CMN 350 PSYCHIATRIC-MENTAL HEALTH NURSING
EXAM #1
Why would someone need to be admitted into a psychiatric hospital? - Answers -If they
are:
-Dangerous to self or others
-Gravely disabled
-Acutely psychotic
-Suicidal or homicidal
If patient is acutely psychotic - Answers --They could be placed in a long term care
facility (e.g., group home)
-they can't take care of themselves
-most likely have schizophrenia
-may be going home with family who can take care of them
The nurse's role in psychopharmacological management - Answers --assess patients'
responses to medication, plan to respond to side effects should they occur, implement
those plans, and evaluate for desired results.
-has a pivotal role, particularly in an inpatient setting, allows intervention before serious
drug-related problems occur. In addition, administers medications and makes decisions
regarding as needed (prn) medications.
-needs a sound foundation in it to teach patients about drugs.
-must have immediate access to information about psychotropic drugs.
The nurse's role in the therapeutic nurse-patient relationship - Answers --is therapeutic
not a therapist
-communication skills
-respect and a desire to help
-understanding
•mental mechanisms
•adaptation styles
•coping strategies
•theraputic intervention skillls
The nurse's role in milieu management - Answers --can change the environment
-The five environmental elements that nurses must consider in creating a therapeutic
atmosphere are the following:
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.
,Nurses don't/aren't - Answers --therapist
-order drugs
-interpret testing
A nurse can disclose patient information when - Answers --the patient is a harm to self
or others
-under a subpoena
-court order
you need a court order to - Answers -force medication or you could be accused of
assault and battery
assault - Answers -making a threat to a client's person, such as approaching the client
in a threatening manner with a syringe in hand, is considered assault
battery - Answers -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 - Answers -↑______________ syndrome
↓depression
dopamine - Answers -↑Schizophrenia
↓Parkinson's
norepinephrine - Answers -↑hypertensive crisis
↓depression
GABA - Answers -↑seizures
↓anxiety
Glutamate - Answers -↑ Excitotoxicity leading to neuronal death
↓Psychotic thinking
Acetylcholine - Answers -↓Alzheimer disease
Priority when dealing with patients from a different culture - Answers --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) - Answers -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? - Answers -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 - Answers -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 - Answers --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.
EXAM #1
Why would someone need to be admitted into a psychiatric hospital? - Answers -If they
are:
-Dangerous to self or others
-Gravely disabled
-Acutely psychotic
-Suicidal or homicidal
If patient is acutely psychotic - Answers --They could be placed in a long term care
facility (e.g., group home)
-they can't take care of themselves
-most likely have schizophrenia
-may be going home with family who can take care of them
The nurse's role in psychopharmacological management - Answers --assess patients'
responses to medication, plan to respond to side effects should they occur, implement
those plans, and evaluate for desired results.
-has a pivotal role, particularly in an inpatient setting, allows intervention before serious
drug-related problems occur. In addition, administers medications and makes decisions
regarding as needed (prn) medications.
-needs a sound foundation in it to teach patients about drugs.
-must have immediate access to information about psychotropic drugs.
The nurse's role in the therapeutic nurse-patient relationship - Answers --is therapeutic
not a therapist
-communication skills
-respect and a desire to help
-understanding
•mental mechanisms
•adaptation styles
•coping strategies
•theraputic intervention skillls
The nurse's role in milieu management - Answers --can change the environment
-The five environmental elements that nurses must consider in creating a therapeutic
atmosphere are the following:
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.
,Nurses don't/aren't - Answers --therapist
-order drugs
-interpret testing
A nurse can disclose patient information when - Answers --the patient is a harm to self
or others
-under a subpoena
-court order
you need a court order to - Answers -force medication or you could be accused of
assault and battery
assault - Answers -making a threat to a client's person, such as approaching the client
in a threatening manner with a syringe in hand, is considered assault
battery - Answers -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 - Answers -↑______________ syndrome
↓depression
dopamine - Answers -↑Schizophrenia
↓Parkinson's
norepinephrine - Answers -↑hypertensive crisis
↓depression
GABA - Answers -↑seizures
↓anxiety
Glutamate - Answers -↑ Excitotoxicity leading to neuronal death
↓Psychotic thinking
Acetylcholine - Answers -↓Alzheimer disease
Priority when dealing with patients from a different culture - Answers --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) - Answers -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? - Answers -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 - Answers -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 - Answers --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.
