Exam 2 (Chapters 4, 6, 14, 15, 25, 10, 16, 13, 17) Flashcards
A patient’s psychiatrist has advised the patient to seek needed hospitalization. In the admitting department of a psychiatric hospital, the patient fills out a standard admission form and agrees to receive treatment & abide by the hospital rules. When the nurse reads the medical record, it will be apparent that this type of admission is known as:
a.) Informal
b.) Involuntary
c.) Voluntary
d.) Legal
c.) Voluntary
A nurse is providing health education about vaping to a group of teenagers at a health fair. What type of prevention is the nurse conducting?
a.) Tertiary prevention
b.) Terminal prevention
c.) Primary prevention
d.) Secondary prevention
c.) Primary prevention
Four individuals have given information about their suicide plans. Which plan evidences the highest lethality?
a.) Overdosing on tylenol with codeine while the spouse is out with friends.
b.) Shooting in the head with a firearm that the spouse keeps in the bedroom
c.) Cutting the wrists in the bathroom while the spouse reads in the next room
d.) Turning on the oven & letting gas escape into the apartment during the night
b.) Shooting in the head wiht a firearm the souse keeps in the bedroom
An adult patient admitted for treatment of symptoms related to paranoid schizophrenia refuses to sign a consent form allowing the nurse to discuss any aspect of his hospitalization with his parents. Which statement by the nurse best respects the patient’s rights while providing effective care?
a.) Telling the parents that “While I can’t discuss his care with you, you can tell me anything you think I need to know”
b.) Reminding the parents that “I can’t discuss your son even though I want to”
c.) Assking the patient to, “Please talk with me about why you don’t trust your parents”
d.) Telling the patient that, “Keeping your parents uninvolved in your care is very painful for them”
a.) Telling the parents that “While I can’t discuss his care with you, you can tell me anything you think I need to know”
A nurse is reprimanded by the nurse manager. Shortly after, the nurse curtly told a patient’s family member “You are not allwed to be here now. You know you need to wait until visiting hours”. The incidence should be discussed with the nurse based on the knowledge taht the defense mechanism used was:
a.) Projection
b.) Displacement
c.) Sublimation
d.) Suppression
b.) Displacement
Displacing how you feel onto someone else who is less threatening - nurse is taking out feelings about the nurse manager on the patient’s family
What is projection?
Putting your own faults onto someone else
What is sublimation?
Channeling of socially unacceptable thoughts or behaviors into a more socially acceptable manner
What is displacement?
displacing your own feelings (regarding someone) onto another person
nurse reprimanded by nurse manager puts anger / hurt feelings (about nurse manager) onto patient’s family members
What is suppression?
Intentionally blocking something out & avoiding thinking about it
A patient states, “I feel detached from my body and weird all the time. It is as though I am just going through the motions of life. It really messes up thingsn at work and school”. This scenario is most suggestive of which health problem?
a.) Derealization disorder
b.) Depersonalization disorder
c.) Disinhibited social engagement disorder
d.) Dissociative amnesia
b.) Depersonalization disorder
What is depersonalization disorder?
feeling of being detatched
- going through the motions of life
- not able to feel engaged with themself or their life
- pt is there & present, but not necessarily present
What is dissociative amnesia?
Memory loss
What is disinhibited social engagement disorder?
When kids have no fear of going off with strangers
What is derealization disorder?
disconnect from surroundings
- there’s something “off” in the person’s environment
- shift in how pt is experiencing the world around them
EX:
* Sky is green
* Everyone on the street has a clown nose
A patient diagnosed with OCT has an obsession with dirt & germs and has a continual compulsion to spray all surfaces with a disinfectant. How would the nurse explain this patient’s action?
a.) The compulsion to spray disinfectant relieves the patient’s anxiety
b.) The compulsion to spray disinfectant reduces bacterial growth
c.) The compulsion to spray disinfectatn increases the patient’s self-esteem
d.) The compulsion to spray disinfectant encourages ego integrity
a.) The compulsion to spray disinfectant relieves the patient’s anxiety
A patient tells the nurse, “I know that I should reduce the stress in my life, but I have no idea where to start”. What would be the best initial nursing response?
a.) “Reading about stress & how to manage it might be a good place to start”
b.) “Let’s talk about what is going on in your life & then look at possible options”
c.) “Why not start by learning to meditate? That tecnhique will cover everything”
d.) “Physical exercise works to elevate mood & reduce anxiety”
b.) “Lets talk about what is going on in your life & then look at possible options”
Which statement helps assure the nurse that the patient has an understanding of how their health information is managed to assure their right to confidentiality? (Select all that apply)
a.) “No one can see my information unless I say it’s okay for them to see it”
b.) “I had to sign a paper saying my information could be released”
c.) “All the doctors will have access to my medical records when I am here”
d.) “My records will be released to only people who really need to know”
e.) “My insurance company will get what they need in order to cover the bill”
a.) “No one can see my information unless i say it’s okay for them to see it”
b.) “I had to sign a paper saying my information could be released”
d.) “My records will be released to only people who really need to know”
e.) “My insurance company will get what they need in order to cover the bill”
Which nursing intervnetions will be implemented for a patient who is actively suicidal? (Select all that apply)
a.) Maintain arm’s length, one-on-one direct observation at all times
b.) Remove the patient’s eye glasses to prevent self injury
c.) Interact with the patient every 15 minutes
d.) Check all items brought by visitors and remove risk items
e.) Use plastic eating utensils; count utensils upon collection
a.) Maintain arm’s length, one-on-one direct observation at all times
d.) Check all items brought by visitors & remove risk items
e.) Use plastic eating utensils; count utensils upon collection
A soldier was diagnosed with PTSD. THe soldier’s spouse reports that when a telephone rings during the night, the soldier rolls out of bed & assumes an aggressive stance. How will the nurse document this finding?
a.) Hyperarousal
b.) Re-experiencing
c.) Flashback
d.) Avoidance
Hyperarousal
What is hyperarousal (in terms of PTSD)?
Exaggerated responses to noises & other environmental stimuli
- it is part of the constellation of problems that impair sleep for individuals with PTSD
A patient diagnosed with bipolar disorder is in the maintenance phase of treatment. THe patient asks, “Do I have to keep taking this lithium even though my modo is stable now”? Select the nurse’s most appropriate response.
a.) “It’s unusual that the health care provider has not already stopped your medication”
b.) “Taking the medication every day helps prevent relapses and recurrences”
c.) “You will be able to stop the medication in approximately 1 month”
d.) “Usually patients take the medication for approximately 6 months after discharge”
b.) “Taking the medication every day helps prevent relapses & recurrences”
A patient experiencing the sudden onset of blindness is diagnosed with a conversion disorder. WHich nursing intevention would be most therapeutic?
a.) Providing nursing care in a supportive but matter-of-fact manner
b.) “Suggesting to the patient that this is possibly malingering”
c.) Assisting him to make an appointment with an ophthamologist
d.) Providing an occupational therapy consult to address the needs of a blind person
a.) Providing nursing care in a supportive but matter-of-fact manner
What is conversion disorder?
Neurological symptoms in the absence of a neurological diagnosis
Explain the purpose of the continuum of mental health care
Chapter 4
Focuses on “least restrictive environment”
- move along continuum in either direction to help guide treatment
When discussing emergency care & crisis stabilization, what is the difference in the comprehensive emergency service model & hospital-based consult model?
Chapter 4
Comprehensive Emergency Service Model
* affiliated with full-service ED
* dedicated clinical space
* specialty psychiatric staffing in the ED (psych nurses, doctors, psych techs, etc.)
Hospital-Based Consult Model
* no dedicated space or separate staffing
* psychiatric staff are on-site or on-call for ED
* * clinicians complete a “level fo care” assessment, attempt to stabilize the patient, & arrange for discharge or transfer
What is the comprehensive emergency care model?
Chapter 4
- affiliated with full service ED
- dedicated clinical space
- specialty psychiatric staffing in the ED (psych nurses, psych techs, etc.)
What is the hospital-based consult model?
Chapter 4
- no dedicated or separate space
- psychiatric staff are on-site or on-call for the ED
- clinicians complete “level of care” assessment, attempt to stabilizie the pt, & arrange for discharge or transfer
What are the levels of prevention in outpatient care?
Primary Prevention:
* occurs before a problem starts
* health promotion & education
Secondary Prevention:
* SCREENING
* Identify the problem & start effective treatment
* Looking for the diagnosis
Tertiary Prevention:
* Pt has the diagnosis
* Preventing the progression of the diagnosis
* teaching pt to administer insulin for DM
When is in-patient psychiatric admission used?
Chapter 4
- suicidal ideation
- homicidal ideation
- need acute care - unable to care for basic needs
Must justify reason for admission if involuntary
What is miliue?
Chapter 4
Surroundings & physical enviornment
- goal is to have an environment that’s healthy & promotes therapuetic learning / healing
Nurses are responsible for: managing behaviroal crises, safety, suicide risk, unit design, etc.
If a person has not been eating for a few days, can they leave AMA if they are checked / in the ED for psychiatric reasons?
Chapter 4
NO
What is autonomy?
Chapter 6
respecting the patient’s right to make their own decision
What is beneficence?
Chapter 6
act to benefit or promote the health & wellbeing of others
- make sure patient’s best interest is considered regardless of nurse’s opinion
What is Non-maleficence?
Chapter 6
Do no harm
What is justice?
Chapter 6
duty to distribute resources & care equally (regardless of personal beliefs, attributions, etc)
What is fidelity?
Chapter 6
Act with integrity & trustworthiness
- loyalty & commitment to the patient
What is veracity?
Chapter 6
provide patient’s with all facts
- communicate truthfully
What is ethics?
Chapter 6
study of right & wrong in society
What is bioethics?
Chapter 6
study of rights & wrongs in healthcare
What is emergency commitment?
Chapter 6
Temporary admission for up to 96 hours
- usually when a person is confused or ill & need admission
