Psychiatric/Mental Health Nursing Exam III
1. The major NTs associated with sleep are: - Answer-- Serotonin & GABA
- Banana: good for 5-HT
2. The major neuro-transmitters associated with wakefulness are
_______________________________, ____________________________________________&
______________________________________. - Answer-Dopamine, Acetylcholine,
Norepinephrine
3. Discuss the role that pain plays in sleep disorders and medications that are helpful for individuals
experiencing sleep initiation. - Answer-a) Fragmented and disrupted sleep may be caused by
chronic pain which will interrupt their sleep cycle and cause a problem.
b) If the patient is not responsive and can't communicate their pain to you - like Alzheimer's patients,
those with dementia etc. who have something going on that you know is painful, ex: trauma, etc... make
sure to medicate them, and become aware of their pain. Their body language, V/S
c) Sleep Hygiene practices: helpful to get to sleep!
a. Develop a pre-sleep routine that signals the end of the day
b. Maintain a regular sleep/wake schedule
c. Reserve bedroom for sleep/intimacy
d. Create sleep-conducive environment
e. Avoid clock watching
f. Limit caffeine1-2/day, none in the evening
g. Avoid heavy meals before mealtime
h. Use alcohol cautiously, and avoid use for several hours before bedtime
i. Avoid daytime napping (20-30 minutes)
j. Exercise daily but not right before bed
,*Medications are usually prescribed for no more than 2 weeks, because tolerance and withdrawal may
result.
4. The classification of medications that help patients initiate sleep and awaken without symptoms
of drowsiness are: - Answer-short-acting sedative hypnotics: take right before sleep since they
work faster than Benzo's. Hypnotic medications should always be used with caution. They can be
very sedating and addicting: follow-up with the doctor regularly as long as they are being taken.
5. Short-acting sedative hypnotics that are helpful for people who have problems with sleep
initiation incl. - Answer-a) Zolpidem (Ambien): give w/ food
b) Zaleplon (Sonata): 15-30 mins. onset of action.
c) Ramelteon (Rozerem)): non-habit forming medication that can be ordered for insomnia
d) Eszopiclone (Lunesta): causes longer sleeping, 7-8 hrs. Unpleasant taste upon waking up. Longer onset
of action. 60 mins.
e) Lou (Lunesta) hears a Sonata to prepare the Ambience (Ambien) for some Z's; Rose
6. Identify signs and symptoms of: Somatoform disorders - Answer-Somatoform Disorders: Cause
the person to feel they have physical pain and other symptoms r/t physical (medical problems)
which don't have a physical explanation. Person has a preoccupation with the symptoms they
are experiencing. Assessment will reveal repeated attempts to search for help for someone to
explain those symptoms to them. Symptoms seriously impair their social, occupational, and daily
functioning.
They are involuntary.
7. Somatization is characterized by a certain number of symptoms accompanied by significant
functional impairment. Pain, gastrointestinal concerns, and psychoneurological symptoms are
hallmarks of this condition. Complaints are dramatic and sometimes difficult to clarify.
8. Identify signs and symptoms of: Body dysmorphic disorder - - Answer-Body Dysmorphic
Disorder: Commonly seen in community, psychiatric, cosmetic surgery, and dermatological
settings. Patients usually have a normal appearance, their preoccupation with an imagined
defective body part results in obsessional thinking and compulsive behavior, such as mirror
, checking and camouflaging. Patients' false assumptions about the importance of appearance,
fear of rejection by others, perfectionism, and conviction of being disfigured lead to
overwhelming emotions of disgust, shame, and depression. May be obsessed to the point of
having repeated surgeries (e.g. Michael Jackson's obsession with his nose)
9. Identify signs and symptoms of: Dissociative Disorders - Answer-Dissociative Disorders: Respond
to unusually stressful experiences with a severe interruption of consciousness and awareness of
themselves and their environment. The DSMIVTR defines it as disturbances in the normally well-
integrated continuum of consciousness, memory, identity, and perception. Unconscious defense
mechanism against anxiety, they are not delusional or hallucinating. For a diagnosis of
dissociative disorder to be made, medical and neurological illnesses, substance abuse, and other
co-existing psychiatric disorders must be R/O as the cause of the patient's symptoms. Scales:
Dissociative Experience Scale (DES), Structured Clinical Interview for Dissociative Disorders (SCID-
D). The care plan: focus on safety and crisis intervention. They may need help to interrupt a
dissociative episode, such as singing or doing a specific activity.
10. Stems from a trauma usually experienced by that person. People can dissociate under normal
circumstances ("automatic pilot") - basically, going thru routine activities without thinking about
them. When a person who has experienced trauma and dissociate it, can be a problem! Ex:
sexual trauma, physical trauma. This may be a survival technique at that time.Dissociation:
coping mechanism.
11. Identify signs and symptoms of: Dissociative Identity Disorder: - Answer-Dissociative Identity
Disorder: 2+ distinct personality states that recurrently take control of behavior. Each alternate
personality (alter) or subpersonality has its own pattern of perceiving, relating to, and thinking
about the self and environment. It is believed that severe sexual, physical, or psychological
trauma in childhood predisposes an individual to the development of DID. Has two dissociative
identity states: 1) a state in which the individual blocks access and responses to traumatic
memories so they are able to function daily; 2) state fixated on traumatic injuries. Often the
original or primary personality is religious and moralistic, and the subpersonalities are pleasure
seeking and nonconforming. The alter personalities may behave as individuals of a different sex,
race, or religion. Also different: dominant hand, voice, intelligence ECG findings can also be
altered. Typical cognitive distortions include the insistence that alternate personalities inhabit
separate bodies and are unaffected by the actions of one another. The primary personality or
host is usually not aware of the subpersonalities and is perplexed by lost time and unexplained
events. Experiences common: finding unfamiliar clothing in the closet, or not having childhood
memories are characteristic. Transition from one personality to another occurs during time of
stress and may range from a dramatic to a barely noticeable event. Some patients experience
the transition when awakening. Shifts may last from minutes to months, although shorter
periods are more common.
, 12. ~ It is functional (coping mechanism) when used to get thru the abuse as a child but when still
being experienced/used as an adult, it is a problem (e.g. child abuse).
~ Usually treated in community, admitted to a psych unit when they are suicidal or in need of crisis
stabilizat
13. Identify signs and symptoms of: Conversion Disorder - Answer-Conversion Disorder - Marked by
the presence of deficits in voluntary motor or sensory functions, incl. paralysis, blindness,
movement disorder, gait disorder, numbness, parathesia, loss of vision/hearing, episodes
resembling epilepsy.
Many patients show a lack of emotional concern about the symptoms: La belle indifference, others
might be distressed though, serves as a coping mechanism to decrease anxiety. Care providers should
assume there is an ORGANIC CAUSE until physical pathology has been ruled out. Patients truly believe in
the symptoms, not fabricated or under voluntary control. Most common somatoform, most common in
females, lower SES, lower educational levels, rural areas, veterans exposed to combat. Childhood
physical or sexual abuse is common. Also common: depression, anxiety, etc.
Symptoms include: blindness, paralysis, loss of use of another limb
14. Organic causes are ruledout, and often the patient will show a lack of emotional concern about
the symptom.
15. Discuss the role of primary gain: - Answer-Discuss the role of primary gain: The anxiety relief
resulting from the use of defense mechanisms or symptom formation such as somatization. E.g.,
getting a headache instead of feeling angry; Alleviations of the symptoms that you see thru the
manifestations that they are having
16. What are personality disorders? - Answer-What are personality disorders? Mental illnesses
which individuals having in perceiving and relating to situations and people
a. Arise from rigid and unhealthy patterns of thinking and behavior that stay the same, no matter what
the situation is;
b. leads to problems in
i. school
ii. relationships
1. The major NTs associated with sleep are: - Answer-- Serotonin & GABA
- Banana: good for 5-HT
2. The major neuro-transmitters associated with wakefulness are
_______________________________, ____________________________________________&
______________________________________. - Answer-Dopamine, Acetylcholine,
Norepinephrine
3. Discuss the role that pain plays in sleep disorders and medications that are helpful for individuals
experiencing sleep initiation. - Answer-a) Fragmented and disrupted sleep may be caused by
chronic pain which will interrupt their sleep cycle and cause a problem.
b) If the patient is not responsive and can't communicate their pain to you - like Alzheimer's patients,
those with dementia etc. who have something going on that you know is painful, ex: trauma, etc... make
sure to medicate them, and become aware of their pain. Their body language, V/S
c) Sleep Hygiene practices: helpful to get to sleep!
a. Develop a pre-sleep routine that signals the end of the day
b. Maintain a regular sleep/wake schedule
c. Reserve bedroom for sleep/intimacy
d. Create sleep-conducive environment
e. Avoid clock watching
f. Limit caffeine1-2/day, none in the evening
g. Avoid heavy meals before mealtime
h. Use alcohol cautiously, and avoid use for several hours before bedtime
i. Avoid daytime napping (20-30 minutes)
j. Exercise daily but not right before bed
,*Medications are usually prescribed for no more than 2 weeks, because tolerance and withdrawal may
result.
4. The classification of medications that help patients initiate sleep and awaken without symptoms
of drowsiness are: - Answer-short-acting sedative hypnotics: take right before sleep since they
work faster than Benzo's. Hypnotic medications should always be used with caution. They can be
very sedating and addicting: follow-up with the doctor regularly as long as they are being taken.
5. Short-acting sedative hypnotics that are helpful for people who have problems with sleep
initiation incl. - Answer-a) Zolpidem (Ambien): give w/ food
b) Zaleplon (Sonata): 15-30 mins. onset of action.
c) Ramelteon (Rozerem)): non-habit forming medication that can be ordered for insomnia
d) Eszopiclone (Lunesta): causes longer sleeping, 7-8 hrs. Unpleasant taste upon waking up. Longer onset
of action. 60 mins.
e) Lou (Lunesta) hears a Sonata to prepare the Ambience (Ambien) for some Z's; Rose
6. Identify signs and symptoms of: Somatoform disorders - Answer-Somatoform Disorders: Cause
the person to feel they have physical pain and other symptoms r/t physical (medical problems)
which don't have a physical explanation. Person has a preoccupation with the symptoms they
are experiencing. Assessment will reveal repeated attempts to search for help for someone to
explain those symptoms to them. Symptoms seriously impair their social, occupational, and daily
functioning.
They are involuntary.
7. Somatization is characterized by a certain number of symptoms accompanied by significant
functional impairment. Pain, gastrointestinal concerns, and psychoneurological symptoms are
hallmarks of this condition. Complaints are dramatic and sometimes difficult to clarify.
8. Identify signs and symptoms of: Body dysmorphic disorder - - Answer-Body Dysmorphic
Disorder: Commonly seen in community, psychiatric, cosmetic surgery, and dermatological
settings. Patients usually have a normal appearance, their preoccupation with an imagined
defective body part results in obsessional thinking and compulsive behavior, such as mirror
, checking and camouflaging. Patients' false assumptions about the importance of appearance,
fear of rejection by others, perfectionism, and conviction of being disfigured lead to
overwhelming emotions of disgust, shame, and depression. May be obsessed to the point of
having repeated surgeries (e.g. Michael Jackson's obsession with his nose)
9. Identify signs and symptoms of: Dissociative Disorders - Answer-Dissociative Disorders: Respond
to unusually stressful experiences with a severe interruption of consciousness and awareness of
themselves and their environment. The DSMIVTR defines it as disturbances in the normally well-
integrated continuum of consciousness, memory, identity, and perception. Unconscious defense
mechanism against anxiety, they are not delusional or hallucinating. For a diagnosis of
dissociative disorder to be made, medical and neurological illnesses, substance abuse, and other
co-existing psychiatric disorders must be R/O as the cause of the patient's symptoms. Scales:
Dissociative Experience Scale (DES), Structured Clinical Interview for Dissociative Disorders (SCID-
D). The care plan: focus on safety and crisis intervention. They may need help to interrupt a
dissociative episode, such as singing or doing a specific activity.
10. Stems from a trauma usually experienced by that person. People can dissociate under normal
circumstances ("automatic pilot") - basically, going thru routine activities without thinking about
them. When a person who has experienced trauma and dissociate it, can be a problem! Ex:
sexual trauma, physical trauma. This may be a survival technique at that time.Dissociation:
coping mechanism.
11. Identify signs and symptoms of: Dissociative Identity Disorder: - Answer-Dissociative Identity
Disorder: 2+ distinct personality states that recurrently take control of behavior. Each alternate
personality (alter) or subpersonality has its own pattern of perceiving, relating to, and thinking
about the self and environment. It is believed that severe sexual, physical, or psychological
trauma in childhood predisposes an individual to the development of DID. Has two dissociative
identity states: 1) a state in which the individual blocks access and responses to traumatic
memories so they are able to function daily; 2) state fixated on traumatic injuries. Often the
original or primary personality is religious and moralistic, and the subpersonalities are pleasure
seeking and nonconforming. The alter personalities may behave as individuals of a different sex,
race, or religion. Also different: dominant hand, voice, intelligence ECG findings can also be
altered. Typical cognitive distortions include the insistence that alternate personalities inhabit
separate bodies and are unaffected by the actions of one another. The primary personality or
host is usually not aware of the subpersonalities and is perplexed by lost time and unexplained
events. Experiences common: finding unfamiliar clothing in the closet, or not having childhood
memories are characteristic. Transition from one personality to another occurs during time of
stress and may range from a dramatic to a barely noticeable event. Some patients experience
the transition when awakening. Shifts may last from minutes to months, although shorter
periods are more common.
, 12. ~ It is functional (coping mechanism) when used to get thru the abuse as a child but when still
being experienced/used as an adult, it is a problem (e.g. child abuse).
~ Usually treated in community, admitted to a psych unit when they are suicidal or in need of crisis
stabilizat
13. Identify signs and symptoms of: Conversion Disorder - Answer-Conversion Disorder - Marked by
the presence of deficits in voluntary motor or sensory functions, incl. paralysis, blindness,
movement disorder, gait disorder, numbness, parathesia, loss of vision/hearing, episodes
resembling epilepsy.
Many patients show a lack of emotional concern about the symptoms: La belle indifference, others
might be distressed though, serves as a coping mechanism to decrease anxiety. Care providers should
assume there is an ORGANIC CAUSE until physical pathology has been ruled out. Patients truly believe in
the symptoms, not fabricated or under voluntary control. Most common somatoform, most common in
females, lower SES, lower educational levels, rural areas, veterans exposed to combat. Childhood
physical or sexual abuse is common. Also common: depression, anxiety, etc.
Symptoms include: blindness, paralysis, loss of use of another limb
14. Organic causes are ruledout, and often the patient will show a lack of emotional concern about
the symptom.
15. Discuss the role of primary gain: - Answer-Discuss the role of primary gain: The anxiety relief
resulting from the use of defense mechanisms or symptom formation such as somatization. E.g.,
getting a headache instead of feeling angry; Alleviations of the symptoms that you see thru the
manifestations that they are having
16. What are personality disorders? - Answer-What are personality disorders? Mental illnesses
which individuals having in perceiving and relating to situations and people
a. Arise from rigid and unhealthy patterns of thinking and behavior that stay the same, no matter what
the situation is;
b. leads to problems in
i. school
ii. relationships
