution, with teenagers and the elderly at highest risk

61
Q

Suicide: Depression

A

Fifteen percent of depressive patients die by suicide.

62
Q

Suicide: Previous attempt

A

Ten percent of those who have previously attempted suicide die by suicide.

63
Q

Suicide: Ethanol abuse

A

Fifteen percent of alcoholics commit suicide

64
Q

Suicide: Rational thinking loss

A

Psychosis is a risk factor, and 10% of patients with chronic schizophrenia die by suicide.

65
Q

Suicide: Sickness

A

Chronic illness is a risk factor.

66
Q

Bipolar disorder must be ruled out prior to prescribing antidepressant medications because they are known to

A

induce mania in susceptible patients. Antidepressants may be carefully administered to patients with bipolar disorder with predominantly depressed features (often must have a mood stabilizing agent on board). Assess if compulsive disorder, generalized anxiety disorder, and panic disorder will all be well treated with SSRI medication

67
Q

Bipolar disorder type 2; example of a diagnosis

A

the patient is demonstrating symptoms of hypomania which have not required psychiatric treatment or caused occupational dysfunction and currently he is in a depressed state. Hypomania with major depression defines bipolar 2 disorder. Bipolar 1 disorder requires one manic episode that is so severe it causes occupational dysfunction. The patient is not demonstrating grandiose symptoms of entitlement or other narcissistic personality traits.

68
Q

Bipolar I disorder is characterized by a history of at least one

A

manic episode. The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes. Bipolar II disorder is characterized by hypomanic episodes alternating with depressive episodes.

69
Q

Another Bipolar I example

A

Bipolar disorder currently meeting criteria for a manic episode including psychomotor agitation grandiose thinking, pressured speech, flight of ideas, impulsive behavior, uncharacteristic excessive spending stated with premorbid euthymia and high functioning behavior. There is no precipitating identifiable stressor as the primary driver of this manic behavior. Because the patient is in a manic episode he should never be diagnosed with major depressive disorder even if he presents as depressed at some time in the future (lest he be treated with antidepressant monotherapy).

70
Q

premenstrual dysphoric disorder; Example of diagnosis

A

duration is not sufficiently long to qualify for major depressive disorder. Dysthymia requires the persistence of symptoms for at least 2 years. Cyclothymic disorder requires alternating between symptoms of depression and hypomania without meeting full criteria most of the time for at least 2 years and a symptom-free period cannot exceed 2 months.

71
Q

Acute stress disorder; example of diagnosis

A

symptoms of intrusive memory, rumination, hypervigilance, apprehensiveness, and avoidance because the incident was less than 4 weeks ago. The NP will rule out the following….Posttraumatic stress disorder would have the same symptoms but they must persist longer than 4 weeks. Generalized anxiety disorder is not associated with a specific traumatic event and the symptoms must persist a majority of the time and include irritability lasting at least 6 months. Adjustment disorder is characterized by the development of mood and anxiety symptoms, not precipitated by a traumatic event.

72
Q

psychotherapeutic approach indicated for anxiety disorders and mood disorders

A

Cognitive behavioral therapy is an evidence-based psychotherapeutic approach indicated for anxiety disorders and mood disorders. The NP knows that EMDR is specifically developed for the treatment of posttraumatic stress disorder (PTSD). Interpersonal therapy looks at the relationships contributing to depression. Supportive psychotherapy aims to strengthen the patient’s defense mechanisms to restore function typically reserved for patients with more primitive coping mechanisms.

781 Dipiazza (2 decks)

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