NUR1212C -HEALTH ALTERATIONS
ACROSS THE LIFE SPAN 1: MENTAL
HEALTH DISORDERS EXAM AND
CORRECT ANSWERS.
MILIEU THERAPY (SECLUSION) - Answer PROVIDES COMFORT AND RELIEF TO MANY PATIENTS
WHO CAN NO LONGER CONTROL THEIR OWN BEHAVIOR, AND SECLUSION SERVES THE
FOLLOWING PURPOSES: REDUCES OVERWHELMING ENVIRONMENTAL STIMULI; PROTECTS A
PATIENT FROM INJURING SELF, OTHERS , OR STAFF; PREVENTS DESTRUCTION OF PERSONAL
PROPERTY OR PROPERTY OF OTHERS
MOOD - Answer HOW THE PATIENT IS FEELING
AFFECT - Answer THE OBSERVABLE RESPONSE OF HOW A PATIENT FEELS
FLAT AFFECT - Answer IMMOBILE FACIAL EXPRESSION OR A BLANK LOOK;THE PATIENT MAY
NOT MAKE EYE CONTACT, SPEAK IN A MONOTONE, MAY SHOW LITTLE OR NO FACIAL
EXPRESSION AND MAY ONLY ANSWER WITH YES OR NO ANSWERS. SIGHING IS COMMON
BLUNTED AFFECT - Answer MINIMAL EMOTIONAL RESPONSE
BIZARRE AFFECT - Answer especially prominent in the disorganized form of schizophrenia and
includes grimacing, giggling, and mumbling to oneself. Bizarre affect is marked when the patient
is unable to relate logically to the environment.
AFFECTIVE INSTABILITY - Answer ANY COMBINATION OF AGITATION, SADNESS, ELATION OR
BLUNTING
BLUNTING - Answer AN ABSENCE OR DIMINISHED PRESENCE OF ANY AFFECT AND THIS
SHOULD BE CONSIDERED A SIGN OF AFFECTIVE INSTABILITY; MAY NOT BE NOTICEABLE RIGHT
AWAY ; SPEECH MAY BE MONOTONE; RESPONSES MAY BE UNUSUALLY BRIEF; MAY MASK
DANGEROUSLY UNSTABLE AFFECT
LABILE MOOD - Answer MOOD THAT CHANGES QUICKLY; FOR EXAMPLE AN ABRUPT CHANGE
OF LAUGH TO ANGER OR CRYING
INAPPROPRIATE AFFECT - Answer AN EMOTIONAL RESPONSE TO A SITUATION THAT IS NOT
CONGRUENT WITH THE TONE OF THE SITUATION.
EXAMPLE: PATIENT LAUGHS WHEN TOLD THAT HER FATHER DIED
,SPLITTING STAFF - Answer A WAY TO DISTRACT STAFF AND LOOSEN STAFF LIMITS.
EXAMPLE: THE PATIENT TURNS STAFF MEMBERS AGAINST OTHER STAFF MEMBERS, OR AGAINST
GROUPS OF STAFF ( DAY STAFF VS. NIGHT STAFF), THE PATIENT MIGHT TELL ONE STAFF MEMBER
"MS DIAZ, YOU ARE THE BEST. YOU ARE THE ONLY NURSE WHO LISTENS TO ME, AND SEEMS TO
CARE, UNLIKE MR PETERS, WHO HARDLY LOOKS AT ME AND SAYS SUCH UNFAIR THINGS ABOUT
YOU." MEANWHILE THE PATIENT TELLS MR PETERS , "THANK GOD YOU ARE HERE. MS DIAZ IS
SO COLD AND UNCARING, AND I HATE TO SAY THIS BUT SHE SAYS TERRIBLE THINGS ABOUT
YOU:. NOW DISSENSION AMONG STAFF MEMBERS LOOSENS THE STAFF'S ENFORCEMENT OF
LIMITS, AND THE PATIENT REMAINS IN CONTROL. THIS TACTIC OF SPLITTING IS USED BY OTHER
PATIENT GROUPS AS WELL SUCH AS BORDERLINE PERSONALTY DISORDER, ANTISOCIAL
PERSONALITY DISORDER, AND SUBSTANCE ABUSERS.
MANIA - Answer AN EXAGGERATED ELEVATED, EXPANSIVE, OR IRRITABLE MOOD
ACCOMPANIED BY A PERSISTENT INCREASE IN ACTIVITY AND/OR ENERGY
BIPOLAR I DISORDER - Answer AT LEAST 1 EPISODE OF "PERSISTENT OR ELEVATED, EXPANSIVE
OR IRRITABLE MOOD" (MANIA), CAUSING MARKED IMPAIRMENT IN SOCIAL AND
OCCUPATIONAL FUNCTIONING, MOST OFTEN ALTERNATING WITH MAJOR DEPRESSIVE
EPISODES. PSYCHOSIS MAY ACCOMPANY THE MANIC EPISODE, AND HOSPITALIZATION MAY BE
WARRANTED.
BIPOLAR DISORDER II - Answer HYPO-MANIC EPISODE(S) ALTERNATION WITH AT LEAST 1
MAJOR DEPRESSIVE EPISODE. PSYCHOSIS IS NOT PRESENT IN BIPOLAR II. THE HYPOMANIA
TENDS TO BE EUPHORIC AND THE DEPRESSION TENDS TO PLACE THE PATIENT AT A PARTICULAR
RISK FOR SUICIDE.' NO LESS SERIOUS THAN BIPOLAR 1 DISORDER, AS BOTH DISORDERS ARE
TYPICALLY ACCOMPANIED BY SERIOUS IMPAIRMENT IN WORK AND SOCIAL FUNCTIONING
CYCLOTHYMIA - Answer HYPOMANIC EPISODES ALTERNATING WITH MINOR DEPRESSIVE
EPISODES (AT LEAST 2 YEARS IN DURATION). INDIVIDUALS TEND TO HAVE IRRITABLE
HYPOMANIC EPISODES
UNIPOLAR DEPRESSION - Answer AFFECTS WOMEN MORE THAN MEN AND APPEARS LATER IN
LIFE. SLEEP DISTURBANCES MANIFEST AS GENERAL INSOMNIA, DIFFICULTY FALLING ASLEEP, OR
WAKING REPEATEDLY AT NIGHT. A LOSS OF APPETITE AND DIMINISHED INTEREST IN EATING ARE
COMMON. DEPRESSION MAY BE AGITATED (E.G. PACING, AND RESTLESSNESS) AND EPISODES
OFTEN LAST LONGER.
BIPOLAR DEPRESSION - Answer AFFECTS MEN AND WOMEN MORE EQUALLY THAN UNIPOLAR
DEPRESSION. ONSET IS USUALLY MUCH YOUNGER, IN THE VICINITY OF 18 YEARS OLD.
DISTURBANCES IN SLEEP MANIFEST AS HYPERSOMNIA, EXCESSIVE TIREDNESS, AND DIFFICULTY
MORNING WAKING. CHANGES IN APPETITE OFTEN TAKE THE FORM OF BINGE EATING AND
CRAVINGS FOR CARBOHYDRATES, WHICH MAY ALTERNATE WITH LOSS OF APPETITE. BIPOLAR
DEPRESSION IS MORE OFTEN MARKED BY PSYCHOMOTOR RETARDATION. PATIENTS WITH
, BIPOLAR DEPRESSION ARE ALSO AT HIGHER RISK OF DRUG ABUSE AND SUICIDE THAN THOSE
WITH UNIPOLAR DEPRESSION.
FLIGHT OF IDEAS - Answer A NEARLY CONTINUOUS FLOW ACCELERATED SPEECH WITH
ABRUPT CHANGES AMONG TOPICS THAT ARE USUALLY BASED ON UNDERSTANDABLE
ASSOCIATIONS OR A PLAY ON WORDS.
EXAMPLE: "HOW ARE YOU DOING KID, NO KIDDING AROUND, I'm GOING HOME..HOME SWEET
HOME..HOME IS WHERE THE HEART IS..THE HEART OF THE MATTER IS i WANT OUT, AND THEY
AIN'T HAY..HEY dOC..GET ME OUT OF THIS PLACE."
GRANDIOSITY - Answer INFLATED SELF REGARD IS APPARENT IN BOTH THE IDEAS EXPRESSED
AND THE PERSON'S BEHAVIOR. PEOPLE WITH MANIA MAY EXAGGERATE THEIR ACHIEVEMENTS
OR IMPORTANCE , STATE THAT THEY KNOW FAMOUS PEOPLE, OR BELIEVE THAT THEY HAVE
GREAT POWERS. THE BOAST OF EXCEPTIONAL POWERS AND STATUS CAN TAKE DELUSIONAL
PROPORTIONS IN MANIA.
BRAIN STIMULATING THERAPY : ECT - Answer THE PATIENT IS SEDATED AND A SEZIURE
LASTING LESS THAN 1MINUTE IS INDUCED WITH ELECTRICITY THROUGH ELECTRODES PLACED
AT PRECISE LOCATIONS; GENERAL COURSE OF TREATMENT IS 3 SESSIONS PER WEEK FOR 4
WEEKS; COMMON SIDE EFFECTS INCLUDE HEADACHES, NAUSEA, MUSCLE ACHES, AND
OCCASIONAL LOSS OF MEMORY; AFTER THE PROCEDURE NURSES SHOULD MONITOR THE
AIRWAY AND MENTAL STATUS AND ASSIST THE PATIENT BY ORIENTING HIM/HER AS IN ANY
POST-OP PROCEDURE.
CATATONIA - Answer EXTREME ABNORMAL MOTOR BEHAVIOR
BIZARRE POSTURING - Answer HOLDING ARMS OR LEGS RIGIDLY OR BENT AT SEVERAL ANGLES
FOR A LONG PERIOD OF TIME
WAXY FLEXIBILITY - Answer WHEN A LEG OR ARM IS PLACED IN AN AWKWARD POSITION BY
SOMEONE ELSE, THE PATIENT WILL HOLD THAT POSITION FOR A UNCOMFORTABLE PERIOD OF
TIME
ideas of reference
schizophrenic delusion - Answer The patient frequently misinterprets the messages of others
or gives private meaning to the communications of others
example: When Maria saw the doctor and nurse talking together, she believed they were
plotting against her. When she heard on the radio that a hurricane was coming, she believed
this was really a message that harm was going to befall her.
ACROSS THE LIFE SPAN 1: MENTAL
HEALTH DISORDERS EXAM AND
CORRECT ANSWERS.
MILIEU THERAPY (SECLUSION) - Answer PROVIDES COMFORT AND RELIEF TO MANY PATIENTS
WHO CAN NO LONGER CONTROL THEIR OWN BEHAVIOR, AND SECLUSION SERVES THE
FOLLOWING PURPOSES: REDUCES OVERWHELMING ENVIRONMENTAL STIMULI; PROTECTS A
PATIENT FROM INJURING SELF, OTHERS , OR STAFF; PREVENTS DESTRUCTION OF PERSONAL
PROPERTY OR PROPERTY OF OTHERS
MOOD - Answer HOW THE PATIENT IS FEELING
AFFECT - Answer THE OBSERVABLE RESPONSE OF HOW A PATIENT FEELS
FLAT AFFECT - Answer IMMOBILE FACIAL EXPRESSION OR A BLANK LOOK;THE PATIENT MAY
NOT MAKE EYE CONTACT, SPEAK IN A MONOTONE, MAY SHOW LITTLE OR NO FACIAL
EXPRESSION AND MAY ONLY ANSWER WITH YES OR NO ANSWERS. SIGHING IS COMMON
BLUNTED AFFECT - Answer MINIMAL EMOTIONAL RESPONSE
BIZARRE AFFECT - Answer especially prominent in the disorganized form of schizophrenia and
includes grimacing, giggling, and mumbling to oneself. Bizarre affect is marked when the patient
is unable to relate logically to the environment.
AFFECTIVE INSTABILITY - Answer ANY COMBINATION OF AGITATION, SADNESS, ELATION OR
BLUNTING
BLUNTING - Answer AN ABSENCE OR DIMINISHED PRESENCE OF ANY AFFECT AND THIS
SHOULD BE CONSIDERED A SIGN OF AFFECTIVE INSTABILITY; MAY NOT BE NOTICEABLE RIGHT
AWAY ; SPEECH MAY BE MONOTONE; RESPONSES MAY BE UNUSUALLY BRIEF; MAY MASK
DANGEROUSLY UNSTABLE AFFECT
LABILE MOOD - Answer MOOD THAT CHANGES QUICKLY; FOR EXAMPLE AN ABRUPT CHANGE
OF LAUGH TO ANGER OR CRYING
INAPPROPRIATE AFFECT - Answer AN EMOTIONAL RESPONSE TO A SITUATION THAT IS NOT
CONGRUENT WITH THE TONE OF THE SITUATION.
EXAMPLE: PATIENT LAUGHS WHEN TOLD THAT HER FATHER DIED
,SPLITTING STAFF - Answer A WAY TO DISTRACT STAFF AND LOOSEN STAFF LIMITS.
EXAMPLE: THE PATIENT TURNS STAFF MEMBERS AGAINST OTHER STAFF MEMBERS, OR AGAINST
GROUPS OF STAFF ( DAY STAFF VS. NIGHT STAFF), THE PATIENT MIGHT TELL ONE STAFF MEMBER
"MS DIAZ, YOU ARE THE BEST. YOU ARE THE ONLY NURSE WHO LISTENS TO ME, AND SEEMS TO
CARE, UNLIKE MR PETERS, WHO HARDLY LOOKS AT ME AND SAYS SUCH UNFAIR THINGS ABOUT
YOU." MEANWHILE THE PATIENT TELLS MR PETERS , "THANK GOD YOU ARE HERE. MS DIAZ IS
SO COLD AND UNCARING, AND I HATE TO SAY THIS BUT SHE SAYS TERRIBLE THINGS ABOUT
YOU:. NOW DISSENSION AMONG STAFF MEMBERS LOOSENS THE STAFF'S ENFORCEMENT OF
LIMITS, AND THE PATIENT REMAINS IN CONTROL. THIS TACTIC OF SPLITTING IS USED BY OTHER
PATIENT GROUPS AS WELL SUCH AS BORDERLINE PERSONALTY DISORDER, ANTISOCIAL
PERSONALITY DISORDER, AND SUBSTANCE ABUSERS.
MANIA - Answer AN EXAGGERATED ELEVATED, EXPANSIVE, OR IRRITABLE MOOD
ACCOMPANIED BY A PERSISTENT INCREASE IN ACTIVITY AND/OR ENERGY
BIPOLAR I DISORDER - Answer AT LEAST 1 EPISODE OF "PERSISTENT OR ELEVATED, EXPANSIVE
OR IRRITABLE MOOD" (MANIA), CAUSING MARKED IMPAIRMENT IN SOCIAL AND
OCCUPATIONAL FUNCTIONING, MOST OFTEN ALTERNATING WITH MAJOR DEPRESSIVE
EPISODES. PSYCHOSIS MAY ACCOMPANY THE MANIC EPISODE, AND HOSPITALIZATION MAY BE
WARRANTED.
BIPOLAR DISORDER II - Answer HYPO-MANIC EPISODE(S) ALTERNATION WITH AT LEAST 1
MAJOR DEPRESSIVE EPISODE. PSYCHOSIS IS NOT PRESENT IN BIPOLAR II. THE HYPOMANIA
TENDS TO BE EUPHORIC AND THE DEPRESSION TENDS TO PLACE THE PATIENT AT A PARTICULAR
RISK FOR SUICIDE.' NO LESS SERIOUS THAN BIPOLAR 1 DISORDER, AS BOTH DISORDERS ARE
TYPICALLY ACCOMPANIED BY SERIOUS IMPAIRMENT IN WORK AND SOCIAL FUNCTIONING
CYCLOTHYMIA - Answer HYPOMANIC EPISODES ALTERNATING WITH MINOR DEPRESSIVE
EPISODES (AT LEAST 2 YEARS IN DURATION). INDIVIDUALS TEND TO HAVE IRRITABLE
HYPOMANIC EPISODES
UNIPOLAR DEPRESSION - Answer AFFECTS WOMEN MORE THAN MEN AND APPEARS LATER IN
LIFE. SLEEP DISTURBANCES MANIFEST AS GENERAL INSOMNIA, DIFFICULTY FALLING ASLEEP, OR
WAKING REPEATEDLY AT NIGHT. A LOSS OF APPETITE AND DIMINISHED INTEREST IN EATING ARE
COMMON. DEPRESSION MAY BE AGITATED (E.G. PACING, AND RESTLESSNESS) AND EPISODES
OFTEN LAST LONGER.
BIPOLAR DEPRESSION - Answer AFFECTS MEN AND WOMEN MORE EQUALLY THAN UNIPOLAR
DEPRESSION. ONSET IS USUALLY MUCH YOUNGER, IN THE VICINITY OF 18 YEARS OLD.
DISTURBANCES IN SLEEP MANIFEST AS HYPERSOMNIA, EXCESSIVE TIREDNESS, AND DIFFICULTY
MORNING WAKING. CHANGES IN APPETITE OFTEN TAKE THE FORM OF BINGE EATING AND
CRAVINGS FOR CARBOHYDRATES, WHICH MAY ALTERNATE WITH LOSS OF APPETITE. BIPOLAR
DEPRESSION IS MORE OFTEN MARKED BY PSYCHOMOTOR RETARDATION. PATIENTS WITH
, BIPOLAR DEPRESSION ARE ALSO AT HIGHER RISK OF DRUG ABUSE AND SUICIDE THAN THOSE
WITH UNIPOLAR DEPRESSION.
FLIGHT OF IDEAS - Answer A NEARLY CONTINUOUS FLOW ACCELERATED SPEECH WITH
ABRUPT CHANGES AMONG TOPICS THAT ARE USUALLY BASED ON UNDERSTANDABLE
ASSOCIATIONS OR A PLAY ON WORDS.
EXAMPLE: "HOW ARE YOU DOING KID, NO KIDDING AROUND, I'm GOING HOME..HOME SWEET
HOME..HOME IS WHERE THE HEART IS..THE HEART OF THE MATTER IS i WANT OUT, AND THEY
AIN'T HAY..HEY dOC..GET ME OUT OF THIS PLACE."
GRANDIOSITY - Answer INFLATED SELF REGARD IS APPARENT IN BOTH THE IDEAS EXPRESSED
AND THE PERSON'S BEHAVIOR. PEOPLE WITH MANIA MAY EXAGGERATE THEIR ACHIEVEMENTS
OR IMPORTANCE , STATE THAT THEY KNOW FAMOUS PEOPLE, OR BELIEVE THAT THEY HAVE
GREAT POWERS. THE BOAST OF EXCEPTIONAL POWERS AND STATUS CAN TAKE DELUSIONAL
PROPORTIONS IN MANIA.
BRAIN STIMULATING THERAPY : ECT - Answer THE PATIENT IS SEDATED AND A SEZIURE
LASTING LESS THAN 1MINUTE IS INDUCED WITH ELECTRICITY THROUGH ELECTRODES PLACED
AT PRECISE LOCATIONS; GENERAL COURSE OF TREATMENT IS 3 SESSIONS PER WEEK FOR 4
WEEKS; COMMON SIDE EFFECTS INCLUDE HEADACHES, NAUSEA, MUSCLE ACHES, AND
OCCASIONAL LOSS OF MEMORY; AFTER THE PROCEDURE NURSES SHOULD MONITOR THE
AIRWAY AND MENTAL STATUS AND ASSIST THE PATIENT BY ORIENTING HIM/HER AS IN ANY
POST-OP PROCEDURE.
CATATONIA - Answer EXTREME ABNORMAL MOTOR BEHAVIOR
BIZARRE POSTURING - Answer HOLDING ARMS OR LEGS RIGIDLY OR BENT AT SEVERAL ANGLES
FOR A LONG PERIOD OF TIME
WAXY FLEXIBILITY - Answer WHEN A LEG OR ARM IS PLACED IN AN AWKWARD POSITION BY
SOMEONE ELSE, THE PATIENT WILL HOLD THAT POSITION FOR A UNCOMFORTABLE PERIOD OF
TIME
ideas of reference
schizophrenic delusion - Answer The patient frequently misinterprets the messages of others
or gives private meaning to the communications of others
example: When Maria saw the doctor and nurse talking together, she believed they were
plotting against her. When she heard on the radio that a hurricane was coming, she believed
this was really a message that harm was going to befall her.
