NUR2459 / NUR 2459: Final Exam (Latest 2024 / 2025) Mental & Behavioral Health Nursing – Rasmussen. Questions and Correct Answers (Graded A+)

1. In dealing with personality disorders, manipulation can be a behavior seen. What is a key in dealing with this type of behavior? o Consistency 2. What are examples of manipulation? o Arguing or begging. o Flattery or seductiveness. o Instilling guilt, clinging. o Constantly seeking attention. o Pitting one person, staff, or group against another. o Frequently disregarding the rules. o Constant engagement in power struggles. o Angry, demanding behaviors. 3. What are physical complications from anorexia nervosa? o Bradycardia o Cardiac murmurs o Sudden cardiac arrest o Electrolyte imbalance o Increased cholesterol o Amenorrhea o Abnormal thyroid o Hematuria o Proteinuria4. What are possible signs and symptoms of anorexia nervosa? o Terror of gaining weight. o Preoccupation with thoughts of food. o View of self as fat even when emaciated. o Peculiar handling of food: cutting food into small bits, pushing pieces of food around. 5. What is milieu therapy for anorexia nervosa? o Precise mealtimes o Adherence to the selected menu o Observation during and after meals o Regularly scheduled weighings (key clue). o Close supervision of patients includes monitoring of all trips to the bathroom after eating. 6. Priority concern for a client with an eating disorder? o Electrolyte imbalances 7. What would be an important part of therapy for bulimia nervosa? o Identifying triggers 8. When dealing with any somatic disorder, what must be done? o Medical rule out 9. Types of Opioids o Heroin o Morphine o Codeineo Fentanyl o Methadone 10. What are symptoms of opioid overdose? o Constricted pupils o Decreased respirations o Decreased blood pressure o Slurred speech o Drowsiness. 11. What is Naloxone (Narcan)? o An opiate antagonist often given to people who have overdosed on an opiate. 12. Signs of opioid withdrawal o Lacrimation o Rhinorrhea o Sweating o Yawning o Anxiety o Hypertension o Tachycardia o Nausea/Vomiting o Abdominal cramps o Muscle/Joint pains13. Types of CNS Depressants o Alcohol o Barbiturates o Benzodiazepines o Hypnotic sedatives 14. What are symptoms of CNS depressant withdrawal? o Nausea and vomiting o Tachycardia o Diaphoresis o Anxiety o Irritability o Tremors in hands, fingers, or eyelids 15. What are used during alcohol withdrawal to help a patient with symptoms? o Benzodiazepines 16. What would be a potential clue a client is advancing into delirium tremens? o Hallucinations 17. What are possible predictive factors of violence? o Increasing anxiety and tension: clenched jaw or fist, rigid posture, fixed or tense facial expression, mumbling to self (patient may have shortness of breath, sweating, and rapid pulse rate). o Verbal abuse: profanity, argumentativeness, loud voice, change of pitch, or very soft voice forcing others to strain to hear. Intense eye contact or avoidance of eye contact. 18. The rationale for assessing everyone in regards to domestic violence?o Because victims are unlikely to self-report. 19. A client declines treatment after a sexual assault, the nurse would still need to do what? o Provide the client with referral and follow-up care information. 20. __________ abuse of ___________ and _____________ is required mandatory reporting. o Suspected, children, elderly 21. What are the Hallmark signs of the progressing disease (dementia)? o 4 A's (amnesia, aphasia, apraxia, and agnosia) ▪ Amnesia: Loss of memory. ▪ Aphasia: Loss of ability to understand or express speech. ▪ Apraxia: Inability to perform particular purposive actions. ▪ Agnosia: Inability to interpret sensations. 22. What drugs are used during the mild-moderate stages of dementia? o Cholinesterase inhibitors or NMDA (Aricept/Exelon or Namenda) 23. Encouraging dementia clients to do this ___________ allows them to be able to remember accomplishments and shared joys which helps distract patient from deficit and gives meaning to existence. o Reminiscing 24. What is the purpose of reminiscing? o Allows them to distract from deficits and give them meaning. 25. What should be done when a patient with dementia demands to leave because they need to get home for an appointment? o Reorient them to time and place, and let them know they are safe. 26. What are the rights the caregiver of dementia has? o Easy access to services.o Respite care. o Full involvement in decision making. o Information and referral. o Case management: coordination of community resources and follow-up. 27. Consider this nursing diagnosis as a priority for patients with dementia. o Risk for injury 28. Dementia is (reversible or irreversible) and has a (slow or rapid) onset. o Irreversible, slow 29. Delirium is (reversible or irreversible) and has a (slow or rapid) onset. o Reversible, rapid 30. What are common causes of delirium? o Surgery o Drugs o Urinary tract infections o Pneumonia o Cerebrovascular disease o Congestive heart failure o THINK: ▪ Toxins ▪ Hypoxemia ▪ Infection▪ Non-pharm (sleep, etc.) ▪ K+ Electrolytes 31. What is a priority nursing concern while caring for a client with delirium? o Safety o Treating underlying cause 32. What could assist with daily living activities with dementia patients? o Orientation tools ▪ Large-faced clocks ▪ Routine schedules 33. What are causes of dementia? o Age o Degeneration of the cerebral cortex 34. What are personality disorders? o Traits are exaggerated and rigid to the point that they cause dysfunction in their relationships. 35. What is a client with antisocial personality disorder? o Have a sense of entitlement, which means they believe they have the right to hurt others, take what they want, treat others unfairly, destroy property. 36. What is dependent personality disorder? o Perceive themselves as being unable to separate from others, work independently, or function at all on their own. 37. What is a client with borderline personality disorder? o Utilizes common responses to threats of separation or rejection include self-mutilation and suicide-prone behaviors.Module 7 – Nursing Care for Clients with Personality Disorders and Eating Disorders NURSING INTERVENTIONS Cluster A • Focus on safety and communication Cluster B • Focus on dealing with manipulation (boundary setting) • If client exhibits splitting behaviors, talk directly to other nurse rather than taking patient’s word Cluster C • Focus on social skills training, reduce anxietyBorderline and Antisocial Personality Disorders Anticipated behaviors, nursing interventions, treatment • A pervasive pattern of unstable relationships • Fluctuating extreme attitudes about people • Fear of real or imagined abandonment • Highly impulsive • Most common personality disorder • No regard to boundaries • Recurrent suicide attempts and self-destructive behaviors • “I hate you, don’t leave me” • Chronic depression • Inability to be alone • Manipulative • Chronic feelings of emptiness • Inappropriate anger • Suicidal gestures to elicit a rescue response from others• A pattern of socially irresponsible, exploitive and guiltless behavior since age 15 • Oldest and best researched of the personality disorders • More common in men • Fails to conform to social norms • Deceitfulness • Aggressive • Impulsive • Disregard for the law • Lack of remorseAssess the patient for a short period before labeling him or her as manipulative. Set limits on manipulative behaviors: • Arguing or begging • Using flattery or seductiveness • Instilling guilt and clinging • Constantly seeking attention • Pitting one person, staff member, or group against another • Frequently disregarding the rules • Constant engaging in power struggles • Exhibiting angry, demanding behaviors • Behaviors should be objectively documented (e.g., time, date, circumstances). • Provide clear boundaries and consequences. • Enforce consequences. Avoid: • Discussing yourself or other staff members with patient • Promising to keep a secret • Accepting gifts from patient • Doing special favors for patient Borderline and Antisocial Personality Disorders Anticipated behaviors, nursing interventions, treatment optionsBorderline and Antisocial Personality Disorders Anticipated behaviors, nursing interventions, treatment options • Interpersonal Psychotherapy • Psychoanalytic Psychotherapy • Group Therapy • Dialectical Behavior Therapy • Cognitive Behavior Therapy • Psychopharmacology • Creating a therapeutic relationship is difficult. • Most health care providers have experienced interrupted therapeutic alliances. • Suspiciousness, aloofness, and hostility will set up failure. • Guarded and secretive style produces an atmosphere of combativeness. • When patients blame or attack others, the nurse needs to understand the context of the complaints. • Attacks spring from a feeling of being threatened.Understand nursing interventions for dealing with manipulation and splitting behaviors • Set limits on manipulative behaviors: • Arguing or begging • Using flattery or seductiveness • Instilling guilt and clinging • Constantly seeking attention • Pitting one person, staff member, or group against another • Frequently disregarding the rules • Constant engaging in power struggles • Exhibiting angry, demanding behaviors • Behaviors should be objectively documented (e.g., time, date, circumstances). • Provide clear boundaries and consequences. Avoid: • Discussing yourself or other staff members with patient • Promising to keep a secret • Accepting gifts from patient • Doing special favors for patientUnderstand nursing interventions for dealing with manipulation and splitting behaviors Tx for BPD •Interpersonal Psychotherapy -May require long-term therapy to understand and modify maladaptive behaviors. •Psychoanalytical Psychotherapy - Focuses on unconscious motivation/need for seeking total satisfaction from others. •Milieu/Group Therapy - Appropriate for others who respond more adaptively to support and feedback from peers. •Cognitive/Behavioral Therapy - This therapy helps the client recognize and correct internal mental schemata. •Dialectical Behavior Therapy - This therapy was developed by Marsha Linehan as treatment for the chronic, self-injurious behavior of clients with a borderline personality disorder. Four primary modes of treatment: • Group skills training – Clients are taught skills relevant to dealing with particular problems. • Individual psychotherapy – weekly sessions to address dysfunctional behavior patterns. • Telephone contact – Therapist is available by phone. This is to give the client support in applying skills. • Therapist consultation/team meeting – The therapists meet regularly to discuss work with their clients.Describe theory regarding personality: Mahler, Sullivan, Erikson Mahler – R/t borderline personality disorder; Love is there when child is good, taken away when child does something wrong Hint: “Mahler” sounds like “Mother”; Mother’s emotions affects child, leading to BPD, focuses on abandonment • Theory on separation and individuation • Believed that children exist in a symbiotic phase until six months • Normal autistic phase • First weeks of life • Little social engagement • Mahler abandoned this phase later in her career. • Normal symbiotic phase • Through first six months • Occurs when child gains awareness of caregivers but no sense of individuality • Separation-individuation • Four or five months • Child begins to develop sense of self, separate from mother • Subphases of separation-individualization that proceed in a predictable order: • Differentiation, or “hatching,” occurs when the child first gains awareness that he or she is separate from the mother. • Practicing occurs as the child becomes a toddler, gaining motor skills that enable the child to explore the world independently from his or her caregivers. • Rapprochement marks a “backing off” from separation, as the child becomes anxious about separating from his or her mother and tries to regain closeness. This can lead to separation anxiety and abandonment fears. As a child develops language skills, this phase winds down.Describe theory regarding personality: Mahler, Sullivan, Erikson Sullivan - Emphasized the fact that early relationships with the parenting figure is crucial for personality development; All human beings are driven for the need for interaction. The purpose of all behavior is to get needs met through interpersonal interactions and reduce anxiety.Describe theory regarding personality: Mahler, Sullivan, Erikson If someone is reflecting in an earlier stage, it is According to Erikson, a person’s personality continued to evolve throughout the life span. The successful or unsuccessful completion of each stage affects the person moving to the next phase. not normalAnorexia and Bulimia – Anticipated findings and thought processes Primary concern: Nutrition r/t electrolyte imbalance • **Hypokalemia Dysrhythmia Death • Eating disorders = physiological needs Nursing interventions: Nutrition, electrolytes, redirect • Psych: Therapy • Anorexia: cognitive distortions • Bulimia/Binge: identify triggers • No bathroom alone • Weighing schedule, not random weights – decreases anxiety, builds rapportModule 7 – Pulse Check – Prof. Wilhelm In dealing with personality disorders, manipulation can be a behavior seen. What is the key in dealing with this type of behavior? “Consistency” What are some “hallmark” behaviors for antisocial personality disorders? Disregard for rules- does not conform to society- manipulative What are some “hallmark” behaviors for borderline personality disorders? Extremes in relationships- “love-you-hate-you”- fears of abandonment- self injury- manipulation What therapy was developed to help the suicidal ideations/self-injury for BPD? Dialectical Behavioral Therapy What are physical complications from anorexia nervosa? Bradycardia, Cardiac murmur, Sudden cardiac arrest, Prolonged QT interval, Electrolyte imbalances, Osteoporosis, Fatty degeneration of liver, Elevated cholesterol levels, Amenorrhea, Abnormal thyroid functioning, Hematuria, Proteinuria What are physical complications from bulimia nervosa? Cardiomyopathy, Cardiac dysrhythmias, Sinus bradycardia, Sudden cardiac arrest, Orthostatic Blood Pressure, Electrolyte imbalances, Dehydration, Attrition and erosion of teeth, Loss of dental arch, Diminished chewing ability Parotid gland enlargement Esophageal tears, Gastric dilation What would be a priority nursing concern be for a client with an eating disorder? Electrolyte imbalances- specifically hypokalemiaWhat would be an important part of therapy for bulimia nervosa? Identify triggersModule 8 – Nursing Care for Clients with Stress-Related Disorders Anxiety Psychological response • Mild – Sharpened senses, increased motivation • Moderate – Selective attentive, immediate task focused • Severe – Single detailed focused, cannot complete task • Panic – Loss of rational thought, can’t communicate verbally Physiological response • Mild – Restlessness, fidgeting, butterflies • Moderate – Muscle tension, sweating, GI upset • Severe – NVD, pale, tachycardia, trembling • Panic – Immobile, mute, or may bolt and run • Fight or flight Tx: Mild to moderate – Verbally deescalate • Goal: Prevent panic level anxiety Tx: Severe to Panic – Reduce stimuli, not leave alone, safety, potential med • Goal: Safety • Illness Anxiety Disorder – Hypochondriac • Conversion disorder – Presents with actual symptoms because of their anxiety (Pseudocyesis)• Panic vs. Dissociative – Panic patient is aware of emotions and symptoms, dissociative is acting subconsciouslyModule 8 – Pulse Check – Prof. Wilhelm (with additional information from overview) What are hallmark symptoms of obsessive-compulsive disorder (OCD?) • Obsessions and Compulsions • Obsessive thoughts • Compulsions usually associated with obsessive thought • Purpose of compulsion: Temporarily relieve anxiety • Psych Tx: Try to delay response, thought blocking activities • Not psych floor: Plan and allow for behaviors to occur • Not many medications available Compare and Contrast Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) • Compare • Same symptoms- nightmares, flashbacks, hypervigilance, emotional withdrawal • Same triggers – traumatic events • Risk of violence toward others d/t hyper arousal • Contrast – Time • Acute stress disorder - Event occurred within 3 months, symptoms RESOLVE within 1 month • PTSD- Event occurred greater than 3 months and symptoms are persistent. • Tx: Symptom management, EMDR therapy for PTSD, group therapy Benzodiazepines- nursing knowledge- client education Nursing knowledge • Short-term and as needed (PRN) due to the possible risk of dependency • Certain client histories may need to be evaluated (Hx alcohol abuse or previous suicide attempt Client education • Take as directed • Side effects: dizziness/sedation, potential dependency/abuse, blurred vision, dry mouth, sedation • Do not take any other CNS depressants such as alcohol • Do not drive until you know how this medication will affect you • Do not discontinue abruptly • -lams and -pams (and chlordiazepoxide)Buspirone (Not benzo) – Non-addictive, long-term, mild side effects, takes 3-4 weeks to reach max effectivenessModule 8 – Pulse Check – Prof. Wilhelm (with additional information from overview) When dealing with a client with a somatic disorder (Somatoform) - what would become a priority? • Medical rule out (Ensure not caused by medical issue) • Matter of fact approach regarding symptoms • Shift focus of conversation to more emotional basis • Making self sick or someone else sick for selfish benefit (attention) • Refocus on emotions/anxiety, not symptoms Body dysmorphic disorder • Perceived flaw • High risk of suicide (d/t no fix since it is perceived) What could trigger a dissociative state? • A traumatic event Dissociative disorders Dissociative identity disorder • Previously multiple personality disorder • Typically caused by trauma • Presents as entirely different person (can speak different language) Dissociative fugue • Like a “Fugitive” (Flees) • Trauma leads to fleeing and starting new life • Unsure who they are or their history • Diagnosed after resolution d/t insufficient knowledge while affected Dissociative amnesia – Black hole in memory • Both fugue and amnesia may be caused by severe trauma/PTSD • Tx: TherapyWhat is a possible treatment for phobias? • Systematic desensitization- gradual exposure to the object/situation over timeModule 9 – Mental Healthcare for Children and Adolescents Conduct disorder (Kid version of antisocial personality disorder) • Repetitive/persistent pattern of behavior that violates rights of others • Bullying, using weapons, deliberate destruction of property • Childhood onset – At least 1 symptom prior to 10yo • Adolescent onset – No symptoms before age 10 • Tx: Try to build empathy ADHD • Issues with following rules, paying attention, distracted, forgetful, impaired time management • Tx: Med - CNS stimulants, provide simple instructions broken into small tasks at a time and have them repeat • Monitor for insomnia, decreased appetite Oppositional defiant disorder • Characterized by angry/irritable mood, defiant behavior for at least 6 months • Tx: Behavior modification Autism spectrum disorder • Classified by level of support • Deficits in social relationships • Resistance to change – Strict adherence to routines/rituals • Potential for self-injuryModule 9 – Pulse Check – Prof. Wilhelm Compare and Contrast Oppositional Defiant Disorder and Conduct Disorder •Compare- Affects children/adolescents- often behavioral modification can be used as treatment option, meds are used for symptoms •Contrast- ODD is more about refusal to engage, follow the rules, obey authority whereas Conduct Disorder shows aggression, can have physical harm to others and animal, they feel no empathy or remorse (precursor to Antisocial Personality Disorder) What are some ways to handle the behaviors of ADHD? •Consistency in all forums (home, school), parent involvement to help maintain consistency; medications can be used such as CNS Stimulants How does the Autism Spectrum Disorder rate dysfunction? • Based on degree of assistance and support needed • Level 1: requires support • Example: person who able to speak in full sentences and engages in communication but to- and-from conversation with others fails and attempts to make friends; odd and typically unsuccessful • Difficulty switching between activities • Problems of organization and planning hamper independence • Level 2: requires substantial support • Example: Speaks simple sentences • Interaction is limited to narrow special interests • Markedly odd nonverbal communication • Distress and/or difficulty changing focus or action • Level 3: requires very substantial support • Example: Few words of intelligible speech • Rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only • Responds to only very direct social approaches • Great distress/difficulty changing focus or actionModule 10 – Factors that Affect Healthcare in Certain Populations •2 Protected populations • Children • Elderly •Nursing interventions • Suspect Report • Suspected: Multiple bruises in different stages of healing, does the story match developmental stage, delay in treatment • Cycle of intimate partner violence (IPV) • Provide information, education, resources – Help them have a plan • Do appear judgmentalModule 10 – Factors that Affect Healthcare in Certain Populations • DABDA • Not always steady or structured • Perception of death • Birth – 2 years old • Unable to understand, but react to emotions of adults (irritable/crying more) • 3-5 years old • Difficulty distinguishing between fantasy and reality • Believes death is reversible • Guilt (may feel at fault for the death) • Feel like there may be a threat to themselves or family • 6-9 years old • Beginning to understand permanence of death • Reactions: Regression, aggression, withdrawn, somatic symptoms, clinging behavior • 10-12 years old • Understand finality of death • Feelings of anger, guilt, depression • Peer relationships and school performance may be affected • Adolescents • Withdrawn or attempt to continue activities to avoid pain of the loss • Potential aggressive or defiant • Adults • Concept is influenced by experimental, cultural, religious beliefs • Older adults • May be difficult to complete the grief process in response of one loss before another occurs • Potential for bereavement overload Nursing interventions: Evaluate for risk of suicideModule 10 – Pulse Check – Prof. Wilhelm What is the rationale for assessing domestic violence risk in all clients? •Because victims are unlikely to self-report If a client declines treatment after sexual assault, what would the nurse still need to do? •Provide referral and follow-up information Considered to be vulnerable populations, and requires mandatory reporting of •Children and elderly adults, suspected abuse- does not need to be validated Describe the cycle of violence: •Tension-building phase- minor incidents•Major battering incident- may seek help, may cover up •Honey-moon phase- the abuser becomes kind, nice, apologizes, gift-giving… this reinforces to the person being abused the possibility of them changing…