CMN 350 PSYCHIATRIC-MENTAL HEALTH
NURSING EXAM #1 COMPLETE SOLUTION
RATED A+
Why would someone need to be admitted into a psychiatric hospital? - If they are:
-Dangerous to self or others
-Gravely disabled
-Acutely psychotic
-Suicidal or homicidal
If patient is acutely psychotic - -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 - -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 - -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 - -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 - -therapist
-order drugs
-interpret testing
A nurse can disclose patient information when - -the patient is a harm to self or others
-under a subpoena
-court order
you need a court order to - force medication or you could be accused of assault and
battery
assault - 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 - 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 vthe vuse vof vrestraints vand vseclusion vthe vnurse vmust vdocument v- v v1. vStaff
vmembers vinvolved v in vdecisions vto vrestrain vor vseclude vand vstaff v who vapply v or v remove
vrestraints vmust vreceive vspecial vtraining vand vdemonstrate vcompetency.
2. vAlternatives vmust vbe vconsidered vbefore vthe vuse vof vrestraint vand vseclusion.
3. vMight vbe vallowed vto vimplement vrestraint vor vseclusion vin vemergent vsituations, va
vphysician's vorder vis vrequired v within v1 vhour. vPhysician vassistants vand vadvanced vpractice
vnurses vcan valso v write vrestraint vand vseclusion vorders.
4. vThe vleast vrestrictive vmethod vor vdevice vpossible vmust vbe vchosen.
5. vShould vcarefully vwrite vdown vevents vleading vto vthe vintervention vand vjustification vfor
vuse.
6. vOrders vmust vcontain vthe vtype vof vrestraint, vrationale vfor vuse, vand vtime vlimitations.
7. vAs vneeded v(prn) vorders vare vnot vpermitted. vEach vepisode vmust vbe vbased von veminent
vrisk.
8. vRestraint vand vseclusion vare vused vfor vthe vshortest vpossible vtime. vMust vtell vthe
vpatients v what vbehaviors vare vexpected vbefore v release vand vreevaluate vthe vpatients vat
vleast vevery v 2 vhours vfor v continued vneed vof vrestraint vand vseclusion.
9. vPatients vmust vbe vobserved vconstantly vduring vrestraint vand vseclusion, vwith
vdocumentation vof vsafety v and vcomfort v interventions vat vleast vevery v15 vminutes.
10. vPatients vmust vbe vdebriefed vafter vrestrictive vinterventions.
11. vPatients vhave vthe vright vto vrequest vnotification vof va vfamily vmember vor vother vperson vin
vthe vevent vthat vrestraints vor vseclusion vare vimplemented.
12. vDeath vof vany vpatient vwhile vin vrestraints, veven vwhen vrestraints vdid vnot vcontribute vto
vdeath vin vthe vjudgment vof vthe vhealth vcare vprovider, v is vrequired vto vbe vreported vto vthe vUS
vFood vand v Drug vAdministration v(FDA).
NURSING EXAM #1 COMPLETE SOLUTION
RATED A+
Why would someone need to be admitted into a psychiatric hospital? - If they are:
-Dangerous to self or others
-Gravely disabled
-Acutely psychotic
-Suicidal or homicidal
If patient is acutely psychotic - -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 - -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 - -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 - -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 - -therapist
-order drugs
-interpret testing
A nurse can disclose patient information when - -the patient is a harm to self or others
-under a subpoena
-court order
you need a court order to - force medication or you could be accused of assault and
battery
assault - 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 - 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 vthe vuse vof vrestraints vand vseclusion vthe vnurse vmust vdocument v- v v1. vStaff
vmembers vinvolved v in vdecisions vto vrestrain vor vseclude vand vstaff v who vapply v or v remove
vrestraints vmust vreceive vspecial vtraining vand vdemonstrate vcompetency.
2. vAlternatives vmust vbe vconsidered vbefore vthe vuse vof vrestraint vand vseclusion.
3. vMight vbe vallowed vto vimplement vrestraint vor vseclusion vin vemergent vsituations, va
vphysician's vorder vis vrequired v within v1 vhour. vPhysician vassistants vand vadvanced vpractice
vnurses vcan valso v write vrestraint vand vseclusion vorders.
4. vThe vleast vrestrictive vmethod vor vdevice vpossible vmust vbe vchosen.
5. vShould vcarefully vwrite vdown vevents vleading vto vthe vintervention vand vjustification vfor
vuse.
6. vOrders vmust vcontain vthe vtype vof vrestraint, vrationale vfor vuse, vand vtime vlimitations.
7. vAs vneeded v(prn) vorders vare vnot vpermitted. vEach vepisode vmust vbe vbased von veminent
vrisk.
8. vRestraint vand vseclusion vare vused vfor vthe vshortest vpossible vtime. vMust vtell vthe
vpatients v what vbehaviors vare vexpected vbefore v release vand vreevaluate vthe vpatients vat
vleast vevery v 2 vhours vfor v continued vneed vof vrestraint vand vseclusion.
9. vPatients vmust vbe vobserved vconstantly vduring vrestraint vand vseclusion, vwith
vdocumentation vof vsafety v and vcomfort v interventions vat vleast vevery v15 vminutes.
10. vPatients vmust vbe vdebriefed vafter vrestrictive vinterventions.
11. vPatients vhave vthe vright vto vrequest vnotification vof va vfamily vmember vor vother vperson vin
vthe vevent vthat vrestraints vor vseclusion vare vimplemented.
12. vDeath vof vany vpatient vwhile vin vrestraints, veven vwhen vrestraints vdid vnot vcontribute vto
vdeath vin vthe vjudgment vof vthe vhealth vcare vprovider, v is vrequired vto vbe vreported vto vthe vUS
vFood vand v Drug vAdministration v(FDA).
