Summary NUR 2459 / NUR2459 Mental and Behavioral Health Nursing Exam 3 Review Study Guide | Rated A | Latest 2022 / 2023 | Rasmussen College

Exam 3 NUR 2459 Study Guide – Winter 2021

Exam 3 Study Guide
We will continue to build on ALL of the first and second exam insights further advancing
our knowledge, skills and attitudes with communication, ethics, Legal, therapies, barriers,
boundaries, safety considerations, Patients’ rights, HIPPA, defense mechanisms,
communication techniques (therapeutic communication), dosage and calculation, and etc…

 Defense mechanisms
 Dosage and Calculation questions
 Understand the Nursing Process for these topics (Goals, interventions) to be able to
answer the questions related to the topics below:

 New Material will include topics from weeks 7 through week 10

Module 7 - Nursing Care for Clients with Personality Disorders and Eating Disorders
 Review Chapters 31-32 and Module 7 Review PPT
 Review Module 7 Content in Blackboard

Understand the Nursing Process for these topics (Goals, interventions) to be able to answer
the questions related to the topics:
 Personality Disorders (Anti-social, Dissociative, Dependent, Borderline, Histrionic,
Avoidant, Paranoid) and Nursing Interventions
o Anti-social
 Characteristics
 Antagonistic, disinhibited, lack of empathy, and absence of
remorse or quilt
 Socially irresponsible, exploitive, guiltless behavior, disregard for
the rights of others
 Most frequently seen in jail, prison, rehab. Not usually in the
clinical setting
 When clients are seen, it is commonly a way to avoid legal
consequences
 Fails to sustain consistent employment
 Fails to conform to the law
 Fails to develop stable relationships
 Often admitted into mental health clinics due to court orders
 Exploit and manipulate others for personal gain
 Unconcerned for obeying the law
 Difficulty sustaining employment and stable relationships
 Low fear, low empathy, domination, callous cruelty, emotional
insensitivity
 Predisposing factors
 low socioeconomic classes or extreme poverty
 history of physical abuse
 disruptive behavior disorder as a child (ADHD, conduct disorder)

,  genetics
 absent or inconsistent parental discipline
 growing up without parental figures of both sexes or maternal
deprivation
 removal from home
 always being ‘rescued’ when in trouble
 substance use disorder
 more prevalent in men
 Assessment
 Patients do not tend to answer honestly
 self-assessment
 Nursing diagnosis
 risk for other-directed violence
 defensive coping
 impaired social interaction
 ineffective health maintenance
 Outcomes (difficult to accomplish, safety is priority!)
 Outcomes
 Abusive behavior self-restraint
 Aggressive self-restraint
 Coping, social interaction, social isolation knowledge
 Health promotion knowledge
 Health promoting behavior
 Planning implementation
 Boundaries, consistency, support, and limits
 Realistic choices
 Teamwork and safety (prime)
 Therapeutic communication
 Pharmacological
 Mood stabilizers
o Interventions
 Make aware of acceptable and unacceptable
behavior and consequences
 Do not coax or convince client to do the right thing
 Positive feedback for acceptable behavior
 Provide milieu therapy that is appropriate
environment
 Least restrictive method to control abusive to others
behavior
 Discuss past behaviors with outcomes
 Maintain attitude “it is not you, but your behavior,
that is unacceptable”
 Recognize manipulative behavior and set limits
 Interventions
 Help client realize you are available without reinforcing
dependence

,  Rotate staff members to avoid client dependence on a particular
individual
 Recognize if the client is playing one staff member against another
(splitting)
 With the client, explore feelings of abandonment (clinging and
distancing)
 Assist the client to work towards “object constancy” without
promoting dependency
o Dissociative
 Characteristics
 Formerly called multiple personality disorder
 Existence of 2 or more personalities in one individual
 Transition from one personality state to another may be sudden or
gradual and sometimes dramatic
 Disruption in the usually integrated functions of consciousness,
memory, and identity
 Occurs when anxiety becomes overwhelming and personality
becomes disorganized
 Symptoms begin in adolescent and early adulthood
 Predisposing factors
 More prevalent in women
 Single brief episodes may occur in as many as half of all adult
when under severe psychosocial stress, sleep-deprived, traveling to
unfamiliar places
 Hallucinogens, marijuana, alcohol
 Nursing care
 Aimed at restoring normal thought processes
 Assistance is provided to the client in an effort to determine
strategies for coping with stress by means other than dissociation
from the environment
o Dependent
 Characteristics
 Lack of self-confidence and extreme reliance on others to take
responsibility for them
 Lack of confidence seen in posture, voice, mannerisms
 Overly generous/thoughtful while underplaying own attractiveness
and achievements
 Sometimes intense discomfort with being alone for even brief
periods
 Act submissively, allow others to make decisions, tolerate
mistreatment by others, demean oneself for acceptable
 Predisposing factors
 More common in women
 Hereditary
 Stimulation and nurturance experienced from one source (1 parent)
 A singular attachment made by the infant to the exclusion of others

,  More common in the youngest children in the family
 Nursing care
 Identify stressors
 Set limits that don’t make them feel punished
 Be aware of countertransference
 Treatment
 Psychotherapy is treatment of choice
o Borderline
 Characteristics
 Tendency of these clients to fall on the border between neuroses
and psychoses
 Chronic depression
 Inability to be alone
 Unstable self-image and interpersonal relationships
 Intense and chaotic relationships with affective instability and
fluctuating attitudes towards others
 Emotionally unstable/labile
 Impulsive and directly and indirectly self-destructive
 Lack clear sense of identity
 Splitting, clinging & distancing behavior, manipulation, self-
destructive, impulsivity
 Severe impairment in functioning
 Antagonism
 Predisposing factors
 job losses, education interruptions, divorce
 biological influences – biochemical, genetic, neurobiological
 psychosocial influences
 childhood trauma and abuse
 development factors – fixed in the rapprochement phase of
development (16-24 months old)
 child fails to achieve tasks of autonomy
 more common in women
 Epidemiology and comorbidity
 10% suicide and mortality rate
 85% of patients have another mental illness
 Etiology
 High genetic association
 Separation-individuation factors
 Assessment
 Semi-structured interview
 Use of MMPI
 Self-assessment
 Nursing diagnoses
 Self-mutilation
 Risk for suicide
 Risk for self/other-directed violence