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Mental & Psychiatric NRSNG Canada > Test1 Prep > Flashcards

Flashcards in Test1 Prep Deck (67):
1

This type of relationship focuses on the needs, experiences, feelings, and ideas of the client only; the nurse and client agree about the areas to work on and evaluate the outcomes; the nurse uses communication skills, personal strengths, and understanding of human behavior to interact with the client, parameters are clear.

Therapeutic Relationship

2

What is extremely important for the nurse to have, in order for them to help maintain the boundaries of the professional relationship?

self-awareness

3

Inappropriate Boundaries/ Appropriate Boundarie?
The nurse doesn't clearly outline the relationship early on during orientation phase; tries to be friends with his client; has a beer after work with them; instead of talking about the client's coping mechanisms-talks about why Sally broke up with Ben, accepts $25 from the client, and gives out his number to his client.

Inappropriate Boundaries.

4

This phase begins when the nurse and client meet and ends when the client begins to identify problems to examine.

Orientation phase

5

This phase of the nurse-client relationship is usually divided into two subphases, where the client identifies the issues or concerns causing problems and then into where the nurse guides the client to examine feelings and responses and to develop better coping skills and a more positive self-image.

Working phase

6

Peplau's working phase that encourages behavior change and develops independence?

exploitation

7

Peplau's working phase that identifies the problem?

problem identification

8

The final phase of the nurse-client relationship begins when the problems are resolved, and it ends when the relationship is ended.

termination/resolution phase

9

what role is the nurse doing here: this role is inherent in most aspects of client care; the nurse is honest about what information they can provide and when and where to refer clients for further information; this is where you are teaching the client.

the role of: teacher

10

what role is the nurse doing here: the nurse is building trust, exploring feelings, assisting the client in problem-solving and helping the client meet psychosocial needs.

the role of: caregiver

11

what role is the nurse doing here: the nurse informs the client and then supports them in whatever decision they make; you are acting on behalf of the client.

the role of: advocate

12

what role is the nurse doing here: when a client exhibits child-like behavior or when a nurse is required to provide personal care such as feeding or bathing, the nurse may be tempted to assume this role.

the role of: parent surrogate

13

A state of emotional, psychological, and social wellness-has many components and with variety of influencing factors; these are characteristics of what?

Mental Health

14

This includes disorders that affect mood, behavior, and thinking and these often cause significant distress, impaired functioning, or both; these are characteristics of what?

Mental Illness

15

(382-322 BC) This person created the 4 humors. blood, water, yellow, and black bile-calmness, happiness, anger, and sadness..these dealt with how we stayed balanced and if we fell out of balance-bloodletting, starving and purging would help put us back into balance.

Aristotle

16

what year did psychotropic drugs (psychopharmacology) begin?

1950's

17

1963 began a movement for community mental health...what would this lead to?

deinstitutionalization

18

what year did mental health commitment laws begin to change?

1970's

19

What are the current trends in the treatment of people with mental illness?

community-based program

20

Assessment; diagnosis; outcomes identification; planning; implementation; coordination of care (RN); health teaching and health promotion (RN)-promoting safety and health promotion; milieu therapy; pharmocologic, biologic, integrative therapies; prescriptive authority and treatment; and psychotherapy....these are the ANA standards of practice for what?

psychiatric mental health nursing

21

This began in the 1790s and began the concerns for those who had mental illness, but was very short lived, lasting only about 100 years.

period of enlightenment

22

This is a concept of safe refuge/haven offering protection at institutions, where the mentally ill were beaten, whipped, and starved; and was the idea created by Phillippe Pinel and William Tukes.

Asylum

23

what were the first psychotropic drugs to be developed?

Lithium (mood-stabilizer) and chlorpromazine (Thorazine)-antipsychotic

24

During the 1960s, 4 types of drug production helped shorten hospital stays and helped quiet the hospitals; what drugs are these?

MAOIs; Haldol; tricyclic antidepressants; and benzodiazepines

25

This is a taxonomy to provide a standard nomenclature of menatl disorders, define characteristics of disorders, and assist in identifying underlying causes of disorders.

DSM

26

Nurse Kelly is talking over discharge paperwork with Client A. The student nurse observes the distance that the nurse and her client are at and recognizes their distance is therapeutic if they are how far apart?
a) 0-18 inches
b) 18-36 inches
c)4-12 feet
d)12-25 feet

answer: c

rationale: therapeutic communication is most comfortable when the nurse and patient are 3-6 feet apart-in a social distance zone(4-12 feet).

27

Are these techniques therapeutic or nontherapeutic:
advising, agreeing, belittling, disagreeing, disapproving, giving approval, giving literal responses, indicating the existence of an external source, interpreting, introducing an unrelated topic, making stereotyped comments, probing, reassuring, rejecting, requesting an explanation, testing, appraising, and using denial.

nontherapeutic

28

Are these techniques therapeutic or nontherapeutic:
accepting, broad openings, exploring, focusing, general leads, offering self, presenting reality, reflecting, restating, silence, summarizing, translating into feelings, voicing doubt...

therapeutic

29

This is an interpersonal interaction between the nurse and the client during which the nurse focuses on the client's specific needs to promote an effective exchange of information; this can help nurses to accomplish many different goals.

therapeutic communication

30

These are important for accurate information exchange; the words are explicit and need no interpretation; the speaker uses nouns instead of pronouns; clear, direct, and easy to understand.

concrete messages

31

Those that are anxious lose cognitive processing skills-the higher the anxiety, the less they are able to process concepts; therefore, it is important to use what type of messaging/questioning with this sort of person?

concrete messages

32

Judy, a PN, is given an exercise from her teacher. Her teacher wants her to observe four different patients; and write down the questions and statements that are said to these clients by their nurses. Her teacher then has Judy look over what she has written, and pick out where concrete messaging has occur and not. Her teacher knows that Judy has an understanding of what concrete messages are when she chooses? Select all that apply.
a)"How did you get here, Mrs Smith?"
b)"What health symptoms caused you to come to the hospital today Mr Jones?"
c)"When was the last time you took your antidepressant medications?"
d)"Did you eat or drink anything after midnight?"

answer: b, c, d

rationales: concrete messages are clear, direct and easy to understand.

33

"Why do you always complain about the night nurse? She is a nice woman and a fine nurse and has five kids to support. You're wrong when you say she is noisy and uncaring."
The example reflects which nontherapeutic technique?
a) requesting an explanation
b) defending
c) disagreeing
d) advising

answer: c

rationale: defending is attempting to protect someone or something from verbal attack.

34

"How does Jerry make you upset?" is a nontherapeutic communication technique because?
a) it gives a literal response
b) it indicates an external source of the emotion
c) it interprets what the client is saying
d) it is just another stereotyped comment

answer: b

rationale: indicating an external source of emotion is attributing the source of thoughts, feelings, and behavior to others or to outside influences.

35

When the client says, "I met Joe at the dance last week," what is the best way for the nurse to ask the client to describe her relationship with Joe?
a) "Joe who?"
b) "Tell me about Joe."
c) "Tell me about you and Joe."
d) "Joe, you mean that blond guy with the dark blue eyes?"

answer: c

rationale: general leading is giving encouragement to continue.

36

What are the signs of lithium toxicity?
a) sedation, fever, restlessness
b) psychomotor agitation, insomnia, increased thirst
c) elevated WBC count, sweating, confusion
d) severe vomiting, diarrhea, weakness

answer: d

rationale: lithium toxicity side effects are severe diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination.

37

Clients taking which of the following types psychotropic medications need close monitoring of their cardiac status?
a) antidepressants
b) antipsychotics
c) mood stabilizers
d) stimulants

answer: b

rationale: because several antipsychotics, though rare may affect the QT interval, leading to potentially life-threatening/serious cardiac situations.

38

True/False
A social relationship involves superficial communication for the purposes of friendship/ task accomplishment.

answer: true

rationale: a social relationship occurs for friendship, socialization, companionship or task achievement. It involves superficial communication with shifting roles.

39

Which of the following drugs would be classified as a conventional antipsychotic?
a) Clozapine
b)risperidone
c)fluphenazine
d)aripriprazole

answer: c

rationale: clozapine and risperidone are atypical (second-generation) antipsychotics; and aripriprazole is a third-generation antipsychotic

40

Of the following statements about mental illness, identify all of the correct ones:

a. about 20% of Canadians experience a mental disorder during their lifetime
b. mental disorders and diagnoses occur very consistently across cultures
c. most serious mental illness are psychological rather than biological in nature
d. the MHC report Changing Directions, Changing Lives outlines the mental health strategy for Canada

a & d;
One in five Canadians will develop a mental illness in their lifetime. The Mental Health Commission report Changing Directions, Changing Lives outlines the 2012 Mental Health Strategy for Canada, highlighting six strategic directions: promotion and prevention; recovery and rights; access to services; disparities and diversity; First Nations, Inuit and Métis; and leadership and collaboration.

41

Which of the following actions represent the primary focus of psychiatric nursing for a basic-level registered nurse?

a. determining a pt diagnosis according to the DSM-5
b. ordering diagnostic tests
c. identify how a pt is coping wit ha symptom such as hallucinations
d. guiding a patient to learn and use a variety of stress management techniques
e. helping a pt without personal transport find a way to his/her treatment appts.
f. collecting petition signatures seeking the removal of stigmatizing images on television

c, d, e & f;

The focus of psychiatric nursing involves using the nursing process to promote mental health and to facilitate constructive responses to mental health problems or psychiatric disorders. Identifying how a patient is coping with a symptom such as hallucinations, guiding a patient to learn stress-management techniques, helping a patient find transportation to treatment appointments, and collecting petition signatures seeking the removal of stigmatizing images on television are all roles of nurses working in psychiatry.

42

Which statement best describes the DSM-5?

a. It is a medical psychiatric assessment system.
b. It is a compendium of treatment modalities.
c. It offers a complete list of nursing diagnoses.
d. It suggests common interventions for mental disorders.

a. it is a medical psychiatric assessment system

The DSM-5 is a classification of mental disorders that includes descriptions and criteria of diagnoses.

43

Current information suggests that the most disabling mental disorders are the result of which of the following?

a. Biological influences
b. Psychological trauma
c. Learned ways of behaving
d. Faulty patterns of early nurturance

a. Biological influences

The biologically influenced illnesses include schizophrenia, bipolar disorder, major depression, obsessive-compulsive and panic disorders, post-traumatic stress disorder, and autism. Therefore, many (but not all) of the most prevalent and disabling mental disorders have been found to have strong biological influences. Psychological trauma, learned behaviours, and faulty patterns of nurturance may contribute to some forms of mental illness, but they are not major factors in most disabling mental disorders.

44

A nurse's identification badge includes the term, Psychiatric Mental Health Nurse. A patient with a history of paranoia asks, "What does that title mean?" The nurse responds best by answering with which of the following?

a. "Don't be afraid; it means I'm here to help, not hurt, you."
b. "Psychiatric mental health nurses care for people with mental illnesses."
c. "We have the specialized skills needed to care for people with mental illnesses."
d. "The nurses who work in mental health facilities have that title."

c. "We have the specialized skills needed to care for people with mental illnesses."

A psychiatric mental health nurse has specialized nursing skills and implements the nursing process to manage and deliver nursing care to mentally ill people. The remaining options either do not effectively answer the patient's question or assume that the question is the result of the patient's paranoia.

45

Which statement about diagnosis of a mental disorder is true?

a. The symptoms of each disorder are common among all cultures.
b. Culture may cause variations in symptoms for each clinical disorder.
c. All mental disorders listed in the DSM-5 are seen in all cultures.
d. Psychiatric diagnoses are listed separately from other physical disorders in a five-axes system.

b. Culture may cause variations in symptoms for each clinical disorder.

Every society has its own view of health and illness and the types of behaviour categorized as mental illness. Culture also influences the symptoms of a particular disorder. For example, individuals of certain cultures are more likely to express depression through somatic symptoms than through affect and feeling tone. The five-axes system was abandoned in this edition of the DSM-5.

46

A nursing diagnosis for a patient with a psychiatric disorder serves which of the following purposes?

a. It justifies the use of certain psychotropic medication.
b. It provides data essential for insurance reimbursement.
c. It provides a framework for selecting appropriate interventions.
d. It completes the medical diagnostic statement.

d. It completes the medical diagnostic statement.

Nursing diagnoses provide the framework for identifying appropriate nursing interventions for dealing with the phenomena a patient with a mental health disorder is experiencing.

47

According to the DSM-5, there is evidence that symptoms and causes of mental illness are influenced by which of the following?

a. Cultural and ethnic factors
b. Occupation and status
c. Birth order
d. Sexual preference

a. Cultural and ethnic factors

The DSM-5 states there is evidence to suggest that mental illness is influenced by cultural and ethnic factors. The DSM-5 does not state that there is evidence that occupation, birth order, or sexual preference affects mental illness.

48

Which of the following is a characteristic of mental health that allows people to adapt to tragedies, trauma, and loss?

a. Dependence
b. Resilience
c. Pessimism
d. Altruism

b. Resilience

Resilience is a characteristic that helps individuals cope with loss and trauma that may occur in life. Dependence is described as being dependent on others for decision making and care. Pessimism is a life philosophy that things are more likely to go wrong than right. Altruism is described as putting others before yourself.

49

The behaviour of an individual who seems unable to learn right from wrong, who repeatedly violates laws, and who lies demonstrates problems related to the brain's inability to do which of the following?

a. Regulate conscious mental activity
b. Retain and recall past experience
c. Regulate social behaviour
d. Maintain homeostasis

c. Regulate social behaviour

The inability to regulate social behaviour usually results in antisocial behaviours such as lying, cheating, taking advantage of others, and breaking laws.

50

On the basis of the current understanding of neurotransmitters, the nurse can view a patient's symptoms of profound depression as likely related in part to which of the following?

a. Increased dopamine level
b. Decreased serotonin level
c. Increased norepinephrine level
d. Decreased acetylcholine level

b. Decreased serotonin level

A lowered serotonin level is highly supported as being related to depression; however, depression is more probably influenced by a number of neurotransmitter abnormalities.

51

The nurse caring for a patient taking risperidone (Risperidal) observes the patient carefully for which of the following?

a. Napping during the day, weight gain, and reports of dizziness
b. Reports of falls, heartburn, and nausea
c. A rapid heartbeat, red rash, and hives
d. Dry mouth, poor urinary output, and constipation

a. Napping during the day, weight gain, and reports of dizziness

H1 blockade has the potential to produce sedation, weight gain, and hypotension.

52

The physician tells a patient suspected of experiencing obessive-complusive disorder that "We want to do an imaging study that will tell us which parts of your brain are particularly active." From this explanation, the nurse can determine that the physician will order which of the following?

a. A computed tomography scan
b. A positron emission tomography scan
c. A ventriculogram
d. An electroencephalogram

b. A positron emission tomography scan

A positron emission tomography scan detects brain activity. The other imaging studies are limited to visualization of structures.

53

Which of the following patients would need monitoring for potential development of the adverse effect of hypothyroidism?

a. The patient taking fluoxetine hydrochloride (Prozac)
b. The patient taking valproate (Depakote)
c. The patient taking lithium
d. The patient taking risperidone (Risperdal)

c. The patient taking lithium

Long-term use of lithium may cause hypothyroidism. The other options refer to drugs whose long-term use do not cause hypothyroidism.

54

A nurse is interviewing a new patient, who is angry and highly suspicious. When asked about sexual orientation, the patient becomes highly distressed and threatens to walk out of the interview. How does the nurse respond?

a. "I would like you to stay and answer the question."
b. "Don't be concerned. I accept homosexuals as well as heterosexuals."
c. "Your distress leads me to believe you may have something you don't want to discuss."
d. "I can see that this topic makes you uncomfortable. We can defer discussion of it today."

d. "I can see that this topic makes you uncomfortable. We can defer discussion of it today."

A cardinal rule of interviewing is "Don't probe sensitive areas." Patients are allowed to take the lead.

55

Which of the following is the primary purpose of performing a physical examination before beginning treatment for any anxiety disorder?

a. Protect the nurse legally
b. Establish the nursing diagnosis of priority
c. Obtain information about the patient's psychosocial background
d. Determine whether the anxiety is primary or secondary in origin

d. Determine whether the anxiety is primary or secondary in origin

The symptoms of anxiety can be caused by a number of physical disorders or are said to be caused by an underlying physical disorder. The treatment for secondary anxiety is treatment of the underlying cause.

56

Which of the following is an important question to ask during the assessment of a patient diagnosed with anxiety disorder?

a. "How often do you hear voices?"
b. "Have you ever considered suicide?"
c. "How long has your memory been bad?"
d. "Do your thoughts always seem jumbled?"

b. "Have you ever considered suicide?"

The presence of anxiety may cause an individual to consider suicide as a means of finding comfort and peace. Suicide assessment is appropriate for any patient with higher levels of anxiety.

57

Which of the following is a possible outcome criterion for a patient diagnosed with anxiety disorder?

a. Patient demonstrates effective coping strategies
b. Patient reports reduced hallucinations
c. Patient reports feelings of tension and fatigue
d. Patient demonstrates persistent avoidance behaviours

a. Patient demonstrates effective coping strategies

58

A teenager changes study habits to earn better grades after initially failing a test. This behavioural change is likely a result of which of the following?

a. A rude awakening
b. Normal anxiety
c. Trait anxiety
d. Altruism

b. Normal anxiety

Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions.

59

A young adult applying for a position is mildly tense but eager to begin the interview. This can be assessed as showing which of the following?

a. Denial
b. Compensation
c. Normal anxiety
d. Selective inattention

c. Normal anxiety

Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive action

60

Which of the following types of altered perception are most commonly experienced by patients with schizophrenia?

a. Delusions
b. Illusions
c. Tactile hallucinations
d. Auditory hallucinations

d. Auditory hallucinations

Hallucinations, especially auditory hallucinations, are the major example of alterations of perception in schizophrenia. They are experienced by as many as 90% of individuals with schizophrenia.

61

A patient diagnosed with paranoid schizophrenia refuses food, stating the voices are saying the food is contaminated and deadly. Which of the following would be a therapeutic response for the nurse?

a. "You are safe here in the hospital; nothing bad will happen to you."
b. "The voices are wrong about the hospital food. It is not contaminated."
c. "I understand that the voices are very real to you, but I do not hear them."
d. "Other people are eating the food, and nothing is happening to them."

c. "I understand that the voices are very real to you, but I do not hear them."

This reply acknowledges the patient's reality but offers the nurse's perception that he or she is not experiencing the same thing.

62

A patient diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me." The term volmers can be assessed as which of the following?

a. A neologism
b. Clang association
c. Blocking
d. A delusion

a. A neologism

A neologism is a newly coined word that has meaning only for the patient.

63

When a patient diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me," which of the following would be an appropriate response for the nurse?

a. "You are safe here. This is a locked unit, and no one can get in."
b. "I do not believe I understand the word volmers. Tell me more about them."
c. "Why do you think someone or something is going to harm you?"
d. "It must be frightening to think something is going to harm you."

d. "It must be frightening to think something is going to harm you."

This response focuses on the patient's feelings and neither directly supports the delusion nor denies the patient's experience. Option A gives global reassurance. Option B encourages elaboration about the delusion. Option C asks for information that the patient will likely be unable to answer.

64

A patient who has been receiving antipsychotic medication for 6 weeks tells the nurse that the hallucinations are nearly gone and that concentration has improved. When the patient reports flulike symptoms including a fever and a very sore throat, what should the nurse do?

a. Suggest that the patient take something for her fever and get extra rest
b. Advise the physician that the patient should be admitted to the hospital
c. Arrange for the patient to have blood drawn for a white blood cell count
d. Consider recommending a change of antipsychotic medication

c. Arrange for the patient to have blood drawn for a white blood cell count

Antipsychotic medications may cause agranulocytosis, the first manifestation of which may be a sore throat and flulike symptoms.

65

Nico, a 22-year-old patient, is diagnosed with schizophrenia. Which of the following symptoms would alert a caregiver to a possible diagnosis of schizophrenia?

a. Excessive sleeping with disturbing dreams
b. Hearing voices telling him to hurt his roommate
c. Withdrawal from college because of failing grades
d. Chaotic and dysfunctional relationships with his family and peers

b. Hearing voices telling him to hurt his roommate

People diagnosed with schizophrenia all have at least one psychotic symptom such as hallucinations, delusional thinking, or disorganized speech. The other options do not describe schizophrenia but could be caused by a number of problems.

66

Which of the following statements about the co-morbidity of depression is accurate?

a. Depression most often exists in an individual as a single entity.
b. Depression is commonly seen in individuals with medical disorders.
c. Substance abuse and depression are seldom seen as co-morbid disorders.
d. Depression may coexist with other disorders but is rarely seen with schizophrenia.

b. Depression is commonly seen in individuals with medical disorders.

Depression commonly accompanies medical disorders. The other options are false statements.

67

When the clinician mentions that a patient has anhedonia, what can the nurse expect about the patient?

a. The patient has poor retention of recent events.
b. The patient experienced a weight loss from anorexia.
c. The patient obtains no pleasure from previously enjoyed activities.
d. The patient has difficulty with tasks requiring fine motor skills.

c. The patient obtains no pleasure from previously enjoyed activities.

Anhedonia is the term for the lack of ability to experience pleasure.