WCU - MH Final Exam Review 2023

Transference - Answer- tendency to assign feelings & attitudes from their childhood onto someone in their present environment. Countertransference - Answer- redirecting psychotherapist's feelings towards a client; therapist's emotional entanglement with a client. A family brings in a non-responsive client. The family reports the client is catatonic due to schizophrenia, has a history of diabetes, seizures & COPD. What is the nurse's initial action? - Answer- check the client's blood sugar What is a good activity for a client diagnosed w/ schizophrenia who is paranoid? - Answer- allow the client to initiate the activity A client asks the nurse if he hears the devil talking. What is the nurse's best response? - Answer- even though the voice seems real to you, I do not hear the voice speaking - Ask the Pt what they're experiencing Which if the below symptoms are positive signs of schizophrenia? Select all that apply. - Answer- - visual hallucinations - making up words - agitation - introducing unrelated topics A schizophrenia client begins to masturbate in the day room. What is the nurse's initial action? - Answer- ask the client if he needs privacy & escort him to his room In the development of a therapeutic relationship w/ a new admission w/ the Dx of post self-inflicted GSW to the head. Which of the following is a priority for the nurse? - Answer- assess the feelings towards this client - Therapeutic relationships includes feelings only of the Pt A 16 y/o Asian client requests an outside provider give her a coining treatment. What is the RN's best response? - Answer- respect cultural beliefs, but do not allow the treatment in the hospital A terminal CA client states to the nurse, "I wish my family would stop hoping for a cure. I know I am going to die and I wish they would stop." The nurse's best response is: - Answer- it sounds as though you are feeling ... A client on the psychiatric unit states "I feel like a bird." The best response for the nurse to make is: - Answer- that must be distressing for you, you don't look different to me - Don't argue w/ the Pt The nurse is deciding if she can restrain an angry, acting out client. The client tells her, "I will sue you if you tie me down." Her best response would be: - Answer- if you cannot be kept from hurting yourself or others except by physical restraint, I will do it A male client is coming down from a manic period. He states, "I feel bad about cheating on my wife." What is the nurse's best response? - Answer- Hyper-sexuality is a part of your illness. Let's discuss early signs of a manic episode - Educate Pt on his condition & that hyper-sexuality is a part of Mania The Rn must inform a family member his mother has just died. When informed of this news, the 35 y/o son smiles & states he is going to the vending area to buy some candy. What is the most appropriate intervention for the nurse to make at this time? - Answer- Repeat, "I just told you your mother died, how do you feel about this?" - important to repeat what has happened b/c some people will go into a form of Shock & will deny the truth A client is diagnosed w/ Major Depression. What is the most important part of the mental status exam to assess? - Answer- mood - "How are you feeling?" A client is scheduled for ECT what family teaching should the RN focus on? - Answer- education on the client's memory loss A nurse has observed that the client is still crying often & expresses anger at her deceased husband after 9 months & has stopped seeing friends and family. She is complaining that she is feeling helpless to change anything to improve her future. The priority assessment would be: - Answer- symptoms of complicated grief, dysfunctional mourning & social isolation Which client is most at risk for committing suicide? - Answer- elderly, single male w/ cancer Which statement shows a nurse has empathy for a patient who made a suicide attempt? - Answer- you must have been very upset when you tried to hurt yourself In a sad voice, an elderly Pt tells the nurse of the recent deaths of a spouse & daughter in an automobile accident. As the person sadly relates that she has no other family, only a few acquaintances in the community, she says there is no hope. The nurse's priority is to gather additional assessment data to determine which nursing diagnosis best directs care for this Pt? - Answer- risk for suicide related to hopelessness after recent deaths of significant others The ED calls the nurse & states a suicidal client needs a bed on her unit. Hospital policy states suicidal clients must have a room w/ locked windows. The only room w/ locked windows is occupied by a post-op client who has been in pain all day & is a now finally sleeping. What is the nurse's best action? - Answer- move the post-op Pt & put the suicidal client in the room w/ locked windows Randall is a 36 y/o male admitted to the hospital for symptoms of depression & passive suicidal thoughts. He tells the nurse upon admission "I know I need to be here, and I'm so happy you are going to be my nurse while I'm here. You are such a good listener!" For the remainder of the shift, Randall... - Answer- set limits on interactions w/ this Pt & discuss his case w/ fellow nurses & supervisors A 20 y/o economics major became severely depressed after failing 2 exams in economics. She cried for 2 hours, then called her parents who live in the neighboring state, planning to ask if she could return home. However, her parents were in Europe. When her roommates went home for the weekend, the Pt gave... - Answer- giving away her favorite possessions A Pt w/ a somatic symptom disorder has been started on relaxation & has identified how negative assumptions make his symptoms worse. Currently, he believes his palpitations in his chest are due to a heart attack. He has a high pulse rate. The nurse is teaching him cognitive reframing. Which statement best shows the Pt understandings? - Answer- a good explanation of how I'm feeling might be the extra coffee & the stress I am under at work. A 22y/o woman is seen in the outpatient mental health clinic complaining of frequent nightmares, feelings of guilt, & poor concentration. During the intake assessment, the nurse learns that the Pt was physically abused as a child. This Hx & symptoms are most related to: - Answer- PTSD Which client is most at risk for development of PTSD? - Answer- rescued client trapped under a collapsed roof of a building - the client actually experienced near death The parent of an adolescent diagnosed w/ depression asks the nurse, "Why do you want to do a family assessment? My teenager is the patient, not the rest of us." Select the nurse's best response. - Answer- every family member's perception of events is different and helps in planning how to improve functioning of the family Which statement about crisis theory will provide a basis of nursing interventions? - Answer- a crisis is an acute, time limited phenomenon experiences as an overwhelming emotional reaction to a problem perceived as unsolvable Which is an effective nursing intervention to assist an angry patient learn to manage anger w/o violence? - Answer- help a pt identify a thought that produces anger, evaluate the validity of belief, & substitute... A student nurse is debriefing w/ the therapist after a family session. Which statement by the student nurse indicates the therapy was successful? - Answer- their communication improved, they were less angry at each other, and the mother s letting the daughter be herself more - communication improved, less angry Ineffective coping behaviors in those w/ medical problems & (others too) are characterized by: - Answer- minimizing & denying, escaping & blaming, hopeless attitude During a meeting on an inpatient addictions unit, a newly admitted client asks what defines drug abuse. The best response by the nurse is that drug abuse is: - Answer- An excessive drug use inconsistent with accepted medical purposes The nurse instructs the client about addiction. The nurse determines that the client understands the info given when the client makes which statement? Select all that apply. - Answer- - addiction is a moral problem - addiction is a medical illness - addiction if a behavioral habit The mental health nurse explains to clients who are learning about cross-addiction that there is a synergistic or addictive effect from using various kinds of chemicals together. The nurse illustrates this point using which example of items that create this combined additive effect? - Answer- Drinking wine and taking a benzodiazepine The nurse is conducting a daily nursing assessment on a client with gambling and alcohol addictions who is in the outpatient addiction program. Which client statement reflects a need for more teaching? - Answer- "I am going to have a night out with some friend at an area night club." The nurse asks the client the following, "What does this mean, don't cry over spilt milk." What is the nurse assessing? - Answer- Concrete thoughts A patient presents at a doctor's office, fearful that she might have a serious heart condition, when she thought she felt palpitation n her chest. It becomes clear that it is illness anxiety. What is the best initial response? - Answer- You must be very distressed by the symptoms & the fear that something might be wrong. Is that right? A patient who experienced myocardial infarction was transferred from critical care to step-down unit. The patient then used the call bell every 15 minutes for minor requests & complaints. Staff nurses reported feeling inadequate & unable to satisfy the patient's needs. When the nurse manager intervenes directly with this patient, which comment is most therapeutic? - Answer- I'm wondering if you are feeling anxious about your illness & being left alone The nurse provides health education for an adult experiencing sleep deprivation. Which instruction has the highest priority? - Answer- It's important to limit your driving to short - Sleep deprivation increases the risk for accident A nurse observes a client with narcissistic P.D. Which behavior would the nurse recognize as most characteristic of this disorder? (Select all that apply.) - Answer- - A lifelong pattern of passive-aggressive behavior - A pattern of impulsive, erratic behavior SIG E CAPS Assessment for Depression - Answer- - Sleep disturbances - Interest decreased in pleasure activities & sex - Guilty feelings - Energy decreased - Concentration - Appetite increase or decrease - Psychomotor function decrease - Suicidal ideations Factors related to risk of developing depression - Answer- - Major depression is characterized by a persistently depressed mood lasting for 2 weeks - Children tend to be irritable rather than depressed - The depressed mood is accompanied by other symptoms, such as insomnia, S/I, and a sense of hopelessness and emptiness - The risk of depression in the elderly increases as health deteriorates - Older individuals suffering from depression are at risk for being untreated Social phobias - Answer- Anxiety or fear provoked by a situation where you have to perform or present Separation anxiety disorder - Answer- Fear or anxiety concerning separation from those to whom the individual is attached Panic Disorders - Answer- - Recurrent attacks of severe anxiety - Lasts moments to hours & is unexpected - Feels out of control & worry when next attack will happen Generalized anxiety disorder (GAD) - Answer- - Pervasive, persistent anxiety of at least 6 months - Chronic feelings of nervousness for no apparent reason - Unable to stop worrying or relax & have insomnia & physical complaints Phobic disorders - Answer- Phobia: irrational fear of specific object, activity, or situation that results in desire to avoid them General adaptation syndrome (GAS) occurs in stress - Answer- *Alarm* - Initial & adaptive response to fight or flight - Pupils dilate, dry mouth, smooth muscle relax, blood glucose increase, endorphins emit the pain *Resistance* (adaptation) - Adapting to stress - Body's attempt to resist or adapt to stressor *Exhaustion * The way you attempt to resist stressor becomes futile > give up Chronic exhaustion = chronic stress Bipolar I Mania Symptoms - Answer- - Extreme drive & energy - Inflated sense of self-importance - Drastically reduced sleep requirements - Excessive talking combined w/ pressured speech - Distraction by environmental events - Unusually obsessed w/ & over focused on goals - Purposeless arousal & movement - Personal feelings of racing thoughts - Dangerous activities as indiscriminate spending, reckless sexual encounters, or risky investments Mania is Euphoric or Dysphoric - Answer- *Euphoric * - Feels wonderful in beginning - Turns scary & dark as they lose control & are confused - Labile: going from happy to angry then back to happy *Dysphoric * - Depressed w/ mania - Irritable, angry, suicidal, &/or hypersexual, panic attacks, delusions, & confusion Bipolar II Hypomania - Answer- - More euphoria than dysphoria - Has energy for 4 days straight - Has at least 3 behaviors from Mania list - Not usually severe enough to cause serious impairment in occupational or social functioning Cyclothymic Disorder - Answer- - Very irritable & Hypomanic - Rapid cycling > 4 or more hypomanic or manic episodes w/n a couple of months - Feels like on a rollercoaster > mood energy up & down - Ultra-rapid cycling > 4 or more hypomanic or manic epidoses w/n a month - Ultra-ultra-rapid cycling > several mood switches w/n a day - Lasts several days in a week Negative Symptoms of Schizophrenia - a decrease of absence of normal function. - Answer- - Apparent lack of emotion / small emotional range - Reduced ability to plan & follow-through with activities - Neglect of personal hygiene - Social withdrawal, decrease in talkativeness - Loss of motivation Positive Symptoms of Schizophrenia - an excess or distortion of normal function. - Answer- - Delusions (false beliefs due to distorted perception) - Thought disorder (difficulty organizing & expressing thoughts) like speaking non-sense or neologism (made up words) - Disorganized behavior like being childish or unpredictable. - Movement disorder (repeated) - Catatonia (non-moving / non-responsive) Dissociative disorders - Answer- - Involuntary escape from reality > disconnecting themselves from thoughts, identity, consciousness, & memory - Pt is aware of sound or smell, but does not link it to actual event itself > leaving them fearful or confused - Re-enact, re-experience trauma w/o knowing why Dissociative identity disorder (Multiple personality disorder) - Answer- - Presence of 2 or more distinct personalities w/n 1 individual - Each personality takes full control of a person's behavior - Personality emerges during stress Dissociative fugue - Answer- - Wanders far from home, days at a time - Triggered by physical/psychological trauma - Forgets identity, past life, & associations Dissociative amnesia - Answer- 2 memories are lost Depersonalization disorder - Answer- Feeling detached from self, living a dream Antisocial P.D. - Answer- Deceitful, manipulative, takes high risk, disregard responsibility, & impulsive - Aka Sociopaths Treatment - Lithium; For aggression & impulsivity Antisocial P.D. Diagnosis: at least 3 of the following - Answer- - Failure to conform to social norms, laws - Deceitfulness (lying, conning for personal profit) - Impulsivity or failure to plan ahead - Irritability/aggressiveness (fights, assaults) - Disregard for safety of self or others - Consistent irresponsibility (work, financial) - Lack of remorse (rationalizes actions) Obsessive-Compulsive P.D. - Answer- - Rigidity & inflexible standards, Perfectionist - Excessive parental criticism, control, & shame Treatment - Cognitive behavioral therapy - Dialectical behavioral therapy (DBT) - Scheme-focused therapy Obsessive-Compulsive P.D. Diagnosis: at least 4 of the following - Answer- - Preoccupied with details, rules, lists, order, organization - Perfectionism that interferes with completion - Devoted to work, productivity to the exclusion of leisure - Over conscientious, scrupulous, inflexible, regarding ethics, morality, values - Unable to discard worn out objects (hoarders) - Reluctant to delegate tasks or work to others - Adopts miserly spending style, hoards $ - Shows rigidity and stubbornness Obsession compulsive disorder (OCD) - Answer- Obsession: recurrent thought Compulsion: compelled to act Rituals to reduce anxiety & create a sense of safety (regressive) Obsession compulsive disorder (OCD) Types of Symptoms - Answer- Types of obsessional symptoms - Contamination, Sexual, Aggressive, Hoarding, Saving, Religious, Symmetry, Exactness, & Somatic Types of compulsive symptoms - Cleaning, checking, repeating, counting, ordering, hoarding, mental, & reassurance checking Obsession compulsive disorder (OCD) Interventions - Answer- Never stop them from performing their obsessions or compulsions Negotiate the limits for their obsessions & compulsions > "I want you to be down for breakfast by 8am, that's enough time to do your rituals" Conversion disorder - Aka Functional neurological disorder - Answer- - Negative neurological diagnosis