CMN 350 PSYCHIATRIC-MENTAL HEALTH NURSING
EXAM #3
Psychotherapeutic management in the continuum of care - Answers -1. Therapeutic
nurse patient-relationship
-Communication skills
-Respect and a desire to help
-Understanding
•Mental mechanisms
•Adaptation styles
•Coping strategies
•Therapeutic intervention skills
2. Psychopharmacology
-Therapeutic versus toxic dosage levels
-Use during pregnancy
-Use with older adults
-Side effects
-Interactions
-Patient teaching
3. Milieu management
-Safety
-Structure
-Norms
-Setting limits
-Balance
•Independence versus dependence
-Environmental modification
Need hospital-based care for acute stabilization - Answers --Danger to self or others
-Gravely disabled
-Acutely psychotic
-Suicidal or homicidal
Deinstitutionalization - Answers -Refers to the depopulating of state mental hospitals.
State hospitals reached their peak population in 1955 and then slowly began the
process of trimming their census rolls. This process began with growing concern about
hospital "asylums" (i.e., a place of poor treatment or no treatment).
Institutions - Answers -They are still ________________ in use today.
serious mental illness (SMI) - Answers -same as chronic mental illness
,more serious mental illness - Answers -A patient would have to have a
_____________________________ to be admitted to a psychiatric hospital today.
Confidentiality - Answers --Only if the client provides consent should the nurse share
information with other persons not involved in the client treatment plan.
Client rights - Answers -◯ Informed consent and the right to refuse treatment
◯ Confidentiality
◯ A written plan of care/treatment that includes discharge follow-up, as well as
participation in the
care plan and review of that plan
◯ Freedom from harm related to physical or
pharmacological restraint, seclusion, and any physical or mental abuse or neglect
◯ Provision of care with the least restrictive
interventions necessary to meet the client's needs without allowing him to be a threat to
himself or others
False imprisonment - Answers -Confining a client to a specific area, such as a
seclusion room, if the reason for such confinement is for the convenience of
the staff.
Assault - Answers -Making a threat to a client's person, such as approaching the client
in a threatening manner with a syringe in hand.
Battery - Answers -Touching a client in a harmful or offensive
way. This would occur if the nurse threatening the client with a syringe actually grabbed
the client and gave an injection.
Wyatt v. Stickney - Answers -confirmed a right to treatment
Rogers v. Okin - Answers -determined the right to refuse treatment
Involuntary Care - Answers -All States Some States:
-Risk of harm through self-neglect, grave disability, or failure to meet basic needs
-Risk that a person might physically injure or kill himself
-Risk that a person might physically harm other persons
Some States:
-Risk of physical deterioration without commitment
-Potential danger to property
-Risk of relapse or mental deterioration
Parkinson's Disease symptoms - Answers --Similar to EPSEs
-Caused by a decrease in dopamine
-Tremor
,-Bradykinesia
-Rigidity
EPSEs - Answers --Akathsia
-Akinesia/Bradykinesia
-Dystonias
-Drug-induced parkinsonism (Tremors, Rigidity, Bradykinesia)
-TD (tongue writhing, tongue protrusion, teeth grinding, and lip smacking)
-NMS
-Pisa syndrome
Short-term goal for a person with low self-esteem - Answers --Patient will verbalize
feelings and needs.
-Patient will verbalize awareness about connecting emotions with physical symptoms.
-Patient will develop adaptive coping behaviors.
-Don't do anything or have them do anything that would embarrass them
Spirituality and Culture - Answers --If the practice or ritual does not harm anything it
should be incorporated into treatment/plan of care
-Put biases aside
Loder: Trust and the Spirituality of Human Development - Answers --postulated that
early developmental experiences set the stage for later spiritual dynamics within the
individual. He pointed out that in the biblical languages the words for "face" also mean
"presence."
-At the age of 3 months, infants begin to recognize faces. The most important face in
the development of trust is the primary caregiver, typically the mother. The primal
response to this presence is a smile. At this point in development, the infant does not
yet have a concept of time. However, by age 9 months, the infant understands when the
mother is not present and experiences anxiety at her absence. For the infant who is 3 to
6 months old (who has not yet developed a sense of time or absence), basic needs are
met by one whose presence is always assumed, who loves unconditionally, and who
orders the infant's whole world. The infant's burgeoning capacity to trust is strengthened
by the presence (face) of the nurturer.
-contended that the spiritual search many people later experience is connected with the
desire to experience in a new way the nature of being "given a place in the cosmos,
confirmed as a self, and addressed by the presence of a loving other."
-noted that the infant experiences no shame when gazing at this face, so this model can
be useful in dealing with issues of abandonment and shame.
Serotonin activation (Increase) - Answers -- _____________ syndrome
-Anti-depressant effect
-anxiety
-nausea
-vomiting
, -other G.I. disturbances
-sexual dysfunction
-reduced appetite and weight loss
-insomnia
-movement disorders
-temperature dysregulation
-psychotic thinking
Sertonin antagonism (decrease) - Answers --Depression
-dysthymia
-suicidality
-aggressiveness
-obsessive thinking
-sleep wake cycle disruption
-pain
-compulsive behavior
-anxiety
-panic
Acetylcholine activation (increase) - Answers --pupil contraction
-decreased heart rate
-constriction bronchi
-increased respiratory secretions
-increased voiding
-salivation
-increased gastric secretions
-increased defecation
-sweating
-enhancement of cognitive processes
Acetylcholine antagonism (decrease) - Answers --Alzheimer Disease
-pupil dilation
-increased heart rate
-dilation of bronchi
-decreased respiratory secretions
-decreased voiding
-dry mouth
-decreased gastric secretions
-constipation
-decreased sweating
-cognitive slowing
Norepinephrine activation (increase) - Answers --anti-depressant effect
-vasoconstriction (alpha1)
-increased heart rate (beta1)
-bronchial dilation
EXAM #3
Psychotherapeutic management in the continuum of care - Answers -1. Therapeutic
nurse patient-relationship
-Communication skills
-Respect and a desire to help
-Understanding
•Mental mechanisms
•Adaptation styles
•Coping strategies
•Therapeutic intervention skills
2. Psychopharmacology
-Therapeutic versus toxic dosage levels
-Use during pregnancy
-Use with older adults
-Side effects
-Interactions
-Patient teaching
3. Milieu management
-Safety
-Structure
-Norms
-Setting limits
-Balance
•Independence versus dependence
-Environmental modification
Need hospital-based care for acute stabilization - Answers --Danger to self or others
-Gravely disabled
-Acutely psychotic
-Suicidal or homicidal
Deinstitutionalization - Answers -Refers to the depopulating of state mental hospitals.
State hospitals reached their peak population in 1955 and then slowly began the
process of trimming their census rolls. This process began with growing concern about
hospital "asylums" (i.e., a place of poor treatment or no treatment).
Institutions - Answers -They are still ________________ in use today.
serious mental illness (SMI) - Answers -same as chronic mental illness
,more serious mental illness - Answers -A patient would have to have a
_____________________________ to be admitted to a psychiatric hospital today.
Confidentiality - Answers --Only if the client provides consent should the nurse share
information with other persons not involved in the client treatment plan.
Client rights - Answers -◯ Informed consent and the right to refuse treatment
◯ Confidentiality
◯ A written plan of care/treatment that includes discharge follow-up, as well as
participation in the
care plan and review of that plan
◯ Freedom from harm related to physical or
pharmacological restraint, seclusion, and any physical or mental abuse or neglect
◯ Provision of care with the least restrictive
interventions necessary to meet the client's needs without allowing him to be a threat to
himself or others
False imprisonment - Answers -Confining a client to a specific area, such as a
seclusion room, if the reason for such confinement is for the convenience of
the staff.
Assault - Answers -Making a threat to a client's person, such as approaching the client
in a threatening manner with a syringe in hand.
Battery - Answers -Touching a client in a harmful or offensive
way. This would occur if the nurse threatening the client with a syringe actually grabbed
the client and gave an injection.
Wyatt v. Stickney - Answers -confirmed a right to treatment
Rogers v. Okin - Answers -determined the right to refuse treatment
Involuntary Care - Answers -All States Some States:
-Risk of harm through self-neglect, grave disability, or failure to meet basic needs
-Risk that a person might physically injure or kill himself
-Risk that a person might physically harm other persons
Some States:
-Risk of physical deterioration without commitment
-Potential danger to property
-Risk of relapse or mental deterioration
Parkinson's Disease symptoms - Answers --Similar to EPSEs
-Caused by a decrease in dopamine
-Tremor
,-Bradykinesia
-Rigidity
EPSEs - Answers --Akathsia
-Akinesia/Bradykinesia
-Dystonias
-Drug-induced parkinsonism (Tremors, Rigidity, Bradykinesia)
-TD (tongue writhing, tongue protrusion, teeth grinding, and lip smacking)
-NMS
-Pisa syndrome
Short-term goal for a person with low self-esteem - Answers --Patient will verbalize
feelings and needs.
-Patient will verbalize awareness about connecting emotions with physical symptoms.
-Patient will develop adaptive coping behaviors.
-Don't do anything or have them do anything that would embarrass them
Spirituality and Culture - Answers --If the practice or ritual does not harm anything it
should be incorporated into treatment/plan of care
-Put biases aside
Loder: Trust and the Spirituality of Human Development - Answers --postulated that
early developmental experiences set the stage for later spiritual dynamics within the
individual. He pointed out that in the biblical languages the words for "face" also mean
"presence."
-At the age of 3 months, infants begin to recognize faces. The most important face in
the development of trust is the primary caregiver, typically the mother. The primal
response to this presence is a smile. At this point in development, the infant does not
yet have a concept of time. However, by age 9 months, the infant understands when the
mother is not present and experiences anxiety at her absence. For the infant who is 3 to
6 months old (who has not yet developed a sense of time or absence), basic needs are
met by one whose presence is always assumed, who loves unconditionally, and who
orders the infant's whole world. The infant's burgeoning capacity to trust is strengthened
by the presence (face) of the nurturer.
-contended that the spiritual search many people later experience is connected with the
desire to experience in a new way the nature of being "given a place in the cosmos,
confirmed as a self, and addressed by the presence of a loving other."
-noted that the infant experiences no shame when gazing at this face, so this model can
be useful in dealing with issues of abandonment and shame.
Serotonin activation (Increase) - Answers -- _____________ syndrome
-Anti-depressant effect
-anxiety
-nausea
-vomiting
, -other G.I. disturbances
-sexual dysfunction
-reduced appetite and weight loss
-insomnia
-movement disorders
-temperature dysregulation
-psychotic thinking
Sertonin antagonism (decrease) - Answers --Depression
-dysthymia
-suicidality
-aggressiveness
-obsessive thinking
-sleep wake cycle disruption
-pain
-compulsive behavior
-anxiety
-panic
Acetylcholine activation (increase) - Answers --pupil contraction
-decreased heart rate
-constriction bronchi
-increased respiratory secretions
-increased voiding
-salivation
-increased gastric secretions
-increased defecation
-sweating
-enhancement of cognitive processes
Acetylcholine antagonism (decrease) - Answers --Alzheimer Disease
-pupil dilation
-increased heart rate
-dilation of bronchi
-decreased respiratory secretions
-decreased voiding
-dry mouth
-decreased gastric secretions
-constipation
-decreased sweating
-cognitive slowing
Norepinephrine activation (increase) - Answers --anti-depressant effect
-vasoconstriction (alpha1)
-increased heart rate (beta1)
-bronchial dilation
