RASMUSSEN MENTAL HEALTH FINAL EXAM CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) ALREADY GRADED A+

RASMUSSEN MENTAL HEALTH FINAL EXAM CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) ALREADY GRADED A+ "Our sense of self. (Also unconscious mind) Acts as an intermediary between the id and the world by using ego defense mechanisms, such as repression, denial, and rationalization. - CORRECT ANSWER The Ego" "Conscious mind. Our conscience (our sense of what is right or wrong) and is greatly influenced by our parents' or caregivers' moral and ethical stances. - CORRECT ANSWER The Superego" "Freud believed that personality development is based on stages. During these stages, the id focuses on an erogenous zone of the body. These zones are oral, anal, and phallic. Fixation through overindulgence or frustration results in pathologic conditions and personality disorders. Freud's work has been criticized for a variety of reasons. One of the harshest criticism stems from the concept of penis envy in which females suffer from feelings of inferiority for not having male genitalia. - CORRECT ANSWER Freud's contribution to mental health" "Pleasure-pain principle Id, the instinctive and primitive mind, is dominant Demanding, impulsive, irrational, asocial, selfish, trustful, omnipotent, and dependent Primary thought processes Unconscious instincts—source-energy-aim-object Mouth—primary source of pleasure Immediate release of tension/anxiety and immediate gratification through oral gratification Task—develop a sense of trust that needs will be met - CORRECT ANSWER Freud - Oral—birth to 1½ years" "Reality principle—postpone immediate discharge of energy and seek actual object to satisfy needs Learning to defer pleasure Gaining satisfaction from tolerating some tension-mastering impulses Focus on toilet training—retaining/letting go; power struggle Ego development—functions of the ego include problem-solving skills, perception, ability to mediate id impulses Task—delay immediate gratification - CORRECT ANSWER Freud - Anal—1½ to 3 years" "When used properly, the use of silence can be an effective tool in encouraging individuals to open up. Silence is not the absence of communication; it is a specific channel for transmitting and receiving messages. If the nurse waits to speak and allows the patient to break the silence, the patient may share thoughts and feelings that would otherwise have been withheld. - CORRECT ANSWER Use of silence" "• Observing the patient's nonverbal behaviors • Listening to and understanding the patient's verbal message • Listening to and understanding the person in the context of the social setting of his or her life • Listening for "false notes" (i.e., inconsistencies or things the patient says that need more clarification) • Providing the patient with feedback about himself or herself of which the patient might be unaware - CORRECT ANSWER Active listening" "Repeats the main idea expressed. Gives the patient an idea of what has been communicated. If the message has been misunderstood, the patient can clarify it. Patient: "I can't sleep. I stay awake all night." Nurse: "You have difficulty sleeping?" Patient: "I don't know ... he always has some excuse for not coming over or keeping our appointments." Nurse: "You think he no longer wants to see you?" - CORRECT ANSWER Restating" "Directs questions, feelings, and ideas back to the patient. Encourages the patient to accept his or her own ideas and feelings. Acknowledges the patient's right to have opinions and make decisions and encourages the patient to think of self as a capable person. Patient: "What should I do about my husband's affair?" Nurse: "What do you think you should do?" Patient: "My brother spends all of my money and then has the nerve to ask for more." Nurse: "You feel angry when this happens?" - CORRECT ANSWER Reflecting" "Examines certain ideas, experiences, or relationships more fully. If the patient chooses not to elaborate by answering no, the nurse does not probe or pry. In such a case, the nurse respects the patient's wishes. "Tell me more about that." "Would you describe it more fully?" "Could you talk about how it was that you learned your mom was dying of cancer?" - CORRECT ANSWER Exploring" "Combines the important points of the discussion to enhance understanding. Also allows the opportunity to clarify communications so that both nurse and patient leave the interview with the same ideas in mind. "Have I got this straight?" "You said that..." "During the past hour, you and I have discussed..." - CORRECT ANSWER Summarizing" "Assumes the nurse knows best and the patient cannot think for self. Inhibits problem solving and fosters dependency. "Get out of this situation immediately." - CORRECT ANSWER Giving premature advice" "Indicates that the nurse is unable to understand or empathize with the patient. The patient's feelings or experiences are being belittled, which can cause the patient to feel small or insignificant. Patient: "I wish I were dead." Nurse: "Everyone gets down in the dumps." "I know what you mean." "You should feel happy you're getting better." "Things get worse before they get better." - CORRECT ANSWER Minimizing feelings" "Prep work prior to going to clinicals Getting the patients chart and being acclimated to their record PRIOR to meeting them. - CORRECT ANSWER Pre-orientation phase" "The first time you meet your patient. Interview includes: -Establishing rapport -Parameters of relationship -Formal/informal contract -Confidentiality -BEGINNING of termination begins (time-frame set) - CORRECT ANSWER Orientation phase" "• Maintain the relationship • Gather further data • Promote the patient's problem-solving skills, self-esteem, and use of language • Facilitate behavioral change • Overcome resistance behaviors • Evaluate problems and goals, and redefine them as necessary • Promote practice and expression of alternative adaptive behaviors - CORRECT ANSWER Working phase" "The final, integral phase of the nurse-patient relationship. Basically, the tasks of termination are as follows: • Summarizing the goals and objectives achieved in the relationship • Discussing ways for the patient to incorporate into daily life any new coping strategies learned during the time spent with the nurse • Reviewing situations that occurred during the time spent together • Exchanging memories, which can help validate the experience for both nurse and patient and facilitate closure of that relationship - CORRECT ANSWER Termination phase" "Respecting the rights of others to make their own decisions. Ex: Acknowledging the patient's right to refuse medication. - CORRECT ANSWER Autonomy" "The duty to distribute resources or care equally, regardless of personal attributes. Ex: When an intensive care unit (ICU) nurse devotes equal attention both to a patient who has attempted suicide and to another patient who suffered a brain aneurysm. - CORRECT ANSWER Justice" "The duty to act so as to BENEfit or promote the good of patients or others. Ex: Spending extra time to help calm an extremely anxious patient is a beneficent act. - CORRECT ANSWER Beneficence" "(Nonmalficence) Maintaining LOYALTY and commitment to the patient and doing no wrong to patient. Ex. Maintaining expertise in nursing skill through nursing education demonstrates fidelity to patient care. - CORRECT ANSWER Fidelity" "One' duty to communicate TRUTHFULLY Ex. Describing the purpose and side effects of psychotropic medications in a truthful non-misleading way - CORRECT ANSWER Veracity" "ALWAYS SAFETY first, and very patient specific. - CORRECT ANSWER Priority nursing interventions, nursing diagnoses, etc" "Depression alone - CORRECT ANSWER Primary depression" "Depression that is secondary to another diagnosis or reason. Such as depression secondary to loss of a loved one or secondary to a cancer diagnosis. - CORRECT ANSWER Secondary depression" "Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac) Fluvoxamine (Luvox) Paroxetine (Paxil) Sertraline (Zoloft) - CORRECT ANSWER SSRI's" "• Headache, which usually dissipates in a few days • Nausea, which usually dissipates in a few days • Sleeplessness and/or drowsiness during day, which usually dissipates in a few weeks • Tremors and/or dizziness • Sexual problems: reduces sexual drive, problems having and enjoying sex • Agitation, feeling jittery and nervous; rare serotonin syndrome; rare activation of suicidal ideation - CORRECT ANSWER Side effects of SSRI's" "Amitriptyline (Elavil) Clomipramine (Anafranil) Desipramine (Norpramin) Doxepin (Sinequan) Imipramine (Tofranil) Maprotiline (Ludiomil) Nortriptyline (Pamelor) Protriptyline (Vivactil) Trimipramine (Surmontil) Amoxapine (Asendin) - CORRECT ANSWER Tricyclic antidepressants (TCA's)" "• Dry mouth • Constipation • Bladder problems (hard to empty bladder, weak urine stream, men with enlarged prostate may be more affected) • Sexual problems include reduced sex drive, problems having and enjoying sex • Blurred vision, which usually dissipates quickly • Drowsiness • CAN CAUSE CARDIO TOXICITY** - CORRECT ANSWER Side effects of TCA's" "• The patient and family should be informed that improvement in mood may take from 7 to 28 days after initiation of treatment. Up to 6 to 8 weeks may be required for the full effect to be reached and for major depressive symptoms to subside. The family should reinforce this frequently to the depressed family member because depressed people have trouble remembering and respond to ongoing reassurance. • The patient should be reassured that drowsiness, dizziness, and hypotension usually subside after the first few weeks. • When the patient starts taking tricyclic antidepressants (TCAs), the patient should be cautioned to be careful working around machines, driving cars, and crossing streets because of possible altered reflexes, drowsiness, or dizziness. • Alcohol can block the effects of antidepressants. The patient should be told to refrain from drinking alcohol. • If possible, the patient should take the full dose - CORRECT ANSWER Patient/family teaching for TCA's" "• Phenothiazines • Barbiturates • Monoamine oxidase inhibitors • Disulfiram (Antabuse) • Oral contraceptives (or other estrogen preparations) • Anticoagulants • Some antihypertensives (clonidine, guanethidine, reserpine) • Benzodiazepines • Alcohol • Nicotine - CORRECT ANSWER Drugs to be used with caution along with TCA's" "Isocarboxazid (Marplan) Phenelzine (Nardil) Tranylcypromine (Parnate) Selegiline (Eldepryl) - CORRECT ANSWER MAOI's" "• MAOIs are always used as second-line treatment and only used in depressions that are resistant to other medications and treatments • MAOIs have high risk of hypertensive crisis**** • If taken with any foods high in tyramine or any sympathomimetic drugs can lead to cerebral hemorrhage or death. - CORRECT ANSWER Side effects of MAOI's" "• Hypotension*** • Sedation, weakness, fatigue • Insomnia • Changes in cardiac rhythm • Muscle cramps • Anorgasmia or sexual impotence • Urinary hesitancy or constipation • Weight gain - CORRECT ANSWER Adverse effects of MAOI's" "Hypertensive crisis***** • Severe headache • Stiff, sore neck • Flushing; cold, clammy skin • Tachycardia • Severe nosebleeds, dilated pupils • Chest pain, stroke, coma, death • Nausea and vomiting - CORRECT ANSWER Toxic effects of MAOI's" "strong or aged cheeses like cheddar, blue cheese, or gorgonzola cured or smoked meats or fish, such as sausage, bologna or salami beers on tap or home-brewed avocados, bananas or figs (especially if overripe) soy products like miso soup, bean curd, or tofu certain beans, such as fava or broad beans some sauces or gravies like soy sauce, teriyaki sauce, or bouillon-based sauces pickled products like sauerkraut sourdough breads - CORRECT ANSWER Foods that contain tyramine" "SSRI's TCA's Atypical antidepressants - CORRECT ANSWER First line treatment for depression" "• Hyperactivity or restlessness • Tachycardia → cardiovascular shock • Fever → hyperpyrexia • Elevated blood pressure • Altered mental status (e.g., delirium) • Irrationality, mood swings, hostility • Seizures → status epilepticus • Myoclonus, incoordination, tonic rigidity • Abdominal pain, diarrhea, bloating • Apnea → death - CORRECT ANSWER Serotonin syndrome symptoms" "1. Discontinue offending agent(s). 2. Initiate symptomatic treatment: • Serotonin receptor blockade: cyproheptadine, methysergide, propranolol • Cooling blankets, chlorpromazine for hyperthermia • Dantrolene, diazepam for muscle rigidity or rigors • Anticonvulsants • Artificial ventilation • Paralysis - CORRECT ANSWER Treatment for serotonin syndrome" "• Children or teens who lost a parent to suicide (three times more likely to commit suicide) • Childhood maltreatment • Problematic family relations • History of bullying and victimization • Family history of suicide • Socioeconomic problems • Parental psychopathology • Peer problems • Legal and/or discipline problems - CORRECT ANSWER Contributing risk factors for suicide" "1. Follow institutional protocol for suicide regarding creating a safe environment (taking away potential weapons—belts, sharp objects; checking what visitors bring into patient's room). 2. Keep accurate and thorough records of patient's behavior—both verbal and physical—as well as all nursing and physician actions: • Establish frequent rapport with the person. • Assess patient for his or her ability to seek out staff when struggling with suicidal thoughts. If patient is unable to do this, place on close observation. 3. Suicide precaution (one-on-one monitoring at arm's length away) or suicide observation (15-minute visual check of mood, behavior, and verbatim statements), depending on level of suicide potential. 4. Keep accurate and timely records and document patient's activity—usually every 15 minutes—including what patient is doing, with whom, etc. Follow institutional protocol. 5. If accepted at your institu - CORRECT ANSWER Interventions during the crisis period" "1. Arrange for patient to stay with family or friends. If no one is available and the person is highly suicidal, hospitalization must be considered. 2. Weapons and pills are removed by friends, relatives, or the nurse. 3. Encourage patients to talk freely about feelings (anger, disappointments) and help plan alternative ways of handling anger and frustration. 4. Encourage patient to avoid decisions during the time of crisis until alternatives can be considered. 5. Contact family members; arrange for individual or family crisis counseling. 6. Activate links to social supports in the community (e.g., self-help groups). 7. If anxiety is extremely high or patient has not slept in days, an antianxiety or antidepressant might be prescribed. Only a 1- to 3-day supply of medication should be given. Family member or significant other should monitor pills for safety. - CORRECT ANSWER Interventions after the crisis period" "-Has greatly reduced perceptual field -Focuses on details or one specific detail -Attention scattered -Completely absorbed with self -May not be able to attend to events in environment even when pointed out by others -In severe to panic levels of anxiety, the environment is blocked out; it is as if these events are not occurring -Unable to see connections between events or details -Has distorted perceptions -Feelings of dread -Ineffective functioning -Confusion -Purposeless activity -Sense of impending doom -More intense somatic complaints (e.g., dizziness, nausea, headache, sleeplessness) -Hyperventilation -Tachycardia -Withdrawal -Loud and rapid speech -Threats and demands - CORRECT ANSWER Characteristics of severe anxiety" "-Unable to focus on the environment -Experiences the utmost state of terror and emotional paralysis; feels he or she "ceases to exist" -In panic, may have hallucinations or delusions that take the place of reality -May be mute or have extreme psychomotor agitation leading to exhaustion Shows disorganized or irrational reasoning -Experience of terror -Immobility or severe hyperactivity or flight -Dilated pupils -Unintelligible communication or inability to speak -Severe shakiness -Sleeplessness -Severe withdrawal -Hallucinations or delusions; likely out of touch with reality - CORRECT ANSWER Characteristics of a panic level of anxiety" "1. Help the patient identify anxiety. "Are you comfortable right now?" 2. Anticipate anxiety-provoking situations. 3. Use nonverbal language to demonstrate interest (e.g., lean forward, maintain eye contact, nod your head). 4. Encourage the patient to talk about his or her feelings and concerns. 5. Avoid closing off avenues of communication that are important for the patient. Focus on the patient's concerns. 6. Ask questions to clarify what is being said. "I'm not sure what you mean. Give me an example." 7. Help the patient identify thoughts or feelings before the onset of anxiety. "What were you thinking right before you started to feel anxious?" 8. Encourage problem solving with the patient.∗ 9. Assist in developing alternative solutions to a problem through role play or modeling behaviors. 10. Explore behaviors that have worked to relieve anxiety in the past. 11. Provide outlets for dissipating excess en - CORRECT ANSWER Interventions for mild to moderate levels of anxiety" "1. Maintain a calm manner. 2. Always remain with the person experiencing an acute severe to panic level of anxiety. 3. Minimize environmental stimuli. Move to a quieter setting and stay with the patient. 4. Use clear and simple statements and repetition. 5. Use a low-pitched voice; speak slowly. 6. Reinforce reality if distortions occur (e.g., seeing objects that are not there or hearing voices when no one is present). 7. Listen for themes in communication. 8. Attend to physical and safety needs when necessary (e.g., need for warmth, fluids, elimination, pain relief, family contact). 9. Because safety is an overall goal, physical limits may need to be set. Speak in a firm, authoritative voice: "You may not hit anyone here. If you can't control yourself, we will help you." 10. Provide opportunities for exercise (e.g., walk with nurse, use a punching bag, play table tennis). 11. When a person is constantly mo - CORRECT ANSWER Interventions for severe to panic levels of anxiety" "The exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness. Examples include forgetting the name of a former boyfriend or girlfriend or forgetting an appointment to discuss poor grades. Repression is considered the cornerstone of the defense mechanisms, and it is the first line of psychological defense against anxiety. - CORRECT ANSWER Repression" "Transfer of emotions associated with a particular person, object, or situation to another person, object, or situation that is nonthreatening is called displacement. The frequently cited example in which the boss yells at the man, the man yells at his wife, the wife yells at the child, and the child kicks the cat demonstrates the successive use of displaced hostility. The use of displacement is common but not always adaptive. Spousal, child, and elder abuse are often cases of displaced hostility. - CORRECT ANSWER Displacement" "Unacceptable feelings or behaviors are kept out of awareness by developing the opposite behavior or emotion. For example, a person who harbors hostility toward children becomes a Boy Scout leader. - CORRECT ANSWER Reaction formation" "Occurs when anxiety is repressed to an unconscious level but is revealed on a physical level in the form of physical symptoms that have no organic cause. Often the symptom functions as an attention-seeking device or as an excuse. - CORRECT ANSWER Somatization" "Compensates for an act or communication (giving a gift to undo an argument). A common behavioral example of undoing is compulsive hand washing. This can be viewed as cleansing oneself of an act or thought perceived as unacceptable. - CORRECT ANSWER Undoing" "Consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller as well as the listener. Common examples are, "If I had Lynn's brains, I'd get good grades, too," or "Everybody cheats, so why shouldn't I?" Rationalization is a form of self-deception. - CORRECT ANSWER Rationalization" "A disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment. - CORRECT ANSWER Dissociation" "The inability to integrate the positive and negative qualities of oneself or others into a cohesive image. Aspects of the self and of others tend to alternate between opposite poles; for example, either good, loving, worthy, and nurturing; or bad, hateful, destructive, rejecting, and worthless. Use of this defense mechanism is prevalent in personality disorders, especially in people who have borderline components - CORRECT ANSWER Splitting" "A person unconsciously rejects emotionally unacceptable personal features and attributes them to other people, objects, or situations. Projection is the hallmark of blaming, scapegoating, prejudicial thinking, and stigmatization. People who always feel that others are out to deceive or cheat them may be projecting onto others those characteristics in themselves that they find distasteful and cannot consciously accept. - CORRECT ANSWER Projection" "SSRIs are treatment of choice; if patients do not respond to SSRIs, short-term treatment with a benzodiazepine may be used, or patients may switch to another type of antidepressant such as venlafaxine or tricyclics. CBT (cognitive behavioral therapy) • Relaxation techniques • Breathing techniques • Cognitive restructuring • Systematic desensitization • In vivo exposure aimed at eliminating avoidance behaviors ***Benzodiazepines (short term) to reduce or eliminate panic attacks in initial phase of treatment Antidepressants may decrease panic episodes and treat underlying depression CBT teaches new coping skills and ways to reframe thinking - CORRECT ANSWER Treatment for panic disorder" "When medications are indicated: • Buspirone (BuSpar) reduces rumination and worry, not addictive • SSRI and TCA antidepressants are effective with chronic anxiety • Investigational drugs include pregabalin and other anticonvulsants -Cognitive behavioral therapy or anxiety management therapy -Anxiety management therapy involves education, relaxation training, and exposure to anxiety-provoking stimuli - CORRECT ANSWER Treatments for generalized anxiety disorder (GAD)" "SSRIs or venlafaxine are first-line drug treatments SSRIs may help lessen rejection sensitivity Beta-blockers target physical symptoms of anxiety (e.g., propranolol) Anticonvulsants such as gabapentin (Neurontin) and pregabalin (Lyrica) are being investigated Cognitive behavioral therapy can help improve symptoms after 6 to 12 weeks ***Benzodiazepines can be addictive over the long term and are not really a drug of choice for social anxiety disorder - CORRECT ANSWER Treatments for social phobia/social anxiety disorder (SAD)" "SSRIs reduce OCD symptoms directly (e.g., fluvoxamine [Luvox] and fluoxetine [Prozac]) TCAs (e.g., clomipramine [Anafranil]) -Exposure and response prevention (ERP) emotionally difficult treatment for patients yet up to 75% to 80% successful -SSRIs reduce OCD symptoms directly - CORRECT ANSWER Treatments for OCD" "Alleviates anxiety, but works best before benzodiazepines have been tried. Less sedating than benzodiazepines. **Does not appear to produce physical or psychological dependence. Requires 3 or more weeks to be effective. - CORRECT ANSWER Buspirone (BuSpar)" "Alprazolam (Xanax) Lorazepam (Ativan) Diazepam (Valium) Prescribed for SHORT-TERM treatment ONLY; not recommended for use by patients with substance use problems. Benzodiazepines can be HIGHLY addictive and are prescribed for short periods of time, especially when used to self-medicate for anxiety or depression. - CORRECT ANSWER Benzodiazepines" "1. Positive symptoms: Psychotic symptoms are the most obvious (e.g., delusions, hallucinations, and perceptions that are not based on reality). 2. Negative symptoms: Include poverty of thought, loss of motivation, inability to experience pleasure or joy, feelings of emptiness, and blunted affect. 3. Cognitive symptoms: Include the inability to understand and process information, trouble focusing attention, and problems with working memory. The cognitive disturbances also account for the inability to use language appropriately (which is manifested by speech; e.g., looseness of association). These are the symptoms that most profoundly affect the individual's ability to engage in normal social/occupational experiences. 4. Mood symptoms: Depression, anxiety, dysphoria, suicide, and demoralization.∗ - CORRECT ANSWER Key symptoms of schizophrenia" "Hallucinations Delusions Bizarre behavior Paranoia - CORRECT ANSWER Positive symptoms of schizophrenia" "Blunted affect Apathy Lack of motivation Anhedonia Poor thought processes - CORRECT ANSWER Negative symptoms of schizophrenia" "The most troubling side effects of first generation anti-psychotics, include: Akathisia Acute dystonia Parkinsonism Tardive dyskinesia (TD) - CORRECT ANSWER Extrapyramidal symptoms (EPS)" "Internal restlessness and external restless pacing or fidgeting. Nursing interventions: Reduced dosage or switched to a low-potency antipsychotic. Treat with anticholinergic, benzodiazepine, or beta blockers. - CORRECT ANSWER Akathisia" "Severe spasms of the muscles of the tongue, head, and neck; fixed upward deviation of the eyes; and severe back spasms that arch the trunk forward and thrust the head and lower limbs backward. Nursing interventions: Diphenhydramine hydrochloride (Benadryl) IM/IV or benztropine IM/IV. Relief occurs in minutes. Prevent further dystonias with any anticholinergic agent. Experience is very frightening. Take patient to quiet area and stay with him or her until medicated. - CORRECT ANSWER Acute dystonia" "Masklike facies, stiff and stooped posture, shuffling gait, drooling, tremor, "pill-rolling" phenomenon Nursing interventions: Alert medical staff. An anticholinergic agent (e.g., trihexyphenidyl [Artane] or benztropine [Cogentin]) may be used. - CORRECT ANSWER Parkinsonism" "Early symptoms of tardive dyskinesia are fasciculations of the tongue or constant lip smacking. These early oral movements can develop into uncontrollable biting, chewing, or sucking motions; an open mouth; and lateral movements of the jaw. In many cases, the early symptoms of tardive dyskinesia disappear when the antipsychotic medication is discontinued. In other cases, however, early symptoms are not reversible and may progress. Nursing interventions: No known treatment. Discontinuing the drug does not always relieve symptoms. Occurs in 15% to 20% of patients taking these drugs for more than 2 years. Eating difficulties; malnutrition can occur because of tongue and mouth involvement. Frequent screening with the AIMS test can help detect TD in early stages. - CORRECT ANSWER Tardive dyskinesia" "Characterized by decreased level of consciousness; greatly increased muscle tone; and autonomic dysfunction, including hyperpyrexia, labile hypertension, tachycardia, tachypnea, diaphoresis, and drooling. Treatment consists of early detection, discontinuation of the antipsychotic agent, management of fluid balance, reduction of temperature, and monitoring for complications. Mild cases of neuroleptic malignant syndrome are treated with bromocriptine (Parlodel), whereas more severe cases are treated with intravenous dantrolene (Dantrium) and even with electroconvulsive therapy in some cases. - CORRECT ANSWER Neuroleptic malignant syndrome (NMS)" "• AGRANULOCYTOSIS • High seizure rate • Increased risk for diabetes • Significant weight gain • High lipid abnormalities • Excessive salivation • Tachycardia - CORRECT ANSWER Clozapine (Clozaril) - Side effects/Adverse reactions" "Severe neutropenia, with less than 200 cells/mm3. Symptoms include: -Sores in the mouth, throat, or gastrointestinal tract -Chronic infections of the gums, throat, or skin -Malaise -Chills -Fever -Weakness -Severe fatigue -Hypotension - CORRECT ANSWER Agranulocytosis" "• Hypotension/dizziness • Insomnia • Sedation • Rarely NMS, TD • Sexual dysfunction • Weight gain • Moderate lipid abnormalities • Increased risk for diabetes - CORRECT ANSWER Risperidone (Risperdal) - Side effects/Adverse reactions" "• Low sedative properties; used in large doses with assaultive patients to avoid severe side effect of hypotension • Lessens chance of falls from dizziness or hypotension • High EPS symptoms • Can prolong the QT interval, leading to dysrhythmias • Tardive dyskinesia - CORRECT ANSWER Haloperidol (Haldol) - Side effects/Adverse reactions" "• Increased sensitivity to sun (as with other phenothiazines) • Highest sedative and hypotensive effects • High Anticholinergic effects • Sedation • Lowers seizure threshold • Rare: agranulocytosis and NMS - CORRECT ANSWER Chlorpromazine (Thorazine) - Side effects/Adverse reactions" "Characterized by persistent disregard for and violation of the rights of others with an absence of remorse for hurting others. Lack regard for the law and the rights of others and have a history of persistent lying, use of aliases, conning others for personal profit or pleasure, and stealing (deceitfulness). Have a sense of entitlement and are very callous Manipulative - CORRECT ANSWER Antisocial personality disorder" "Unstable and intense relationships, and, instability of affect. Emotional liability Poor impulse control Primitive defense mechanism of projected identification and splitting Always seeking relationships to avoid feelings of abandonment and chronic feelings of emptiness - CORRECT ANSWER Borderline personality disorder" "People with dependent personality disorder traits believe they are incapable of surviving if left alone and have an excess need to receive care. They solicit caretaking by clinging and being perversely and excessively submissive. If others do not initiate or take responsibility for them, their needs remain neglected. Their intense fear of separation and being alone is so great that they tolerate poor, even abusive treatment in order to stay in a relationship, and once a relationship ends there is an urgent need to get into another. They obsessively ruminate and fantasize about abandonment even when it is not threatened. Their high levels of anxiety intensify their inability to complete anything on their own; they are UNABLE TO MAKE DECISIONS WITHOUT EXCESSIVE ADVISE AND REASSURANCE. - CORRECT ANSWER Dependent personality disorder" "Maladaptive social response characterized by a person's grandiose sense of personal achievements. People with this disorder consider themselves special and expect special treatment. Their demeanor is arrogant and haughty and their sense of entitlement is striking. They lack empathy for the needs or feelings of others and in fact exploit others to meet their own needs. If they are at fault in some way, they always blame others for the problems they themselves have caused. At times, people who have narcissistic PD are admired and envied by others for what appears to be a rich and talented life. However, they require this admiration in greater and greater quantities (attention seeking). On the other hand, narcissistic PD patients often envy others' successes or possessions, believing that they deserve the admiration and privileges more. Because of their fragile self-esteem, they are prone to depression, interperso - CORRECT ANSWER Narcissistic personality disorder" "People with histrionic personality disorders manipulate others through their dramatic, rapidly shifting, charming, flamboyant, and sexually seductive behaviors. Their excessively emotional behavior is an attempt to be and remain the center of attention, love, and admiration that they require. They may act out with displays of temper, tears, and accusations when they are not getting the attention or praise they believe they deserve. Interactions are often characterized by a seductiveness or provocation to draw others into a relationship or work project, but their attention is usually short-lived since they are subject to constant, sudden emotional shifts and emotional lability. Their relationships tend to be superficial and shallow and usually do not last long because of their constant need for attention and their insensitivity to the needs of others. Histrionic people lack insight about their role in the failur - CORRECT ANSWER Histrionic personality disorder" "1. Assess your own reactions toward patient. If you feel angry, discuss with peers ways to reframe your thinking to defray feelings of anger. 2. Assess patient's interactions for a short period before labeling as manipulative. 3. SET LIMITS on any manipulative behaviors, such as • Arguing or begging • Flattery or seductiveness • Instilling guilt, clinging • Constantly seeking attention • Pitting one person, staff, group against another • Frequently disregarding the rules • Constant engagement in power struggles • Angry, demanding behaviors 4. Intervene in manipulative behavior. • All limits should be adhered to by all staff involved. • Objective physical signs in managing clinical problems should be carefully documented. • Behaviors should be documented objectively (give time, dates, circumstances). • Provide clear boundaries and consequences. • Enforce the consequences. 5. Be vigilant; avoid: • Discussing yourse - CORRECT ANSWER Interventions for manipulation" "SAFETY!!! - CORRECT ANSWER Priority nursing intervention for personality disorders" "Depression Bipolar disorder OCD Social phobia - CORRECT ANSWER Comorbidities with anorexia and bulemia" "• Terror of gaining weight • Preoccupation with thoughts of food • View of self as fat even when emaciated • Peculiar handling of food: • Cutting food into small bits • Pushing pieces of food around plate • Possible development of rigorous exercise regimen • Possible self-induced vomiting; use of laxatives and diuretics • Cognition is so disturbed that the individual judges self-worth by his or her weight • Controls what he or she eats to feel powerful to overcome feelings of helplessness - CORRECT ANSWER Signs and symptoms of anorexia" "• Binge eating behaviors • Often self-induced vomiting (or laxative or diuretic use) after bingeing • History of anorexia nervosa in one fourth to one third of individuals • Depressive signs and symptoms • Problems with: • Interpersonal relationships • Self-concept • Impulsive behaviors • Increased levels of anxiety and compulsivity • Possible chemical dependency • Possible impulsive stealing • Controls/undoes weight after bingeing, which is motivated by feelings of emptiness - CORRECT ANSWER Signs and symptoms of bulemia" "**Physical Criteria • Weight loss more than 30% over 6 months • Rapid decline in weight • Inability to gain weight with outpatient treatment • Severe hypothermia caused by loss of subcutaneous tissue or dehydration (body temperature lower than 36° C or 96.8° F) • Heart rate less than 40 beats per minute • Systolic blood pressure less than 70 mm Hg • Hypokalemia (less than 3 mEq/L) or other electrolyte disturbances not corrected by oral supplementation • Electrocardiographic changes (especially dysrhythmias) **Psychiatric Criteria • Suicidal or severely irrepressible, self-mutilating behaviors • Uncontrollable use of laxatives, emetics, diuretics, or street drugs • Failure to comply with treatment contract • Severe depression • Psychosis • Family crisis or dysfunction - CORRECT ANSWER Criteria for hospital admission of individuals with eating disorders" "1. Acknowledge the emotional and physical difficulty the patient is experiencing. 2. Assess for suicidal thoughts/self-injurious behaviors. 3. Monitor physiological parameters (vital signs, electrolyte levels) as needed. 4. Weigh patient wearing only bra and panties/underwear on a routine basis (same time of day after voiding and before drinking/eating). Some protocol includes weighing with the patient's back to the scale. 5. Monitor patient during and after meals to prevent throwing away food and/or purging. 6. Recognize the patient's distorted image/overvalued ideas of body shape and size without minimizing or challenging patient's perceptions. 7. Educate the patient about the ill effects of low weight and resultant impaired health. 8. Work with patients to identify strengths. - CORRECT ANSWER Nursing interventions for anorexia" "1. Assess mood and presence of suicidal thoughts/behaviors 2. Monitor physiological parameters (vital signs, electrolyte levels) as needed. 3. Monitor the patient's weight as needed. 4. Explore dysfunctional thoughts that maintain the binge/purge cycle. 5. Educate the patient that fasting can lead to continuation of bingeing and the binge/purge cycle, emphasizing its self-perpetuating nature. 6. Monitor patient during and after meals to prevent throwing away food and/or purging. 7. Acknowledge the patients overvalued ideas of body shape and size without minimizing or challenging the patients perceptions. 8. Encourage the patient to keep a journal of thoughts and feelings. - CORRECT ANSWER Nursing interventions for bulemia" "Disorder that presents with one or more symptoms of impaired motor or sensory function. The deficit causes significant distress to the patient and impaired social or occupational functioning. Symptoms include weakness or paralysis, abnormal movement, swallowing or speech difficulties, seizures or attacks, sensory loss or anesthesia, or symptoms involving the senses (blindness or loss of smell). The symptoms are not voluntarily controlled or created. Patients may be highly distressed or show a lack of emotional concern known as la belle indifférence. Episodes are typically brief but may become chronic. Some symptoms such as tremor may disappear when the patient is distracted. - CORRECT ANSWER Conversion disorder" "SET LIMITS!! Use a straight forward approach, and be consistent! Be supportive, yet ASSERTIVE with them Pt independence is IMPORTANT, they need to be able to take care of THEMSELVES. Don't do everything for them! - CORRECT ANSWER Nursing interventions for conversion disorder" "Inability to take care of basic self-care needs related to conversion symptom (paralysis, seizures, pain, fatigue) **Focus on self-care deficit (hygiene, dressing, feeding, toileting) - CORRECT ANSWER Nursing diagnosis related to conversion disorder" "Peaks 24-48 hrs after cessation of alcohol** -Jerky tremors -Diaphoresis -Abdominal cramps -Hyper-alertness -Irritability -Vomiting -Increases in heart rate, blood pressure, respiratory rate and temperature -Transient hallucinations or illusions -Seizures - CORRECT ANSWER Signs and symptoms of alcohol withdrawal" "• Confidentiality related to information concerning a chemical dependency problem is required by federal law. Each employer should have a policy that includes: 1. A cause for testing policy 2. Identification of the person who will interact with the employee concerning their impaired practice 3. A referral process for evaluation and treatment 4. Clear consequences associated with refusing treatment • It is the obligation and responsibility of a colleague or coworker to document and report an impaired health professional's behavior to the employer or designated supervisor. Such a worker should not be allowed to give patient care until he or she has been evaluated and received treatment. • A health care worker should be offered professional treatment in lieu of termination. It is more cost effective; valuable expertise and service history may be lost if the health professional's employment is pre-emptively terminated, - CORRECT ANSWER Guidelines for colleagues that demonstrate impairment in the workplace" "**Sedatives Benzodiazepines Chlordiazepoxide (Librium) -Provides safe withdrawal and has anticonvulsant effects; chlordiazepoxide and diazepam are cross-addicting Diazepam (Valium) -Given for alcohol withdrawal delirium symptoms. Has anticonvulsant qualities. Not metabolized in the liver. - CORRECT ANSWER Drugs for alcohol withdrawal delirium" "Carbamazepine (Tegretol), or valproic acid (Depakote) -Helps reduce withdrawal symptoms and the risk of seizures Magnesium sulfate -Increases effectiveness of vitamin B1 and helps reduce postwithdrawal seizures Thiamine (vitamin B1 ) -Given intramuscularly or intravenously before glucose loading to prevent Wernicke's encephalopathy - CORRECT ANSWER Meds for seizure control with alcohol withdrawal delirium" "Volatile solvents (paint thinners, glues, gasoline, dry cleaner fluid) Gases (butane, propane, nitrous oxide) Nitrates (isoamyl, isobutyl, commonly known as "poppers") Aerosols (spray paint, hair or deodorant sprays, fabric protector sprays, vegetable oil sprays) - CORRECT ANSWER Inhalants" "Similar to alcohol: -Slurred speech -Lack of inhibitions -Euphoria -Dizziness -Drunkenness -Violent behavior - CORRECT ANSWER Intoxification effects of inhalants" "Liver and brain damage, heart failure, respiratory arrest, suffocation, coma, death Capable of interfering with oxygen supply to vital organs by destroying oxygen-carrying ability of red blood cells; associated with fatal cardiac rhythm **Long-term use can lead to deterioration of myelin sheath of nerve fibers, resulting in muscle spasms and tremors, or even permanent difficulty with basic movements such as walking, bending, and talking - CORRECT ANSWER Overdose effects of inhalants" "-Support affected systems -Neurological symptoms may respond to vitamin B12 and folate - CORRECT ANSWER Treatment for damages from inhalants" "1. Always identify yourself and call the person by name at each meeting. 2. Speak slowly. 3. Use short, simple words and phrases. 4. Maintain face-to-face contact. 5. Be near patient when talking, one or two arm-lengths away. 6. Focus on one piece of information at a time. 7. Talk with patient about familiar and meaningful things. 8. Encourage reminiscing about happy times in life. 9. When patient is delusional, acknowledge patient's feelings and reinforce reality. Do not argue or refute delusions. 10. If a patient gets into an argument with another patient, stop the argument and separate individuals. After a short while (5 minutes), explain straightforwardly to each patient why you had to intervene. 11. When patient becomes verbally aggressive, acknowledge patient's feelings and shift topic to more familiar ground (e.g., "I know this is upsetting for you, because you always cared for others. Tell me about - CORRECT ANSWER Nursing interventions for dementia" "1. Always have patient perform all tasks within his or her present capacity. 2. Always have patient wear own clothes, even if in the hospital. 3. Use clothing with elastic, and substitute fastening tape (Velcro) for buttons and zippers. 4. Label clothing items with patient's name and name of item. 5. Give step-by-step instructions whenever necessary (e.g., "Take this blouse...put in one arm ... now the next arm ... pull it together in the front ... now ..."). 6. Make sure that water in faucets is not too hot. 7. If patient is resistant to performing self-care, come back later and ask again. - CORRECT ANSWER Nursing interventions for dementia - Dressing and bathing" "1. Monitor food and fluid intake. 2. Offer finger foods that patient can take away from the dinner table. 3. Weigh patient regularly (once a week). 4. During periods of hyperorality, watch that patient does not eat nonfood items (e.g., ceramic fruit, food-shaped soaps). - CORRECT ANSWER Nursing interventions for dementia - Nutrition" "1. Begin bowel and bladder program early; start with bladder control. 2. Evaluate use of disposable diapers. 3. Label bathroom door as well as doors to other rooms. - CORRECT ANSWER Nursing interventions for dementia - Bowel and bladder function" "1. Because patient may awaken, be frightened, or cry out at night, keep area well lit. 2. Maintain a calm atmosphere during the day. 3. Medications are not recommended for sleep. The use of nonmedical interventions has proven most helpful in many cases. When medications have been prescribed, low-dose tricyclic antidepressants, neuroleptics with sedative properties (haloperidol [Haldol]), benzodiazepines, and others may be ordered. 4. Avoid the use of restraints. - CORRECT ANSWER Nursing interventions for dementia - Sleep" "galantamine hydrobromide (Razadyne) rivastigmine tartrate (Exelon) donepezil hydrochloride (Aricept) memantine hydrochloride (Namenda) - CORRECT ANSWER Medications for Alzheimer's" "1. Guide the person to understand and practice tension reduction and stress control strategies such as stress avoidance, correction of negative self-talk, and breathing control exercises. 2. Promote the progressive substitution of alternate, less maladaptive responses to tension, such as applying pressure to one's scalp with a thumb rather than pulling out one's hair. 3. Assist the person to explore feelings associated with the impulses, such as shame, fear, or guilt, and to manage these feelings adaptively. 4. Assist the person to identify the consequences of his or her actions ("How do other people respond when you _____?" "Tell me what things are like the day after you've set a fire," "Imagine you set the fire: what do you think will happen in the days and weeks that follow?" [anticipatory fantasy]) 5. Educate the person that drugs and alcohol may increase impulsiveness through disinhibition or impairment of j - CORRECT ANSWER Interventions for impulse control disorders" "After determining whether there is a need for safety interventions because of suicidal or homicidal ideation or gestures, the nurse then assesses three main areas: (1) the patient's perception of the event (2) the patient's available supports (3) the patient's usual coping skills - CORRECT ANSWER Nursing assessment priority with patients in crisis" "1. Assess for suicidal or homicidal thoughts or plans. 2. Take initial steps to make patient feel safe and to lower anxiety, such as providing a quiet environment, building rapport, and acknowledging the crisis experience. 3. Listen carefully using eye contact and supportive body language, and provide feedback/summarization to ensure understanding. 4. Crisis intervention calls for directive and creative approaches. Initially the nurse may make phone calls to help with tasks such as arranging babysitters and finding shelter. 5. Assess patient's support systems. Rally existing supports (with patient's permission) if patient is overwhelmed. 6. Identify and mobilize needed social supports. 7. Identify needed coping skills such as problem solving, relaxation, or job training. 8. Collaborate with the patient to plan interventions, as much as he or she is able at given time. 9. Plan regular follow-up to assess patie - CORRECT ANSWER Nursing interventions for patients in crisis" "Arises from an external rather than an internal source and is frequently unanticipated. Examples of external situations that can precipitate a crisis include loss of a job, death of a loved one, unwanted pregnancy, a move, change of job, change in financial status, divorce, and severe physical or mental illness. - CORRECT ANSWER Situational crisis" "AKA crisis of disaster Unplanned and tend to be catastrophic or violent in nature. Adventitious crises may result from natural disasters such as tsunamis, fires, hurricanes, flooding, or earthquakes; national disasters such as war, terrorist attacks, airplane or train crashes; or crimes of violence such as shootings in a public venue. - CORRECT ANSWER Adventitious crisis" "1. Use methods that can facilitate the grieving process. a. Give your full presence: use appropriate eye contact, attentive listening, and appropriate touch. b. Be patient with the bereaved in times of silence. Do not fill silence with empty chatter. 2. Know about and share with the bereaved information about the phenomena that occur during the normal mourning process, because they may concern some people (intense anger at the deceased, guilt, symptoms the deceased had before death, unbidden floods of memories). Give the bereaved support during the occurrence of these phenomena and a written handout for reference. 3. Encourage the support of family and friends. If no supports are available, refer the patient to a community bereavement group. (Bereavement groups are helpful even when a person has many friends or much family support.) 4. Offer spiritual support and referrals when needed. 5. When intense emotions ar - CORRECT ANSWER Interventions for people who are grieving" "One of the most important skills necessary in caring for the dying and their family members is to be "in the moment." Demonstrate presence and caring behaviors. Allow for a review of successes in the patients' lives and their lasting legacy; discuss any suicidal thoughts using a nonjudgmental approach and make appropriate referrals for care; allow time for patients to express their feelings and give them as much control over their care as possible; assist in supporting the family in repairing conflicts; help to make the most of things they enjoy (visits with friends, foods and music, storytelling, living in the moment); and assist with spiritual comfort—finding solace in spiritual beliefs and achieving a peaceful death. Convey caring, sensitivity, and compassion. Listen. Be patient; be present - CORRECT ANSWER Caring for the dying" "The stress response is also referred to as the "fight-or-flight response." The fight-or-flight response is a survival mechanism by which our body and mind become immediately ready to meet a threat or stress. - CORRECT ANSWER Fight or flight response" “Milieu refers to the environment in which holistic treatment occurs and includes all members of the treatment team in a positive physical setting, with interactions among those who are hospitalized and activities that promote recovery. The psychiatric mental health registered nurse provides, structures, and maintains safe, therapeutic, recovery oriented environment collaboration with health care consumers, families, and other health care clinicians. Among other things milieu management includes orienting patients to their rights and responsibilities. Milieu management also includes informing patients in a culturally competent manner about the need for structure, maintenance of a safe environment, and limits set on the unit. The nurse selects activities (both individual and group) that meets the patient's physical and mental health needs. The patient should always be maintained in the least restrictive environmen - CORRECT ANSWER Milieu Therapy" "Successful performance of mental functions, resulting in the ability to engage in productive activities, enjoy fulfilling relationships, adapt to change, and cope with adversity. Mental health is the foundation of thinking, communication skills, learning, emotional growth, resilience, and self-esteem throughout the life span. It is a STATE OF WELL-BEING in which individuals are able to realize their abilities as well as contribute to their community within the context of life stressors. - CORRECT ANSWER Mental health" "Actual diagnoses, gets in the way of obtaining mental health. Medical conditions that affect a person's thinking, feeling, mood, ability to relate to others, and daily functioning. Basically, mental illness can be seen as the result of flawed biological, psychological, or social processes. Fortunately mental illnesses are treatable, and individuals can experience symptom relief, and complete cure in some cases, with treatment and support. - CORRECT ANSWER Mental illness" "Needs are placed conceptually on a pyramid, with the most basic and important needs on the lower level. The higher levels, the more distinctly human needs, occupy the top sections of the pyramid. According to Maslow, when lower level needs are met, higher level needs are able to emerge. **Physiological needs first, safety second - CORRECT ANSWER Maslow's hierarchy of needs" "Food, water, oxygen, elimination, rest, and sex - CORRECT ANSWER Physiological needs" "Security, protection, stability, structure, order, and limits. - CORRECT ANSWER Safety needs" "Affiliation, affectionate relationships, and love - CORRECT ANSWER Love and belonging needs" "Self-esteem related to competency, achievement, and esteem from others. - CORRECT ANSWER Esteem needs" "Becoming everything one is capable of. - CORRECT ANSWER Self-actualization needs" "When a person experiences a sense of identity that transcends or extends beyond the personal self. - CORRECT ANSWER Self-transcendence" "The primitive, pleasure-seeking part of our personalities that lurks in the unconscious mind. - CORRECT ANSWER The Id" "Superego develops via incorporating moral values, ideals, and judgments of right and wrong that are held by parents; superego is primarily unconscious and functions on the reward and punishment principle (sexual identity attained via resolving oedipal conflict) Conflict differs for boy and girl masturbatory activity Task—develop sexual identity through identification with same-sex parent - CORRECT ANSWER Freud - Phallic—3 to 7 years" "Desexualization; libido diffused Involved in learning social skills, exploring, building, collecting, accomplishing, and hero worship Peer group loyalty begins Gang and scout behavior Growing independence from family Task—sexuality is repressed during this time; learn to form close relationship(s) with same-sex peers - CORRECT ANSWER Freud - Latency—7 to 12 years" "Fluctuation regarding emotion stability and physical maturation Very ambivalent and labile, seeking life goals and emancipation from parents Dependence vs. independence Reappraisal of parents and self; intense peer loyalty Task—form close relationships with members of the opposite sex based on genuine caring and pleasure in the interaction - CORRECT ANSWER Freud - Genital phase (adolescence)—13 to 20 years" "Words we speak, clear, honest, convey interest and understanding - CORRECT ANSWER Verbal communication" "The tone and pitch of a person's voice and the manner in which a person paces speech Body language Physical appearance Facial expressions Body posture Amount of eye contact Eye cast (emotion expressed in the eyes) Hand gestures Sighs Fidgeting Yawning - CORRECT ANSWER Non-verbal communication" "Prevents problem solving. Can make the patient feel guilty, angry, misunderstood, not supported, or anxious to leave. "How come you still smoke when your wife has lung cancer?" - CORRECT ANSWER Making value judgments" "Implies criticism; often has the effect of making the patient feel defensive. "Why did you stop taking your medication?" - CORRECT ANSWER Asking "why" questions" "A well-defined therapeutic relationship allows for the establishment of clear patient boundaries that provide a safe space through which the patient can explore feelings and treatment issues. In reality, boundaries are at risk of blurring, and a shift in the nurse-patient partnership may lead to nontherapeutic dynamics. Examples of circumstances that can produce blurring of boundaries include the following: • When the relationship slips into a social context • When the nurse's needs are met at the expense of the patient's needs - CORRECT ANSWER Boundaries" "• Overhelping: Doing for patients what they are able to do themselves or going beyond the wishes or needs of patients • Controlling: Asserting authority and assuming control of patients "for their own good" • Narcissism: Having to find weakness, helplessness, and/or disease in patients to feel helpful, at the expense of recognizing and supporting patients' healthier, stronger, and more competent features - CORRECT ANSWER Warning signals that indicate a nurse may be blurring boundaries" "The process whereby a person unconsciously and inappropriately displaces (transfers) onto individuals in his or her current life those patterns of behavior and emotional reactions that originated in relation to significant figures in childhood. The patient may even say, "You remind me of my ______" (mother, sister, father, brother) Patient: "Oh, you are so high and mighty. Did anyone ever tell you that you are a cold, unfeeling machine, just like others I know?" Nurse: "Tell me about one person who is cold and unfeeling toward you." (In this example, the patient is experiencing the nurse in the same way she did with significant other[s] during her formative years. It turns out that the patient's mother was very aloof, leaving her with feelings of isolation, worthlessness, and anger.) - CORRECT ANSWER Transference" "The tendency of the nurse to displace onto the patient feelings related to people in his or her past. Frequently, the patient's transference to the nurse evokes countertransference feelings in the nurse. If the nurse feels either a strongly positive or a strongly negative reaction to a patient, the feeling most often signals countertransference in the nurse. One common sign of countertransference in the nurse is overidentification with the patient. - CORRECT ANSWER Countertransference" "Act or an omission to act that breaches the duty of due care and results in or is responsible for a person's injuries. The five elements required to prove negligence are (1) duty (2) breach of duty (3) cause in fact (4) proximate cause (5) damages. Foreseeability or likelihood of harm is also evaluated. - CORRECT ANSWER Negligence" "Made without the patient's consent. Generally, involuntary admission is necessary when a person is in need of psychiatric treatment, presents a danger to self or others, or is unable to meet his or her own basic needs. **Involuntarily admitted patients have the right to refuse medications and treatment, refuse informed consent, but CANNOT LEAVE the hospital due to legal hold. - CORRECT ANSWER Involuntary admission" "Sought by the patient or the patient's guardian through a written application to the facility. **Voluntarily admitted patients have the right to refuse medications, informed consent, and can demand and obtain release. - CORRECT ANSWER Voluntary admission" "Making sure that the patients have everything they need to be educated on any procedure, medications, or any treatment for them to be able to give informed consent. Patient must be of sound mind. - CORRECT ANSWER Informed consent" "The psychiatric patient's right to receive treatment and to have confidential medical records is legally protected. Therefore, you MAY NOT, without the patient's consent, disclose information obtained from the patient or information in the medical record to anyone except those individuals for whom it is necessary for implementation of the patient's treatment plan. Special protection of notes used in psychotherapy that are kept separate from the patient's health information was created by this HIPAA rule. Discussions about a patient in public places such as elevators and the cafeteria, even when the patient's name is not mentioned, can lead to disclosures of confidential information and liabilities for you and the hospital. - CORRECT ANSWER HIPAA" "The psychiatric mental health nurse collects and synthesizes comprehensive health data that are pertinent to the health care consumer's health and/or situation. Nurses who work in the mental health field need to assess, or have access to, past and present medical history, a recent physical examination, and any physical complaints the patient is experiencing, as well as document any observable physical conditions or behaviors (unsteady gait, abnormal breathing pattern, facial grimacing, or changing position to relieve discomfort). - CORRECT ANSWER Psychiatric Nursing Assessment" "• Establish rapport. • Obtain an understanding of the current problem or chief complaint. • Review physical status and obtain baseline vital signs. • Assess for risk factors affecting the safety of the patient or others. (Suicide/homicide) • Perform a mental status examination (MSE). • Assess psychosocial status. • Identify mutual goals for treatment. • Formulate a plan of care that prioritizes the pati