NURS 3481 Psychiatric Mental Health Exam Questions With Answers | Latest Update 2023/2024 (GRADED)

Discuss the use of therapeutic responses that can be helpful in challenging denial in your patient with substance abuse disorder. The nurse will point to evidence of severe dysfunction that is inevitably going to impair in the substance abusers, lives, job losses, financial problems, estranged family and friends, legal problems. The nurse can be very respectful, but remind the client about the problems that have resulted from their drug and alcohol use. Nurse must self-assess their own feelings because those feelings can be transferred to clients through body language and the terminology nurses can use in assessing clients. An objective, nonjudgmental nurse approach is imperative. Compare and contrast the etiology and symptoms of Wernicke’s and Korsacoff’s giving examples of each. Wernicke encephalopathy, a degenerative brain disorder caused by thiamine deficiency, is characterized by vision impairment, ataxia, hypotension, confusion, and coma. ACUTE phase Korsacoff’s Syndrome is associated with alcoholism, involves the heart, vascular system, nervous system, and the problem of acquiring new information and retrieving memories, and so that would be primary problem sits a problem related to the nervous system that depletion of B vitamins. CHRONIC phase Symptoms include Amnesia, confabulation, attention deficit, disorientation, and vision impairment. warning signs: which usually happens first nystagmus (vision condition in which the eyes make repetitive, uncontrolled movements.) Confusion. Early symptoms can be reversed, but without long-term treatment, the prognosis is poor. Compare and contrast screening tools used to determine the existence and severity of withdrawal, addictions and substance use including CIWA, CAGE, MAST, DAST. CIWA is one that we use to measure physiological parameters. When a patient is going through alcohol withdrawal, it helps us to easily determine if they need a benzodiazepine, if they need a PRN Benzo and how much and so forth. 1 CAGE is a tool that helps us to identify if there is a problem with alcohol and they have a revised CAGE. The CAGE asks four questions. Have you ever felt you ought to cut down? Have your people been annoyed or criticized you for your drinking? Have you felt bad or guilty about your drinking? Have you ever had to drink in the morning to steady your nerves or get rid of a hangover as an Ioss? I they answer two of those, they have a problem. New research say one one MAST- Michigan Alcohol Screening Test DAST Drug-Abuse-Screening-Test : is looking at the same kinds of things, other longer profiles, but they're adding in a drug as does the revised CAGE safe withdrawal from alcohol is always going to be accomplished with a benzodiazepine because of Benzodiazepine is a CNS depressant like alcohol, so we are able to substitute the Benzodiazepine. Compare and contrast medications that are used for maintenance of sobriety, including Antabuse, Campral, Revia and Suboxone and identify how each is used, potential adverse and common side effects and important teaching for each. Compare and contrast medications regimes for alcohol dependent patients experiencing withdrawal and for those patients striving to maintain sobriety; include therapeutic effect, common side effects, adverse effects, important teaching. Alcohol withdrawal: Diazepam (Valium), carbamazepine (Tegretol), clonidine (Catapres), chlordiazepoxide (Librium), Phenobarbital (Luminol), naltrexone (Vivitrol) Alcohol abstinence: Disul ram, naltrexone, acamprosate. Safe withdrawal from alcohol is always going to be accomplished with a benzodiazepine because a Benzodiazepine is a CNS depressant like alcohol - we are able to substitute the Benzodiazepine in place of alcohol. 2 Benzodiazepines, librium, Ativan, valium and Sarat suppress the withdrawals symptoms, stabilize their blood pressure and vital signs and help the patient withdrawal comfortably. This way tapers them off slowly and gets them invested in their sobriety. Discuss ADHD in children including common characteristics, assessment and treatment issues and the role that biochemical abnormalities play in development of ADHD. Biochemical = changes to the dopamine transport gene. Stimulants: Ritalin, Adderall- increase that dopamine by blocking its transporter. Non-stimulants: Straterra increase norepinephrin by blocking its transporter Common Characteristics = Inappropriate attention, impulsiveness, and hyperactivity. Assessment = Identify etiology, onset, findings & common behaviors, priority needs, diagnostic criteria for autism spectrum disorders and discuss applicable nursing diagnosis and interventions. Etiology = neurobiological, environmental, genetic, and they manifest in the behavioral symptoms. Diagnostic = Autism spectrum disorders are diagnosed on the basis of behavioral symptoms. Onset = Autism spectrum is usually first observed before age three. Findings = Parents report abnormalities in language development, Social Awkwardness, atypical eye contact, delayed language, some sensory motor, social behavior abnormalities, the decline in eye fixation Presenting symptoms: Impairment in communication, daily activity, imaginative activity, language delays, repetitive phrases, stereotypical language, impaired social interaction, lack of responsiveness and lack of eye contact. They have mark restricted stereotypical patterns of behavior, adherence to routines, rituals, preoccupied with certain repetitive activities that are abnormal in intensity or their focus towards these activities. Intervention Goal: improve some of these symptoms. Discuss characteristics, common behaviors, priority needs, important teaching, diagnostic criteria for Tourette’s disorder. Characteristics: Ticks are rapid involuntary repetitive movements or vocalizations and they fluctuate and frequency and they are often absent or reduced during sleep. Common behaviors: Priority needs: Important teaching Diagnostic criteria: 3 Meds: Two classes of drugs that we use. Anti-psychotics: atypical anti psychotics like Risperidone and aripiprazole (abilify) are most commonly used. Alpha 2 adrenergic receptor agonists: Older drug that's used, Catapres (Clonidine) and then a newer drug that is used, which is an Alpha 2 adrenergic receptor, is Intuniv (Guanfacine.) 4. Compare and contrast autistic spectrum, ADHD, conduct Disorder, oppositional defiant disorder and separation anxiety describing each, identifying motives for each and give characteristics and examples of each. Autistic Spectrum: distortions in development of social skills and social language ADHD: hyperactive, impulsive, inattentive. Conduct disorder: have destructive acts with no remorse. They may have aggression towards people and animals. Destruction of property and rule violation. Oppositional defiant disorder: angry, irritable mood, argumentative, defiant, and they have been addicted behaviors. Separation Anxiety: have great difficulty separating from their parents. 5. Compare and contrast psychotropic medications (Ritalin, Concerta, Adderall, Strattera) for children and adolescents experiencing ADHD, including classification, therapeutic effects, important differences between these treatments, therapeutic actions expected to be observed, common adverse reactions/side effects and important nursing teaching. Straterra: SNRI Concerta: Stimulant Ritalin: Stimulant Adderall: Stimulant 6. Compare and contrast and give examples of the following paraphelias: Fetishistic disorder; Exhibitionistic disorder; pedophilia; voyeuristic disorder; sexual masochism disorder, sexual sadism disorder. Paraphilias: Sexual expression is characterized by recurrent intense sexually arousing fantasies, urges, behaviors generally involving non human objects, suffering, humiliation, using children or other nonconsenting persons, and they occur in terms of diagnosis over six months, at least six months. They have 4 to be clinically significantly distressing or impair social, occupational, or other areas of functioning. They tend to be lifelong and chronic. Identify the characteristics of a paraphelia. Fetishistic disorder: An object is used for sexual arousal. Exhibitionism: The behavior involves exposing genitals to strangers with occasional masturbation. Pedophilia: is sexual activity with a child usually 13 years or younger by an individual of at least 16 years or five years older than the child. Voyeurism: Involves peeping unsuspecting people who are undressing, nude or engaged in sexual activity. Sexual masochism: involves being humiliated, beaten, bound, or made to suffer. Sexual sadism: Compare and contrast sexual orientation, gender identity and biosexual identity giving examples of each. Sexual orientation: refers to a person's sexual attraction to those of the opposite sex, heterosexual, or same sex, homosexual or both sexes, Bisexual. Sexual orientation is determined early in development as a result of influences of genetic factors and interactions between sex hormones and the developing brain and should not be considered a lifestyle choice. There's no evidence that interventions can change sexual orientation. Gender identity: is the conviction of belonging to a male or female gender. Bisexual identity refers to the Anatomic and physiologic state of being male or female. Culturation cultural identity and so forth, everyone has a cultural identity or a set of cultural beliefs from which we view and look for standards of behavior. Acculturation is the socialization process by which minority groups learn and adopt selective aspects of the dominant culture, eventually leading to involvement, the involvement of the new minority culture, when that's different from the native culture and different from the dominant culture Discuss the relationship of the sympathetic, parasympathetic nervous system to arousal and sex drive. Compare and contrast acute stress disorder and PTSD, giving examples of each. 5 Acute stress disorder. Symptoms occur during or immediately after trauma and last at least two days. If the symptoms don't resolve within four weeks after the conclusion of the event, then that diagnosis has changed to PTSD. PTSD: major elements of PTSD are re-experiencing the through dreams or recurrent intrusive thoughts showing emotional numbing, such as feeling detached, being on guard, irritable, hyper vigilance or hyper-arousal and feeling very anxious and symptoms usually occur three weeks or more after the trauma. Discuss the major elements and diagnostic of Post-Traumatic Stress Disorder. **Differentiating acute stress with PTSD*** Usually that acute stress symptom disorder is changed to a PTSD-If it's not resolved within a month, it's usually going to occur three months or more after the trauma. Compare and contrast exposure therapy, cognitive restructuring, cognitive processing therapy, stress inoculation training giving examples of each. exposure therapy, cognitive restructuring exposure therapy involves mental imagery of a trauma. It is characterized by re experiencing the traumatic event through remembering, engaging rather than avoiding and reminders of triggers. Cognitive restructuring is learning to identify and dispute irrational or maladaptive thoughts, (known as cognitive distortions). Stress inoculation training, essentially inoculates relates that's why that word is in there, the individual against the effects of severe stress by preparing them to be able to handle it. Advanced cognitive processing therapy is a trauma focused psychotherapy that teaches to evaluate and change the upsetting thoughts that a patient might have after a trauma. Compare and contrast Disinhibited social engagement disorder, Reactive attachment disorder and Adjustment disorder giving examples of each. Disinhibited social engagement. exists when children are overly familiar with a stranger, Reactive attachment adjustment disorder is caused by a lack of attachment to a caregiver, usually at an early age. A child is unable to form relationships with others that are normal. Adjustment Disorder developed in response to a stressful event. There are emotional symptoms that develop