CMN 350 EXAM UPDATED SCRIPT QUESTIONS AND
SOLUTIONS RATED A+
✔✔battery - ✔✔touching a client in a harmful or offensive way. This could occur if the
nurse threatening a client with a syringe actually grabbed the client and gave an
injection.
✔✔serotonin - ✔✔↑______________ syndrome
↓depression
✔✔dopamine - ✔✔↑Schizophrenia
↓Parkinson's
✔✔norepinephrine - ✔✔↑hypertensive crisis
↓depression
✔✔GABA - ✔✔↑seizures
↓anxiety
✔✔Glutamate - ✔✔↑ Excitotoxicity leading to neuronal death
↓Psychotic thinking
✔✔Acetylcholine - ✔✔↓Alzheimer disease
✔✔Priority when dealing with patients from a different culture - ✔✔-Communication
1. Do you speak any foreign languages?
2. Is English your first language?
3. Does the patient speak English fluently?
4. Does the patient prefer an interpreter?
5. Does the patient believe that appropriate touching is acceptable?
6. Does the patient use ethnic behaviors?
✔✔5 areas of the milieu (environment) - ✔✔1. Safety: keeping the patient free from
danger or harm
2. Structure: the physical environment, regulations, and schedules
3. Norms: specific expectations of behavior (e.g., acceptance, nonviolence, privacy)
4. Limit setting: clear and enforceable limitations on behaviors
5. Balance: negotiating the line between dependence and independence.
✔✔What the nurse must know/ do about restraints and seclusion? - ✔✔Nurses who are
aware of the potential negative physical, psychological, and legal consequences
associated with restraint and seclusion are more apt to look for alternative strategies.
The most valuable interventions are aimed at preventing a patient's escalation in
behavior and loss of control. Attention to the nurse-patient relationship, therapeutic
,milieu, and principles of pharmacologic management can reduce the need for restrictive
measures. Guidelines issued by the CMS for use of restraint and seclusion are
substantially different in medically necessary and behavioral control situations. Although
laws differ from state to state, general guidelines for use in psychiatry include multiple
elements important for the nurse to document.
✔✔During the use of restraints and seclusion the nurse must document - ✔✔1. Staff
members involved in decisions to restrain or seclude and staff who apply or remove
restraints must receive special training and demonstrate competency.
2. Alternatives must be considered before the use of restraint and seclusion.
3. Might be allowed to implement restraint or seclusion in emergent situations, a
physician's order is required within 1 hour. Physician assistants and advanced practice
nurses can also write restraint and seclusion orders.
4. The least restrictive method or device possible must be chosen.
5. Should carefully write down events leading to the intervention and justification for
use.
6. Orders must contain the type of restraint, rationale for use, and time limitations.
7. As needed (prn) orders are not permitted. Each episode must be based on eminent
risk.
8. Restraint and seclusion are used for the shortest possible time. Must tell the patients
what behaviors are expected before release and reevaluate the patients at least every 2
hours for continued need of restraint and seclusion.
9. Patients must be observed constantly during restraint and seclusion, with
documentation of safety and comfort interventions at least every 15 minutes.
10. Patients must be debriefed after restrictive interventions.
11. Patients have the right to request notification of a family member or other person in
the event that restraints or seclusion are implemented.
12. Death of any patient while in restraints, even when restraints did not contribute to
death in the judgment of the health care provider, is required to be reported to the US
Food and Drug Administration (FDA).
✔✔Occupational Therapy - ✔✔-concerned with the functional abilities of patients as
these abilities affect their capacity to work and perform tasks of daily living.
-assist patients in mastering skills needed for self-care, work, and play.
✔✔Stress Adaptation Syndrome stages - ✔✔Stage I: Alarm Stage
Stage II: Resistance Stage
Stage III: Exhaustion Stage
✔✔Stage I: Alarm Stage - ✔✔Mobilization of the body's defensive forces and activation
of the potential for "fight or flight"; increase in alertness to mobilize defenses to alleviate
stressor (+ 1 to + 2 anxiety).
✔✔Stage II: Resistance Stage - ✔✔The body attempts to adapt to the ongoing stress
and tries to return to normal, within the person's capabilities (+ 2 to + 3 anxiety).
, ✔✔Stage III: Exhaustion Stage - ✔✔Loss of ability to resist stress because of depletion
of body resources; decreased resistance to disease (+ 3 to + 4 anxiety).
✔✔Mild anxiety - ✔✔-can exhibit behaviors such as finger- or foot-tapping, fidgeting, or
lip-chewing as mild tension-relieving behaviors.
✔✔Moderate anxiety - ✔✔-Ability to think is clearly hampered, but learning and
problem-solving can still occur
-Other characteristics include concentration difficulties, tiredness, pacing, change in
voice pitch, voice tremors, shakiness, and increased heart rate and respiratory rate.
-The client can report somatic manifestations including headaches, backaches, urinary
urgency and frequency, and insomnia.
-benefits from the direction of others
✔✔Severe anxiety - ✔✔-perceptual field is greatly reduced with distorted perceptions
-Learning and problem-solving do not occur
-functioning is ineffective
-other characteristics include confusion, feelings of impending doom, hyperventilation,
tachycardia, withdrawal, loud and rapid speech, aimless activity
-not able to take directions from others
✔✔Panic-level anxiety - ✔✔-characterized by markedly disturbed behavior
-not able to process what is occurring in the environment and can lose touch with reality
-experiences extreme fright and horror
-experiences severe hyperactivity or flight
-immobility can occur
-other characteristics can include dysfunction in speech, dilated pupils, severe
shakiness, severe withdrawal, inability to sleep, delusions, and hallucinations
✔✔defense mechanisms - ✔✔-patients use them to try and protect themselves from
pain
-they need to overcome that pain
-nurses should set goals for good coping mechanisms and teach good coping
mechanisms
✔✔altruism - ✔✔-adaptive
-dealing with anxiety by reaching out to others
✔✔sublimation - ✔✔-adaptive
-Consciously or unconsciously channeling instinctual drives into acceptable activities
-Guy, a former heroin addict, starts a local Narcotics Anonymous meeting.
✔✔Suppression - ✔✔-maladaptive
-Conscious exclusion from awareness anxiety-producing feelings, ideas, and situations
Aaron states to the nurse that his recent divorce is no big deal.
SOLUTIONS RATED A+
✔✔battery - ✔✔touching a client in a harmful or offensive way. This could occur if the
nurse threatening a client with a syringe actually grabbed the client and gave an
injection.
✔✔serotonin - ✔✔↑______________ syndrome
↓depression
✔✔dopamine - ✔✔↑Schizophrenia
↓Parkinson's
✔✔norepinephrine - ✔✔↑hypertensive crisis
↓depression
✔✔GABA - ✔✔↑seizures
↓anxiety
✔✔Glutamate - ✔✔↑ Excitotoxicity leading to neuronal death
↓Psychotic thinking
✔✔Acetylcholine - ✔✔↓Alzheimer disease
✔✔Priority when dealing with patients from a different culture - ✔✔-Communication
1. Do you speak any foreign languages?
2. Is English your first language?
3. Does the patient speak English fluently?
4. Does the patient prefer an interpreter?
5. Does the patient believe that appropriate touching is acceptable?
6. Does the patient use ethnic behaviors?
✔✔5 areas of the milieu (environment) - ✔✔1. Safety: keeping the patient free from
danger or harm
2. Structure: the physical environment, regulations, and schedules
3. Norms: specific expectations of behavior (e.g., acceptance, nonviolence, privacy)
4. Limit setting: clear and enforceable limitations on behaviors
5. Balance: negotiating the line between dependence and independence.
✔✔What the nurse must know/ do about restraints and seclusion? - ✔✔Nurses who are
aware of the potential negative physical, psychological, and legal consequences
associated with restraint and seclusion are more apt to look for alternative strategies.
The most valuable interventions are aimed at preventing a patient's escalation in
behavior and loss of control. Attention to the nurse-patient relationship, therapeutic
,milieu, and principles of pharmacologic management can reduce the need for restrictive
measures. Guidelines issued by the CMS for use of restraint and seclusion are
substantially different in medically necessary and behavioral control situations. Although
laws differ from state to state, general guidelines for use in psychiatry include multiple
elements important for the nurse to document.
✔✔During the use of restraints and seclusion the nurse must document - ✔✔1. Staff
members involved in decisions to restrain or seclude and staff who apply or remove
restraints must receive special training and demonstrate competency.
2. Alternatives must be considered before the use of restraint and seclusion.
3. Might be allowed to implement restraint or seclusion in emergent situations, a
physician's order is required within 1 hour. Physician assistants and advanced practice
nurses can also write restraint and seclusion orders.
4. The least restrictive method or device possible must be chosen.
5. Should carefully write down events leading to the intervention and justification for
use.
6. Orders must contain the type of restraint, rationale for use, and time limitations.
7. As needed (prn) orders are not permitted. Each episode must be based on eminent
risk.
8. Restraint and seclusion are used for the shortest possible time. Must tell the patients
what behaviors are expected before release and reevaluate the patients at least every 2
hours for continued need of restraint and seclusion.
9. Patients must be observed constantly during restraint and seclusion, with
documentation of safety and comfort interventions at least every 15 minutes.
10. Patients must be debriefed after restrictive interventions.
11. Patients have the right to request notification of a family member or other person in
the event that restraints or seclusion are implemented.
12. Death of any patient while in restraints, even when restraints did not contribute to
death in the judgment of the health care provider, is required to be reported to the US
Food and Drug Administration (FDA).
✔✔Occupational Therapy - ✔✔-concerned with the functional abilities of patients as
these abilities affect their capacity to work and perform tasks of daily living.
-assist patients in mastering skills needed for self-care, work, and play.
✔✔Stress Adaptation Syndrome stages - ✔✔Stage I: Alarm Stage
Stage II: Resistance Stage
Stage III: Exhaustion Stage
✔✔Stage I: Alarm Stage - ✔✔Mobilization of the body's defensive forces and activation
of the potential for "fight or flight"; increase in alertness to mobilize defenses to alleviate
stressor (+ 1 to + 2 anxiety).
✔✔Stage II: Resistance Stage - ✔✔The body attempts to adapt to the ongoing stress
and tries to return to normal, within the person's capabilities (+ 2 to + 3 anxiety).
, ✔✔Stage III: Exhaustion Stage - ✔✔Loss of ability to resist stress because of depletion
of body resources; decreased resistance to disease (+ 3 to + 4 anxiety).
✔✔Mild anxiety - ✔✔-can exhibit behaviors such as finger- or foot-tapping, fidgeting, or
lip-chewing as mild tension-relieving behaviors.
✔✔Moderate anxiety - ✔✔-Ability to think is clearly hampered, but learning and
problem-solving can still occur
-Other characteristics include concentration difficulties, tiredness, pacing, change in
voice pitch, voice tremors, shakiness, and increased heart rate and respiratory rate.
-The client can report somatic manifestations including headaches, backaches, urinary
urgency and frequency, and insomnia.
-benefits from the direction of others
✔✔Severe anxiety - ✔✔-perceptual field is greatly reduced with distorted perceptions
-Learning and problem-solving do not occur
-functioning is ineffective
-other characteristics include confusion, feelings of impending doom, hyperventilation,
tachycardia, withdrawal, loud and rapid speech, aimless activity
-not able to take directions from others
✔✔Panic-level anxiety - ✔✔-characterized by markedly disturbed behavior
-not able to process what is occurring in the environment and can lose touch with reality
-experiences extreme fright and horror
-experiences severe hyperactivity or flight
-immobility can occur
-other characteristics can include dysfunction in speech, dilated pupils, severe
shakiness, severe withdrawal, inability to sleep, delusions, and hallucinations
✔✔defense mechanisms - ✔✔-patients use them to try and protect themselves from
pain
-they need to overcome that pain
-nurses should set goals for good coping mechanisms and teach good coping
mechanisms
✔✔altruism - ✔✔-adaptive
-dealing with anxiety by reaching out to others
✔✔sublimation - ✔✔-adaptive
-Consciously or unconsciously channeling instinctual drives into acceptable activities
-Guy, a former heroin addict, starts a local Narcotics Anonymous meeting.
✔✔Suppression - ✔✔-maladaptive
-Conscious exclusion from awareness anxiety-producing feelings, ideas, and situations
Aaron states to the nurse that his recent divorce is no big deal.
