Exam 1

Question 1

Why theorists developed theories and what are they

Answer 1

They are treatments based on these theories

because they Help us understand why

Question 2

*Father of psychology - what theory he developed?

Answer 2

Sigmund Freud

(Psychoanalytic theory)

First five years is important -Developmental stages

3 structures of personality- ID, Ego, superego (conscience) =these resolve internal conflicts

Question 3

*The primitive pleasure seeking part (sexual desire) of our personalities that lurks around our unconscious mind.

Answer 3

ID (Simmons Freud)

Question 4

*Our sense of self and ask between the ID in the world by using its defense mechanisms such as repression, denial, and rationalization

Answer 4

Ego (Freud)

Question 5

*Is assigned to those processes that Freud referred to as our conscience and is greatly influenced by our parents or caregivers moral and ethical stances

Answer 5

Superego

Question 6

*This theory considers the impact of external factors , parents and society on personality development from childhood to adulthood

Answer 6

Eriksons

Question 7

Eriksons theories

0-1 y
1-3y
3-6y
6-12
12-19
20-25
26-64
65-death

Answer 7

Basic trust vs mistrust -hope,

Autonomy vs shame -will

Initiative vs guilt -purpose

Industry vs inferiority -competence

Identity vs confusion -fidelity

Intimacy vs isolation -love

Generativity vs stagnation -care

Integrity vs despair -wisdom

Question 8

*Theory that helps determine priority

SEA- SAFETY, EXPRESS FEELINGS, ASSIST

Answer 8

Humanistic theory

Question 9

Maslow theory- self fulfillment needs

Psychological needs

Basic needs

Answer 9

Self actualization -achieving ones full potential

—————————

Esteem needs-feeling of accomplishment

Belongingness and love needs: intimate relationships , friends

—————————-
Safety needs :security,safety

Physiological needs: food, water, warmth, rest

Question 10

Theory-

individual behavior and personality are the direct result of interpersonal relationships

Answer 10

. Interpersonal theory (Harry Stack Sullivan)-

Question 11

birth to 1 and 1/2; mother figure is the source of tension relief, the goal is biological satisfaction and psychological security; learn to count on others for security

Answer 11

Sullivan Infancy stage

Question 12

1 and 1/2 to 6 years old; beginning to develop self-esteem; learning to delay satisfaction of wishes with relative comfort

Answer 12

Sullivan Childhood Stage

Question 13

6-9 years old; develops satisfying interpersonal relationships with peers that involve competition and compromise

Answer 13

Sullivan Juvenile Stage

Question 14

12-30 years old; forming intimate and long-lasting relationships with members of the opposite sex

Answer 14

Sullivan Adolescence Stage

Question 15

Neurotransmitters and what mental illness is associated with each

Answer 15

Role of dopamine in mental disorders

Fine muscle movement, Integration of, emotions and thoughts, Decision making, Stimulates hypothalamus to release hormones (sex, thyroid, adrenal). Too much: schizophrenia and mania; Not enough: parkinsons and depression

Role of Serotonin in mental disorders

Mood, Sleep regulation, Hunger
Pain perception, Aggression, and libido, Hormonal activity. Too much: Anxiety; Not enough: Depression

Role of norepinephrine in mental disorders

Mood, Attention, and arousal, Stimulates sympathetic branch of autonomic nervous system for “fight or flight” in response to stress. Too much: mania, anxiety, schizophrenia. Not enough: depression

Gaba- relaxation transmitter= too little= anxiety
disorders, too much=anxiety, hyperactivity, mood disorders, depression

Norepinephrine- too little: depression, too much: schizophrenia

Adrenaline- too much: anxiety disorders, insomnia, stress, low-lack of focus, lack of energy

Epinephrine: too little depression

Serotonin- too little: depression & anxiety
disorders (OCD), high-mania, hypertension, confusion

Dopamine- too much: schizophrenia, too little: depression, tremors, muscular rigidity (Parkinson’s)

Acetylcholine- too much: depression, too little: dementia
Factors contributing: genetics; environment

Question 16

Classifications of Mental Health medications and what they affect

Answer 16

First generation antipsychotic:

Low potency-chlorpromazine, Prochlorperazine, thioridazine
First generation (high potency):
Fluphenazine
Haloperidol
Pimozide

2nd generation antipsychotic:

Aripiprazole
Asenapine
Olanzapine
Quefiopine
Rejexidone
Antidepressants:

Reversible inhibitors of MAO-1:

Moclobmide
Clorgyline
Tricyclic antidepressants:
Imipramine
Trimipramine
Amitriptyline
SSRI:
Fluoxeline
Fluvoximine
Paoxetine

Question 17

manipulate environment so all aspects of client’s hospital experience are considered therapeutic. To effect behavioral changes in the environment and to improve mental health and functioning of the individual.
Milieu consists of patients, environment and staff
1. Safety check
2. No contraband- metals, glass, strings, utensils, garbage bag, coins, purses, no phone with cords lighters, alcohol, cigarretes, mouthwash, hairspray, necklaces, shoelaces, knives. Razors, no pills, bra w/ wires
3. Locked doors
4. Interdisciplinary team
5. Patient identifiers
6. Calm environment – quiet, music, lighting, homey environment,
7. Monitor visitors
8. Schedule/ structure
9. Group therapy
10. Nurses station visible

Answer 17

Therapeutic milieu

Milieu therapy- therapeutic community

Question 18

Difference between Therapeutic and Non-therapeutic Communication X

Answer 18

Non therapeutic
(Non-therapeutic comm- can block development of trust and relationship with clients.
reassurance, approval, agreeing, rejecting, disapproving, advising, etc.)

Therapeutic Communication
the face-to-face process of interacting that focuses on advancing the physical and emotional well-being of a patient.

Question 19

Sections of psychiatric assessment

How to assess them

Answer 19

establish rapport, understand the chief complaint, review physical status and baseline vitals, assess for risk factors, perform a mental status exam, assess psychosocial status, identify mutual goals for treatment, formulate a care plan, document data in a retrievable format

How to assess attention
performance on serial sevens, digit span tests

How to assess abstraction
performance on tests involving similarities, proverbs

How to assess insight
Cognition portion of Mental status evaluation

How to assess judgement
Cognition portion of Mental status evaluation

Question 20

Cultural considerations in Mental Health Nursing

Answer 20

Cultural awareness, cultural knowledge??

Understand the pt culture viewpoint and adapt to their cultural needs.

Question 21

Least restrictive environment

Answer 21

Setting that provides the necessary care while allowing greatest personal freedom

Question 22

. Patient rights, consent, and privacy?

Answer 22

right to treatment, right to refuse treatment, right to informed consent, right to be free from physical and mental abuse, discuss observations about the client with treatment team regarding privacy.

Question 23

Mental Health documentation and patient outcomes

Answer 23

Document the effect a med had on the patient, negative or positive.

Question 24

Ethical Principles of Mental Health Nursing:

Answer 24

Negligence
Autonomy
Justice
Beneficence
Fidelity
Veracity

Question 25

the act or omission to act that results in or is responsible for a person's injuries.

Answer 25

Negligence

Question 26

*Respecting the rights of others to make their own decisions. Acknowledging the patient's right to refuse their medication is an example

Answer 26

Autonomy

Question 27

The duty to distribute care or resources equally regardless of personal attributes. An intensive care unit (ICU) nurse devotes equal attention both to a patient who has attempted suicide and to another patient who suffered a brain aneurysm

Answer 27

Justice

Question 28

The duty to act so as to promote the good of others. Spending extra time with an extremely anxious patient is an example

Answer 28

Beneficence

Question 29

AKA nonmalefesence. Maintaining loyalty and commitment to the patient and doing no harm to the patient. Maintaining expertise in nursing skills through education demonstrates this

Answer 29

Fidelity

Question 30

One's duty to communicate truthfully. Describing the purpose and side effects of psychotropic medications in a truthful and non-misleading way is an example

Answer 30

Veracity

Question 31

right to treatment, right to refuse treatment, right to informed consent, right to be free from physical and mental abuse

Answer 31

What rights do all patients have? Do psyc patients have the right to chose the care giver?

Question 32

A court-appointed guardian may give or refuse consent for treatment. Advanced psychiatric directives may identify guardian and or treatments

Answer 32

What rights are limited to involuntarily admitted patients?

Question 33

Practitioners have a duty to protect third parties from threats to their life (Tarasoff vs. University of California)

Answer 33

Duty to warn

Question 34

How is HIPAA used in psych nursing?

Answer 34

psychotherapy notes are kept separate from the patient's health information; the "dead man's statute" private information is still privileged after death

Question 35

Appropriate use of restraints and seclusion

Answer 35

the least restrictive means of restraint for the shortest duration of time. Order must be renewed every 4 hours for a maximum of 24 hours, observation must be documented every 15-30 minutes

Question 36

Purpose of seclusion

Answer 36

May only be used to ensure the immediate safety of the patient, staff, or other patients and must be discontinued at the earliest possible time

Question 37

*Common typical antipsychotics Common side effects of typical antipsychotics

Answer 37

chlorpromazine, haloperidol, fluphenazine, thiothixene extrapyramidal side effects, neuroleptic malignant syndrome, anticholinergic effects, sedation, sexual dysfunction

Question 38

*Teaching points with typical antipsychotics Common atypical antipsychotics

Answer 38

chew sugarless gum, sip water, avoid hazardous activity, wear sunglasses outdoors, eat fiber, participate in regular exercise aripiprazole (abilify), clozapine (clozaril), olanzapine (zyprexa), risperidone (risperdal)

Question 39

*Orientation phase of nurse-client relationship

Answer 39

It is the first time the nurse and the patient meet, and they are strangers to each other. Rapport, parameters, and a contract is established.ti

Question 40

*Working phase of nurse-client relationship

Answer 40

Maintaining the relationship, gathering further data, promote patient's problem-solving skill and self-esteem, evaluate problems and goals, redefine if necessary

Question 41

*Termination phase of nurse-client relationship

Answer 41

Begins during the orientation phase, summarize the goals and objectives, exchange memories, can end with patient's discharge or end of student's rotation

Question 42

nurse-client relationship vs social relationship

Answer 42

A nurse-patient relationship differs from both a social and an intimate relationship in that the nurse maximizes his or her communication skills, understanding of human behavior, and personal strengths to enhance the patient's growth. A social relationship is a relationship that is primarily initiated for the purpose of friendship, socialization, enjoyment, or accomplishment of a task

Question 43

The focus is on the patient, and the relationship is not designed to meet the nurse's needs. Warning signs include overhelping, controlling the patient, and narcissim

Answer 43

Patient boundaries

Question 44

Psych RN scope of practice

Answer 44

works with individuals, families, groups, and the community to assess mental health needs, develop diagnoses, plan, and implement care; use interventions including health promotion and maintenance, assessment and evaluation, case management, provision of therapeutic milieu, client education, self-care promotion, crisis intervention, social and community mental health issues

Question 45

mental health vs mental illness (know the difference)

Answer 45

They exist on a dynamic, shifting continuum. Mental health is the successful performance of mental functions, resulting in the ability to engage in productive activities, enjoy fulfilling relationships, adapt to change, and cope with adversity. Mental illness affect a person's thinking, feeling, mood, ability to relate to others, and daily functioning.

Question 46

What is included when developing goals/outcomes

Answer 46

Engage patients or designated surrogates (e.g., family members) and active partnerships that promote health, safety, well-being, and self-management

Question 47

Describe the nursing process when developing plan of care

Answer 47

Assessment The nurse collects comprehensive data using therapeutic techniques employing evidence-based assessment skills Diagnosis has three structural components: the problem (the unmet need), the etiology (the probable cause), and the supporting data (the signs and symptoms supporting the stated problem) Planning Goals must be safe, appropriate, individualized to the patient, and evidence-based Implementation the mental health nurses practice is accomplished through the nurse-patient partnership and the use of therapeutic intervention skills. The nurse implements the plan using evidence-based interventions whenever possible, utilizing community resources and collaborating with nursing colleagues Evaluation Evaluate and monitor the patient's outcomes (long- and short-term goals) and make changes to improve and increase the quality and safety of patient care

Question 48

*Sections of MSE

Answer 48

``` personal information, appearance, behavior, speech, affect and mood, thought, perceptual disturbances, cognition ```

Question 49

What considerations should be made during an interview

Answer 49

age, language barriers, use of standardized rating scales

Question 50

Empathetic vs. sympathetic responses Empathy-

Answer 50

putting yourself in their shoes Sympathy-feelilng sorry for them

Question 51

Describe and give examples for Therapeutic Communication

Answer 51

“how does that make you feel? (how the patient feels)

Question 52

Define ethnicity: give examples

Answer 52

relating to large groups of people classed according to common racial, national, tribal, religious, linguistic, or cultural origin or background

Question 53

​Define culture: give examples

Answer 53

the customary beliefs, social forms, and material traits of a racial, religious, or social group; also :the characteristic features of everyday existence (such as diversions or a way of life) shared by people in a place or time

Question 54

Apply the impact of culture to patient care

Answer 54

Culture formulation interview takes into account cultural norms for distress, family support, religion, etc