final exam

Question 1

ADHD:

Answer 1

-the most common disorder of
childhood, results in poor academic
performance, strained family dynamics
and/or rejection by peers
-Behavioral interventions
– Parental education/support
– Special Education assistance may also be
needed to reach academic benchmarks

Question 2

Autism:

Answer 2

-includes a continuum approach to
developmental disorders, which are characterized by severe impairment of reciprocal social interaction skills, communication deviance, and restricted stereotyped behavioral patterns
-do not relate to peers or
parents, lack spontaneous enjoyment, and
cannot engage in play or make-believe with toys.
-autism is often treated with behavioral
approaches. Months or years of treatment may be needed before a positive outcome is seen

Question 3

Lithium therapeutic vs. toxic ranges:

Answer 3

-therapeutic: 0.8-1.2
-1.2 - 1.5 – lethargy, slurred speech, muscle weakness, thirst, polyuria
-1.5 - 2.0 – above reactions plus ECG changes
-2.0 - 2.5 – ataxia, clonic movements, hyperreflexia, seizures
->2.5 – multiorgan toxicity, significant risk of death
Nursing considerations: Slowly crosses the blood brain barrier, crosses the placenta, enters breast milk, monitor sodium level: low sodium = risk for toxicity

Question 4

neurologic side effects that can be treated with anticholinergic medications (diphenhydramine) are called EPS and include:

Answer 4

acute dystonia, akathisia, pseudoparksonism

Question 5

resilience:

Answer 5

term for having healthy responses to stressful circumstances or risky situations is

Question 6

torts (intentional and unintentional)

Answer 6

wrongful act, resulting in injury, loss, or damage
-unintentional: negligence, malpractice
-intentional: assault, battery, false imprisonment

Question 7

negliegence:

Answer 7

is an unintentional tort causing harm through failure to act

Question 8

malpractice

Answer 8

is negligence by health professionals in cases where they have a duty to the client that is breached, causing injury or damage to the client

Question 9

assault:

Answer 9

act of intentionally or recklessly causing someone to fear immediate and unlawful violence, assault doesn’t require physical contact

Question 10

battery:

Answer 10

act of intentionally or recklessly inflicting unlawful force or physical contact on someone

Question 11

deontological principles:

Answer 11

-autonomy: right to self-determination,
independence
-beneficence: duty to benefit others or promote good
-nonmaleficence: requirement to do no harm
-justice: fairness
-veracity: honesty, truthfulness
-fidelity: obligation to honor commitments and contracts

Question 12

revolving door:

Answer 12

a cycle of frequent psychiatric hospitalizations and discharges

Question 13

breach of confidentiality-when is it acceptable to breach confidentiality in mental health

Answer 13

-what should you say when someone asks about a patient: ‘i cant confirm or deny the existence of that patient’
-breach confidentiality when patient is deemed to be a danger to themselves or others, abuse
-HIPAA, health insurance portability and accountability act
-each individual is entitled to have all identifying information that a provider maintains or knows about him remain confidential, HIPAA, if patient is proved to be a threat, report

Question 14

Freud’s assumption?

Answer 14

all human behavior is cased and can be explained, psychosexual development, five stages of development:
-oral - 18-24 months
-anal 18-36 months
-phallic/oedipal 3-5 years
-latency 5-11 years
-genital 11-13 years

Question 15

therapeutic communication techniques and how to use and identify.

Answer 15

sympathy: feeling of concern for someone who is experiencing something difficult (pity)
empathy: ability to understand and share another persona feelings (im on your side of help)

Question 16

therapeutic nurse client relationships goals

Answer 16

-Establish a working relationship
-Identify patients most important concerns: assess patient’s perceptions
-Assess the client’s perception of the problem as it unfolds
-Facilitate the client’s expression of emotions
-Teach the client/family necessary self-care skills
-Recognize the clients needs

Question 17

therapeutic communication (appropriate responses)

Answer 17

Accepting, broad openings, exploring, general leads, making observations, presenting reality, reflecting, and restating, eye contact, up right, open space, 3-6 feet

Question 18

non therapeutic communication

Answer 18

Advising, challenging, defending, disagreeing, disapproving, reassuring, rejecting, requesting an explanation- using why? fidgeting, slouching, crossing arms

Question 19

professional responses to inappropriate comments or questions from patients

Answer 19

“I understand you may be feeling frustrated, but please refrain from making comments like that as they are not appropriate for this setting,” or “Let’s keep our conversation focused on your medical care.” do not tell patient they are being rude, be direct and firm with what you say

Question 20

roles of nurses:

Answer 20

-teacher: methods of coping skills, solving problems, medications, self care, community and family resources
-caregiver: physical nursing care
-advocate: acting on clients behalf when they cannot do so (privacy and dignity)
-parent-surrogate: childlike behavior set clear and firm limits

Question 21

therapeutic responses to maintain professional boundaries

Answer 21

-focus on client needs, experiences, feelings, ideas, goal oriented
-pre-interaction: explore own feelings, fantasies, and fears, analyze own professional strengths and limits, gather data about patient, plan first meeting
-orientation: why patient sought help, establish trust, communication, acceptance, contract, goals with patient
-working: start doing goals, overcome resistance behaviors
-termination: reality of separation, renew progress, explore feelings of anger

Question 22

transference vs. countertransference

Answer 22

transference: what the patient feels towards the nurse
countertransference: what the nurse feels towards the patient

Question 23

neurotransmitters and which mental disorders they affect:

Answer 23

-dopamine: the “feel good” neurotransmitter
thought to be increased in people with schizophrenia, excitatory transmitter
-norepinephrine: is associated with “fight or flight”, excitatory transmitter
-GABA: “calming” neurotransmitter and may be decreased in depression and anxiety, inhibitory transmitter
-serotonin: sleep, mood, memory neurotransmitter can be decreased in depression and anxiety, inhibitory transmitter

Question 24

Carper’s Patterns of Knowing

Answer 24

four patterns:
-empirical (derived from nursing science)
-personal (from life experience)
-ethical (from moral nursing knowledge)
-aesthetic (from art of nursing)

Question 25

5 phases of aggression:

Answer 25

1) triggering: an event or circumstances in the environment initiates the clients response, which is often anger or hostility 2) escalation: clients responses represent escalating behaviors that indicate movement toward a loss of control 3) crisis: during a period of emotional and physical crisis, client loses control 4) recovery: client regains physical and emotional control 5) postcrisis: client attempts reconciliation with others and returns to the level of functioning before the aggressive incident and its antecedents

Question 26

what is aggression and some characteristics of aggression?

Answer 26

-hostility = verbal aggression, usually when feeling threatened or powerless -physical aggression: attack on or injury to another person; destruction of property -both to harm or punish another person or force into compliance -clenched jaw, pacing, clenched fists, raised voices, irritability

Question 27

the cycle of violence:

Answer 27

1) honeymoon stage: apologetic, respectful, attentive, promises, improved communication, helpful, gift giving/compliments, spends time 2) tension stage: insults, threats, sarcasm, jealousy, accusations, fault finding, controlling actions, quick mood changes, emotional distance 3) explosion stage: intimidating body language, keeps them from leaving, throwing things, slamming doors, silent treatment, name calling, swearing, yelling

Question 28

cluster a personality disorders: odd or eccentric behaviors “accusatory”

Answer 28

-paranoid personality disorder -schizoid personality disorder -schizotypal personality disorder may have trouble forming close relationships and may have odd or cold traits that can lead to criticism from others

Question 29

cluster b personality disorder: erratic or dramatic behaviors “wild”

Answer 29

-antisocial personality disorder -borderline personality disorder -histrionic personality disorder -narcissistic personality disorder dramatic, impulsive, and emotional behaviors and thoughts

Question 30

cluster c personality disorder: anxious or fearful behaviors “worried”

Answer 30

-obsessive personality disorder: compulsive -avoidant personality disorder: cowardly -dependent personality disorder: clingy cause persistent and harmful patterns of behavior and thinking, affecting how individuals perceive themselves and interact with others

Question 31

nursing interventions for personality disorders

Answer 31

be cautious and avoid patient attempts to use manipulation or splitting techniques, use clear communication, set limits, boundaries, and realistic goals, deal with frustration: patients change slowly yet “look” like they are capable of better behavior, work effectively as part of team; consistency is essential

Question 32

difference between factitious disorder and illness anxiety disorder

Answer 32

-factitious: characterized by physical symptoms that are feigned or self inflicted for the sole purpose of drawing attention to oneself and gaining emotional benefits of assuming the sick role Munchausen Syndrome and Munchausen Syndrome by Proxy (imposed on someone else so they can be a hero or get sympathy from people) hyperchondriasis: defined as the preoccupation with the fear that one has or will contract a serious and possibility life threatening disease, clients often misinterpret bodily sensations or functions

Question 33

5 stages of grief

Answer 33

1) denial: avoidance, confusion, elation, shock 2) anger: frustration, irritation, anxiety 3) bargaining: overwhelmed, helplessness, hostility 4) depression: struggling to find meaning, reaching out to others, telling ones story 5) acceptance: exploring options, new plans, moving on

Question 34

types of grief

Answer 34

-complicated: person void of emotion; grieving for prolonged periods; expressions of grief seem disproportionate to event, usually sudden deaths, multiple deaths, suicide or murder -uncomplicated: this is also known as normal grieving, a grief process that involves a range of emotions and behaviors that are common after a loss -disenfranchised: grief over loss that is not or cannot be openly acknowledged, mourned publicly, or supported socially, like a nurse losing their patient

Question 35

PTSD:

Answer 35

disorder in which a person has difficulty recovering after experiencing or witnessing a terrifying event

Question 36

eating disorders:

Answer 36

-anorexia nervosa: refusal or inability to maintain minimal normal body weight, intense fear of gaining weight or becoming fat, significantly disturbed perception of body shape or size, steadfast inability or refusal to acknowledge seriousness of problem or even that one exists, anorexia starves on purpose, very thin, some may use laxatives -bulimia nervosa: recurrent episodes of binge eating (secretive); compensatory behaviors to avoid weight gain (purging, use of laxatives, diuretics, enemas, emetics, fasting, excessive exercise), recognition of behavior as pathologic; feelings of guilt, shame, remorse, contempt, usually normal weigh, bulimia binge eating followed by purging, average weight, heavy meals followed by purging, guilt -purging: making self throw up -anorexia: eat too little -bulimia: eat too chaotically -obesity: eat too much

Question 37

major depressive disorder

Answer 37

changes in eating habits → weight gain or loss, hypersomnia or insomnia, impaired concentration, decision making, or problem solving, worthlessness, hopelessness, despair, guilt, thoughts of death/suicide, overwhelming fatigue, negative thinking, anhedonia, at least 2 weeks

Question 38

suicide risk factors

Answer 38

deliberate non-suicidal behaviors intended to cause self-harm, family history, may be seen as an acceptable behavior, previous attempts Feelings of hopelessness, isolation, barriers to accessing mental health treatment, history of alcohol or substance use disorders

Question 39

bipolar 1 disorder: manic depressive disorder

Answer 39

will experience a full manic episode excessive cheerfulness or elevation in mood, extreme mood fluctuations from mania to depression, manic episodes begin suddenly, last from a few weeks to several months, manic episodes-pressured speech, sleeplessness, impulsiveness, grandiose

Question 40

bipolar 2 disorder

Answer 40

will experience only a hypomanic episode (a period that’s less severe than a full manic episode), the “up” moods never reach full blown mania -hypomania: period of milder expansive or irritable mood, milder symptom of mania

Question 41

nursing interventions for client experiencing mania:

Answer 41

provide a safe environment, meet physiological needs, therapeutic communication, promote appropriate behaviors, manage medications, educate client and family

Question 42

schizophrenia:

Answer 42

positive symptoms: delusions, hallucinations, grossly disorganized thinking, speech, and behavior negative symptoms: flat affect, lack of volition (making a decision), social withdrawal, low energy, anhedonia (lack of interest)

Question 43

therapeutic communication with client experiencing delusions or hallucinations

Answer 43

-assess and intervene to maintain safety – suicide, violence, physiological stability -establish trusting relationship with patient and family -recognize suspicious and paranoid behaviors by the client as part of the illness, -fear of the hostile or aggressive patient, -frustration with client for not adhering to medication regimen, -you are not expected to have all of the answers and solutions

Question 44

types of delusions:

Answer 44

-persecutory Delusions: The person feels he or she is being plotted or discriminated against, spied on, threatened, attacked or deliberately victimized. This is the most common form of psychotic delusion. -grandiose Delusions: The person believes he or she has enormously superior characteristics or is a person of great power or fame. -delusions of reference: Also common, these symptoms occur when a person attaches special personal meaning to television broadcasts, music, or newspaper articles- they may believe television sets are talking to them or that people are sending thoughts to them. -somatic delusions: unrealistic beliefs about their own health or bodily functions.

Question 45

risk factors for alcoholism: how can we help prevent alcoholism?

Answer 45

-early age of alcohol starts at 12-14 years old -biologic factors: kids of alcoholic parents are at higher risk for developing alcoholism -children of alcoholics are 4x more likely to develop it (inconsistent behaviors, poor role modeling, lack of nurturing, maladaptive coping skills) -prevent: going to groups, therapy, knowing your triggers

Question 46

Disulfiram (Antabuse) patient teachings

Answer 46

should never take place until the patient has abstained from alcohol for at least 12 hours, should avoid alcohol and alcohol-containing products for at least 14 days after discontinuing disulfiram, as there are reports of disulfiram-alcohol reactions within 2 weeks of discontinuation

Question 47

priority when suspecting nurse diverting drugs:

Answer 47

characteristics: isolates from others, eats alone, avoid staff events, unexplained disappearances, shows up on days off, volunteers for extra shifts, and hold narcotic keys, spills or waste narcotics, chaotic home life, refuses to comply, implausible excuses for behavior handling waste: must have a documented witness, document as soon as u make a mistake, MAR, document pain score, report any discrepancies, suspected diversion, inapporiate access

Question 48

differences in dementia and delirium: do we care for patients with these disorders?

Answer 48

delirium: a mental state in which you are confused, disoriented, and not able to think or remember clearly. It usually starts suddenly dementia: the loss of cognitive functioning — thinking, remembering, and reasoning — to such an extent that it interferes with a person’s daily life and activities, slow

Question 49

differences between dementia and delirium

Answer 49

dementia is gradual, long, LOC is unaffected, worsens as life goes on, memory is impaired, pt looks healthy, common disturbances delirium is fast, brief, LOC fluctuates during the day, speech incoherent, hallucinations common, pt looks sick, memory infected

Question 50

motivational learning:

Answer 50

O: open ended questions A: affirmations R: reflections S: summarizing

Question 51

stigma:

Answer 51

1 in 4 people get treated for their mental health, refers to the negative attitudes, beliefs, and stereotypes that people hold towards individuals experiencing mental health conditions

Question 52

phases of therapeutic relationship:

Answer 52

-pre-interaction: explore own feelings, fantasies, and fears, analyze own professional strengths and limits, gather data about patient, plan first meeting -orientation: why patient sought help, establish trust, communication, acceptance, contract, goals with patient -working: start doing goals, overcome resistance behaviors -termination: reality of separation, renew progress, explore feelings of anger

Question 53

generalized anxiety disorder is defined as?

Answer 53

causes people to experience excessive and persistent worry about everyday things

Question 54

obsessive compulsive disorder is defined as?

Answer 54

-obsessions = recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses -compulsions = ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety

Question 55

what is PTSD defined as?

Answer 55

post traumatic stress disorder, disturbing patterns of behavior demonstrated by someone following a major trauma beginning at least 3 months after the event or even months or years later

Question 56

what is mild/moderate, up to 3 months, 6 months after end of stressor duration for symptoms disorder called?

Answer 56

adjustment disorder

Question 57

what is severe, few days to maximum 4 weeks, maximum one month duration for symptoms disorder called?

Answer 57

acute distress disorder

Question 58

what is severe, sometimes years, >1 month duration for symptoms disorder called?

Answer 58

PTSD

Question 59

different dissociative disorders:

Answer 59

dissociative amnesia disorder: what is sudden memory loss cause by an event depersonalization disorder: whats is a person feels detachment from ones mind or body dissociative fugue disorder: what is forgetting personal info and taking on a new identity and including moving, but forget fugue state when it ends dissociative identity disorder: what is the existence of two or more distinct personalities within a distinct individual

Question 60

grounding:

Answer 60

technique reminds the patient that they are in the present and are safe, can be used for anxiety and PTSD

Question 61

signs of physical abuse:

Answer 61

unexplained cuts, abrasions, bruising or swelling, unexplained burns or scalds, cigarette burns, rope burns or marks on arms, legs, neck, torso, unexplained fractures, strains or sprains; dislocation of limbs, bite marks, dental injuries, ear or eye injuries

Question 62

levels of anxiety:

Answer 62

-mild: special attention; increased sensory stimulation; motivational -moderate: feeling something is definitely wrong; nervousness/agitation; difficulty concentrating; able to be redirected, learning is still able -severe: trouble thinking and reasoning; tightened muscles; increased vital signs; restless, irritable, angry -panic: fight, flight, or freeze response; increased vital signs; enlarged pupils; cognitive processes focusing on defense

Question 63

OCD characteristics:

Answer 63

-excoriation: skin picking -trichotillomania: hair-pulling -onychophagia: chronic nail-biting -BDD(body dysmorphia): a preoccupation with an imagined or slight defect in physical appearance -hoarding -kleptomania: compulsive stealing -oniomania: compulsive buying -body identity integrity disorder

Question 64

antipsychotics medication side effects:

Answer 64

electrocardiogram (ECG) changes- prolong QT interval neuroleptic malignant syndrome (NMS) agranulocytosis-severe low white blood count extrapyramidal symptoms (EPS) -pseudoparkinsonism -akathisia-state of agitation, distress and restlessness -dystonia-muscles contract involuntarily -tardive dyskinesia-movements appear in the eyes, lips, tongue and jaw weight gain

Question 65

somatic symptom illness:

Answer 65

-conversion disorder: involves unexplained, usually sudden deficits in sensory or motor function (blindness, paralysis), client is usually indifferent or shows a lack of distress to the functional loss - pain disorder: client complaints of physical pain that is not relieved by pain medications, greatly affected by psychological factors in terms of onset, severity, exacerbation, and maintenance -hyperchondriasis: defined as the preoccupation with the fear that one has or will contract a serious and possibility life threatening disease, clients often misinterpret bodily sensations or functions -somatic symptom disorder: when a person has a significant focus on physical symptoms, such as pain, weakness or shortness of breath, to a level that results in major distress and/or problems functioning

Question 66

malingering:

Answer 66

feigning (or pretending to be affected by) physical symptoms for some external gain such as avoiding work

Question 67

disordered speech patterns: for schizophrenia

Answer 67

-tangential: the person’s ideas are only loosely connected to the topic, i.e. there are “loose associations” between expressed ideas and one thought or statement does not logically follow the other -neologisms: the person makes up new words that have meaning only to them -circumstantial: provides unnecessary detail but does return to the point -preservation: adherence to a single idea or topic, and verbal repetition of the sentence phrase or word even when attempts are made to change the topic -word salad: the person’s language can become so disordered as to be incomprehensible, a senseless jumble of words -flight of ideas: the person’s ideas rapidly shift from one subject to another and are not related at all, however he or she believes the incoherent statements make perfect sense

Question 68

Conduct disorder:

Answer 68

-is the most common disruptive behavior disorder and is characterized by aggression to people and animals, destruction of property, deceitfulness and theft, and serious violation of rules, Callous and unemotional traits -Decreasing violent behavior – Increasing compliance – Improving coping skills and self-esteem – Promoting social interactions – Education and support of the parent

Question 69

Oppositional Defiant Disorder:

Answer 69

-conduct disorder may be diagnosed with antisocial personality disorder as adults, involves and enduring pattern of uncooperative, defiant, disobedient, and hostile behavior toward authority figures that exceeds the periodic negative behaviors that are usually seen in adolescence -do not associate their behaviors with consequences of those behaviors -management training is based on behavioral principles of decreasing reinforcing attention for negative behaviors, rewarding positive behaviors and setting consistent expectations and consequences -Treatment—parent management training models of behavioral interventions

Question 70

Intermittent Explosive Disorder

Answer 70

-sudden, intense, and out-of-proportion anger outbursts -Repeated episodes of impulsive, aggressive, violent behavior; angry verbal outbursts -May physically injure others and self -May feel guilty after outbursts; this does not prevent future outbursts -Most common in adolescence and adulthood -serotonin imbalance

Question 71

limit setting

Answer 71

a technique used to establish boundaries and expectations for acceptable behavior, and to communicate the consequences of breaking those rules

Question 72

treatment for disruptive behavioral disorders

Answer 72

Stimulants like methylphenidate (Ritalin) and amphetamine compounds such as Adderall. – Atomoxetine (Strattera) – THE ONLY NON- STIMULANT MEDICATION THAT HAS BEEN SPECIFICALLY DEVELOPED AND TESTED BY THE USDA FOR THE TREATMENT OF ADHD.

Question 73

gender dysmorphia:

Answer 73

a condition that describes a person’s distress or discomfort when their gender identity differs from their assigned sex at birth

Question 74

different effects:

Answer 74

blunted effect: restricted range of emotional feeling, tone, or mood flat effect: absence of any facial expression that would indicate emotions or mood

Question 75

flumazenil:

Answer 75

helps overdose on benzo, No, flumazenil does not have effects like benzodiazepines (benzos); instead, it acts as an antagonist to benzodiazepines, meaning it actively reverses the effects of benzodiazepines by blocking their receptors in the brain, making it the specific antidote for benzodiazepine overdose