Test 1 Flashcards
(191 cards)
1
Q
Is this Therapeutic Communication?
Accepting
Define
Examples
A
Yes
Indicating reception
Ex: “Yes” “I follow what you said” Nodding
2
Q
Is this Therapeutic Communication?
Broad Openings
Define
Examples
A
Yes
Allowing the client to take the initiative in introducing the topic
“Is there something you’d like to talk about?” “Where would you like to begin?”
3
Q
Is this Therapeutic Communication?
Verbalizing the implied
Define
Examples
Prompt: Client “I can’t talk to you or anyone. It’s a waste of time.”
A
Yes
Voicing what the client has hinted at or suggested
Client: “I can’t talk to you or anyone. It’s a waste of time.”
Nurse: “Do you feel that no one understands?”
4
Q
Is this Therapeutic Communication?
Rejecting
Define
Examples
A
No
Refusing to consider or showing contempt for the client’s ideas or behaviors
“Let’s not discuss…”
“I don’t want to hear about…”
5
Q
Is this Therapeutic Communication?
Encourgaing comparison
Define
Examples
A
Yes
Asking that similarites and differneces be noted
“Was it something like…?” “Have you had similar experiences?”
6
Q
Is this Therapeutic Communication?
Encouraging description of preceptions
Define
Examples
A
Yes
Asking the client to verbalize what they perceive
“Tell me when you feel anxious.”
“What is happening?”
“What does the voice seem to be saying?”
7
Q
Is this Therapeutic Communication?
Introducing an unrelated topic
Define
Examples
Prompt: Client “I’d like to die.”
A
No
Changing the subject
Client: “I’d like to die.”
Nurse: “Did you have visitors last evening?”
8
Q
Is this Therapeutic Communication?
Seeking information
Define
Examples
A
Yes
Seeking to make clear that which is not meaningful or that which is vague
“I’m not sure that I follow.”
“Have I heard you correctly?”
9
Q
Is this Therapeutic Communication?
Encouraging expression
Define
Examples
A
Yes
Asking the client to appraise the quality of their experiences
“What are you feelings in regard to…?”
“Does this contribute to your distress?”
10
Q
Is this Therapeutic Communication?
Translating into feelings
Define
Examples
Prompt: Client “I’m dead” & “I’m way out in the ocean.”
A
Yes
Seeking to verbalize client’s feelings that they express only indirectly
Client: “I’m dead.”
Nurse: “Are you suggesting that you feel lifeless?”
Client: “I’m way out in the ocean.”
Nurse: “You seem to feel lonely or deserted.”
11
Q
Is this Therapeutic Communication?
Challenging
Define
Examples
A
No
Demanding proof from the client
“But how can you be president of the United States?” “If you’re dead, why is your heart beating?”
12
Q
Is this Therapeutic Communication?
Giving approval
Define
Examples
A
No
Sanctioning the client’s behavior or ideas
“That’s good.”
“I’m glad that….”
13
Q
Is this Therapeutic Communication?
Giving information
Define
Examples
A
Yes
Making available the facts that the client needs
“My name is…”
“Visiting hours are…”
“My purpose in being here is…”
14
Q
Is this Therapeutic Communication?
Defending
Define
Examples
`
A
No
Attempting to protect someone or something from verbal attack
“This hospital has a fine reputation.”
“I’m sure your doctor has your best interest in mind.”
Defending what the client has criticized implies that they have no right to express impressions, opinions, or feelings.
15
Q
Is this Therapeutic Communication?
Summarizing
Define
Examples
A
Yes
Organizing and summing up that which has gone before.
“Have I got this straight?”
“You’ve said that…”
“During the past hour, you and I have discussed…”
16
Q
Is this Therapeutic Communication?
General leads
Define
Examples
A
Yes
Giving encouragement to continue
“Go on.”
“And then?”
“Tell me about it.”
17
Q
Is this Therapeutic Communication?
Silence
Define
Examples
A
Yes
Absence of verbal communication, which provides time for the client to put thoughts or feelings into words, to regain composure, or to continue talking
Nurse says notheing but continues to maintain eye contact and conveys interest
18
Q
Is this Therapeutic Communication?
Advising
Define
Examples
A
No
Telling the client what to do
“I think you should ….”
“Why don’t you ….”
19
Q
Is this Therapeutic Communication?
Exploring
Define
Examples
A
Yes
Delving further into a subject or an idea
“Tell me more about that.”
“Would you describe it more fully?”
“What kind of work?”
20
Q
Is this Therapeutic Communication?
Focusing
Define
Examples
A
Yes
Concentrating on a single point
“This point seems worth looking at more closely.”
“Of all the concerns you’ve mentioned, which is most troublesome?”
21
Q
Is this Therapeutic Communication?
Formulating a plan of action
Define
Examples
A
Yes
Asking the client to consider kinds of behavior likely to be appropriate in future situations
“What could you do to let your anger out harmlessly?”
“Next time this comes up, what might you do to handle it?”
22
Q
Is this Therapeutic Communication?
Disapproving
Define
Examples
A
No
Denouncing the client’s behavior or ideas
“That’s bad.”
“I’d rather you wouldn’t…”
23
Q
Is this Therapeutic Communication?
Giving recognition
Define
Examples
A
Yes
Acknowledging, indicating awareness
“Good morning, Mr. S…”
“You’ve finished your list of things to do.”
“I notice that you’ve combed your hair.”
24
Q
Is this Therapeutic Communication?
Agreeing
Define
Examples
A
No
Indicating accord with the client
“That’s right” “I agree”
25
# Is this Therapeutic Communication?
Making observations
Define
Examples
Yes
Verbalizing what the nurse perceives
“You appear tense.”
“Are you uncomfortable when…?”
“I notice that you’re biting your lip.”
26
# Is this Therapeutic Communication?
Interpreting
Define
Examples
No
Asking to make conscious that which is unconscious; telling the client the meaning of their experience
"What you really mean is..."
"Unconsciously you're saying..."
27
# Is this Therapeutic Communication?
Offering self
Define
Examples
Yes
Making oneself available
“I’ll sit with you awhile.”
“I’ll stay here with you.”
“I’m interested in what you think.”
28
# Is this Therapeutic Communication?
Placing event in time or sequence
Define
Examples
Yes
Clarifying the relationship of events in time
“What seemed to lead up to…?”
“Was this before or after…?”
“When did this happen?”
29
# Is this Therapeutic Communication?
Probing
Define
Examples
No
Persistent questioning of the client
“Now tell me about this problem. You know I have to find out.”
“Tell me your psychiatric history.”
30
# Is this Therapeutic Communication?
Presenting reality
Define
Examples
Yes
Offering for consideration that which is real
“I see no one else in the room.”
“That sound was a car backfiring.”
“Your mother is not here; I am a nurse.”
31
# Is this Therapeutic Communication?
Making stereotyped comments
Define
Examples
No
Offering meaningless clichés or trite comments
“It’s for your own good.”
“Keep your chin up.”
“Just have a positive attitude and you’ll be better in no time."
32
# Is this Therapeutic Communication?
Restating
Define
Examples
## Footnote
Prompts: Client "“I can’t sleep. I stay awake all night.” & “I’m really mad, I’m really upset.”
Yes
Repeating the main idea expressed
Client: “I can’t sleep. I stay awake all night.”
Nurse: “You have difficulty sleeping.”
Client: “I’m really mad, I’m really upset.”
Nurse: “You’re really mad and upset.”
33
# Is this Therapeutic Communication?
Voicing doubt
Define
Examples
Yes
Expressing uncertainity about the reality of the client's perceptions
"Isn't that unusual?"
"Really?"
"That's hard to believe."
34
# Is this Therapeutic Communication?
Disagreeing
Define
Examples
No
Opposing the client's ideas
“That’s wrong.”
“I definitely disagree with…”
“I don’t believe that.”
35
# Is this Therapeutic Communication?
Suggesting collaboration
Define
Examples
Yes
Offering to share, to strive, and to work with the client for their benefit
"Perhaps you and I can discuss and discover the triggers for your anxiety."
"Let's go to your room, and I'll help you find what you're looking for."
36
# Is this Therapeutic Communication?
Giving literal responses
Define
Examples
## Footnote
Prompt: Client “They’re looking in my head with a television camera.”
No
Responding to a figurative comment as though it were a statement of fact
Client: “They’re looking in my head with a television camera.”
Nurse: “Try not to watch television” or “What channel?”
37
# Is this Therapeutic Communication?
Using denial
Define
Examples
## Footnote
Prompt: Client "I'm nothing" & "I'm dead"
No
Refusing to admit that a problem exists
Client: “I’m nothing.”
Nurse: “Of course you’re something—everybody’s something.”
Client: “I’m dead.”
Nurse: “Don’t be silly.”
38
# Is this Therapeutic Communication?
Indicating the existence of an external source
Define
Examples
No
Attributing the source of thoughts, feelings, and behaviors to others or to outside influences
“What makes you say that?”
“What made you do that?”
“Who told you that you were a prophet?”
39
# Is this Therapeutic Communication?
Reflecting
Define
Examples
## Footnote
Prompt: Client “Do you think I should tell the doctor…?” & “My brother spends all my money and then has nerve to ask for more.”
Yes
Directing client actions, thoughts, and feelings back to client
Client: “Do you think I should tell the doctor…?”
Nurse: “Do you think you should?”
Client: “My brother spends all my money and then has nerve to ask for more.”
Nurse: “This causes you to feel angry?”
40
# Is this Therapeutic Communication?
Reassuring
Define
Examples
No
Indicating there is no reason for anxiety or other feelings of discomfort
“I wouldn’t worry about that.”
“Everything will be alright.”
“You’re coming along just fine.”
41
# Is this Therapeutic Communication?
Requesting an explanation
Define
Examples
No
Asking the client to provide reasons for thoughts, feelings, behaviors, and events
"Why do you think that?"
"Why do you feel that way?"
42
# Is this Therapeutic Communication?
Testing
Define
Examples
No
Appraising the client's degree of insight
“Do you know what kind of hospital this is?”
“Do you still have the idea that…?”
43
# Is this Therapeutic Communication?
Consensual Validation
Define
Examples
Yes
Searching for mutual understanding, for accord in the meaning of the words
"Tell me whether my understanding of it agrees with yours."
"Are you using this word to convey that...?"
44
Which is the most restrictive setting in the continuum?
Acute inpatient hospitalization
45
What occurs during the working phase of the nurse-client relationship?
Evaluation of mutually identified goals
46
During the mid-20th century, the focus of treatment centered on treating neurotransmitter dysfunction in the brain. As a result hospital stays were shortened due to the introduction of what?
Psychopharmacology
47
The client has been diagnosed with a mood disorder. Which element(s) should the nurse assess during data collection? Select all that apply.
A. mood and affect
B. thinking and perceptual ability
C. somatic concerns
D. sleep patterns (current and usual)
E. changes in energy levels
F. character of speech pattern
All the above
A. mood and affect
B. thinking and perceptual ability
C. somatic concerns
D. sleep patterns (current and usual)
E. changes in energy levels
F. character of speech pattern
48
A psychiatric-mental health nurse is working a booth at a local community college job fair. One of the participants comes to the booth and asks the nurse about the different types of conditions for which psychiatric-mental health nurses provide care. Which condition(s) would the nurse most likely include in the response? Select all that apply.
A. issues involving self-mutilation
B. self-esteem issues related to loss of a limb
C. problems associated with family or group isolation
D. substance use disorders
E. high health literacy issues for adherence
A. issues involving self-mutilation
B. self-esteem issues related to loss of a limb
C. problems associated with family or group isolation
D. substance use disorders
49
Which court decision or act states that psychotherapists have a duty to exercise reasonable care in protecting the foreseeable victims of their clients' violent actions?
Tarasoff v. Regents of the University of California
50
A client has gone without treatment for a mental health condition for several years. Which explanation would the nurse consider as the reason for the client not seeking medical care?
Cost of treatment
51
The client has been on a phenothiazine antipsychotic for over a year for schizophrenia. Which finding(s) would be essential for the nurse to monitor the client for? Select all that apply.
A. weight gain
B. smoking
C. prolonged QT interval
D. hypoglycemia
E. hypertension.
A. weight gain
B. smoking
C. prolonged QT interval
52
A psychiatric nurse notices that a client is becoming overly dependent on social conversations with staff. Which intervention best ensures the nurse maintains professional boundaries and promotes therapeutic communication?
Redirecting the conversation by saying, "Let’s focus on how you're feeling today and how we can work on your treatment goals."
53
The client is in the working phase of the therapeutic nurse–client relationship. Which action by the nurse would best help the client to explore problems?
Encouraging the client to clarify feelings and behavior
54
Which of the nurse's assessment questions would best identify whether the client has insight into the illness?
"Do you think that your illness prevents you from functioning well, and if so, how?"
55
The nurse is preparing to interview a newly admitted client. Which action will the nurse make a priority during the first interaction with this client?
Establish rapport.
56
A client diagnosed with anxiety is being assessed by the nurse utilizing the biopsychosocial model. Which question made by the nurse would indicate the social domain is being assessed?
“Who is in your support network?”
57
A client has lived independently prior to being admitted to an inpatient unit. The client will be unable to return home following discharge. Which environment would be most appropriate for the client?
Least restrictive
58
The nurse is planning care for a client with a mental health condition. Which phenomenon(a) of concern will the nurse incorporate into the client’s plan of care? Select all that apply.
A. recognizing barriers to treatment
B. identifying emotional stress related to illness, pain, disability, and loss
C. realizing additional circumstances that have an effect on mental health
D. assessing for physical symptoms that occur along with an altered mental health state
E. determining the cost for mental health care
A. recognizing barriers to treatment
B. identifying emotional stress related to illness, pain, disability, and loss
C. realizing additional circumstances that have an effect on mental health
D. assessing for physical symptoms that occur along with an altered mental health state
59
Which is a clinical activity of only the advanced practice registered nurse?
Psychotherapy
60
A psychiatric-mental health nurse is engaged in crisis intervention. The nurse would expect to focus on which area? Select all that apply.
A. Prevention of relapse
B. Stabilization
C. Symptom reduction
D. Behavioral therapy
E. Social skills training
A. Prevention of relapse
B. Stabilization
C. Symptom reduction
61
The nurse has been caring for a pediatric client in an inpatient psychiatric unit over the last week. Upon entering the unit for morning assessments, the client greets the nurse and reaches out for a hug. Based on understanding therapeutic principles of touch, which response is appropriate?
Say good morning and offer a fist bump.
62
A nurse, who is documenting a client’s communication patterns during an assessment, asks the client if they took their morning medication. Which client statement would the nurse document as circumstantial thinking?
"So, I was at the store, and I saw this dog, and it reminded me of my trip last year... Oh, and by the way, yes, I did take my medication this morning."
63
A family member of a client diagnosed with Alzheimer disease asks the nurse what is causing the client’s memory loss. Which neurotransmitter does the nurse identify that plays a role in memory loss in Alzheimer disease?
acetylcholine
64
A client diagnosed with major depression is prescribed electroconvulsive therapy (ECT) for the treatment. Which statement made by the client would indicate a need for the nurse to follow up with the health care provider?
“It is not really my decision; I have to get these treatments to feel better.”
65
A client arrives for a scheduled meeting with the nurse. Which statement should the nurse make that indicates the working phase of the relationship?
“Your idea would help prevent this from happening again.”
66
Which is the nurse’s priority when assessing ongoing family communication patterns?
Identify which family members confide in one another.
67
A client has been started on an antipsychotic medication and is exhibiting muscle stiffness of the arms, slowness of gait, and tremors. Which extrapyramidal syndrome (EPS) is the client displaying?
Pseudoparkinsonism
68
The nurse is caring for a client who is placed in seclusion for hitting another client. Which action(s) will the nurse implement? Select all that apply.
A. Ensure the client is observed at all times.
B. Provide a blanket for the client.
C. Check the client’s restraints every 10 minutes.
D. Provide the client privacy.
E. Check the client every 15 minutes.
A. Ensure the client is observed at all times.
B. Provide a blanket for the client.
69
The nurse is assessing a client who is hospitalized for an episode of mania. When the nurse sits down across from the client to begin the interview, the client moves to sit right less than a foot away from the nurse. The client is positioned in which body space zone of the nurse?
intimate
70
When describing the various neurotransmitters, which chemical would a nurse identify as the primary cholinergic neurotransmitter?
Acetylcholine
71
The nurse begins an assessment of an older adult client who was brought to the hospital by the client’s adult child. The client states, "I don't want your kind of help." What is the nurse's best response?
"Have you had a bad experience in the hospital before?"
72
The nurse reviews the nurse's note shown for a newly admitted hospitalized client. Based on the chart findings, what is the nurse’s priority assessment question?
“What thoughts of suicide have you had?”
73
A client describes the recent breakup of a dating relationship when being interviewed by the nurse. Which finding will the nurse determine is the client's affect?
An emotionless tone and flat facial expression
74
Which problems can arise during the working phase of a nurse-client relationship that serve to impair the therapeutic work? Select all that apply.
A. The client struggles with expressing feelings
B. The client demonstrates dependence on the group
C. The nurse believes that the relationship has not been productive
D. The nurse demonstrates evidence of countertransference
E. The client demonstrates aggressive behavior towards the nurse
A. The client struggles with expressing feelings
B. The client demonstrates dependence on the group
D. The nurse demonstrates evidence of countertransference
75
The client presents to the mental health clinic with reports of fibromyalgia, migranes, and GI distress. The nurse talks about the different neurotransmitters and what each neurotransmitter does. How would you elaborate on the type of symptoms this client is demonstrating?
"Lack of serotonin in the body produces symptoms such as irritability, sleep disturbances, and compulsiveness."
76
A client is admitted to the psychiatric-mental health unit. What question made by the nurse indicates intellectual functioning is being assessed?
“What is similar about an apple and an orange?”
77
1st generation antipsychotics
-zine, -idol
Cholpromazine ( Thorazine)
Fluphenazine (Prolixin)
Haloperidol ( Haldol)
78
2nd generation antipsychotics
-done, - pine
Risperidone (Risperadal)
Quetiapine ( Seroquel)
Clozapine (Clozaril)
Ziprasidone (Geodon)
Olanzapine ( Zyprexa)
Paliperidone ( Invega)
Lurasidone (Latuda)
79
3rd generation antipsychotics
ARIPIPRAZOLE (ABILIFY)
ASENAPINE (SAPHRIS)-SUBLINGUAL TABLET
BREXPIPIZOLE (REXULTI)
CARIPRAZINE (VRAYLAR)
LUMATEPERONE (CAPLYTA)
80
Long acting antipsychotics
Abilify Maintena
Haldol Decanoate
Invega sustenna/trinza/hafyera
Prolixin Decanoate
Risperdal Consta
Zyprexa Relprevv
81
3rd gen antipsychotics most common side effects
sedation, weight gain, akathisia, headache, anxiety, nausea
82
Neuroleptic Malignant Syndrome (NMS)
A potentially fatal, idiosyncratic reaction to an antipsychotic (or neuroleptic) drug
83
NMS s/s
Extreme muscle rigidity, mutism, elevated CPK (muscle contraction and destruction), myoglobinuria (breakdown of muscle cells, rhabdomyolysis), increased WBCs, and increased LFTs
84
atypical antipsychotics can increase mortality rates in ...
older adults with dementia-related psychosis
85
antipsychotic drug MOA
work by blocking receptors of the neurotransmitter dopamine
86
Conventional (1st gen) antipsychotics MOA
Book: potent antagonists (blockers) of D2, D3, and D4 dopamine receptors which make them effective in treating target symptoms however produces many extrapyramidal side effects
Slide: Stronger D2 receptors blockade (antagonist)
87
Atypical antipsychotic MOA
Book: blocks serotonin and dopamine receptors, increasing effectiveness in treating depressive aspects of schizophrenia
Slide: D2 and 5HT receptors blockade (antagonist)
88
Asenapine (Saphris) SL patient teaching
atypical antipsychotic
sublingual
Do not chew/crush, must avoid food or drink for 10-15 minutes after medication dissolves
89
Extra Pyramidal Symptoms
** SE of Antipsychotic
Like Parkinson's, drooling, shuffling, pill rolling
(use antiparkinson drug to treat)
90
Acute Dystonia
Acute, often painful, sustained contraction of muscles, usually of the head and neck, which typically occurs from 2 to 5 days after the introduction of antipsychotic medications. Includes cramping/stiff thick tongue with difficulty swallowing
91
anticholinergic side effects
orthostatic hypotension, dry mouth, constipation, urinary hesitance or retention, blurred near vision, dry eyes, photophobia, nasal congestion, decreased memory
92
Weight gain is most common with (which antipsychotic drug)
second generation antipsychotics
Clozapine and Olanzapine (zyprexa)
93
Tardive dyskinesia (TD)
a late-onset, irreversible neurologic side effect of antipsychotic medications; characterized by abnormal, involuntary movements such as lip smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform movements of the limbs and feet
94
antipsychotic nurse teaching
-drug adherence
-Do not stop abruptly can result in withdrawal
-eating sugar-free candies/fluids for dry mouth
-method to reduce constipation
-use sunscreen
-do not operate MV until effects are known
-do not take if 4 hours past scheduled time
95
Special considerations for clozapine
Agranulocytosis (can cause dangerously low neutrophil count)
96
What kind of neurotransmitter is Dopamine?
What does it do?
Excitatory
Controls complex movements, motivation cognition; regulates emotional response
97
What kind of neurotransmitter is histamine?
What does it do?
Neuromodulator
Controls alertness, gastric secretions, cardiac stimulation, peripheral allergic responses
98
What kind of neurotransmitter is norepinephrine?
What does it do?
Excitatory
Causes changes in attention, learning and memory, sleep and wakefulness, mood
99
What kind of neurotransmitter is epinephrine?
What does it do?
Excitatory
Controls fight-or-flight response
100
What kind of neurotransmitter is serotonin?
What does it do?
Inhibitory
Controls food intake, sleep and wakefulness, temperature regulation, pain control, sexual behaviors, and regulation of emotions
101
What kind of neurotransmitter is acetylcholine?
What does it do?
Excitatory or inhibitory
Controls sleep and wakefulness cycle; signals muscles to become alert
102
What kind of neurotransmitter is neuropeptides?
What does it do?
Neuromodulators
Enhance, prolong, inhibit, or limit the effects of principal neurotransmitters
103
What kind of neurotransmitter is glutamate?
What does it do?
Excitatory
Results in neurotoxicity if levels are too high
104
What kind of neurotransmitter is Gamma-aminobutyric acid (GABA)?
What does it do?
Inhibitory
Modulates other neurotransmitters
105
What is drug efficacy?
Maximal response a drug can produce
106
What are anxiolytic drugs used for?
used to treat anxiety and anxiety disorders, insomnia, obsessive- compulsive disorder ( OD ), depression, PTSD, and alcohol withdrawal
107
What is dystonia?
Extrapyramidal side effects of antipsychotic medication include acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties; also called dystonic reactions
108
What are extrapyramidal symptoms (EPSS)?
Neurologic side effects of antipsychotic medications that are drug and dose related: treated with anticholinergic medication: includes dystonia, pseudoparkinsonism, and akathisia
109
What is neuroleptic malignant syndrome (NMS)?
Potentially fatal , idiosyncratic reaction to an antipsychotic ( or neuroleptic ) drug
110
What happens when olanzapine (Zyprexa Reprevv) is injected intravenously?
Bloodstream postinjection delirium sedation syndrome
(cluster of symptoms , such as slurred speech , confusion , sedation , altered gait , or unconsciousness)
111
What are Risk Evaluation and Mitigation Strategy Strategies (REMS)?
Specific actions and / or safeguards instituted by the FDA that govern the use of drugs that are approved but have infrequent serious side effects that require close monitoring
112
What are abstract messages?
Unclear patterns of words that often contain figures of speech that are difficult to interpret
113
What is circumstantiality?
The use of extraneous words and long tedious descriptions
114
What are the 4 stages of crisis?
1. Exposure to stressor
2. Increased anxiety when usual coping ineffective
3. Increased efforts to cope
4. Disequilibrium, significant distress
115
What is the 4 step crisis helper approach?
1. Assess-listen carefully, reflect feelings, convey acceptance, ask open-ended questions, assess lethality for suicide
2. Identify goals for crisis intervention-help brainstorm, set priorities, set specific short-term goals, assist with problem solving
3. Implementation with directive and supportive interventions- provide encouragement and feedback
4. Evaluation
116
What is drug potency?
Amount of drug necessary to cause an effect
117
What is akathisia?
Inability to sit still (restless)
118
What are some anticholinergic side effects?
dry mouth, constipation, urinary hesitancy or retention, dry nasal passage, and blurred near vision ; commonly seen as side effects of medication
119
What are antidepressant drugs used to treat?
Primarily used in the treatment of major depressive illness, anxiety disorders, the depressed phase of bipolar disorder, and psychotic depression
120
What are mood-stabilizing drugs used to treat?
Used to treat bipolar disorder by stabilizing the client's mood, preventing or minimizing the highs and lows that characterize bipolar illness, and treating acute episodes of mania
121
What is tardive dyskinesia?
Late-onset, irreversible neurologic side effects of medications; characterized by abnormal, involuntary movements such as lip smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform movements of the limbs and feet
122
What is active listening?
Concentrating exclusively on what the client says, refraining from other internal mental activities
123
What is active observation?
Watching the speaker's nonverbal actions as they communicate
124
What is assertive communication?
Ability to express positive and negative ideas and feelings in an open, honest, and direct way
125
What are closed body positions?
Nonverbal behavior such as crossed legs and arms folded over the chest indicates the listener may be failing to listen, may be defensive, or may not be accepting
126
What is a concrete message?
Words that are as clear as possible when speaking to the client so that the client can understand the message; concrete messages are important for accurate information exchange
127
What is a congruent message?
When communication content and processes agree
128
What is the intimate zone?
Space of o to 18 in between people; the amount of space comfortable for parents with young children, people who mutually desire personal contact, or people whispering; invasion of this intimate zone by anyone else is threatening and produces anxiety
129
What is the personal zone?
Space of 18 to 36 in; a comfortable distance between family and friends who are talking
130
What is the public zone?
Space of 12 to 25 ft: the acceptable distance between a speaker and an audience within small groups. and among others at informal functions
131
What is the social zone?
Space of 4 to 12 ft, which is the distance acceptable for communication in social work, and business settings
132
At what distance is therapeutic communication most comfortable?
When the nurse and patient are 3 to 6 feet apart
133
What are some symptoms of mild anxiety?
Restlessness, increased motivation, irritability, alert, can solve problems, sharpened senses
134
What are some symptoms of moderate anxiety?
-Focus on immediate concerns
-difficulty staying attentive and being able to learn, but can be directed to focus
-muscle tension
- increased rate of speech
-GI upset
135
What are some symptoms of severe anxiety?
-significant reduction in perceptual field; focus is on specific detail only
-all behavior is aimed at relieving anxiety
-much direction needed to focus on another area
- cannot solve problems
awe/dread/horror
crying
136
What are some symptoms of panic attack/anxiety?
Unable to focus. Not a learning opportunity. Hallucinate. Not able to have an intelligent conversation. Not much you can do except give medication. Doesn't recognize danger, possibly suicidal
137
What is transference?
Occurs when client displaces onto the therapist attitudes or feelings that the client originally experienced in other relationships
138
What happens during the orientation phase of a therapeutic relationship?
Directed by nurse involves engaging the patient in treatment, providing information, answering questions
139
What happens during the identification phase of a therapeutic relationship?
Patient works interdependently with the nurse, expresses feelings, begins to feel stronger
140
What happens during the exploitation phase of a therapeutic relationship?
Pt. makes full use of services offered
141
What happens during the resolution phase of a therapeutic relationship?
Pt. no longer needs professional services and gives up dependent behavior, relationship ends
142
Roles of nurse in therapeutic relationship
Stranger, resource person, teacher, leader, surrogate, counselor
143
What occurs during the pre-group stage?
Members are selected, the purpose is identified, group structure is addressed
144
What occurs during the initial group stage?
Members introduce themselves, leader is selected, purpose is discussed, rules and expectations for group are reviewed
145
What occurs during the working stage of group?
Members begin to focus their attention on the purpose
146
What occurs during the termination stage of group?
The work of the group is reviewed, group ends
147
What are partial hospitalization programs?
Provide intense short term treatment for clients who are well enough to go home every night and who have a responsible person at home to provide support and a safe environment
148
What is Mandatory Outpatient Treatment ( Conditional release)?
Continued participation in treatment on involuntary basis after release such as taking prescribed meds, attending HCP appts, attending specific groups or programs
149
What are some unitary Unintentional Torts?
Negligence and malpractice
150
What are some intentional torts?
Assault, battery, false imprisonment
151
What is mental health?
A state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self concept, and emotional stability.
152
What are the factors that affect mental health?
- Individual (personal): biological makeup, self-esteem, coping/stress mngt.
- interpersonal (relationship): communication, ability to help others, intimacy
- social/culture (environment): sense of community & adequate resources
153
What is mental illness?
Includes disorders that affect mood, behavior, & thinking, such as depression, schizophrenia, anxiety disorders, and addictive disorders
154
What is DSM-5?
Diagnostic and Statistical Manual of Mental Disorders
- provides standardized names and language for all mental health professionals
- list defining characteristics/symptoms that differentiate specific diagnoses
- Assist in identifying the underlying cause of disorders
155
What are neurotransmitters?
Chemical substances manufactured in the neuron that aid in transmission of info. through the body
156
How are psychotrophic medications stopped?
They are to be tapered
NOT STOPPED ABRUPTLY
157
What are some antipsychotics: off-label use?
Treat anxiety, insomnia, aggressive behavior, & disruptive behaviors related to alzheimers
158
First-generation antipsychotics are described as?
What are they used to treat?
Potent antagonists (blockers); effective in treating target symptoms but produce many extrapyramidal side effects
159
What do second-generation antipsychotics do?
What are they used to treat?
Inhibit reuptake of serotonin, as do some antidepressants, increase their effectiveness in treating depressive aspects of schizophrenia
160
What is Pseudoparkinsonism?
Resembles parkinsons; stiff, stooped posture, mask-like faces, decreased arm swing, walk with small steps, drooling, tremors, & bradycardia
- treat by changing antipsychotic med or add anticholinergic or amantadine (dopamine antagonist)
161
What are incongruent messages?
When the content and process disagree
162
What is proxemics?
the study of distance zones between people during communication
- intimate zone (0-18 inches)
- personal zone (18-36 inches)
- social zone (4-12 feet)
- public zone (12-25 feet)
Nurse & client most comfortable at 3-6 feet
163
What is empathy?
The ability to place oneself into the experience of another for a moment in time
164
What are overt cues?
Clear, direct statements of intent
165
What are convert cues?
Vague indirect messages that need interpretation and exploration
166
What is nondirective role?
Using broad openings and open-ended questions to collect information and help the client to identify and discuss the topic of concern
167
What is directive role?
Asking direct, yes/no questions and using problem-solving to help the client develop new coping mechanisms to deal with present, here-and-now issues
- typically when pt is suicidal, experiencing crisis, or out of touch with reality
168
What should you do if a patient experiences illusions?
Present reality
169
What should you do when dementia patients experience illusions
Do not present reality (can be confusing and agitating)
170
What is denial?
Failure to acknowledge an unbearable condition; failure to admit the reality of a situation or how one enables the problem to continue
171
What is displacement?
Ventilation of intense feeling towards persons less threatening than the one who aroused those feelings
172
What is projection?
Unconscious blaming of unacceptable inclination or thoughts on an external object
173
What is undoing?
Exhibiting acceptable behavior to make for or negate unacceptable behavior
174
What is rationalization?
Excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-respect.
175
What is regression?
Moving back to a previous developmental stage to feel safe or have needs met
176
What is suppression?
Conscious exclusion of unacceptable thoughts and feeling from conscious awareness
- student decides not to think about a parents illness to study for a test
177
What makes up a rich therapeutic environment?
- safety
- structure
- setting limits
- promoting adaptation
- environmental issues
178
What is transfernce?
Occurs when pt displaces onto the therapist attitudes & feelings that the client originally experience in other relationships
179
What is countertransference?
Occurs when therapist displaces onto the client attitudes or feelings from his/her past
180
What is anxiety?
A vague, apprehension assoc. with feelings of uncertainty & helplessness-internally anticipation of some perceived threat
181
What is a crisis?
A turning point in an individual's life that produces an overwhelming emotional response
182
What is affect?
Outward expression of the client's emotional state
183
What is blunted affect?
Showing little or a slow to respond facial expression
184
What is broad affect?
Displaying a full range of emotional expression
185
What is flat affect?
Showing no facial expression
186
What is inappropriate affect?
Displaying a facial expression that is incongruent with mood or situation
187
What is restricted affect?
Displaying one type of expression, usually serious or somber
188
What is restraint?
Direct application of physical force to a person with out his or her permission to restrict his or her freedom of movement
189
What is human restraint?
Occurs when staff members physically control the client and move him or her to a seclusion room
190
What is mechanical restraint?
Devices, usually ankle or wrist restraints, that are fastened to the bed frame to curtail the client's physical aggression, such as kicking, hitting, or hair pulling
191
3rd Generation MOA
Slide: Partial D2 agonist; other effects varies w/ drug–may affect 5HT and D3 as well
