Exam 1 Study Guide

Question 1

The nurse needs to consider the

Answer 1

cultural, religious, and spiritual practices of the client and whether these practices may give the client hope, comfort, and support while healing.

Question 2

Therapeutic communication process (in every chapter): remember

Answer 2

we have verbal and nonverbal, successful communication includes appropriateness, efficiency, flexibility, and feedback, Anxiety in the nurse or client impedes communication, communication needs to be goal-directed within a professional framework.

Question 3

Transference

Answer 3

suggests feelings and thoughts that a client has towards the nurse, psychiatrist, or another service provider are rooted in the client’s unconscious, or repressed emotions and feeling toward people in his or her past, such as parents or teachers.

Question 4

Countertransference

Answer 4

refers to the feelings and thoughts that a mental-health service provider has toward a client that may be related to the provider’s own unconscious or repressed emotions, feeling, or experiences.

Question 5

The therapeutic communication interaction is most comfortable when the nurse and client are

Answer 5

3 to 6 feet apart; 0 to 18 inches is comfortable for parents with young children, people who mutually desire personal contact, or people whispering; 2 to 3 feet is comfortable between family and friends who are talking; 4 to 12 feet is acceptable for communication in social, work, and business settings

Question 6

Consider the differences between coping and defense mechanisms: Coping mechanisms:

Answer 6

coping involves any effort to decrease anxiety, coping mechanisms can be constructive or destructive tasks or problem oriented in relation to direct problem solving, cognitively oriented in an attempt to neutralize the meaning of the problem or defense or emotion oriented thus regulating the response to protect oneself.

Question 7

Now look at Defense mechanisms:

Answer 7

As anxiety increases the individual copes by using defense mechanisms*, A defense mechanism is a coping mechanism used in an effort to protect the individual from feelings of anxiety, as anxiety increases and becomes overwhelming, the individual copes by using defense mechanisms to protect the ego and decrease anxiety. (coping mechanism and defense mechanisms are used by the client as protection from unmanageable stress and to decrease anxiety**).

Question 8

Review Types of Defense Mechanisms

Answer 8

Neurotransmitters

Question 9

Anxiety (ADPIE) assessment and coping strategies, defense mechanisms (positive vs negative), patient teaching, know pharmacological interventions that we can give for a client with signs and symptoms of anxiety (know anxiolytics / anti-anxiety meds) therapeutic communication with anxious client

Answer 9

Anxiety interventions for panic attack), Medication Interventions: Take a peek at table 27.4 SSRI, SNRI, Benzodiazepines.

Question 10

Consider: Anxiety is a normal response to stress, A subjective exp. That includes feelings of

Answer 10

apprehension, uneasiness, uncertainty, or dread, occurs as a result of threat that may be misperceived or a threat to identify or self-esteem, Anxiety may be the result when values are threatened, or preceding NEW experiences.

Question 11

Think about how there are different types of Anxiety:

Answer 11

1. Normal: a healthy type of anxiety 2. Acute: precipitated by imminent loss of change that threatens one’s sense of security and 3. Chronic: Anxiety that persists as a characteristic response to daily activities.

Question 12

Now look at the different levels of anxiety:

Answer 12

mild, moderate, severe, panic

Question 13

Know differences between the degrees of anxiety, mild, moderate, severe, and panic.

Answer 13

Input response

Question 14

MODERATE: the focus is on

Answer 14

immediate concerns, narrowed perceptual field, sense of sight and sound diminish as selective inattentiveness occurs, learning and problem solving still occur, physical symptoms include increased heart rate, perspiration, gastric discomfort, headache, urinary urgency, and or mild tremors.

Question 15

SEVERE: severe anxiety is a feeling that

Answer 15

something BAD is about to happen, a significant narrowing in the perceptual field occurs, focus is on minute or scattered details, all behavior is aimed at relieving the anxiety, learning and problem solving are not possible, actions are aimed at reducing or alleviating anxiety, physical symptoms are caused by stimulation of the sympathetic nervous system (ex: headache, nausea, dizziness, sleep disturbance) increased tremors, pounding heart rate, and hyperventilation, the individual needs direction to focus.

Question 16

PANIC: Associated with

Answer 16

dread and tremor and a sense of impending doom, disorganization, difficulty perceiving perception occurs, the individual is unable to communicate or function effectively, if prolonged, panic can lead to exhaustion and death, increased motor activity (PACING, SHOUTING, SCREAMING) or Withdrawal, Impulsive or erratic behavior.

Question 17

Interventions (Take actions): General Nursing Measures:

Answer 17

recognize the anxiety, establish trust, protect the client, modify the environment by setting limits, do NOT criticize (coping mechanisms), provide creative outlets monitor for signs of impending destructive behavior, promote relaxation techniques such as BREATHING EXERCISES AND GUIDED IMAGERY, monitor vital signs, and administer anti-anxiety meds as prescribed, DO NOT force the client into situations that provoke anxiety. REMEMBER: the IMMEDIATE nursing action for the client with ANXIETY is to DECREASE STIMULI in the environment and provide a calm and quiet environment.

Question 18

What are my PRIORITY NURSING ACTIONS with Anxiety in a client?? 1. Provide a…….

Answer 18

calm environment, decrease environmental stimuli and stay with the client 2. Ask the client to identify what and how she or he feels. 3. Encourage the client to describe and discuss her or his feelings. 4. Help the client identify the causes of feelings if she or he is having difficulty doing so. 5. Listen to the client for expressions of helplessness and hopelessness 6. Document the event, significant information actions taken and follow up actions and the client’s response.

Question 19

Now look at Interventions specific to MILD TO MODERATE LEVELS: Help the client identify the

Answer 19

source of their anxiety, encourage the client to talk about feelings and concerns, help the client identify thoughts and feelings that occurred before the onset of anxiety, encourage problem solving, and encourage gross motor exercise

Question 20

Now look at interventions specific to SEVERE TO PANIC LEVELS: reduce the

Answer 20

anxiety quickly, use a calm manner, ALWAYS REMAIN WITH THE CLIENT, minimize environmental stimuli, provide clear, simple statements, use a low pitched voice, attend to the physical needs of the client, provide gross motor activity, administer antianxiety meds as prescribed, and ensure safety.**

Question 21

Anxiety disorders: Assessment & Interventions: Review Generalized Anxiety Disorder:

Answer 21

an unrealistic anxiety about everyday worries that persist more days than not, over at least 6 months and is not associated with another mental health or medical problem.

Question 22

Physical symptoms occur. Review Assessment:

Answer 22

restlessness and inability to relax, episodes of trembling and shakiness, chronic muscular tension, dizziness, inability to concentrate, chronic fatigue and sleep problems, inability to recognize the connections between the anxiety and physical symptoms, client is focused on the physical discomfort.

Question 23

UNEXPECTED AND EXPECTED PANIC ATTACKS:

Answer 23

most extreme level of anxiety resulting in disturbed behavior, produces a sudden onset of feelings of intense apprehension and dread, cause usually cannot be identified, severe, recurrent, intermittent anxiety attacks lasting 5 to 30 minutes occur.

Question 24

UNEXPECTED AND EXPECTED PANIC ATTACKS: ASSESSMENT:

Answer 24

choking sensation, labored breathing, pounding heart, chest pain, dizziness, nausea, blurred vision, numbness or tingling of the extremities, sense of unreality and helplessness, fear of being trapped, fear of dying

Question 25

UNEXPECTED AND EXPECTED PANIC ATTACKS:INTERVENTIONS:

Answer 25

REMAIN WITH THE CLIENT, attend to physical symptoms, assist the client to identify the thoughts that aroused the anxiety and identify the basis for these thoughts, assist the client to change the unrealistic thoughts to more realistic thoughts, use cognitive restructuring to replace distorted thinking, administer antianxiety meds if prescribed

Question 26

UNEXPECTED AND EXPECTED PANIC ATTACKS: INTERVENTIONS:

Answer 26

REMAIN WITH THE CLIENT, attend to physical symptoms, assist the client to identify the thoughts that aroused the anxiety and identify the basis for these thoughts, assist the client to change the unrealistic thoughts to more realistic thoughts, use cognitive restructuring to replace distorted thinking, administer antianxiety meds if prescribed

Question 27

Now look at Specific Phobia:

Answer 27

Irrational fear of an object, activity, or situation that persists and that leads to avoidance, Associated with panic level anxiety or fear if the object, situation, or activity cannot be avoided.

Question 28

DEFENSE MECHANISMS commonly used in phobia

Answer 28

include REPRESSION AND DISPLACEMENT

Question 29

Review the various types of specific phobias: such as

Answer 29

agoraphobia: fear of open spaces, Claustrophobia: fear of closed spaces and think about how with specific phobias the client reports a fear of specific objects (spiders, snakes, or strangers), fear of specific experiences (flying, being in the dark, an enclosed space),and the client might experience anxiety manifestations just by thinking of the feared object of situation and might attempt to decrease the anxiety through the use of alcohol or other substances (ATI, 2019, p. 57).

Question 30

Look at Obsessive compulsive and Related Disorders:

Obsessions are

Answer 30

preoccupations with persistently intrusive thoughts, impulses, or images and ideas.

Question 31

Compulsions are

Answer 31

the performance of rituals or repetitive behaviors an individual is driven to perform to prevent some event, divert unacceptable thoughts, and decrease anxiety.

Question 32

1. Obsessions and compulsions often

Answer 32

occur together and can disrupt normal daily activities. 2. Anxiety occurs when one resists obsessions or compulsions and from being powerless to resist the thoughts or rituals. 3. Obsessive thoughts can involve issues of violence, aggression, sexual behavior, orderliness, or religion and uncontrollably can interrupt conscious thoughts and the ability to function.

Question 33

Compulsive behavior patterns: (behaviors or rituals): 1. Compulsive behavior

Answer 33

patterns decrease the anxiety 2. The patterns are associated with the obsessive thoughts 3. The patterns neutralize the thought 4. During stressful times, the ritualistic behavior increases 5. Defense mechanisms include REPRESSION, DISPLACEMENT, UNDOING.

Question 34

(the last area to consider is what are some other related disorders that are talked about:

Answer 34

Hoarding disorder, Excoriation (skin picking) disorder, Substance or Medication induced disorder due to another medical condition and Trichotillomania (Hair pulling disorder). ——————-then as the nurse think about what Interventions for OCD and Related Disorders?

Question 35

Ensure that basic needs

Answer 35

(food, rest, hygiene) are met.

Question 36

-Identify situations that

Answer 36

precipitate compulsive behavior encourage the client to verbalize concerns and feelings.

Question 37

Be empathetic toward

Answer 37

the client and aware of her or his need to perform the compulsive behavior. Allow time for the client to perform the compulsive behavior, but SET LIMITS on behaviors that may interfere with the client’s physical well-being to protect the client from physical harm. – IMPLEMENT A SCHEDULE for the client that distracts from the behaviors (STRUCTURE simple activities, games, or tasks for the client). -Establish written contract that assists the client to decrease the frequency of compulsive behaviors gradually. -Recognize and reinforce positive non- ritualistic behaviors.

Question 38

Do NOT interrupt compulsive behaviors UNLESS

Answer 38

they jeopardize the safety of the client or others (provide for client safety R/T behavior). -

Question 39

Allow time for the client to perform the compulsive behavior, but

Answer 39

SET LIMITS on behaviors that may interfere with the client’s physical well-being to protect the client from physical harm. – IMPLEMENT A SCHEDULE for the client that distracts from the behaviors (STRUCTURE simple activities, games, or tasks for the client). -Establish written contract that assists the client to decrease the frequency of compulsive behaviors gradually. -Recognize and reinforce positive non- ritualistic behaviors.

Question 40

IMPLEMENT A SCHEDULE for the client that distracts from the behaviors (STRUCTURE

Answer 40

IMPLEMENT A SCHEDULE for the client that distracts from the behaviors (STRUCTURE simple activities, games, or tasks for the client). -Establish written contract that assists the client to decrease the frequency of compulsive behaviors gradually. -Recognize and reinforce positive non- ritualistic behaviors.

Question 41

PTSD ADPIE:

Patient Teaching about PTSD?

Answer 41

assessment, signs and symptoms, recognizing cues, and interventions

Question 42

PTSD: trauma and stressor related disorders:

Answer 42

manifestations (Changes or signs and symptoms in physical and emotional reactions) of PTSD in a school aged child

Question 43

PTSD: Nursing considerations to help with studying: PTSD DESCRIPTION: After experiencing a psychologically traumatic event, the individual is prone to

Answer 43

re-experience the event and have recurrent and intrusive dreams or flashbacks.

Question 44

PTSD DIAGNOSIS:

Answer 44

Symptoms last at least 1 month and can occur months to years after the traumatizing events.

Question 45

PTSD STRESSORS:

Answer 45

natural disaster, terrorist attack, combat experiences, accidents, rape, crime or violence, sexual, physical and emotional ABUSE, RE- EXPERIENCING the event as FLASHBACKS.

Question 46

PTSD ASSESSMENT:

Answer 46

ASSESSMENT: Avoidance or numbness, irritability or outbursts of anger, detachment, depression that may involve suicidal thoughts, anxiety, sleep disturbances and nightmares, flashbacks of event, hypervigilance and exaggerated startle response, Guilt about surviving the event, Poor concentration and avoidance of activities that trigger the memory of the event.

Question 47

PTSD INTERVENTIONS: Be non-judgmental and supportive, assure the client that her or his

Answer 47

feelings and behaviors are normal reactions, Assist the client to recognize the association between her or his feelings and behaviors and the trauma experience, Encourage the client to express her or his feelings; provide individual therapy that addresses loss of control or anger issues, Monitor for Suicidal risk, Teach stress management techniques, Assist the client to develop adaptive coping mechanisms and to use relaxation techniques, Encourage use of support groups, Facilitate a progressive review of the trauma experience (CALLED FLOODING),

Question 48

PTSD INTERVENTIONS:Encourage the client to

Answer 48

establish and re-establish relationships, Include the family in treatment, Inform the client that hypnotherapy or systematic desensitization may be recommended as a form of treatment.

Question 49

**Clients dealing with cancer may develop

Answer 49

Posttraumatic stress (PTS). Cancer related PTS can occur ANYTIME during or after treatment. The symptoms of PTS are similar to those of PTSD but are generally NOT as severe.**

Question 50

Diagnostic And Statistical Manual 5th edition of Mental Health Disorders: (DSM-5): Know the purposes

Answer 50

The DSM published by the APA provides guidelines for health care personnel for identifying and categorizing mental health problems
• The manual is a system used in clinical research, and educational settings, in which diagnostic criteria are included for each mental health problem
• The manual addresses culturally diverse populations and mental health problems that may be associated with a particular culture
• Dual diagnosis: refers to the client who has both a mental health problem and a substance related problem simultaneously; also known as comorbidity or co-occurring problems

Question 51

Think about the Mental Health Admissions and Discharges: Remember there are VOLUNTARY:

Answer 51

he client seeks admission for care, the voluntary client is free to sign out of the hospital with the psychiatrist (primary health care provider notification and prescription,

Question 52

Detaining a voluntary client against her or his will is termed

Answer 52

FALSE IMPRISONMENT, the client retains all full civil rights

Question 53

Now think about Right to Confidentiality: a client has the right to

Answer 53

confidentiality of her or his medical information, HIPAA ensures client confidentiality with regard to release and electronic transmission of data, the information sometimes must be released in life threatening situations without the client’s consent, in the event of a specific threat against an identified individual, the health care professional has a legal obligation to warn the intended victim of a client’s threat of harm. **Except in an emergency situation, client information can be released only with the client’s informed consent, which specifies the information that can be released and the time frame for which the release is valid.

Question 54

Now look at INVOLUNTARY: (Review the Clients Rights)** think about involuntary admission: involuntary admission may be necessary when

Answer 54

a person is mentally ill, is a danger to self or others, or is in need of mental health treatment or physical care, involuntary admission occurs when a person is admitted or detained involuntarily for mental health treatment because of actual or imminent danger to self or others, the persons condition is deteriorating and they require hospitalization,

Question 55

A client who is admitted involuntarily retains her or his

Answer 55

right for informed consent,

Question 56

The client retains the right to refuse treatments including

Answer 56

medications, UNLESS a separate and specific treatment order is obtained from the court, Depending on the jurisdiction an order from an external board such as the court or from the

Question 57

The client loses the right to refuse treatment when she or he poses an

Answer 57

poses an IMMEDIATE DANGER to self or others, requiring immediate action by the interprofessional health care team,

Question 58

Depending on the jurisdiction an order from an external board such as the court or from the

Answer 58

psychiatrist or PHCP is required for involuntary admissions except in the case of emergency, which allows time to obtain the necessary order from the board:

Question 59

in case of all involuntary admissions legal counsel must be provided for the client. In this situation, the client may be held for

Answer 59

a 72 hour period until further evaluation is completed. Please note that** a hearing is held by an external board or court within a specified time period for a client admitted INVOLUNTARILY and the specific time period VARIES by state.

Question 60

The psychiatrist or PHCP may also be

Answer 60

the person making decisions surrounding a client discourse, depending on location.

Question 61

In most states a client can institute a

Answer 61

hearing to seek an expedient judicial discharge (a writ of habeas corpus). At the hearing a determination is made as to whether the client may be released from the hospital or detained for further treatment and evaluation or committed to a mental health facility for an undermined period.

Question 62

A client has the right to treatment in the

Answer 62

LEAST RESTRICTIVE treatment environment, if the treatment objectives can be achieved by court ordered treatment to an outpatient facility as opposed to an inpatient facility, the client has the right to be treated in the outpatient setting

Question 63

A client is considered LEGALLY COMPETENT UNLESS

Answer 63

she or he has been declared INCOMPETENT through a legal hearing separate from the involuntary commitment hearing. In the course of providing nursing care and carrying out medical prescriptions if the nurse believes that the client lacks competency to make informed decisions, action should be initiated to determine whether a legal guardian or substitute decision maker needs to be appointed by the court

Question 64

How does the client get released from the hospital?

Answer 64

In some but NOT all jurisdictions a client may be released voluntarily against medical advice, or with conditions (conditional release). It is important to be familiar with the laws in the area in which you work regarding conditional release. A client who has sought voluntary admission has the right to receive release upon request.

Question 65

How does the client get a voluntary release?

Answer 65

In the absence of an act of self-harm or danger to others, a voluntary client should never be detained, If a voluntary client wishes to be discharged from treatment but is considered potentially dangerous to self or others the PHCP can order the client to be detained while legal proceedings for involuntary status are sought. In other areas the PHCP places them on 72 hour hold while further evaluation occurs. Some states provide for conditional release of involuntarily hospitalized clients, this enables the treating PHCP to prescribe continued treatment on an outpatient basis as opposed to discharging the client to follow up on her or his own initiative. Community treatment orders may also be instituted depending on the facility and on the area. Conditional release usually involves outpatient treatment for a specified period to determine the client’s compliance with medication protocol, ability to meet basic needs, and ability to reintegrate into the community. An involuntary client who is released conditionally may be reinstitutionalized while the commitment is still in effect without recommencement of formal admission procedures.

Question 66

Lastly: What would discharge planning and follow up care look like?

Answer 66

Discharge is the termination of the client institution relationship, the release may be prescribed by the psychiatrist, external board (court) or administration for involuntarily admitted clients and may be requested by voluntary clients at any time. In most states the client can institute an external board hearing to seek an expedient judicial discharge (writ of Habeas corpus). Discharge planning and follow up care are important for the continued well-being of the client with a mental health problem. Aftercare case managers are used to facilitate the client’s adaptation back into the community and to provide early referral if the treatment plan is unsuccessful. Please also review the intentional torts in ATI on page 11: false imprisonment, assault, battery.

Question 67

Mental health vs mental illness

Answer 67

Input response

Question 68

Suicide Prevention: Assessment to Recognize Cues and think about what matters most?,

Answer 68

Diagnosis with Analyzing the Cues and think about what is the relevant data or what could be the complications with this client?, Planning / Goals: what is my solution for client?, Interventions: what is my nursing action for this client?, Evaluation (ADPIE): What are high and Low Lethality Methods; What are some expected behaviors, What are risk factors for this client?

Question 69

Case Study: 2 questions based on one case study: Anxiety (ADPIE): Refer to Boyd Table 27.4 to view medications for Panic Anxiety for example

Answer 69

SSRIs, SNRIs, Benzodiazepines…

Question 70

Suicide and depression with interventions and medications prescribed, suicide and high risk factors, suicide prevention, suicide plans (assessment), SAD PERSONS SCALE, therapeutic communication with clients who are suicidal

Answer 70

Input response

Question 71

Math calculation: Review week 3 Module & practice with example

Answer 71

Input response

Question 72

How do Interventions differ between the degrees of Anxiety: Mild, Moderate, Severe, Panic

Answer 72

Input response

Question 73

Drug actions including EPS, Anticholinergic effects, Dopamine-blocking effects
tricyclic antidepressant, selective norepinephrine reuptake inhibitor (SNRI), MAO
inhibitor, SSRI. (know classification, side effects, and meds in each class for comparison)

Answer 73

Input response

Question 74

What is Extrapyramidal Symptoms (EPS) and what does it look like? What is the cause?

Answer 74

Input response

Question 75

Review ATI chapter 31: Anger Management: Focus on Seclusion and Restraints (ATI, 2019, p. 181-182),

Answer 75

Input response

Question 76

Review patient centered care focusing on the steps to handle AGGRESSIVE BEHAVIOR**

Answer 76

Input response